Diets and Dietitians Flashcards by Lara Everett

what is a dietitian

only qualified and regulated health professionals that assess, diagnose and treat dietary and nutritional problems at individual and wider public health level

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role of the dietitian

work in complex situations to improve health outcomes
by integrating social clinical and dietary information from a variety of sources
to make professional judgements
and work with service users to plan and implement evidence based interventions
which leads to improved nutritional health
improving outcomes for service users

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model and process for nutrition and dietetic practice

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assessment stage

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antropometry

BMI
define the degree of central adiposity based on waist to height ratio
body composition
family history
age of onset
trend of weight status
triggers to weight changes
significant life transitions and events

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definitive test for diagnosis of obesity

BMI

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classes of BMI

Obese:BMI ≥30.0 kg/m²
Class I: BMI 30 to 34.9 kg/m²
Class II: BMI 35.0 to 39.9 kg/m²
Class III: BMI ≥40 kg/m²
Class IV: BMI ≥50 kg/m²
Class V: BMI ≥60 kg/m²

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pros of BMI

quick and easy to calculate
good indication of health of a population

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cons of BMI

Body composition/fat distribution
Ethnicity
Tends to underestimate body fat

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biochemistry

lipid profile
HbA1c
serum creatinine
eGFR
ACR

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clinical

medical history
medications: dosage, frequency,course started, duration, adherence and tolerance
blood pressure

confirmed diagnoses
weight related co-morbidities
mental health
heath care professionals involved
any planned investigations or treatment

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pharmacotherapy

anti obesity medications
Offered at Tier 3 and Tier 4 as an adjunct to dietary, physical activity and behaviour modification.

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approved anti-obesity medication in the UK

Liraglutide (Saxenda®)
Semaglutide (wegovy®)
Orlistat®
Naltrexone/bupropion(Mysimba®)

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selective serotonin reuptake inhibitors SSRIs

Paxil, Zoloft, Celexa, Prozac

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older antidepressants

Amitriptyline, Imipramine, Nortriptyline, Trazodone, Monoamine oxidase inhibitors
Lithium
Benzodiazepines

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antipsychotics

olanzapine, Clozapine, Risperidone, Quetiapine, Aripiprazole, Haloperidol

diabetes medications

Insulin: Both short- and long-acting
Sulfonylureas: Glimepiride, Glipizide, Glyburide
Thiazolidinedione: Pioglitazone
Other: Nateglinide, Repglinide

dietary assessment

other components of dietary assessment

assess preferences
dietary considerations
dietary patterns
portion sizes
nutritional analysis
assess alcohol intake
dieting history
duration outcome and helpfulness
triggers to dietary deviations
disordered eating screening

environmental behavioural social

Lifestyle and social information
Sleep patterns and quality
Quality of life
Relationship between food and mood
Occupational stress / work patterns
Understanding of relationship between diet /weight status/ Type 2 diabetes on health
Nutrition knowledge and skills
Diet supporters in the household

functional

Instrumental activities of daily living
Physical activity / exercise
Sedentary time
Tasks related to the shopping, preparation and cooking of meals

factors in readiness to change

capability
motivation
opportunity

capability

Knowledge and understanding of the problem
Knowledge and understanding of how to address it
Any impairments in memory/concentration
Physical limitations

motivation

Balance of reflective vs. automatic processes (emotions, habits, impulses)
Importance and priority of change
Confidence (knowledge and skills)

opportunity

1. Social and environmental factors 2. Adverse circumstances 3. Time and resources 4. Influence of socio-cultural norms and attitudes

what occurs in the assessment clinic

weight status and hisotu dietary and psychological assessment medical information readiness to change

nutrition and dietetic diagnosis

identify and prioritise problems causes signs and symptoms to be addressed using information from step 1

sign and symptoms PASS

problem, alterations in nutritional status related to as evidenced by, defining characteristics

strategy

immediate aim: prevent further weight gain/ promote weight loss. promote weight loss maintenance

examples of diet interventions

low fat 600kcal deficit low carbs partial/total meal replacements mediterranean low energy low glycaemic index very low energy eat well guide energy controlled intermittent fasting formula diets

low carbohydrate diets

50-130g CHO daily. Improve fasting glucose level and HbA1c short term (3-6m). Improve TG’s short term (3-6m). Inconsistent evidence on body weight short term and adequate evidence no benefit long term >=12m. Need advice and support from relevant clinical care team.

low energy diets

Consideration for Diabetes Remission. Total diet replacement phase (3m), food reintroduction phase (3m), and weight loss maintenance phase (6-18m). Target 15kg or 15% (if above 100kg) weight loss. Overall, the extension intervention group saw greater improvements in blood pressure and blood sugar levels and had fewer needed medication than the control group.

eat well guide

the food plate to visualise balance from each food group

proposed actions

Self-monitoring weight status, food and drink intake. Modify shopping habits and reduce availability of identified snacks in the home and at work. Alternative agreed snacks to be available in the home and at work (within advised amount and frequency). Plan alternative activities/ strategies during ‘trigger times’ for snacking. Engage with core weight management classes/ materials. Engage with self-directed resources. Monitoring and reviews at agreed intervals.

evaluation

Reduction in excess body weight. Improvement in emotional wellbeing and weight-related Quality of Life. Improvement in nutritional adequacy and dietary patterns. Engagement with physical activity and in non-exercise activity.

impact of weight stigma

often considered a lifestyle choice healthcare professionals may hold the same weight stigmas as those of the general population heavy burden on individuals living with obesity

obesity as a disease

multifactorial consider social economic genetic and environmental