Memorandum by Dietitians Working in Obesity
Management (WP 102)
DOM UK (Dietitians Working in Obesity Management),
a specialist group of The British Dietetic Association welcomes
the Government's White Paper, entitled Choosing Health: Making
Health Choices Easier. Choosing Health addresses a wide range
of health issues; nutrition and diet are integral to many of the
issues highlighted. Consequently, dietitians have a key role to
play in the delivery and promotion of the healthy lifestyle featured
in the White Paper.
1. Will the Proposals Enable the Government
to Achieve its Public Health Goals?
The need for the Government to work in partnership
with others to create an environment that promotes health is central
to proposals in the white paper. There are no quick solutions
and DOM UK welcomes the opportunity to work in partnership with
other organizations, looking to Government to take a lead on establishing
working groups as required.
DOM UK is delighted to see progress in this
area over the last six months where the Department of Health has
already established some working groups: a group to develop NICE
(National Institute of Clinical Excellence) guidelines on obesity,
another group will develop an obesity pathway and in addition
DOM UK has been commissioned to work with other obesity organizations
and produce a directory of obesity training for PCTs.
2. Are the Proposals are Appropriate, Will
They be Effective and do they Represent Value for Money?
By 2007, the White Paper proposes that NICE
will prepare definitive guidance on the prevention, identification,
management and treatment of obesity. DOM UK welcomes this long
term vision and is delighted to be in this working group. However
we also recognise the importance of ensuring that recommendations
for the medium term can be achieved. For example recommendation
no 66, to develop "a comprehensive `care pathway' for obesity,
providing a model for prevention and treatment" and no.68
"we will also commission production of a weight loss guide
to set out what is known about regimes for losing weight".
Development of these tools will be more straightforward than practical
implementation. The infrastructure needs to be developed in primary
to enable these tools to be used effectively.
3. Do the Necessary Public Health Infrastructure
and Mechanisms Exist to Ensure that Proposals will be Implemented
and Goals Achieved?
The infrastructure in primary care requires
much refining to enable obesity to be addressed. Historically
almost no doctors or nurses have had any training in the area
of nutrition and obesity. On 30 December the government announced
£3 million funding for up-skilling the workforce which has
been welcomed by all groups. A major challenge is that the level
of funding available will support only isolated training courses
and the level of training required fits a longer term strategy.
Training needs to support organizational change not only clinical
knowledge to be effective. If training is a one off and there
is no support in practice when clinicians return to the workplace
this will affect effectiveness of the new initatives. The Counterweight
programme has demonstrated that intensive training over a six
month period enabled primary care clinicians to effectively manage
obesity.
Additional time required to address obesity
is a barrier for weight management systems being implemented.
There is huge reluctance to allocate more time is also influenced
by obesity not being a priority in the GMS contract. In summary
funding for training is a great start, but training programmes
need to have a long term vision and addressing the cost of clinical
time needed to systematically manage obesity in primary care still
needs to happen.
Dietitians are already involved in a number
of initiatives, but in order to maximize the potential of this
highly skilled workforce, the DOM UK recommends that:
— A dietetic adviser at the Department
of Health;
— A public health dietetic post at
regional level.
Dietitians—key to delivery of Choosing Health
Registered dietitians in the UK hold the only
legally recognised graduate qualification in nutrition and dietetics
and work to promote nutritional well-being, treat disease and
prevent nutrition-related health problems. Their unique skill
is to interpret and translate the science of nutrition into practical,
impartial and safe information about food and health. Therefore
they have a key role to play in the implementation of the recommendations
made in the White Paper, particularly in relation to the promotion
of a healthy diet and preventing and treating obesity. In terms
of obesity their training provides them with an understanding
of the causes, consequences and treatment strategies (including
dietary approaches, physical activity, behaviour change skills,
drug treatment and surgery). They understand the public health
issues in addition to the clinical implications of disease. Dietitians
do not see their role as solely managing those who are overweight/obese,
but also have a role in working within PCTs to help develop strategic
approaches, involving all agencies (leisure services, slimming
clubs, local government, schools, workplace, minority groups and
those from lower socio-economic groups) to improve the health
of their population as a whole.
January 2005
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