As the challenge of an increasing obesogenic population shows no sign of going away, the deluge of diet regimes, fitness regimes and research that either condemns or promotes certain foods over another continues to flow. How do we begin to make sense of it all?
Our guest blog on Monday highlighted the valuable role dietitians can play in helping us navigate this deluge and support us all to live healthier lives, drawing upon their high level of skill and expertise in food and nutrition.
One of the concluding themes from 2020health’s recent report ‘Careless eating costs lives’ was that our health needs change depending on where we are in the life cycle so understanding our dietary needs throughout life is paramount. The focus needs to shift from a particular diet to ‘our diet’ and an improved understanding of food and what it means to eat a nutritious healthy diet.
Coupled with this is the need to help make healthy choices easier. Simply reinforcing messages about poor choices will not work. People need to be educated to understand what constitutes good choice so they can take steps to change their behaviour.
So how might the specialized skills and expertise of the dietician be more effectively utilized within the health and social care system?
With the general shift towards community based care and a focus on integration of services, one approach would be to make greater use of dieticians within the community setting and increasing ‘touch points’ with dieticians within the GP surgery.
Our ‘Careless eating costs lives’ report reviewed many different areas of interventions, which different countries have adopted to try and tackle obesity. One example was EPODE, originating in France, and an acronym for ‘together let’s beat childhood obesity’. The largest national obesity network, EPODE has fostered a multi-stakeholder approach with links established between civil society, the corporate sector, NGOs, academia and institutions.
The EPODE approach endeavours to deliver programmes that create everyday norms and settings for children to eat healthily and play safely and actively. The multi-stakeholder, whole community approach facilitates the development of healthy environments including mapped walking routes, playgrounds and cycle routes. Community involvement discourages opposition and provides individuals with a value in the local environment. Local government is closely involved and a local figurehead is appointed to pioneer projects and motivate the population.
Whilst some speculate as to whether some grand initiative like EPODE could run in the UK, owing to a perceived lacklustre community spirit and local engagement, it does offer an enticing innovative and sustainable approach. It demonstrates how adopting a network framework and nurturing a positive attitude towards effective change might reap health benefits in communities and bring about a reverse in the current trends of societal divide.
There are two key aspects of the EPODE programme which I particularly want to highlight here which are relevant to developing the role of the dietician:
- a. Tailoring support to the needs of the community
- b. Helping children reconnect with the food system
a) Tailoring support to the needs of the community
The EPODE programme is specifically designed for tailoring to the individual requirements of communities.
Changes in the global food system, including reduced time-cost of food, changes to local environments and increased automation of labour at home and in the workplace contribute to the obesogenic environment (Swinburn et al 2013). An obesogenic environment is an environment which encourages unhealthy eating and insufficient physical activity. Contributing factors are high density of fast food outlets, restaurants and vending machines, and environments that discourage movement, e.g. either by making walking difficult (encouraging car use) or buildings where lifts are prominent and stairs are hidden (BBC News Magazine Monitor 2014).
Whilst current findings do not appear to be based on robust scientific trials, the opportunity for change which EPODE offers is clear, not only in terms of improving the health of our younger generation, but in building united, healthy communities.
Dieticians and community engagement is nothing new but is under utilized currently. In certain areas of the UK dieticians recognize that it is easier to build a rapport with people when the environment is informal, such as in the community setting of a children’s centre to run Cook 4 Life sessions with mothers.
The dietitian’s skill set positions them to play an invaluable role in any community strategy for building and strengthening healthy communities. Their specialized training allows them to assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. This knowledge and understanding can then be used to evaluate the specific needs of a community and then translate it into practical lifestyle advice and guidance.
b) Helping children reconnect with the food system
Data from Public Health England indicates that one in 10 kids in England are obese by the time they start primary school. By the time they leave, one in five is obese and a third are overweight. It is therefore becoming increasingly urgent to help educate from an early age the importance of making healthy lifestyle choices.
EPODE helps to demonstrate the value of reconnecting children with the food system and food supply, by helping to instill a better understanding of what it means to live healthily. It is never too early to provide the best information to children about the importance of making healthy decisions. As recommended in ‘Careless eating costs lives’, practical cookery skills and clear food education should form a statutory part of the Key Stage 3 Design & Technology curriculum, under Food Technology.
With their specialized knowledge of diet and nutrition and the skills to synthesis the latest scientific and public health data, dieticians have a critical part to play in the shaping and direction of any food education programme that aims to improve health literacy from an early age.
It is becoming increasingly clear that no one solution will resolve the obesity challenge. It is much more complex because it underpins how we live our daily lives, the environment in which we live and work and how we feel about ourselves.
Amongst the noise of talking ‘organizational change’, integration and collaboration between disciplines and professionals will be crucial. And amongst the noise of the latest statistics, diet fad or research finding will need to be the voice of the dietician, shining a much needed light on how to make sense of it all and move forward effectively.