Dietetics: Eat some of this and you'll feel much better

The work of a dietitian is to turn nutrional information into practical guidance for people. Encouraging weight loss may be part of the job, but on the NHS front line it's about saving lives too. Clare Dwyer Hogg reports

Being a dietitian, then, is essentially about taking the scientific, nutritional information vital for a patient's wellbeing, and translating that into a practical understandable way of life for them. Weight loss sometimes comes into it, but this is just a fraction of the job. Collins has been a dietitian since 1983 and says she has not been bored yet. Working on the intensive care ward, she liaises with doctors, pharmacists and microbiologists to work out the best treatment for the patients.

Dealing with people who have kidney failure and are on a life support machine, for instance, she needs to develop a feeding regime that will help minimise the worsening condition; if people are on drugs that make them vomit when they try to eat, she finds ways of managing this, such as choosing a selection of pre-digestive foods. Some of her patients are young, but suffer from rheumatoid arthritis: she has researched certain fish oils that help to down-regulate inflammation. "I'm lucky to have chosen a career I really love," she enthuses, remembering that she originally thought about going into medicine, but didn't fancy the hands-on aspects of it. She laughs. "It's like clean medicine."

What attracted her to the career - one she'd never heard of before she went on work experience - was that many facets made up one whole. "I shadowed a chief dietitian for two days when I was doing my A-levels," Collins says. "In that time, she was talking to consultants on the ward at a scientific level - gobbledygook to me at back then - and next speaking to patient in language I understood. Then she was speaking to the nurses about the technical science of it, all the tubes and so on, before she went down to the kitchen staff to discuss preparing meals for the patient's condition. There were four conversations about one condition."

For this reason, dietitians must have the in-depth medical knowledge acquired through training that is recognised by the Dietitians Board for the Council for Professions Supplementary to Medicine.

The course must have accreditation from the Health Professions Council(HPC) - without that, you will be unable to register and work for the NHS. The Honours Degree in Human Nutrition and Dietetics is a four-year course, which normally requires an A-level in chemistry and one other scientific subject.

Students are schooled in nutrition and metabolism, typically combining study in biochemistry, pharmacology, physiology and food science. But because a dietitian's role is to apply the science practically, students will also learn about the context in which problems with food intake exist: the patient's psychology is important, as well as the social influences on their environment. Study is combined with clinical placements to prepare students for the workplace.

If you already have a degree that contains an acceptable level of biology and physiology, you can become a dietitian with a recognised postgraduate diploma in dietetics. The career opportunities for dietitians are as varied as the career itself. As well as opportunities in many areas of the NHS, the option to go freelance appeals to some dietitians. After five years in the NHS, Azmina Govindji was the chief dietitian for Diabetes UK for eight years. After that, having children provided the impetus to freelance. " It gives me a great feeling of fulfilment," she says of helping her patients.

"It's not just about calories. Often people will come to see me saying they want to lose weight, but very quickly will share the reasons they have a weight problem in the first place. I use neurolinguistic techniques - eating behaviour knowledge - to help." Her book The GI Plan: Lose Weight Forever was a result of her experience, and the desire for good healthy eating to reach more people."I could have written a book called 'eating healthily from the five food groups', but I'm not sure that more than two people would have read it," she laughs.

"But the science behind the GI approach is really the concept that I used at Diabetes UK: concentrating on foods with a low glycaemic index, wholegrains, beans, lentils and so on." Unlike the term " nutritionist" which has been appropriated by some people who are not professionally qualified, "dietician" is a protected title - the Health Professions Act 2002 saw to that."The challenge for freelances is to be committed enough to professionally run a business ethically," confirms Govindji. "Dietitians have a code of conduct: we can't endorse products." Dietetics is therefore an interesting combination of strict ethical guidelines for procedure and enormously flexible working practice. It's the job of a dietitian to regard each patient as an individual, adjust advice accordingly, and acknowledge that no ailment is ever the same because personality can play such a large part in the subject of food.

And while any job requires the updating of knowledge to promote success, dietetics requires more of this than most. "Evidence-based practice" is a buzz-word in the NHS at the moment: dietetics is an evolving science, and it's not acceptable to think that because something worked in the past that it's the best option today.

This is mainly because food science is constantly developing, and there are more foods available than there were, say, 20 years ago. People's options are changing, and will continue to do so. It's the job of a dietitian to make sure they have their finger on the pulse, so that they can do everything within their power to make life better for their patients.

The Lowdown

Qualifications:
BSc (Hons) degree in dietetics - four years full-time

Pay structure:
Graduate entrant - £19,525 to £21,073
Senior Position II (possible after 12 months) - £20,222 to £26,911
Senior Position I - £24,015 to £29,460
Chief III - £27,499 to £31,401
District Chief II - £31,917 to £35,195
District Chief I - £34,195 to £38,900
District Senior Chief - £36,320 to £40,191
Consultants - £37,331 to £51,344

Further information:

NHS- www.nhscareers.nhs.uk

British Dietetic Association - www.bda.uk.com CDH

Nigel Denby, 37, is a freelance dietitian and nutrition consultant: 'You have to find ways of motivating people'

"I originally trained as a chef but in my early twenties I accidentally drank oven cleaner on a cruise ship and ended up in hospital in the United States for two months. Because my digestive system was burnt, I had to work with a dietitian to find foods I could eat, and it really inspired me. When I was 25 I decided to train as a dietitian. I'd left school just with O-levels so I had to start from the beginning, doing an access course that got me up to speed. I was studying for five years in total.

When I graduated, my first job was a research dietitian. I was working with families, researching how to help people make dietary changes. At the same time I was doing clinical work in hospital: I did that for two years, and then I came out of the NHS and went to work for Boots. For two years I headed up weight management and general nutrition, working alongside osteopaths and homeopaths. My patients were all self-referring so they were very motivated.

When the Boots project folded we were made redundant, and I went freelance. It was scary, but the risk paid off: that was three years ago, and I split my work now between my private clinic in Harley Street and clinical work at Hammersmith and Queen Charlotte's hospital where I work with women's health - menopause, PMT, infertility, and so on. I'm part of a multidisciplinary team there and it's great working with other health professionals. I also work as a nutrition consultant for food manufacturers, helping to plan strategies and product development.

It's a really varied career, and while the traditional role of dietitian is great if you decide to take it, there are a lot of opportunities outside that too. To do this job, you really have to like food, and be able to communicate with people on various different levels. Keep a sense of humour: it can be terribly frustrating when you ask people to make what seem like simple changes and they find it difficult to put them into practice. You have to find different ways of motivating people. Since coming into the profession, I have a much better understanding of what makes people tick."

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