“Oh, By the Way…”: How to Handle Nutrition Questions When the Visit’s Already Over

It’s one of the most common—and most frustrating—moments providers face.

You’re done with the visit. You’ve reviewed the labs, updated the med list, and walked the patient through their primary concerns. You’re standing up, maybe already halfway out the door, when they drop the line:

“Oh, by the way… what do you think about _____?”

Sound familiar?

These “oh by the way” questions often come at the end of a packed appointment. They’re never easy, and they rarely come with a quick answer. But how we respond in these moments matters. Because behind every last-minute question is often a deeper need: a patient trying to make a change, even if they’re not sure how to begin.

In this episode of Exam Room Nutrition, I sat down with registered dietitian Alexandria Hardy to explore the most common “oh by the way” questions patients ask—and how we, as clinicians, can respond with empathy, clarity, and evidence-based guidance.

Here’s a breakdown of the questions we covered—and the strategies you can use to give helpful, on-the-spot answers (even when your time is short).

“Oh by the way… what’s the fastest way to lose weight?”

Instead of jumping into a lecture about calorie deficits, Alexandria takes a step back and uses two tools that make this question more manageable in real time:

1. A grocery cart check-in
   Ask the patient: “What’s in your cart each week? How many colors of fruits and vegetables are you seeing?”
   This question gives you insight into their current habits without needing a full food log—and it invites a non-judgmental reflection on variety and nutrient density.

2. A protein and fiber focus
   Alexandria prioritizes two things with her weight loss clients: Are they getting enough protein and enough fiber? Especially for women between the ages of 30 and 55—many of whom are entering perimenopause—these nutrients play a critical role in satiety, metabolism, and sustainable energy.

Then comes the practical part:

Don’t just say “eat more peppers.” Help the patient plan how to use those peppers—chopped into an omelet, sliced for a snack with hummus, or baked into stuffed peppers.

👉 Takeaway for clinicians: Patients often don’t need more knowledge. They need help applying that knowledge in real life. When you’re short on time, even one follow-up question like “how would you use that in a meal?” can make your advice more actionable.

“Oh by the way… do certain foods speed up metabolism?”

The short answer? Not in any significant, sustainable way.

While spicy foods, caffeine, or green tea may offer a temporary metabolic bump, it’s small—and often not meaningful in the long run. Instead, redirect the conversation to:

• Muscle mass and movement: Support muscle retention and growth through strength training and consistent movement. Alexandria encourages patients to find forms of activity they actually enjoy and can repeat regularly—whether that’s walking, yoga, or light weights.

• Energy intake patterns: If patients skip meals or eat erratically throughout the day, it can contribute to feeling sluggish and overeating later—another reason to review their meal timing and composition.

And most importantly, assess the patient’s history. If there's a background of disordered eating, avoid rigid tracking or performance-based exercise goals. Prioritize a healthy relationship with movement.

👉 Clinical pearl: Asking “what’s one form of movement you could do this week that you might enjoy?” is often more effective than prescribing a formal exercise plan.

“Oh by the way… how do I stop snacking at night?”

Nighttime snacking can stem from many different causes—habit, emotional eating, or underfueling earlier in the day.

Alexandria breaks it into two categories:

1. Physiological hunger
   If the patient is skipping breakfast, grabbing a minimal lunch, or rushing through dinner, it’s no surprise they’re reaching for snacks late at night. Help them identify whether they’re eating enough throughout the day—especially protein and fiber.

2. Habitual or emotional eating
   For patients who are eating consistently all day but still snack out of habit or boredom, a few effective tools include:

   • Moving their oral care routine earlier in the evening (this is brilliant)

   • Creating a non-food evening routine (e.g., reading, stretching, puzzles)

   • Identifying the sensory need they’re trying to meet (crunchy, salty, creamy)

   • Swapping in herbal tea or flavored water as a transition cue

👉 Try this question: “What time do you usually brush your teeth at night?” Then suggest they move it earlier. It’s a surprisingly effective starting point for shifting nighttime snacking patterns.

“Oh by the way… I eat when I’m stressed. What can I do?”

Start with empathy. This is a common and very human behavior.

Instead of shaming stress eating, Alexandria reframes it:

“This is a coping mechanism—and like any coping tool, we can work to understand it and explore other options.”

Next steps:

• Identify stress triggers: Work? Parenting? Relationships?

• Brainstorm alternatives: Deep breathing, journaling, movement, hot tea, or music

• Build stress-supportive meals with anti-inflammatory foods like berries, walnuts, salmon, quinoa, and dark chocolate

Then ask: “Of the foods we just discussed, which ones do you like? Let’s build a breakfast or snack you’d actually want to eat.”

“Oh by the way… is sugar the same as carbs?”

A classic teachable moment.

Alexandria recommends pulling out a food label (or asking the patient to bring one from home) and walking them through the section on total carbohydrates, dietary fiber, and added sugars.

This approach helps patients:

• Understand that not all carbs are created equal

• See the difference between natural sugars (in fruit or dairy) and added sugars

• Spot “sneaky” sources of sugar like granola bars, flavored yogurts, or beverages

👉 Bonus idea: Ask them to calculate how much sugar is in their usual soda or coffee drink—and compare that to the recommended daily limit. That “aha moment” is often more effective than any lecture.

“Oh by the way… do I need to buy organic?”

Ask the patient: “Is eating organic something that’s important to you?”

If yes—support it. If no, help reduce the guilt they may be carrying from social media or marketing messages. Alexandria reminds us that:

• The label “organic” does not automatically mean healthier

• Many organic snack foods are still ultra-processed

• A conventional apple is still a nutritious, valuable food

You can also ask what food-related values do matter to them—like supporting local farmers, reducing waste, or feeding their family on a budget.

“Oh by the way… is coffee bad for me?”

Not necessarily.

Coffee can offer benefits—focus, alertness, antioxidants—but it depends on:

• How much they’re drinking

• What they’re putting in it (creamers, syrups, sugar)

• Their individual health history

Instead of asking them to give it up, Alexandria explores their routine:

“What do you like about your coffee? Is it the flavor? The ritual? The caffeine?”

Once you know what they value, you can suggest small swaps—like trying a smaller size, using milk instead of cream, or reducing sugar gradually.

“Oh by the way… what about artificial sweeteners?”

This question can feel like a landmine. But you don’t have to give an all-or-nothing answer.

Instead, assess:

• Quantity: Is the patient drinking multiple diet sodas daily, or just using a stevia packet here and there?

• Source: Are they getting artificial sweeteners in liquid form, baked goods, or supplements?

• Health history: Do they have insulin resistance? Gut issues? A history of cancer or family concerns?

If the patient wants to reduce their intake, offer realistic swaps—like flavored water, unsweetened tea, or sodas with alternative sweeteners like monk fruit or stevia.

And if they ask whether honey or maple syrup is “better” than sugar? You can say this:

“They’re all forms of sugar. But if you enjoy the flavor of honey and it helps you use less, that’s a reasonable choice—just be mindful of portion size.”

Final Thoughts: A Framework for End-of-Visit Conversations

You won’t always have time for a full nutrition counseling session. But you can offer more than a rushed answer.

When those “oh by the way” moments happen, try this three-step framework:

1. Ask a clarifying question
   (“What made you think about that today?” or “Where did you hear about that?”)

2. Give a simple, truthful answer
   Even one sentence of accurate, non-alarmist education can go a long way.

3. Offer one next step
   A resource, a visual, a follow-up question, or a referral to a dietitian.

Nutrition counseling doesn’t have to be overwhelming. And when we stay curious instead of rushed, even five minutes of thoughtful conversation can spark meaningful change.

🎧 Listen to the full episode:
Episode 119 – “Oh, By The Way…”: Answers to Last-Minute Nutrition Questions
Available now on Exam Room Nutrition wherever you get your podcasts.

Click here to listen

Looking for more tips like these? Join Nutrition Grand Rounds to stay ahead on clinical nutrition. Learn more here!