When John Prescott, the former deputy prime minister, confessed to a 10-year battle with the eating disorder bulimia, he threw a light on the disturbing and growing prevalence of eating disorders in our society. The 69-year-old's admission of a vicious circle of secret gorging and vomiting caused concern among eating disorders professionals, worried there be many more men like Prescott, the secret victims of a disorder more commonly associated with teenage girls and young women.
There are no hard and fast statistics about the numbers suffering from eating disorders – these are, after all, disorders that thrive on secrecy and shame – but bulimia is estimated to affect between 1 and 2 per cent of women aged 15 to 40, with anorexia thought to affect between one and five teenage women in every 100,000. Men are thought to account for between 5 and 10 per cent of all cases. It would appear that numbers are on the rise, with all age ranges and social groupings apparently affected. This disturbing trend means there is increased demand for professionals skilled in dealing with these deeply entrenched and dangerous behaviours (anorexia has the highest death rate of all mental illnesses). This is where dietitians come in. Working alongside psychiatrists and psychologists, a dietitian will help a sufferer regain a healthy attitude to food and nutrition.
"We help people regain their confidence in food and eating, to meet their body's nutritional needs and restore physical health," says Ann Fennell, who works with adult sufferers in the West Midlands.
This isn't just about providing advice on healthy eating: dietitians have to be able to empower people to identify and make changes to eating habits that may have ruled their lives for decades. Many dietitians take on extra-training, in skills such as motivational interviewing and cognitive behavioural therapy, to help with this side of the job. Fennell is herself now in the final year of a Masters in solution focused therapy.
"We know it's really different for people to change and it's about helping people find ways of trying," she says.
Dietitians can also be found on the other side of the food wars, helping with the battle against obesity. Adult obesity rates have almost quadrupled in the last 25 years, with 22 per cent of Britons now officially obese, while 10 per cent of six-year-olds are obese, rising to 17 per cent of 15-year-olds. This has a massive cost to those families blighted by ill-health, and to the NHS, which struggles to resource the rising tide of obesity-related conditions. Dietitians are out in the community, in GP's surgeries, schools, youth centres and mother and toddler groups, trying to help people understand the healthy eating agenda and make practical changes in their daily lives.
"Dietetics is about translating the scientific evidence into language people can understand," says Sue Baic, a lecturer in public health and nutrition at Bristol University, who also runs her own nutrition consultancy. "It's turning that science into something practical people can use."
This means dietitians need a solid grounding in science. The qualification involves a four-year BSc at undergraduate level or, for those with a first degree in life sciences, a two-year post-graduate qualification. There are only 14 universities running these courses in the UK (see the British Dietetic Association website, www.bda.uk.com, for details) and places are over-subscribed. The course is intensive and covers biochemistry, microbiology, food science and physiology, plus a 28-week placement in the NHS.
On graduation and registration with the Health Professions Council, most will join the NHS, where the starter Band 5 pay scale is a pretty reasonable £19,000-£24,000. Many will work in hospitals, providing nutrition advice for a wide range of sick people, from burns patients and cancer sufferers to the very old and very young. Others will join a community practice, often working from a GP's surgery, to help promote healthy food choices through one-on-one sessions with patients and working with schools and other health providers.
There are opportunities for experienced dietitians outside the NHS. Sports dietitians help athletes understand that what, when and how much they eat and drink can have an effect on their performance. They can be found advising football teams, Olympic squads and working with the public in local fitness centres. Many food manufacturers, retailers and pharmaceutical companies also employ dietitians to provide advice on their products, prepare nutritional literature and draw up nutritional standards.
"It's a gateway to a very varied career," says Baic, who worked for 20 years in the NHS before turning freelance. "You can work with sick people, healthy people, the young, the old. You have to be a people person and able to communicate with lots of different people, from cardiovascular surgeons to very young children."
June Copeman, head of nutrition and dietetics at Leeds Metropolitan University, which trains 60 dietitians a year, says there are a lot of misconceptions about the job. "Everybody eats so everybody thinks they know about nutrition," says Copeman. "If you introduce yourself as a dietitian people always ask you 'how can I lose a few pounds?' But our work is based on science and we are trained to work with sick people in a therapeutic environment."
It's a job that suits those who are science-minded, have an interest in health and nutrition and enjoy working with people. "It's a fantastic job and I can't see any downside," says Sue Baic.
See www.bda.uk.com for further information on dietetics
'The degree was intense. You need that depth of training'
Ann Fennell is a specialist dietitian working with adults suffering from eating disorders in the West Midlands.
I was approaching my thirties and working in banking when I decided to have a complete career change and try my hand at dietetics. I enjoyed working for the bank but I realised that it wasn't a career I would be satisfied doing until retirement. I had a real interest in health and nutrition and wanted a job that I could put more of myself into.
The four-year degree course was arduous and very intense, studying nine-to-five, five days a week, but I do think this depth of training is needed to work at this level. Although we might not get asked questions about biochemical processes and human physiology everyday, this knowledge underpins the advice we give and the way we are able to tailor it to individual people and populations. I think it's important for people receiving advice on nutrition to get it from someone with this level of training.
I've been working as a dietitian for 15 years now and I've no regrets about leaving banking. I've worked in different clinical roles in hospitals, in the community and now I specialise in mental health, in particular working with people with eating disorders.
Eating disorder recovery is a challenge for both the clients and the workers. People come for help at various stages of their difficulty. Some are thinking about change but not yet sure if they want to or are able to. Others are so frustrated with their situation that they are beginning to make changes and this is often a slow and difficult process. We aim to support people wherever they are at. People do have success and when they do it's really great to know you had a role in this. You can actually help save someone's life.