Nutrition, procrastination and making a change

Mark Aitken
Dianne is an Accredited Practising Dietitian who generously discusses her own journey with food and weight loss, which led to a later-in-life career change to Dietetics, and why her research focused on how nurses’ feelings of stress and anxiety can manifest in their relationship with food. 
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nutrition podcast

Travelling the country for Nurse & Midwife Support, I meet many nurses and midwives who talk to me about food. A lot of our conversations centre on their love of food: they recommend places to go while I am in town, or offer tips for eating well while working - often I leave with better tips than I provide! I also hear a lot about how many nurses and midwives struggle with food. It can be a complex, even vulnerable, area for many people, often with multifaceted issues connected to it.

Why nutrition?
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Our conversations led to an idea for a podcast about food and how we as nurses and midwives can improve our relationship with it. I was determined that it wouldn’t just be a chat reiterating the obvious ‘eat less and move more’ mantra. As health professionals, you already know that. Instead, we needed to talk about why we may struggle and how we can make change in a helpful way.

It all came together when we found the amazing Dianne Wintle. Dianne is an Accredited Practising Dietitian who generously discusses her own journey with food and weight loss, which led to a later-in-life career change to Dietetics, and why her research focused on how nurses’ feelings of stress and anxiety can manifest in their relationship with food.

The book: Procrastinating, Stressing, Eating

procrastinating, stressing, eating by dianne wintle front coverDianne also explains how this led to her to write a book. Procrastinating, Stressing, Eating, which provides tips to maintain a healthy lifestyle whilst living a normal life. The book explores complex ideas which are explained with humour, cartoons and stories of varied people Dianne has met.

The book answers common questions like “How can I lose weight with so much stress in my life? Why is it so hard to do what I know I need to do?” and offers strategies to stop procrastinating, deal with stress and eat ‘real’ food. Simple recipes, focussed on cooking with joy, are there to remind us of the simple pleasure to be found in cooking and eating.

Enjoy!

Happy listening. If you have some tips of your own or would like to share a recipe, drop me an email: mmark@nmsupport.org.au.  

Once you have finished the podcast, we also recommend that you check out this blog Dianne wrote for us, ‘Willpower – Joy – Food’, which offers a great strategy to get you started.

Mark Aitken RN
Stakeholder Engagement Manager
Guest: Dianne Wintle

Guest Speaker: Dianne Wintle
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Guest Speaker: Dianne Wintle

dianne wintleDianne Wintle is an Accredited Practising Dietitian with a Master of Health Science (Hons) awarded for her research centred around procrastination, stress and obesity in nurses. Dianne has worked as a dietitian in private practice, in community health, in clinical dietetics and in Aboriginal health. She also lectured in Nutrition and Dietetics at Charles Sturt University from 2008 to 2016. Coming to dietetics later in life, after a varied career, allowed for a different perspective. While still studying it was obvious to her templates are of little use to the individual trying to lose weight. Fat people are not stupid!

The issues were clear to Dianne that education would do little to help the situation. Lack of knowledge was not the main issue. Her studies fell short, but her research made matters clearer. Having seen many people in private practice who were procrastinating over weight loss, Dianne had the anecdotal evidence, she searched widely across disciplines for commentary and research, and had wide response to her own research. She adds to this the 'lived experience' of being overweight much of her adult life. This led to Procrastinating, Stressing, Eating.

Listen to the podcast
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Transcript
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Mark Aitken: Hello! And welcome to the Nurse and Midwife Support podcast. Your
health matters. I’m Mark Aitken, your podcast host for today. I’m the stakeholder engagement manager with Nurse and Midwife Support and I’m a registered nurse. Nurse and Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free. You can call us anytime about any issue you need support for: 1800 667 877. Or contact us via the website at nmsupport.org.au.

My guest today is Dianne Wintle. Diane is an accredited practicing dietician with a master of health science. Diane is also the author of Procrastinating, Stressing, Eating (2018). This is a book about why we procrastinate in relation to adopting a healthy lifestyle. Welcome, and hello Diane! 

Dianne Wintle: Hi Mark! Thanks for having me.

MA: Great to have you here today Diane. Please, tell our listeners about your background, and why you wrote this book?

DW: Right, becoming a dietician was a very late career choice. I think that’s given me a very different perspective on the profession and what we, as dieticians, actually do and what our clients or patients really want from us. Before I was a dietician I studied a lot of things, from speech pathology to accounting, but I never actually finished anything. I saw the flaws rather than the good things, then I had lots of jobs from telephone betting at the TAB to working as an accountant at the Timber Yard. I had a small corner store, and then really later in life I had two lovely children. Then I thought; oh gosh, I haven’t got any current skills! We haven’t got any money, I’ll study something then. I ended up studying dietetics, just because of a slight interest in the past around food and health and took it from there. 
 
MA: Sounds like a very interesting journey Diane, tell us a bit about the book and why you wrote it for nurses?

DW: The book, that came from both working in clinical practice, community health, private practice, I also worked in Aboriginal health. I talked to a lot of people and even back at university as a (very mature age) student, I noticed that the emphasis was always on assessment and education. My experience was that people who needed to lose weight were fully aware that they needed to lose weight, they were not ignorant of this. They even had a pretty good idea of how to do it, but something was holding them back. So, this was my interest in that. My research was on nurses so I got to learn a lot more about the background and I think that nurses are the perfect example of those who care for others but haven’t got much energy left to care for themselves. There’s no template, but this did seem to be a theme that I noticed across the board.

There are in the caring profession, so nurses are really aware of any health risks that they’re carrying through having too much weight. They fully intend to lose weight, and are often frustrated in themselves and sometimes that’s combined with a guilt around not doing themselves what they’re telling their patients to do. It just doesn’t make it to the top of their priority list, to focus on themselves. That’s true for a lot of people. You’ve got stress at work, stress at home, often there’s financial stresses, there’s just so much that we have to do in today’s world. The workplace, for nurses in particular, is getting increasingly stressful. More and more workload, there’s the usual shift worker problems of irregular meal schedules and long hours which increases tiredness. Sometimes tiredness creeps up on people, and nurses in particular, because they’re so busy caring that their own tiredness escapes them. There’s that emotional cost of caring. Most of us have got the emotional cost of caring for the very old or the very young, but nurses have that every day when they go to work. I think that makes a big difference and the case studies within the book highlight these. All of the other risk factors for high weight gain in the general population are also high risk for nurses. Some of us procrastinate and that gives us temporary relief: Oh, I’ve got to do this. I’ve got to plan what I’m going to eat. I haven’t got time. So, we just don’t do it. That actually feels good, just for a little bit. Now, one of the really good nursing researchers found that the most frequent stress release method used by nurses was eating. With this book, I wanted to acknowledge the stress, explain the links between procrastination and then look at some of the pathways that focus more on joy and pleasure rather than abstinence or pain. 

MA: Sounds very interesting Diane, I’ve read your book several times and there’s some really interesting information in there. Your book is full of interesting facts and is based on the research which you’ve spoken about, could you provide a bit more information about that research and who you spoke to and what the research told you?

DW: Yes, so when I was teaching at the nutrition and dietetics program and Charles Sturt University I took that opportunity to do my research to work towards the master’s thesis. I wanted to examine the relationships, if any, between procrastination and obesity. Then procrastination and stress. They were my background research. My particular area of interest is behavioural economics, so I was looking at it from a psychological viewpoint, philosophical viewpoint and classical and behavioural economics. It’s not just eating that these types of things effect. Some of the other underlying thoughts were that eating is used to relieve stress, and eating is used to procrastinate. I created a survey, with a lot of help from people experienced in survey methodology, and it was actually entitled: Procrastination, Stress and Obesity in Nurses. I contacted the state branches of the Nurses Federation, and Queensland and Victorian were fantastic. They let me put a little link to my survey in their online newsletters, and I got 459 responses from that alone. 

MA: That’s good.

DW: That was great. That really sort of validated my thought that this is a topic that those who are experiencing these things can really relate to. The survey also included some validating scales, I know nurses are really interested in real research with real genuine results that can be evidence based to then be expanded more broadly. I included Lay’s General Procrastination Scale (1986) and I contacted Clarry Lay himself, he was so good. He approved our usage of it and it was robust enough that we could use it on our website. It had some really good questions all around procrastination. The other one I used was the Perceived Stress Scale (1983) and it looks at the sorts of questions that you would expect to see around stress, we incorporated the two and anthropometric questions and questions around television viewing, smoking, alcohol, financial stress and meal planning. In a nutshell; some of the results were that procrastination and stress were strongly linked. Other researchers have found this as well. The frequency of television viewing effected the probability of being obese. Not planning meals had a big impact on the probability of obesity. 

MA: That’s very interesting research Diane. So, procrastinating, over eating and weight gain are described in your book and they’re obviously outcomes of your research that you have just explained. In the book, you state that over eating and procrastinating are both self-defeating behaviours. Could you talk a little about that?

DW: Yes, we procrastinate about a lot of things. Around 20% of people identify themselves as chronic procrastinators and 90% of them do not want to be. It just is. It’s a significant problem. We don’t just procrastinate about adopting healthy lifestyles or going on a diet, or starting to walk or exercise. We do it in a range of things. The thing that matters is that we make it worse by delaying it. If we do it sooner, we’d be better off. Things like delaying tax makes you end up with a fine, so it costs more. If you want to buy a ticket to a sporting event or a concert and you think, Oh I’ll do that as soon as I finish work. You’ve missed it. You don’t get to see the concert or the football match. If you don’t pay your electricity bill on time, you miss your so-called discount. It’s a penalty payment that happens. That’s a bigger background. People who over eat or eat junk foods or frequently snack, generally have unwanted weight gain. It’s one of those things that happen. Most people would prefer not to be carrying excessive weight. Most of us are aware of the health risks, but we still procrastinate over a lifestyle change. Even though, we know, in the long run we’re going to be worse off. I argue that in both the self-defeating behaviours are preceded by stress and cognitive overload (we simply have too many things to do). Or scarcities: scarcity of time, scarcity of money.

MA: Diane that’s really interesting, so what tips do you have for our listeners? In relation to not procrastinating?

DW: Ok, it’s really complicated. I think you have to start in a really small way. Maybe something that’s not threatening. Do your procrastinating and then go to bed. A lot of people experiencing stress stop and they just think, this is me time. So, they stay up. They might be watching television and eating, they might be playing on the computer, they might be reading a book, they might network with friends. They just delay going to bed. I think that’s something that’s probably not too threatening. You could say, oh well. I’ll just alter a habit. A habit that’s harmless.

MA: That’s interesting, altering a habit. Do you think that setting goals is important? And then having a plan?

DW: Yes, I do. When I first started thinking about goals it was always like, people who are athletes or going to the gym or having a goal that they were doing to do. I was suspicious if that was appropriate for a lot of us. Maybe we’re too old to set goals. But I’ve been thinking more and more about it, over time. Goal setting is actually useful, on the condition that they’re smart goals. The specific, measurable, achievable and realistic goals within a certain timeframe. That type of goal. Then you can see, relative to the timeframe you can see what happens. Recently I decided that it was time to get a little bit fitter, I can’t just sit and work. I found a personal trainer, and this is hugely good fun. We started playing with weight lifting. I haven’t ever had so much fun. 

MA: Enjoying weightlifting?

DW: Enjoying weightlifting! So, it seems really, really unusual. But the thing is that you can have the smart goals; maybe you start at 15 kilos’, and before you know it you’re at 35 kilos! You think, oh! This is working! So, it’s like a hobby that serves two purposes.

MA: It sounds like the key here is to do something that you enjoy and is fun.

DW: Yes!

MA: Because if you don’t, it seems to me that you won’t stick to it.

DW: I totally agree. You will not stick to it. And this is what goes wrong, I think, with the templates that we have around what you’re meant to do to lose weight. If you go to the doctors and they tell you that your BMI is too high, they tell you to go see a dietician and they give you a little form that has a very specific food intake. You might not even like the food on that form! It might not be possible for your work or life schedule. Everything has to be genuinely relevant for the individual, rather than general and broad patient centred care. It has to be someone who can get into the life of that person, see where their barriers are, see where their joys are, and work towards it.

MA: So, this book Diane is equally applicable to the midwives who may be listening? Even though your research was specifically done in relation to nurses? Did your research include midwives as well?

DW: It would have included midwives as well, because it was the Nursing and Midwives Federation, the state branches there. All of their members were able to submit the survey. I didn’t separate the responses from nurses and midwives. 

MA: But your data would have included them, right?

DW: Definitely.

MA: You book talks about the relationship between meal planning and obesity. Would you please outline this relationship for our listeners?

DW: Yes, I was actually really surprised by the extent of the relationship. So, the more you plan your meals the less likely you are to be obese. The less you plan your meals, the more likely you are to be obese. So, that sort of sounds a little bit surprising. Well, it was surprising to me. But I was really surprised that the results indicated that those who never plan their meals had a 74% probability of being obese. Those who very frequently plan their meals have a 34% chance of being obese.

MA: So, planning is the key here?

DW: Planning is key. I presented my research at a critical dietetics conference in Canada, and that was the one thing that was picked up across the board, because I think that it surprised most people. I don’t know, did it surprise you?

MA: No, not really. But when you think about it, we all like to think that we have a plan. But as you said before, nurses and midwives are often good at planning for other people, but not necessarily ourselves. 

DW: Yes.

MA: At Nurse and Midwife Support, we talk a lot about the importance of self-care and filling your own cup. Or as our listeners would know, your own mug first, because we have Nurse and Midwife Support mugs. By the time you get the chance to have a drink you need a drink that is in a decent sized mug. Not a cup. I often think that planning is difficult for the individual, but we’re very good at doing it for other people. So, meal planning can be challenging for shift workers, many of our listeners are shift workers. Certainly, when I did shift work the planning was difficult because my shifts were constantly changing. I didn’t have a lot of say in that, in my day when I was a young nurse doing shift work the roster was often given to us and that’s what we did. I think that people get a bit more flexibility now in their rosters, but not always. People are often doing day shift, afternoon shift, night shift and rotating. So that’s challenging to plan. What tips do you have for our listeners to assist them with planning their meals while they’re doing these shifts?

DW: Okay, so I’ve thought about this a lot because I’ve thought about this for myself as well. What can you do? It sounds a bit trite, but you find some time on a day off and write down what you’d like to eat by way of real food. Not, you know, looking at low carb/hi fat/paleo whatever it might be, but what do you like to eat? Go and buy your main ingredients, just for that one meal. Make it with enough to take to work the next day. Start small. Just this one little thing. Then you build up to planning four or five days of meals and I promise, it is easier once the first attempt is achieved. Another thought I had, and I can’t remember who I was talking to, but it was someone who does shift work but in another area. They were saying that they’ve totally flipped their pattern. They noticed that their colleagues were actually eating the equivalent of an extra meal if they were doing night shift, that sort of thing. This person actually had really good control of a healthy lifestyle, they were young. They said that what they did was that they cut back and had one meal less. They planned it, they had a light meal before they went to work. They took a little packet of nuts and a piece of fruit. Then just drank lots of water and tea throughout the shift. They felt that they had more energy throughout the shift, eating less that way. 

MA: That’s really interesting, what about people who have different body types? For instance, I need to eat smaller meals more often because I’ve got quite a fast metabolism. But other people don’t have metabolisms like that.

DW: That’s right, you’re truly blessed! Very very lucky, except for you and probably for other people who have small amounts, but often when people are battling with weight issues they are often not hungry. They are just eating, sometimes it’s a habit, sometimes they are hungry and that’s when the planning needs to come in. But often you can be a bit hungry and highly efficient. As long as you have plenty of water and cups of tea or coffee, a handful of nuts and a piece of fruit is often going to do it. Or sometimes that planning where, again, it sounds trite but it works: you chop up some cherry tomatoes, celery, carrots, a punnet of blueberries and a handful of nuts, that’s a really good little snack pack if you’re lucky enough to get a 10-minute break. But I know that nurses often do not.

MA: So,

  • Being organised.
  • Having nutritious and healthy food.
  • taking it with you. 
  • Giving yourself permission to have that break to be able to eat this food.

DW: Yes.

MA: …so that you don’t get to the point of being over-hungry, and craving the chips from the cafeteria?

DW: Exactly, and sometimes that’s a mind game that you play with yourself too. You know in advance that you’re going to be really really tired at 2am or 3am or 3pm if it’s the other shift. You know it’s going to happen, you know historically that you’re going to go and get the chips. What you did in the past is often the best predictor of what you’re going to do in the future. So, you put that to the forefront of your mind, that you’ve got to have a backup plan. That’s implementation intentions, which economists talk about a lot. If you know that something is going to happen, then you will do this. If I want chips, then I’ll have a green tea bag ready. It’s not quite the same, but if you can delay it, it does work. 

MA: That’s really interesting, in your book Diane you talk about the risk of weight gain from eating and watching TV. I find that really interesting, could you please tell us a bit more about that?

DW: Ok so my research, and many other researchers have found a link between television viewing and weight gain. When you think about it, most people, if are sitting and staring at the television are probably going to be eating snack food of some kind. The longer you’re sitting there looking at the TV, the greater the concentration of snack food. I don’t think it’s just not being mindful of what you’re having, I think it’s more than that. It’s a really really strong habit. Eating and television watching are economic compliments, that just means that their combined value is greater than either of the activities alone. The joint activity is greater than the sum of the parts. The good news here is that the craving to eat while watching TV loses that compulsive power over us just after separating them three or four times.

MA: How interesting.

DW: Yes! That’s one of the most useful things that you can do.

MA: Yes, that is very interesting. Your book has some great recipes, do you have a favourite?

DW: Oh, such a hard question! 

MA: What about one that nurses and midwives would be able to make at home, have it at home and then take it for the next meal at work?

DW: Ok, so Catherine Lockley was my recipe creator. What I said to her was that it has to be heavily vegetable focused, it has to be fresh and non-processed, easy. But, importantly, it has to communicate that sense of joy in preparing and eating real food. It has to be fun. When you read Catherine’s recipe’s, the little preamble to them it just makes you smile when you’re reading it. She ticked all the boxes there, but it’s hard for me, because I love those stories that she’s got. In terms of what we’re looking for here, I’d have to say the red lentil and beetroot fritters with roasted sesame dressing and the maple smoked panera salad. I mean, amazing stuff. They sound good, but they taste great.

MA: I must say, when I read the book and looked at your recipes that was the one that appealed to me. I haven’t made them yet. But I certainly plan to.

DW: Then you can put them in your lunch box for tomorrow!

MA: That’s the plan! Diane, what three pieces of advice do you have for our listeners in relation to good nutrition and unwanted weight gain?

DW: Three things,

  1. Plan small meals around real foods that you actually enjoy.
  2. Find ways other than food to relieve stress.
  3. In your earlier podcast Mark, I don’t know, with people like those from the Evolve Yourself Institute? They are a really good place to start for looking at that joy from other sources. I think, importantly, become someone who doesn’t snack. Find some pleasurable exercise to get that same lift.

MA: Thanks Diane, great advice. Well we’ve come to the end of the podcast. Today we’ve talked about Nurse and Midwife Support, Dianne Wintle’s informative book: Procrastinating, Stressing, Eating (2018), the research that informed this book, and the relationship between procrastinating and overeating and how they are self-defeating behaviours. We’ve talked about the connection between stress and overeating, and Diane you’ve provided some great tips on meal planning and advice for good nutrition and weight management. Any final words of wisdom?

DW: Yes, I think so Mark. I think the most important thing is that you don’t have to follow a template of what someone else tells you to do. Find what gives you joy, and just do it. 

MA: Wonderful. Thanks Diane, you’ve been a great guest and I know the nurses and midwives listening to this will benefit from your words of wisdom and your words of advice. Listeners, you can find out more at nmsupport.org.au or call us at 1800 667 877 anytime. We’ve got some great resources available on our website, and Diane’s book will be posted there when we post this podcast. If you found this podcast useful, please share it with other nurses, midwives and students and Diane where will people find your book?

DW: They can find it on Amazon or they can go to my website: diannewintle.com.au and most bookstores.

MA: Thanks Diane.

DW: Thanks Mark.

MA: Your health matters everybody, so get into healthy eating if you don’t do it already. If you’ve got some great tips for healthy eating and weight management, we’d love to hear from you. Contact me via the website. Look after yourself and each other, and I’ll speak to you next time.