Diet and dietitians lecture Flashcards
What is the deal with the qualifications of a dietitian?
Are the only qualified and regulated health professionals that assess, diagnose and treat diatary and nutritional problems at the indivdual and wider public health level
What are the key parts of a dietitians role?
Translate research and public health data on food, health and disease into practical guidance for lifestyle and food choices
Combine social, clinical and dietary information
Plan and implenent evidence based intervention
Imporve nutritional health and patient outcomes
What are the stages a dietitian follows when getting involved with and treating a patient?
Indentification of nutritional need so refered to deititian
Assessment
Nutrition and dietetic diagnosis
Stratergy
Implementation
Monitor and review
Evaluation
What are the different tiers of services in monitoring patient weight and diet?
Tier 1 - universal interventions, such as publich health schemes
Tier 2 - lifestyle intervention, diets and pharmacology, indivudal based, interacts with different services - these patients have no additional health needs
Tier 3 - Specialist services in a MDT, often have high BMI and additional health needs, this stage will involve a dietitian
Tier 5 - surgery
What tier of care in weight and diet management will a dietitain become involved?
Tier 3
What are the different elements of an assessment by a dietitian of a patient?
ABCDEF
Anthropometry
Biochemistry - blood and urine tests
Clinical
Dietary
Environmental/behavioural/social
Functional
What are the anthropometry tests with a dietitian?
The study of the measurements and proptions of the human body
BMI
Weight to height ratio - indicates degree of central adiposity (typically only when BMI is under 35)
Body composition tests
How does BMI vary for different ethncities?
Non white ethnicities, particularly black and asian have a lower BMI threshold, typically 2kg/M2 lower
With obese being classified from 27.5kg/m2
Overweight 23kg/m2
What are the different classes of obesity by BMI?
Class 1: 30 to 34.9
Class 2: 35 to 39.9
Class 3: Above 40 (morbidly obese)
Class 4: Above 50
Class 5: ABove 60
What else alongside body measurements might be taken in an anthropology history?
Family history
Onset of weight problems
Trends in weight changes
Tiggers to weight changes (pregnancy)
Significant life event (divorce, ACEs)
What are the key biochemistry measurements a dietitian might want in a diabetic patient?
What do they mean?
Blood
HbA1c - amount of blood sugar attached to Hb
Serum creatinine - waste product from muscles
eGFR - estimated glomerular filtration rate, indicates kidney health
Urine
Albumin:creatinine ratio - compares liver and kidney function, a high A:C ration indicates more protein in the blood and poor kidney function
Lipid profile
What is involved in a clinical assessment of a patient by a dietitian?
Medical history (diagnosis, mental health and physical)
Medication
Vitals
Any planned investigations or treatment
Other health professionals they are owkring with
What are the UK approved anti-obestiy medications and when might they be offered?
Liraglutide
Semaglutide
Orlistat
Naltrexone/buproprion
Offered at tier 3 and tier 4 care alongside lifestyle modifications
What is part of a dietary assessment?
calculate nutritional requirements (energy, vitamin and minerals)
Calculat current nutritional intake (self monitoring of dietary requirement)
Identify differences and areas of concerns.
Consider future intake needs
Patient may need screening for disordered eating, consider personal food preferences, dietary history and potential limitation to a successful diet.
What is included in a patient environmental, behaviioural or social history at a dietitian?
Lifestyle and social life questions
Sleep patterns and quality
Relationship between food and mood
Diet supporters or inhibitors in the household
Nutritional knowledge and skills
What is part of a functional history by a dietitian?
Understand instrumental activities of daily living
Physical activity and exercise
Sedentary time
Tasks related to shopping, preparation and cooking of meals
What factors influence if a patient is ‘ready’ to make change?
Capability - their knowledge, skills, understanding, memory and physical ability
Motivation - confidence, priority, reflective v automatic choice dominance
Opportunity - social and environmental factors, time and resources, influence of culture
What are the four key elements on a dietitian and nutrition diagnosis statement?
PASS
Problems - BMI, nutritional intake, knowledge
Aetiology (cause) - knowledge, behaviour, binge
Signs and symptoms - BMI, weight gain, failed diets, health problems
What indicators can be used to measure success from dietitain plan?
Weight change (absolute or percentage)
Nutritional values
Patterns of consumption and thoughts around consumption
What are some examples of diet interventions?
Low fat diet
Formula diet
Intermittent fasting
Low glycacemic diet
Low energy
mediterranean
What are the key features of a low carbohydrate diet?
50-130g CHO daily
Improves fasting glucose level and HbA1c short term
Poor benefit long term and little evidence on weight changes
Requires advice and support from nutritional team to plan
What are the key features of a low energy diet?
Considered for diabetes remission
Starts with a total diet replacement, then gradullay introduces food and aims to maintain weight that was lost during deit replacment
Is successful long term (2yrs), succes decreases time after original diet replacement
Improves BP, Blood sugar, and reduce need for medication
What is the Eatwell guide?
Recommended portion sizes
40% plate fruit and veg
40% carbohydrates and fibre
20% protein
8% dairy
2% oils and spread
What are some ways a dietitian can implement a plan?
Self monitoring of food intake
Modify behaviour (shopping and impulse purchases)
Planning alternate activities to avoid triggers
Engage with resources and classes
Attend monitoring appointments
How can you evaluate the success of the diet?
Reduction in body weight
Improvement in emotional wellbeing and weight related quality of life
Improvement in nutrition and deitary patterns
Engagement with physical activity
What is the key thing to remember about obesity in order to reduce stigma?
Obesity is a multifactorial disease
