Diet is quality control
Moderation works but it’s easier said than done. This is where the specialist steps in, writes Julia Stirling
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’’.
Not just scientists: Adam Walsh says a dietitian needs to be a people person