by After smoking and obesity, poor diet is the largest contributor to Australia’s disease burden, but it is rare for patients to be offered personalized nutrition interventions when they seek healthcare.
For people with chronic disease management plans, only 1–2% of allied health services include referrals to Accredited Practice Dietitians (APDs); and for pregnant women there are no usual APD referrals.
One side effect of this is that intakes of discretionary (aka ‘energy-dense, nutrient-poor’) foods are twice what is recommended in Australia’s Healthy Eating Guidelines, which halves the burden of heart disease. The burden of conditions such as bowel cancer, diabetes and stroke could be reduced by up to 25% if healthy eating habits were the default.
Laureate Professor Clare Collins, Director of the Food and Nutrition Research Program at the Hunter Medical Research Institute and Newcastle University, wants to introduce dietary checks into our healthcare system on a model that more closely mirrors dentistry.
She believes that several key events should prompt nutritional intervention, particularly early pregnancy and chronic disease risk detection.
“If I were in charge of the health department, I would introduce a Medicare item that would allow people to have dietary checks at these key life stages,” she said Hospital + Healthcare.
“Currently, the system only offers this to people who already have a chronic disease – and even then it can be an afterthought.
“Yes, we see dietitians as central to the management of kidney disease and diabetes, but so many other conditions are falling apart.
“Nutrition currently plays a small role in disease management compared to its impact on disease burden.”
Surprising results
Collins believes that more work is also needed to ensure that colleagues are delivering evidence-based messages about dietary intake. She says nutrition is a complex field, and many of the latest research findings are meaningless.
“Some of our medical colleagues may be contributing misinformation. Some of them may not know the answers but they are very keen to give advice. Then there are people who were trained many years ago, which may not be in line with the latest guidelines.”
Among the most surprising recent findings, underconsumption of legumes, such as beans and chickpeas, is the highest dietary risk factor for chronic disease. The second highest dietary risk factor is a diet low in whole grains or fiber.
“These results are unprecedented – and challenging to understand, especially among carbohydrate consumption guidelines. Yes, people need to watch their processed carb intake very high, but it is important to choose bread that is so full of whole grains that it has a nutty flavor. Working more closely with allied health teams and medical colleagues in this area is of great benefit.”
Although nutrition fact sheets can be useful, Collins believes they are only sufficient for certain groups of patients. She said referring doctors should be trained to identify who needs additional nutritional support.
“If someone is very interested in nutrition and seems to be good at finding information, a leaflet might work for them. If a person appears desperate for advice and their HBA1 is not on the Richter scale, referral to APD is necessary. Our medical colleagues will be able to assess that.”
That said, many doctors may be overestimating their patients’ nutritional knowledge, Collins argued.
“It is common for obese people to be told to quit and lose weight. What we may not realize is that many of these patients were never given adequate nutritional advice by a suitably qualified professional.
“A large part of the public does not know that we have moved on from the nutritional pyramid that was produced decades ago and that nutrition counseling includes support for setting realistic goals and support for changing food behaviour. “
Huge potential for improvement
Collins says that the underrepresentation of nutrition in the management of chronic disease is disconcerting to patients, and that a greater emphasis on diet as a disease prevention puzzle piece is missing.
“If a miracle happened and the entire population suddenly started following the current recommended dietary guidelines, then we would see a 50% reduction in the disease burden of heart disease and a 25% drop in the burden of diabetes.”
Collins also wants nutrition to play a bigger role in mental health management, given the recent discovery that dietary improvements are effective in depression.
“This is a huge missed opportunity. If you are not eating healthily, the first thing you will feel is a poorer sense of well-being. You won’t feel like you’re running on all cylinders. We now know that improving people’s diets can greatly improve well-being, and we are under-serving people by withholding this evidence-based advice.
“I hope that our future health care system will give nutrition the attention and funding it deserves,” she said.
