A Proposed Framework to Capture Dietetic Preceptors’ Experiences of Weight-inclusive Practice

Background:
Weight-inclusive practice is an evolving aspect in dietetic practice. Registered dietitians are increasingly adopting the paradigm and embedding it into curriculum of some university programs. This study explored dietetic internship preceptors’ perceptions of weight-inclusive practice, their current use of it, and their learning needs.

Methods:
Semi-structured telephone interviews were conducted with 13 dietitians with recent involvement as a preceptor for medical nutrition therapy internships. Interview questions explored participants’ experiences with and/or perspectives on weight-inclusive practice and their use of it. Thematic analysis was conducted, informed by a constructivist grounded theory approach.

Results:
Five themes were identified, and a theoretical framework developed to reflect a continuum of adopting weight-inclusive practice: grappling with unfamiliarity (lacking understanding, wanting safe practice, integrating approaches with difficulty, and thinking dichotomously), juggling authority (challenging hierarchy, enforcing decisions, belonging to diet culture, and frustrating discord), seeking acceptance (questing for knowledge, desiring validation, meeting perceived expectations, considering relationships with referrers, and finding reassurance), making a positive difference (holding good intentions, learning from experience, fostering autonomy, and practicing with flexibility) and shifting the dietetic paradigm (appreciating the complexities of health, recognizing injustice, addressing incongruence, and embracing human diversity).

Conclusion:
The theoretical framework developed explains the continuum of themes aligned with a practice paradigm shift for dietitians. Dietetic internship preceptors have a range of perspectives and a spectrum of experiences with exposure to, or use of, weight-inclusive practice. Future training programs for dietitians in weight-inclusive care should be targeted to where practitioners are placed on this continuum.