11 Oct 2019
The Role of Dietitians
As evidence-based professionals, dietitians already play an absolutely core role in the UK’s food system, but that this should be expanded and grown. When thinking of the food workforce, it is tempting to think only of those that are involved in the growing, distribution and preparation of that food, but any National Food Strategy must also consider the role of those that advise upon diet and use the science of nutrition to help tackle health and wellbeing issues.
What is needed:
- A recognition that good nutrition and hydration are fundamental to good health as the primary consideration for the National Food Strategy.
- Ensuring that everyone has access to support to eat a healthy diet.
- A clear commitment to developing and growing the dietetic workforce as part of the National Food Strategy.
- Action to upskill the wider food workforce with better understanding of the role of diet, nutrition and hydration for health and wellbeing.
Improving people’s understanding of what constitutes a good diet, and the risks of a poor diet, is vital as part of a successful food strategy. Without this understanding, changes to the way we produce food or what we sell will have much lower impact. Evidence shows that the vast majority of people at every age are not currently meeting dietary recommendations around sugar, fruit and vegetable intake and fish intake amongst others[i][ii]. Diet-related disease is now responsible for 12 per cent of all premature deaths, more than smoking or alcohol[iii].
We know that some key groups are lacking in cooking skills and that those that lack these skills make worse dietary choices[iv]. We need a comprehensive strategy to educate and upskill both young people and adults so they can prepare healthy food. The BDA has supported the Let’s Get Cooking programme[v] since 2017, but programmes like it should be in place across the UK.
Dietitians have a strong track record of using evidence-based approaches with individuals, groups and on a train-the-trainer basis to improve people’s understanding of nutrition and diet. Programmes such as Nutrition Skills for Life in Wales[vi] have improved the skills of others to education, while initiatives such as CHAMP in Manchester have used data to more effectively target preventative interventions[vii].
Our current food system is responsible for significant rates of obesity, overweight and related health conditions, such as Type 2 Diabetes. It is tempting to believe that this is an issue of “personal responsibility”, but evidence shows it is systemic, and that many factors that impact on people’s diets and risk of developing obesity are outside of their control. People with overweight and obesity need support to help them reach and maintain a healthy weight. Obesity for future generations also needs to be prevented. It is estimates that obesity costs society over £27 billion and the NHS specifically £6.1 billion[viii].
Structured, evidence-based weight management programmes at all tiers, with dietetic involvement, have been proven to be effective and are recommended by NICE guidance[ix]. Dietitians have also been shown to be effective in supporting weight loss[x]. Unfortunately, access to such programmes remains patchy across the UK[xi][xii].
Role of nutrition in treatment of clinical conditions
Good nutrition and hydration are absolutely vital for those with other health problems. This is reflected in the NICE Quality Standard 24[xiii]. Disease related malnutrition was estimated in 2015 to cost £19.6 billion per year[xiv], half of that on malnutrition in the elderly.
Dietitians play a crucial role across a wide of different health conditions, including cancer[xv], kidney disease[xvi], neurological conditions[xvii], mental health conditions[xviii], critical care[xix] and gastrointestinal conditions[xx] to name just a few. European research has shown that dietetic treatment is cost effective, offering a 4:1 return on investment[xxi].
Access to a dietitian needs to be improved, even in secondary care settings. With only 4,212 dietitians in the English NHS[xxii] and fewer than 10,000 registered dietitians in any role across the UK[xxiii], we have low per-head numbers of dietitians compared to comparable countries such as Canada, Australia and Sweden[xxiv].
Malnutrition in the elderly
Our current food (and care) system leaves over one million older people malnourished or at risk of malnutrition[xxv]. Although malnutrition in care settings is significant, we know that a majority of those at risk of or suffering malnutrition are in the community, in their own homes. If we are to meet the Grand Challenge of an ageing population[xxvi] as set out by the government in its industrial strategy, this is a fundamental problem we need to address.
The reasons why someone cannot access sufficient high-quality nutrition are not just linked to poverty. Physical and mental health limitations to shopping or cooking, loneliness and reduced appetite all play a role as well[xxvii]. Dietitians have a proven track record of tackling malnutrition and improving the nutritional status of older people[xxviii]. The BDA has set out clearly the steps that need to be taken to address malnutrition in the community and across healthcare settings[xxix].
Ensuring our diets and wider food system is environmentally sustainable is vital if we are to meet the government’s ambitious targets for a carbon neutral economy by 2050[xxx]. However, although there is a desire to make changes from the public, there is a lack of understanding about what changes need to be made[xxxi].
Dietitians have the skills and to make personalised, evidence-based recommendations to patients to support them to eat more healthily and sustainably. The BDA’s One Blue Dot toolkit is designed for dietitians to help them better understand the science of sustainability and how they can integrate this into the advice and support they offer to patients and clients[xxxii].
Although dietitians have a clear role to play in directly supporting patients and the public to eat a healthier diet and to navigate the food system, it is also vital that others can do so as well. Dietitians already undertake education of doctors and nurses within the health system[xxxiii],[xxxiv], but this needs to be expanded.
Dietitians can also upskill others in the “wider public health workforce”, such as initiatives to support firefighters to spot issues of dehydration and malnutrition in older people who they visit[xxxv].