Diets and Dietitians Flashcards
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
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
model and process for nutrition and dietetic practice
assessment stage
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
definitive test for diagnosis of obesity
BMI
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
pros of BMI
quick and easy to calculate
good indication of health of a population
cons of BMI
Body composition/fat distribution
Ethnicity
Tends to underestimate body fat
biochemistry
lipid profile
HbA1c
serum creatinine
eGFR
ACR
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
pharmacotherapy
anti obesity medications
Offered at Tier 3 and Tier 4 as an adjunct to dietary, physical activity and behaviour modification.
approved anti-obesity medication in the UK
Liraglutide (Saxenda®)
Semaglutide (wegovy®)
Orlistat®
Naltrexone/bupropion(Mysimba®)
selective serotonin reuptake inhibitors SSRIs
Paxil, Zoloft, Celexa, Prozac
older antidepressants
Amitriptyline, Imipramine, Nortriptyline, Trazodone, Monoamine oxidase inhibitors
Lithium
Benzodiazepines
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
- Social and environmental factors
- Adverse circumstances
- Time and resources
- 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
