A few words to introduce yourself….
I am a nutritionist biologist. After several years of scientific research in the field of cancer, I changed direction. The role of nutritionist was included in the professional activities for biologists, so I decided to dedicate myself to nutrition by attending masters and specialisation courses, because my degree course at the time did not involve the study of human nutrition. I have now been doing this for thirteen years, but I soon realised how important it was to consider the medical humanities1 in addition to scientific skills, in order to connect more deeply with my patients and to stimulate greater awareness in them. So, in the end, I obtained a professional diploma in counselling and more recently a master’s degree in Narrative Medicine from Istud.
How does narrative medicine fit into your work?
The idea of using storytelling as a tool to reach a higher level of awareness and to gain well-being originated during my training period in counselling. Every time I put pen to paper, prompted by the appropriate narrative stimuli, a world of insights unfolded before me. In my work I advise my patients to keep a food diary, in which they can also write down the emotions they felt during their day. I have found that those who do this achieve better results, both in terms of their inner well-being and in relation to their weight goals. It is immediately apparent, during the interviews in which the process unfolds, that people’s life story goes hand in hand with the story of their weight. Life events, in fact, correlate with the relationship with food, from which the shape of the body derives. The narrative of everyday life is connected with the increased ability to manage the time of day, as well as the ability to manage one’s habits related to emotions. This narrative is decisive because it allows the person to unhinge the dysfunctional behaviours in which they are stuck. The narrative, therefore, is the theme and narrative medicine is the tool, which allows it to be systematised.
The narrative, therefore, is the theme and narrative medicine is the tool, which allows it to be systematised. Not everyone manages to implement the suggestion to write about themselves, but those who do, generally show better compliance.
Do you think that narrative medicine has changed your professional approach? If so, what connection does it enable you to make with the patient?
My approach was already very much about mindfulness work rather than mere calorie counting. The fact of having codified tools allows me to place narrative medicine within tracks that are not, however, without artistic flair. It may happen, for example, that I have the patient draw his diary or read it.
My training as a counsellor also allows me to use methods that go beyond written and oral language. It is clear that having the intention to collaborate with the patient and to work as their partner changes the quality of the bond. The moment the relationship becomes one of trust, the client feels willing to open up and use tools that are not congenial to them.
I believe that the quality of this type of bond, which is created step by step, certainly makes my work more fulfilling and more in keeping with my nature.
The nutrition professional is required to work in depth with a communication professional (e.g. counselling, psychologist…)?
We are not required to do work on ourselves, we are not given the input to try to drain our experience so as not to ‘infect’ patients. But I find this serious, because this profession can have a great impact on a patient’s life, even if only by giving indications in terms of lifestyle. Control is exercised over that person with regard to acts that he or she performs several times a day, every day. So if the practitioner is not already mentally and emotionally balanced or does not do his best to be, he risks projecting his own experience onto the patient. Thus, one ruins patients with violent, unhealthy diets and brutal indications.
I believe that it is important to do some self-awareness work, as soon as one embarks on this career, searching for the reason for the ‘vocation’, and to do some supervision work with respect to the cases, because, often, it happens that one is confronted with people who carry stories characterised by deep pain, people who are sick or who fall ill, people who die, people who do not behave in a correct manner, people who are unreliable, people who cannot be helped, people who ‘abandon’ by expressing their mistrust and dissatisfaction, and thus to be confronted with their own frailties, which may manifest themselves not only because of a moment of fatigue due to too much work, fear for the future, enormous competition in work, but also because one has not thoroughly investigated the reasons for one’s ‘vocation’, and one does not work daily on one’s emotional solidity.
All this, in the professional, risks generating, born out and a deterioration of the quality of work with patients.
What do you think about psychological support in communicating with the patient?
I think it is necessary. Master’s degrees in nutrition science, in Italy, still have purely technical-scientific curricula. However, even if rarely, the order of biologists encourages participation in a few courses in which the first rudiments of communication between us professionals and the patient are taught, in order to improve patient compliance. Often, in fact, the patient risks a very strong dropout and a long-term failure of the therapeutic approach through diet. So, in summary, it would be advisable, not only during the degree course, but also during the work phase, to make a personal journey on motivation and vocation to do the work and to make a supervisory course to drain the psychological fatigue.
Active listening to the patient, when to apply it and how to integrate it with the more normative approach, dietary decisions to be made?
Finding a synthesis between the counselling approach that is non-judgmental, non-directive and non-vertical and the request that the patient makes to the nutrition professional, ‘tell me what to do’, is very difficult.
I have chosen an approach where I try to be a partner in a journey that can lead exactly where the other person wants. What I ask of patients, right from the start, is to decide what life they want to lead. I can give directions, I can say what is the most functional on paper, to possibly achieve weight loss or a greater state of well-being, but then in the end the result must be directed towards a ‘happy’ life. This pathway must not be a fatigue on top of another fatigue, but must be sustainable in daily life and ‘look like’ the patient, in his or her life expectations and aspirations. The practitioner and the patient work to try to bring the focus on well-being, that is, on something that is not perceived as suffering but is experienced as pampering.
My work, I believe, focuses on the possibility of implementing free will and becoming aware of the reality principle. There are some things that work, others that work less, you can decide how to use them, aware that whatever act one performs in daily life should be directed towards being serene and at the maximum level of healthy pleasure. For example, craving for food is not freedom.
In summary, it is not trivial to get patients to find a balance whereby they can manage themselves, but when it happens the satisfaction of having done valuable work together is enormous.
Are women or men more likely to seek counselling, and what are their reasons for asking for ‘help’?
With respect to my experience, the filter to keep in mind is that the people who come to me do so by word of mouth. If I am suggested, I am suggested on the basis of the type of approach I have, i.e. to probe emotions in depth, shifting the focus to how people eat, how they are also based on how they eat, and how to do a deeper change work to achieve also, but not only, weight loss. It must therefore be borne in mind that this is a significant ‘opening-up’ work, which requires aptitude and willingness to process one’s own emotional experience, which statistically are more feminine characteristics.
Remaining therefore within the scope of my personal ‘observatory’, I can say that the discrepancy between the epidemiological data on the incidence of overweight and obesity among men and women and the actual access to my service is very evident. In Italy, in fact, many more men are overweight and obese than women: specifically, 44% of men against 27% of women are overweight, and 10% of men against 9% of women are obese. From my experience, taking a snapshot today of the gender distribution of the 177 people who are doing a course with me, 78% are women and 22% are men.
From my estimation, therefore, given the significant disproportion that emerges from this data, it seems that, however overweight a man may be, he perceives the problem with less urgency and is more reluctant to take responsibility for a profound and lasting change.
Men tend to come because they are often pushed by their wives, and sometimes it is the latter who call instead. Or, they come because they have had health problems. Younger men, on the other hand, want a diet suited to the type of training they do to gain or rebuild muscle mass, but, rarely the input that comes, from them, is I want to be better looking.
Much rarer, compared to women, are men in their 40s and 50s, the latter often being people who did a lot of sport when they were young and then, when they stopped, did not know how to relate the amount of food they put in to their new lifestyle.
Most of the women who come to me, on the other hand, come with the false belief that being fat is unacceptable. Often, they are people who feel fat even if they are normal weight or who feel fat even if they are slightly overweight and this has led them to try all sorts of diets. The spring is always a problem of aesthetics, of acceptance, which has been going on since they were children or young girls, also due to certain approaches of paediatricians who tend to stigmatise ‘the problem’. They are often people who have experienced a deep conflict with the body and with food, which is considered to be the means that modifies the body and not exempt from moral judgement (good food and bad food). In the profile of the married woman with children, eating without rules is the only form of freedom in their daily life.
They feel pressurised by this incessant task of protecting others, but, in doing so, they withdraw from themselves and lose sight of the need for physical activity and free time for personal growth, for moments of relaxation. They find themselves taking pleasure only in food, this generates the supreme dissatisfaction of having a body that does not conform to their ideal of a beautiful body and food, which had already become an emotional sedative or the place to tear themselves apart, becomes the cause of their feeling ugly, fat and unlovable.
Are there commonalities? What are the differences?
Women show a more pronounced emotionality. They bring their problems to the studio so much that a deeper relationship is usually established with them, whereas men seek mechanical solutions. It is rare to find men who understand that the discourse to be had is broader than the calorie discourse. Men seem to be totally oblivious to energy balancing, while women are more used to caring about these things.
In middle-aged men, stress is often the reason for being overweight and the mode: ‘I eat because I have no more room for anything else’, which is different from ‘I am not worthy because I am fat’, also manifests itself in them. The expressions ‘I suck’ and ‘I no longer recognise myself in my body’ are also typically feminine, whereas men tend not to make any particular self-judging comments. Rarely, for them, is it an aesthetic discomfort, and they bring as their main cause the fact that they like to eat ‘robustly’, almost as an element of ancestral masculinity. In contrast, women tend to be ashamed of eating, as if it were an intolerable manifestation of lust and lack of control.
Young males are very technical and rational, they tend, for example, to have certain beliefs, dictated by the environment they frequent, such as gyms and all sporting environments.
Many women are willing to work, together with me, to achieve a healthy balance, also through the use of the arts: they write, read, look at paintings and draw more willingly, whereas men tend not to be able to enlist even in the purely food diary. Obviously my filter has to be taken into account here, because it is I who am in relationship with people and the path taken depends a lot on what I feel. If what I perceive is a wall of mistrust or a lack of interest in going deeper, I also stay more on the surface; whereas, if I see that there is a deep need behind it, I always try to do some work with the arts so that all the emotions at stake can be plumbed.
[1] ‘A term for medicine seen as a unity of natural sciences and humanities.,…, this view assumes that health and illness have to do with life and death and are closely related to the physical, social, psychological and spiritual nature of the human being.’ Treccani Encyclopaedia