5 Things I’ve Learned in 20 Years as a Dietitian (Plus One Bonus Lesson)

This year marks 20 years since I graduated as a registered dietitian from Stellenbosch University in South Africa. While I’m far from done learning, this milestone feels like a meaningful moment to pause. To reflect on what the past two decades have taught me.

Not to revisit what I’ve learned from courses, textbooks, or scientific articles (although those were meaningful too) - but to reflect on what lessons I learned from real-life practice.

Before I dive into what I’ve learned, I want to quickly answer a question I’m often asked: What's the difference between a dietitian, a nutritionist, and a health coach?

Dietitian, Nutritionist, or Health Coach — What’s the Difference?

Although these roles can sometimes overlap, they’re not the same.

Dietitians are university-qualified and regulated allied health professionals. We’re trained in medical nutrition therapy, psychology, biochemistry, food systems, and public health. We also complete a required number of supervised clinical hours before we’re eligible to register and practise independently.

Our training enables us to assess, diagnose, and treat nutrition-related concerns, and we adhere to professional codes of conduct and ongoing education. In many countries, dietetic services are also covered by health insurance.

Nutritionists, in some regions, may hold formal qualifications and can play essential roles in public health, education, or wellness. Many dietitians also work as nutritionists (like I do). However, in many countries, the title isn't protected, meaning anyone can use it, regardless of training. This can make it difficult for the public to know who is truly qualified.

Health coaches often offer motivational or lifestyle support. Some have extra specialist training, but generally, a health coach is not medically or clinically qualified to assess or manage medical, mental health, or feeding issues, especially in children.

If you’re working with someone for nutritional support, particularly a child or teen with specific health needs, it’s worth verifying their qualifications and scope of practice.

What I’ve Learned After 20 Years as a Dietitian

In two decades of practice, I’ve seen my fair share of nutrition and wellness trends come and go. Some are grounded in sound research evidence. Others, less so. Either way, I’ve learned to stay curious and cautious when something new is marketed as the latest game-changer.

I’ve invested heavily in training and ongoing education over the years to stay at the forefront of nutrition science and clinical practice. And this is very necessary. But some of the most meaningful lessons haven’t come from books or research articles, valuable as they are. They’ve come from sitting alongside families. From thousands of hours spent listening to parents, children, and teens talk about their relationships with food and their bodies. From trying different strategies, noticing what helps, and learning what doesn’t.

That lived experience matters. It brings nuance to the evidence and allows me to apply the science in ways that are not only effective but deeply human.

Here is what I have learned over the past 20 years as a dietitian that I couldn't learn from a book.

1. We need to eat to live.

A lot in nutrition has changed over time, but one thing I know to be true is this: humans need food.

Long before modern medicine, nourishment was, and still is, the foundation of growth, healing and health. Most medical interventions (like surgery or medication) are more effective when someone has a healthy nutritional status.

The right to food is a universal human right, recognised by the United Nations, which affirms everyone's entitlement to access sufficient, safe, and nutritious food to live with dignity. This makes what is happening in places like Gaza and the Congo even more devastating.

I’ve witnessed what malnutrition, intentional or not, can do to a person’s body, mind, and spirit.

And unfortunately, I’ve seen how often it’s missed, or even praised, in a culture that equates thinness and restriction with health and idealises unrealistic beauty and fitness ideals.  

Malnutrition or under-eating doesn’t always look like the starvation you see on the news. It can show up quietly: in poor growth and development, nutrient deficiencies, digestive struggles, hormonal disruptions, low mood, anxiety, fatigue, ‘brain fog’, frequent illness or delayed recovery — especially in children, teens, athletes and people living with chronic stress.

Under-eating is also one of the most common (and misunderstood) drivers of binge eating and feeling “out of control” around food. What is often framed as a lack of willpower is, in truth, the body’s survival response to not getting enough.

I regularly see this in teens: skipping breakfast, avoiding food during school hours, then coming home ravenous — devouring large amounts of energy-dense foods, often in secret, and then feeling ashamed. It’s not an “addiction to processed food”. It’s merely the body's coping mechanism to survive.

There are many reasons someone might experience the symptoms mentioned above. But we can’t ignore the most straightforward (and most commonly missed) question:

Good nutrition won’t magically cure all health and mental problems. But for most people, eating more consistently and adequately makes a meaningful difference to their wellbeing. It’s the foundation that helps everything else work more effectively — medical care, mental health support, exercise, and daily life.

2. Most people, especially parents, are doing the best

After 20 years of working with people, I can confidently say: most people, especially parents, are doing their best with what they have. They love their children and want to care for them and themselves. They want to have a healthy family that feels good.

But wanting to be healthy and eat well — and actually being able to — are not the same thing.

And contrary to popular opinion, the issue isn’t motivation. It is capacity.

Some families are juggling long work hours, caregiving responsibilities, financial strain, limited access to appropriate foods, or housing conditions that make food prep difficult. Others still rely on outdated or conflicting nutrition advice that leaves them feeling overwhelmed and confused.

Then there are the invisible barriers: sensory sensitivities, neurodivergence, trauma histories, mental illness, chronic pain, medication side effects, or decision fatigue. For many, even something as seemingly simple as packing a lunchbox or making dinner can require immense effort — physically, emotionally, and logistically.

And beyond all of this lie the structural barriers no individual can “mindset” their way out of: the rising cost of living, inaccessible healthcare, weight stigma, racism, and ableism — all of which shape a family’s access to food, movement, and support.

In that context, even well-meaning advice like “just cook more meals at home” can feel completely unrealistic.

And when a child has feeding challenges — or grows in a body that doesn’t fit society’s narrow standards — too often the finger gets pointed at parents, especially mothers.

But the truth is, most of these issues are outside a parent’s control.

And while blame is common, it’s rarely helpful.

So here's what I want you to know:

You didn't cause this.

But you do hold incredible influence.

Even in the messiness and challenges, you are not powerless. You can help your child feel safe and supported around food and connected to their bodies. You don’t need to get everything “right.” What matters most is showing up with compassion, staying open to learning, and creating a space where your child’s needs can be seen and accommodated.

My job as a dietitian isn’t to hand out rigid advice — it’s to meet families where they are and adjust the plan to fit. Not shame them for not being able to follow it.

Because nutrition doesn’t happen in perfect homes with perfect people.

It happens in real life, with all its beautiful, complicated mess.

3. General nutrition strategies work for many, but not for everyone

For many people, general nutrition guidelines go a long way. Eating a variety of foods, including more fruit and vegetables, eating more whole, unprocessed foods, moving your body in ways you enjoy, limiting alcohol and avoiding smoking. This type of widely shared advice is often enough to support better health.

But for others, things aren’t so simple.

Some individuals need extra care and creativity due to allergies, intolerances, sensory sensitivities, disability or chronic health conditions. That’s where nutrition becomes more personalised.

Take someone with sensory processing differences. Certain textures or tastes, especially in fruits and vegetables, might feel unbearable. In these cases, we work with the person, not against them, finding ways to support nutritional adequacy that are respectful and realistic.

Or someone living with gastrointestinal issues or chronic conditions like hypermobility spectrum disorders might need more targeted support: limiting trigger foods, managing hydration and electrolytes, or trialling specific supplements.

This is where tailored, evidence-based nutrition comes into play.

But it is also where things can get tricky.

When something works well for one person, it’s tempting to believe it will work for everyone. I call this the “n=1 fallacy" (sometimes called "faulty generalisation" or "naive realism"): when personal experience gets mistaken for universal truth.

For example, from research, we can estimate that ~1 in 10 children with ADHD may benefit from reducing artificial food dyes. If you're that “one,” it can feel like a breakthrough, and you might want to share your success far and wide. However, for the remaining nine families, this advice may not be applicable. Worse, it can create confusion, stress, or unnecessary food restrictions, which may lead to malnutrition.

So here’s what I recommend: If you’ve found something that works for you or your child, that’s wonderful. Celebrate it. Honour it.

But be mindful of turning it into a universal rule. That’s where trained professionals come in: to help you understand what’s likely to help, what’s safe to explore, and what’s best to leave until we have more research.

4. Body size alone does not determine health

Let me say it plainly: I’ve seen just as many people in smaller bodies living in ways that harm their health as I have in larger ones. Weight alone doesn’t tell you what’s going on.

The idea behind Health at Every Size® is often misunderstood. It doesn’t claim that everyone is healthy. Instead, it recognises that health can exist at any body size and what matters more are behaviours, access, wellbeing and context, not the numbers on a scale.

I’ll be honest: I was trained and worked for years in a weight-centric model. But the more I listened, the more I learned. I saw how this pursuit of thinness often led to more harm, not health. I saw how the fear of living in a larger body could distort people's choices, and how often well-meaning healthcare providers and family systems reinforced that fear.

And I get it - the world is not kind to people in larger bodies.

But that means something is wrong with our society.

Not with the people.

I’ve seen clients go to painful, exhausting lengths to lose weight or avoid gaining it:

• Delaying quitting smoking.

• Injecting unregulated substances

• Avoiding community or joyful events for fear of “imperfect” food.

• Overtraining into injury or illness.

• Undereating and developing nutritional deficiencies.

• Speaking to themselves with cruelty

• Cycling through restriction, overeating, guilt, and shame.

That’s not health.

That’s disordered eating, often praised for "discipline" or “wellness.”

And here’s the harder truth: I've seen people in larger bodies repeatedly denied safe, compassionate care. When weight becomes the only focus, medical concerns are overlooked, misdiagnosed, or dismissed entirely.

It’s dehumanising. It's unethical. And honestly, it nearly made me walk away from this profession.

What kept me here was discovering the non-diet, weight-inclusive approach — and a community of practitioners committed to doing better.

It’s the work I believe in.

And it’s why I’m still here.

5. A peaceful relationship with food and body is the best gift you can give your child

What shapes a child’s relationship with food is about so much more than how many veggies they eat.

What truly supports children is:

• Talking about food with curiosity, not judgment

• Exploring new foods without pressure

• Setting boundaries with respect

• Valuing all bodies—starting with your own

  
  

When kids feel safe, supported, and trusted around food, they grow up with the confidence to trust themselves too.

That sense of safety is what builds the foundation for lifelong wellbeing.

Bonus Lesson: Good intentions aren’t enough

This might be one of the hardest lessons I’ve had to learn.

You can be kind, thoughtful, and genuinely well-meaning, and still cause harm. I know, because I’ve been there. As a younger dietitian, I had plenty of empathy, passion and drive. However, I hadn’t yet grasped the depth of nuance required for some of the more complex and sensitive work. And yes, I caused harm, unintentionally.

In sensitive and specialised spaces, like eating disorders, neurodivergence, disability, or working with people from different cultural, ethnic, or socioeconomic backgrounds, we have to acknowledge the limits of our lived experience and the boundaries of our scope of practice. Even when we relate to a client, their experience is still their own.

If this is the work you’re doing, please hear me:

Do the training.

Seek out supervision.

Learn from the communities you serve.

And not just once - keep doing it.

Every practitioner (myself included) has blind spots. That doesn’t make us bad people. It makes us human.

But what we do with that awareness is what matters.

We all need room for reflection, accountability, and the courage to sit with discomfort. That’s how we grow. That’s how we reduce harm. And that’s how we offer support that’s truly respectful, especially for children, and for people from marginalised or medically complex communities.

What’s Next

This work is rooted in clinical training and supervision. But it’s also been shaped by something just as powerful: listening. Hearing from families about their challenges, hopes, and struggles has shaped not just how I practise as a dietitian, but how I live.

As a young dietitian, I thought I had so much to offer in the field of nutrition. Now I know how deeply this work would go on to shape me.

I’ve wanted to be a dietitian since I was 14. That vision has evolved with life, but its core has stayed the same: to help you and your family find better ways to eat.

And in many ways, I still can’t quite believe I get to do what I dreamed of 20 years ago: just with a more educated, compassionate, and updated lens.

I’ve carved out a practice that reflects what truly matters: Connection. Creativity. Freedom.

And today, I feel more connected to my purpose than ever before.

Watch this space.

I’m not holding back.

And, God willing, I’ll be here for another 20 years.