Addition, Not Subtraction to Best Support Clients

By: Angela Gomez, RDN

Key messages

  • Focusing on what can be added rather than reduced or eliminated, when it comes to behavior change, may help build a growth mind-set and build self-efficacy in the clients we work with.
  • Supporting clients on their health journey by adding to the behaviors they are already engaged in is a more collaborative and positive approach that may increase success and reduce harm.

When discussing behavior change, emphasizing addition (rather than harping on subtraction), can create a mind shift in the individuals and families we work with. Focusing on the addition of health behaviors gives people more options and helps create an experimental environment, rather than a “pass-fail” environment. If we help develop this skill in parents or guardians, then they, in turn, can influence their family in a similar way. This is where the “think addition, not subtraction” phrase comes into play.

I have used this phrase in my work with
private clients, youth sports teams, collegiate athletes, and clients with
eating disorders. In my sessions, I’ll often redirect the “subtraction talk”
and ask open-ended questions to elicit some “addition talk”. I am not as
concerned with emphasizing the behavior a client wants to avoid; I am
interested in the behavior they want to change – given what they have available
to them now (i.e., time, food accessibility, etc.). There is hope and
positivity in the idea of adding small behavior modifications, whereas only
focusing on avoiding habitual behaviors can feel defeating.

Need more convincing on why we should
emphasize addition over subtraction? Here are three reasons to consider
implementing this mindset in your own practice:

Subtraction represents rules and restrictions, while addition calls attention
to abundance and provides options.
emphasizes the “don’t” without providing options for the “do”. There are simply
more possibilities with addition. Supporting clients as they build a growth
mindset fosters agency, self-efficacy, and honesty in their journey towards
owning their positive health behaviors. In more vulnerable populations, such as
clients with eating disorders, encouraging subtractions (or restrictions) will
not aid in their recovery process.

Instead of: “Stop eating ‘junk food’ or no more ‘junk food’.”
Try: “What foods would you like to add? How do you feel about brainstorming some snack ideas together that incorporate the foods you’d like to add?”
Benefit: You are discussing foods the client is already interested in adding, instead of directing the client toward restrictions (and creating stress in the process).

Focusing on addition fosters a relationship of collaboration between the
provider and the client.
of our clients want to please their healthcare providers and don’t want to
“fail”. We can encourage the people we work with to get out of this “pass or
fail” mindset by emphasizing addition and treating goals like experiments. We
can accept that clients are experts of their own bodies, experiences, and
lives. We have the education and experience in our field, and more importantly,
our clients have the experience of being in their own bodies and living their
day-to-day life. Working collaboratively sets the client up for success as we
guide and support them on their health journey.

Instead of: “You should eat breakfast every morning.”
Try: “What days work for you to eat something in the morning, even if it is not a full meal – like having some hard-boiled eggs? What are some foods that sound appealing to eat in the morning?”
Benefit: You open the door to possibilities that appeal to the client, and the client tells you what days they may be able to try and eat something for breakfast. Therefore, the focus is not eating breakfast seven days a week; instead it is creating manageable change by encouraging something in the morning when it works for the client.

Focusing on subtraction turns individualized care into generalized care.
All of our clients do not have the same
access or the same ability to work towards your idea of a desirable health
behavior. If you are speaking to a family who has limited resources, it may be
harmful to recommend specific subtractions (such as “don’t eat canned foods
because they are too high in sodium”). If you are telling individuals to remove
a food that strongly connects to their family or culture, it is unlikely they
will comply. We need to work with the client to tailor the behavior
modification to meet them where they are.

The health of the whole being is the most important. Relying on subtractions will restrict, and may ultimately hinder not only your relationship with the client, but also their personal progress. No one wants more rules to follow or more things to avoid. Shifting to addition will encourage our clients to focus on building positive, sustainable behaviors that work within their current lives, work for their families, and allow progress to occur at their own pace.

Gomez, RDN is based out of both Peoria and Phoenix, Arizona and is a School
Nutrition Dietitian, an Eating Disorder Dietitian, and a volunteer Dietitian
for a collegiate soccer team.

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