Savina Rego Interview

Can you tell us a little bit about yourself?

I graduated from Curtin University in Perth, Western Australia in 2013. I have been working full time as a Dietitian since graduation, working across multiple areas – hospitals, community and aged care. I now work for a not-for-profit organisation, that focuses predominately around chronic disease management. My clinical areas of expertise include Diabetes Management (type 1 and 2), Pre-diabetes, fatty liver disease and aged care; which includes a range of dietetic specific areas e.g. pressure injury management, nasogastric feeds, malnutrition, chronic kidney disease, stoma management and texture modified diets. I am also interested in the area of bariatric surgery and IBS management – specifically the low FODMAP diet, having IBS myself.

I am now working towards becoming a Credentialed Diabetes Educator. Between full time work and working on the weekends and study, I somehow find time to create content for my Instagram page @thesavvydietitian.

Do you see any reasons why you think dietitians get a bad rap for “defending” sugar?

Are Dietitian’s defending sugar? I think Dietitian’s are trying to draw awareness around the difference between intrinsic sugar and free sugar, and trying to encourage the public to not fear the intrinsic sugar found naturally in foods like fruit, dairy and vegetables. Personally, I am all for the message of limiting ‘free’ or ‘added’ sugar. Aussies consume an average of 60g (14-15 teaspoons) of free sugar per day, which is well above the World Health Organisations recommendation of 6 teaspoons! Whilst I feel all foods can fit into a healthy balance diet, I don’t like pretending that more nutritious choices don’t exist.

I also prefer the word carbohydrate over sugar. Carbohydrates are sugars. I often see people separating the two and that often causes even more confusion. I also often find people trying to defend the sugar in fruit by saying “fruit has some sugar” however if you think about what fruit is, it is a carbohydrate and therefore it provides sugar, though this sugar also comes with other important nutrients like fibre, vitamins, minerals and
phytochemicals! So instead of saying “fruit has some sugar” EMBRACE the sugar found intrinsically in fruit for what it is!

For people who say they are looking to decrease their portion sizes in a bid to lose weight, do you see this as a good approach? Or do you mainly encourage volume eating?

Portion awareness is key to successful weight loss, weight gain and weight maintenance. However, what I find even more important, is diet quality first! Gone are the days of overly simplistic advice such as “eat less”. The key to long term weight loss is improving quality and creating long lasting healthy habits. A study published in 2018 in the Journal of the American Medical Association found that the key to weight management, especially in the long term, is diet quality, rather than diet quantity (in relation to calories). The study found that people who cut back on lower quality foods such as those with added sugar, refined grains and other ultra processed foods, whilst focusing on high quality, unrefined, minimally processed foods such as vegetables and fruits, whole grains, healthy fats and healthy sources of protein, without worrying about calorie counting or even limiting portion sizes, had greater success with weight loss. The researchers did not disregard the importance of calories, instead suggesting that simply choosing high quality foods and decreasing the consumption of lower quality foods is an important factor in helping individuals consumer fewer calories.

As shown below, both diets provide ~ 1950 calories and whilst a calorie is a calorie, simply choosing foods based only on caloric value, think instead about focusing on diet quality – by focusing on quality, there is no need to ‘eat less’. It is more about eating better!

Do you have any tips for weight loss that you feel are underrated?

Prioritising VEGETABLES!

Why? Vegetables, especially non-starchy vegetables, provide very little energy (calories) but provide important vitamins, minerals and nutrients, including hunger-busting fibre.

Our most recent data (2014/15) indicates ONLY 7% of Australian adults & 5% of children met the Australian Dietary Guidelines recommendation for daily vegetable intake!

You can prioritise veggies by:

1) filling 1/2 your plate with non-starchy vegetables.
By aiming to fill up half of your plate with non-starchy veggies, you automatically reduce the portion size of your meal, without decreasing the volume you consume. I’ve done this with the meal above.

2) Including veggies into recipes e.g. soups, curries, sauces, smoothies.
Adding veggies to your recipe is another way to help bulk up your meal without significantly impacting the energy density. I’ve done this with the meal above by adding lentils and other veggies! ⠀

3) Incorporating veggies as a snack between meals.
Instead of looking for ‘fancy’ packaged products to snack on between meals when you are hungry, keep it simple and focus on including veggies as a between meal snack!

Before getting on the next crash diet, meal plan or meal delivery service (all things that spoon feed you rather than educate you). Take note on whether you are actually prioritising vegetables and consider forming that habit as a priority first!

#prioritiesveggies – is a new hashtag I’ve created to build awareness around this healthyhabit and I’d love for everyone to add it to their hashtags to demonstrate how they priorities veggies!

Thoughts on the non-diet approach and HAES?

There is no one size fits all approach to nutrition. I think all approaches are useful tools to have in our dietetic tool box, and the approach we select comes down to the patient. I like that HAES focuses on addressing health behaviours and better self care. I am all about focusing on health behaviours e.g. increasing vegetables as stated above as well as improving diet quality. I guess my posts are seen as being “diet focused” because I use calories (the big bad C word). A very narrow minded opinion, but that’s exactly what it is, an opinion. I use calories most days in my day to day work in a clinical dietetic setting and don’t see the stigma behind them. Using calories is just a way to quantify the benefits of simple strategies like adding more vegetables to our diet. It also helps show people that all foods can fit into a balanced diet without just simply telling them but actually showing them. If the calories weren’t associated with my post, the general public would likely not believe my posts.

Working in the area of diabetes, I am lucky that I have another measure to determine how someone is progressing – their day to day blood sugar readings and their average HbA1c – I focus on these markers over weight because the individual can see how dietary change can impact their blood sugar control by self-monitoring.

Do you have any philosophies that you feel are separate from the majority of other dietitian’s?

This is a hard one because I don’t really know? I guess I tend to follow or talk to dietitian’s that share the same values and beliefs as myself, as of course we are naturally drawn to the same target audience. I guess my experience in Diabetes Management does separate me a little. A lot of my nutrition messages come from my experience working in Diabetes. I have gained valuable experience and knowledge from the Credentialed Diabetes Educators, Endocrinologists and Exercise Physiologists I have worked with since graduation and these experiences have shaped my beliefs and practices as a Dietitian.

Do/would you ever use meal replacements or a VLCD with clients? Is there any particular aspects you would focus on?

VLCD (very low calorie diet) and meal replacements are two separate players. I have used both in a clinical setting, it really comes down to the patient, their specialist and what the overall goal is. VLCDs are often recommended to patients prior to bariatric surgery to reduce the severity of co-morbidities and minimise operating recover times. The shakes may even be required post bariatric surgery as the patient is transitioning from clear fluids to full fluids. I have supported many patients through this journey, as an Optifast Accredited Dietitian. That was more clinical dietetics, but in terms of the general population who are seeking meal replacement shakes for ‘weight loss’ – it is important to remember they aren’t a magical elixir. They work because they are: portion controlled, they are quick and convenient to grab and go and they take the thinking out of creating or deciding on a meal. I often find meal replacement shakes work for people who skip meals, those who are time poor or have a job that limits their access to food e.g. Longhaul Truck Drivers.

If somebody had no taste preferences, which type of milk would you encourage most out of full cream, light or skim, and why?

Firstly I’d need to find out how much milk they were consuming in the first place, their physical activity status and their medical history before discussing which option would serve them best. There is nothing wrong with full cream milk, even the Heart Foundations new position statement on their new heart healthy eating principles outlines this. However, it does come with more calories per mL, so if the person was more sedentary
and were consuming amounts above what is recommended for their age, gender and physical activity status, there would be a discussion around this and then the client would be the one making the decision with the information provided.

Is there a “problem” that you try to solve through Instagram, or any particular way you attempt to provide value?

Portion distortion! Portion distortion refers to the growing portion sizes that people consider ‘normal’. Portion distortion is a huge issue in our society, and one of the main reasons I believe our health is suffering. The other problem I am trying to solve is clever food marketing and looking past the health halo around cleverly marketed foods. The growing trend in healthy ‘discretionary foods’ and consumers desperately trying to find healthy alternatives to products such as biscuits, chips, cakes etc. when they don’t exist.

Is there anything you would like to add to wrap it up?

I’d love for all health professionals to acknowledge that there is a difference between calorie awareness and calorie counting. There seems to be a stigma around calories, when they are simply a unit of measure. I use calories frequently as a dietitian especially in the area of malnutrition! That’s right, calorie awareness is not only for ‘weight loss’. Whilst Dietitian’s and Registered Nutritionists might be privileged in understanding nutrition, it is important to acknowledge that the general population has a limited understanding.

Another stigma I see on social media, is that weighing yourself on ‘scales’ is automatically linked with diet culture or disordered body image. It is such a shame people only see scales in such a negative light when scales are used for many medical reasons – pre and post dialysis, for people with congestive heart failure – checking for fluid retention, to calculate anesthesia, sports nutrition, pregnancy weight targets, growth charts for children and malnutrition, just to name a few! Why is it that everything is becoming so one sided? The scales aren’t bad, the context around why you are using the scales is important, but don’t demonise a valuable tool.

Lastly a gentle reminder that dietetics is not only about weight loss, weight gain, eating disorders and disordered eating. Dietetics involves many disease states, and some conditions require patients to be put on diets. It isn’t a diet for ‘dieting’, but rather a diet to manage a condition and that’s just that patients reality. Just one of many examples – a client with chronic kidney disease requiring dialysis might need to be educated on a low potassium diet. Diets aren’t only for weight loss. Diets can be for disease/condition management. Don’t demonise the ‘diet’ in dietitian 😉

Share this post: