Taste of a rewarding occupation: How dietitians are striving to improve the nutrition of the nation

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The Independent Online

"When I qualified, doctors were so ignorant about dietitians, they thought it was our job to cook food," says Chris Cashin. Fed up with such misconceptions, dietitians have worked tirelessly to raise the profile of the profession, and finally, she says, it's paying off, with dietitians now enjoying high status and recognition that they improve nutritional well-being, prevent food-related problems and treat diseases. "One of my colleagues recently received an OBE for their services."

It's also increasingly realised that dietitians don't just work in hospitals, says Cashin. Indeed, while many dietitians work with sick people, for example in intensive care or dialysis, others like working in the community, for instance in children's centres where they might advise about eating on a budget and on how to prevent child obesity.

Others love lecturing on university courses or researching things like the benefits of Vitamin D or the role of diet in dental health. You also get people working for government departments, consumer groups such as Which?, and charities such as the British Heart Foundation. The food industry appeals to many dietitians too, where they do things such as advise on how a new product could have better health benefits.

Cashin runs her own dietitian business, working with elite athletes and sportspeople. "I started out in the NHS, but when my children were quite small I realised I could take advantage of the fact that I'd always had a big interest in sport. I qualified as a sports dietitian by doing a specialist course with the British Dietetic Association (BDA) and soon managed to get work with governing bodies, where I work closely with other professionals to work out individual training plans. Elite athletes have intense training schedules, often training for five or six hours a day. That means they need a lot of food – often around 6,000 to 7,000 calories a day. It's my job to work out how they do that in the best way."

Over the past 10 years, Cashin has enjoyed working with the Professional Jockeys Association and the British Paralympic Association as well as athletes who approach her independently. "I also teach on some degree courses at the University of Wales in Newport, so my work is incredibly varied," she says.

Like many dietitians, she was originally attracted to the job because she had a keen interest in the medical field, but didn't fancy the "grizzly bits". Others point to the opportunity to specialise – if not in sports, then allergies, oncology, paediatrics and syndromes such as IBS (irritable bowel syndrome). But most of all, people are drawn to the link between diet and behaviour. "Unlike nutritionists, dietitians are qualified in human behaviour as well as diet and nutrition, so they are really able to change the way people eat," says Laura King, spokeswoman for the BDA. "Also unlike nutritionists, the title of dietitian is protected so you can't call yourself one unless you've got a qualification approved by the Health Professions Council."

There are two ways to achieve this. The first is to complete a four-year undergraduate degree course in dietetics or nutrition. The other option is to do a two-year postgraduate qualification, having first completed an honours degree course in a relevant subject which contains an acceptable level of human physiology and biochemistry. For those that can't commit to full-time study, a growing number of institutions are developing flexible study routes, including part-time courses. "People tend to really enjoy the study, not least because it involves a clinical placement, enabling you to apply what you learn," says King, who adds that, once qualified, dietitians usually start out in the NHS. "This is great because you often get rotated and therefore get the chance to work in areas ranging from mental health to obesity to diabetes. This enables you to find out where your particular interests lie before committing to specialising."

Besides a flair for science, you'll need a caring nature and the ability to communicate with people from surgeons and GPs through to patients, says King. "That means being able to talk at a very professional level, as well as being able to translate often quite complicated scientific information to a level that lay people can understand."

Lucy Jones, a bariatric specialist, says: "Only today, I've been working with someone who needs to go for a second lot of weight-loss surgery and I needed to tell them exactly what to expect, as well as having some difficult conversations with a family member. Weight-loss surgery for the morbidly obese – which is my area of work – is high-risk, and you need the whole family to be on board to make it work."

Jones is the first person the patient sees once they're referred for the surgery. "I give them three hours of extensive education on the risks, how much weight they can expect to lose and how every aspect of their life will be changed. And in cases where patients need to get some weight off pre-surgery – to make the surgery safer – I assess them individually prior to the surgery."

Most of her work, however, is post-surgery, where she focuses on behaviour-change strategies and advising their GP on overcoming any nutritional deficiencies. "It is very rewarding because you see incredible changes," she says. "For instance, I may see a patient coming in at 60 stone and leaving at 15 stone, able to get married and have children and get a job. People feel very grateful. And because we are all working towards one clear aim, there is a great sense of camaraderie working here. You also wind up being quite famous in this area."

Jones enjoys the cultural aspects to her job, too. "Because the geographical area I work in is very culturally mixed, I work with a lot of Jewish and African communities; and, because there are strong cultural influences when it comes to cuisine and how weight is perceived, that brings particular challenges, which makes my job extremely interesting."

Eleanor Donaldson works in the area of weight loss, too. Having initially specialised in working with people with HIV, she now spends two days a week training doctors, nurses and healthcare assistants to deliver weight management groups, while the rest of her time involves delivering a 12-week weight management course herself.

"GPs refer patients to our team for weight-loss advice, and they are offered this on a one-to-one basis or through group sessions, and it's the latter that I'm involved in," she says.

The word "diet" is banned, however. "This is about encouraging people to have a whole new attitude to becoming more active and mindful about the food they eat. It's certainly not about fad diets, which have often caused the problem of weight gain in the first place," explains Donaldson.

Like a growing number of dietitians, Donaldson is also involved in media work. "Each month, we have a regular live slot on BBC Radio Leicester, and I have a chat with the show's producer and broadcaster before preparing a topic such as healthy breakfasts, food labelling and calcium. It's a very interactive show and has an average of 180,000 listeners a week, so we reach a wide audience with our health messages."

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