Diet is qual­ity con­trol

Mod­er­a­tion works but it’s eas­ier said than done. This is where the spe­cial­ist steps in, writes Ju­lia Stir­ling

The Weekend Australian - Travel - - Career One -

LIKE many ado­les­cent boys, Adam Walsh didn’t know much about food. Af­ter leav­ing school he had a ‘‘ ter­ri­ble’’ diet and grad­u­ally gained weight dur­ing an ex­tended gap year. It wasn’t un­til he worked in the hos­pi­tal­ity in­dus­try where groom­ing was im­por­tant that he took a hard look at him­self.

He started run­ning, swim­ming and go­ing to the gym: I was work­ing in­cred­i­bly hard but feel­ing I wasn’t get­ting my just re­wards — I’d lost about four ki­los.’’ Leav­ing the gym one day he no­ticed a sign about an in-house di­eti­tian, and won­dered if his diet might be let­ting him down. Af­ter some con­sul­ta­tions and a diet re­struc­ture, the weight fell off — he lost 26 ki­los.

I felt like a new per­son, and I felt I had found my call­ing. I in­ves­ti­gated what I needed to do to be­come a di­eti­tian, so I could help oth­ers the way I’d been helped.’’

Walsh en­joys a beer and a bar­be­cue, and in a so­cial sit­u­a­tion he of­ten gets the com­ment, ‘‘ Are you meant to drink and eat that?’’ Since he is a di­eti­tian, peo­ple com­monly as­sume he eats healthily all of the time.

‘‘ As bor­ing as the mes­sage sounds — ev­ery­thing in mod­er­a­tion — it re­ally does work. You don’t have to ex­clude any one par­tic­u­lar food or food group to be healthy.’’ Walsh says not main­tain­ing a healthy weight is ‘‘ a lit­tle bit of an oc­cu­pa­tional risk. You wouldn’t see an ac­coun­tant who was broke, so would you see a di­eti­tian who was over­weight?’’

There are many mis­con­cep­tions around the pro­fes­sion of di­etet­ics. ‘‘ In re­al­ity most peo­ple don’t know what I do on a daily ba­sis,’’ says Walsh. When peo­ple find out Walsh works at Melbourne’s Royal Chil­dren’s Hospi­tal, they as­sume he works with over­weight kids all day.

‘‘ For some rea­son, peo­ple don’t as­so­ci­ate di­eti­tians with sick kids. The re­al­ity is that at the Chil­dren’s I work as a clin­i­cal di­eti­tian. My role can vary be­tween num­ber crunch­ing and ed­u­ca­tion. They are poles apart, but they hap­pen un­der one roof. It can be very math­e­mat­i­cal or it can verge on coun­selling. We of­ten pro­vide nu­tri­tion through naso-gas­tric tubes or di­rectly into veins. We can deal with acute sit­u­a­tions such as chil­dren in­jured in car ac­ci­dents or chronic ill­ness such as cys­tic fi­bro­sis or di­a­betes. Fun­da­men­tally what­ever the rea­son, chil­dren re­quire nu­tri­tion. It’s part of my role to pro­vide it. The role is a very di­verse one that presents many chal­lenges.’’

Walsh di­vides his week be­tween clin­i­cal di­etet­ics, private prac­tice and more re­cently Deakin Univer­sity. ‘‘ It is di­verse, and I love that about my qual­i­fi­ca­tion. It can re­ally take you to dif­fer­ent places. You are only held back by your imag­i­na­tion.’’

Walsh has a Bach­e­lor of Ap­plied Science and a Masters in Nu­tri­tion and Di­etet­ics. Af­ter six years in pe­di­atrics, he still finds it an in­spir­ing area to work within. ‘‘ It can be ex­traor­di­nar­ily sad at times, though — hos­pi­tals can be that way. Chil­dren can die and that’s al­ways hard, more so when you’ve de­vel­oped a re­la­tion­ship with the fam­ily, of­ten from close to the time of birth. The re­wards come daily in know­ing that you’re help­ing in your own way to bet­ter a child’s life.’’

The chil­dren he sees in his private prac­tice tend not to have as many health is­sues as those at the hospi­tal. ‘‘ I find my role is more about ed­u­ca­tion. Clients might have gas­troin­testi­nal is­sues such as coeliac dis­ease, weight is­sues, ba­bies who are fail­ing to thrive or ado­les­cents with eat­ing disor­ders,’’ he says.

‘‘‘‘Doc­tor Tim Crowe, se­nior lec­turer in nu­tri­tion and course co-or­di­na­tor of the di­etet­ics pro­gram at Melbourne’s Deakin Univer­sity, says there has never been more of a need for di­eti­tians.

‘‘ Cur­rently 60 per cent of adult Aus­tralians are over­weight or obese, and with this comes much higher risk of se­ri­ous health prob­lems such as car­dio­vas­cu­lar dis­ease, type 2 di­a­betes and even can­cer. Al­most one mil­lion Aus­tralians have di­a­betes, with likely the same cur­rently un­di­ag­nosed — poor diet and in­ac­tiv­ity are the big­gest cul­prits for this surge in rates of di­a­betes.

‘‘ The need for di­eti­tians who have cred­i­ble nu­tri­tion knowl­edge, ap­pro­pri­ate train­ing, and clin­i­cal knowl­edge is greater now than ever be­fore in pre­vent­ing and treat­ing th­ese health and weight prob­lems,’’ he says.

Thirty years ago, di­eti­tians mainly worked in hos­pi­tals or com­mu­nity health cen­tres. In 1976 the Di­eti­tians As­so­ci­a­tion of Aus­tralia (DAA) had 337 mem­bers, it now has 3200. Crowe says di­eti­tians can find work in a whole range of di­verse ar­eas such as the food in­dus­try, private prac­tice, sports, ed­u­ca­tion and re­search, health pro­mo­tion, me­dia, PR and mar­ket­ing, con­sumer ed­u­ca­tion and cor­po­rate health.

Crowe says Deakin’s in­ter­nal em­ploy­ment sur­vey con­sis­tently finds that 90 per cent of their di­etet­ics grad­u­ates are work­ing as di­eti­tians within six months of com­plet­ing their de­gree. The 2005 grad­u­ate des­ti­na­tion sur­vey found the an­nual me­dian salary for grad­u­ates in first full­time em­ploy­ment in Aus­tralia was $43,000.

The gen­eral pub­lic is much more ed­u­cated about nu­tri­tion and health than ever be­fore, but Crowe says there is a lot of in­for­ma­tion from books, the me­dia and the in­ter­net that is of poor qual­ity and from un­re­li­able sources.

‘‘ Knowl­edge of nu­tri­tion and how it af­fects health does not al­ways mean trans­lat­ing this into prac­tice, hence there is a strong need for cred­i­ble ex­perts in nu­tri­tion, such as di­eti­tians, to work with and ed­u­cate the pop­u­la­tion,’’ he says.

A re­cent pilot study found that many peo­ple with type 2 di­a­betes were not re­ceiv­ing the nec­es­sary care to man­age their con­di­tion. Some peo­ple had waited up to seven years for help.

Julie Dun­don is vice-pres­i­dent of DAA and lead di­eti­tian in­volved in the pilot study. She has worked in the field of di­etet­ics for 26 years and is a di­rec­tor of Nu­tri­tion Pro­fes­sion­als Aus­tralia (NPA) in Ade­laide. The re­search pro­gram iden­ti­fied bar­ri­ers that make it dif­fi­cult for peo­ple to see a di­eti­tian, such as cost and lo­ca­tion. ‘‘ They don’t want to visit an al­lied health prac­ti­tioner in a hospi­tal, so they never ac­cess those ser­vices.’’ Dun­don says it’s im­por­tant for di­eti­tians to have strong links with GPs.

Dun­don finds work­ing in aged care in the food ser­vice area the most re­ward­ing, be­cause she can in­flu­ence the nu­tri­tion of many peo­ple.

The el­derly are of­ten in­ac­tive and their ap­petites can be quite poor. Says Dun­don, ‘‘ Their en­ergy re­quire­ment can be low — so to get in enough nu­tri­ents within their en­ergy re­quire­ments is quite chal­leng­ing. Their ap­petites drop away. They lose their taste, they are anx­ious, they are in unfamiliar sur­round­ings. Their food is not the same as it was when they cooked at home. We as di­eti­tians need to work very closely with the food ser­vices work­ers to re­ally be able to boost the nu­tri­tion of th­ese res­i­dents.’’

Adam Walsh rec­om­mends new grad­u­ates get a cou­ple of years of clin­i­cal ex­pe­ri­ence in a hospi­tal be­fore ven­tur­ing into private prac­tice alone. He says you can have the best train­ing, but as in most pro­fes­sions, there will be gaps in one’s knowl­edge. Hos­pi­tals or large private prac­tices of­fer the men­tor­ing and sup­port nec­es­sary when some­one presents with an un­usual med­i­cal con­di­tion.

Di­etet­ics re­mains a mainly fe­male dom­i­nated pro­fes­sion, but the rea­son for the gen­der im­bal­ance is not ob­vi­ous.

Says Crowe, ‘‘ there may be the per­cep­tion that di­eti­tians just work with over­weight peo­ple, which may not make it an at­trac­tive ca­reer choice for males. The re­al­ity is that be­cause of myr­iad ca­reer choices avail­able in di­etet­ics, this per­cep­tion is ob­so­lete.’’

Dun­don agrees. ‘‘ We’re sci­en­tists, but we have peo­ple skills mixed with that science. Many peo­ple just as­sume you’re a di­eti­tian, that it’s just about los­ing weight. They’re very sur­prised we are ad­vo­cates for nu­tri­tion. Over­all it does in­clude weight, but there is a whole range of other things that we do.’’ So what qual­i­ties does it take? Walsh says ‘‘ to be a great di­eti­cian you need to be a peo­ple per­son. All walks of life will come through your door whether it be in a clin­i­cal set­ting, in private prac­tice or out in the com­mu­nity. To be able to re­late with peo­ple from all so­cio-eco­nomic back­grounds will en­able you to be ef­fec­tive in your work. We are ed­u­ca­tors a lot of the time. If you can’t pitch it at the right level, the mes­sage won’t get through’’.

Pic­ture: Shan­non Mor­ris

Not just sci­en­tists: Adam Walsh says a di­eti­tian needs to be a peo­ple per­son

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