Dietary Reference Values in the UK; Duties, Responsibilities and Job Proβile of a Nutritionist

10.1 Introduction

The UK government and SACN (Scientific Advisory Committee on Nutrition) have examined eating patterns and food habits of different groups and published reports containing Dietary Reference Values, Dietary Guidelines and goals for different groups within the UK population. These values also help identify groups which suffer from nutritional deficiencies.

Our eating habits and personal relationship with food influences the amount of nutrition that we consume. It is possible to change eating patterns and break away from unhealthy habits by using a consistent and informed approach towards food. Older adults need to consume nutrient-dense foods with lower levels of salt and sugar. Sports persons require diets that are high in proteins and carbohydrates.

There are several professionals involved in the field of nutrition. Some important examples include dietitians, nutritionists and nutritional therapists. While dietitians possess university qualifications, it is not mandatory for nutritionists and nutritional therapists. Nutritionists and nutritional therapists often work with GPs, schools, offices and industrial kitchens to ensure compliance with nutritional standards prescribed by UK government agencies.

The primary job of a nutritionist includes evaluation and assessment of the nutritional needs of different clients and patients, and providing guidance on positive food choices. Your responsibility is to help people achieve their unique health goals using nutrition as a tool along with positive lifestyle choices. It is very important to evaluate the client's current eating, sleeping and exercise habits before offering guidance. Nutritionists should also encourage clients to record all intake of food in a diary or log. You must also explain to clients that they need a realistic time frame for achieving health goals.

Fact

The government of UK spends about £2 billion per year on providing food and drinks to the general public, service staff and visitors. The most prominent public sector entities include schools and the NHS as well as the armed forces.

Source: www.food.gov.uk

10.2 Dietary Reference Values (DRV), Goals and Guidelines

We need to consume a variety of nutrients and each nutrient should be consumed in a certain amount. The Committee on Medical Aspects of Food (COMA) has published detailed information on DRV for different sections of the population. COMA has now been replaced by SACN (Scientific Advisory Committee on Nutrition) and the body will perform regular reviews of food and nutritional requirements for various population groups in the UK.

In order to arrive at DRV estimates for different foods, COMA used four types of references including:

EAR (Estimated Average Requirement) EAR is defined as the estimated energy required from nutrients by a group of people. In any group, roughly 50% of the members will consume values below the EAR and 50% will consume above the EAR. Reference Nutrient Intakes (RNI) refer to the amount of nutrients needed to ensure that the health needs of a majority of a group are satisfied. For example, if the average intake of the group in question is the RNI, then there are very minimal chances of deficiency.

Lower Reference Nutrient Intake (LNRI) refers to the amount of nutrients required for a small group of people of the group with a low requirement. Safe intake: This value is used when the EAR, RNI and LNRI values are not available. Safe intake refers to values that are determined to be adequate for everyone in the group.

The Dietary Reference Values for vitamins and minerals, for example, are usually evaluated as RNI or LRNI. In general, if an adult is recommended to eat 2,000 calories a day, the calories should ideally be proportioned in the following manner:

900 to 1300 calories/45% to 60% should be derived from carbohydrates (this translates to roughly 225 to 325 grams of carbohydrates).

200 to 700 calories/10% to 35% should be derived from proteins (this translates to roughly 50 to 175 grams of proteins.

400 to 700 calories/20% to 30% should be derived from fats (this translates to roughly 144g to 170 grams of fat).

Please remember that fats provide 9 calories per gram compared to carbohydrates and proteins that provide 4 calories per gram. However, out of this, limit saturated fat intake to 22 grams per day. These are suggested nutrients for normal British adults; the recommended nutrient intakes may vary for women, children, elderly people, sports persons and patients.

10.3 How Eating Behaviours Influence our Relationship with Food

In general, we eat to satisfy hunger and to stay alive. Food also provides sensory satisfaction and we often eat to gratify our senses instead of fulfilling a basic physiological need. In fact, eating often develops into an addictive behaviour because many eat for several reasons other than to satisfy genuine hunger.

For example

People consume food when they are bored, depressed and for social reasons. Food is a source of comfort when we feel stressed or down. This goes to show that in addition to physiological need, there are strong psychological influences at work. For example, food is often eaten together after funerals because it provides comfort. Food is also offered as a sign of hospitality or friendship. When we eat erratically and infrequently, the brain slowly fails to recognise feelings of hunger and the lines become blurred. Hence, we tend to eat when we feel like it rather than when we are actually hungry.

Children often reject or demand food when they experience anger, jealousy or anxiety. When parents use food as a bribe or punishment, the child is likely to develop eating disorders when they grow into adulthood; this is because they develop a negative relationship with food.

Food also stimulates our senses with its texture, colour, taste and flavour. However, it is important to remember that the visual appeal of food gives no indication of its nutritional value. Appearances (especially as food goes) can be extremely deceptive. Commercial marketers of food make full use of the visual appeal of food to drive people to eat substances which may provide no nutritional value at all.

For example

Children have taste buds on the insides of their cheeks and throats as well as on the surface of the tongue, and they judge food by taste. The number of taste buds reduces as the child grows into adolescence and considerably decreases during old age. This is also why adults experience less aversion to bitter foods. Taste perception is also altered in pregnant women, cancer patients, patients with liver disease and surgical patients. Our personal satisfaction in food is determined by different factors such as sugar and salt proportions, spice, fat, taste, texture etc. These are known as 'bliss points' in food technology and it is possible to alter bliss points with consistent approaches to nutritional intake.

For example

If you have always liked to take two teaspoons of sugar in your tea, that is your bliss point. Then you may decide to cut down sugar to one teaspoonful instead of two. After some days, this will become your new bliss point. You may now find that you are unable to enjoy tea with two teaspoonfuls of  sugar.

Hence, by altering sensory implications, we can adopt healthy eating habits and we will be able to set new 'bliss points' along the way. Our eating habits reflect our upbringing, our society, our family and also who we are as people; our eating behaviours also reflect our attitudes towards ourselves.

10.4 Nutrition Tips for Older Adults

Older adults often experience loss of taste perception and also find it difficult to cook for themselves when they are alone. In addition, they are prone to losing muscle mass and may have low levels of physical activity.

Keeping the limitations in mind, here are some useful nutritional tips for elderly people:

-Consume more nutrient-dense foods like fruits, vegetables, whole grains (oatmeal), lean meat, seafood, eggs and low-fat dairy products

-Avoid foods that provide high calories but low nutrients such as pastries, cakes, pies, sweetened drinks, red meats and so on

-Choose foods with low sodium or low salt content

-Avoid oversized portions and eat less as older adults need fewer calories

-Drink water instead of artificial drinks

-If you have dental problems, choose softer foods

-Read food labels carefully as there could be ingredients that you should eat less of or more of

10.5 Nutrition Tips for Sports Persons

Eating tips for sports people involves much more than guzzling sports drinks or gorging on carbohydrates. Athletes and other sports people may require higher number of calories and their recommended intake may vary anywhere from 2,000 to 4,000 calories per day depending on their age and level of physical activity.

Avoid skipping breakfast

Sports people and athletes should eat something when they wake up because blood sugars are already low in the morning. Avoid going for your morning jog or run before consuming toast.

Sweet potatoes

Sweet potatoes are an excellent source of vitamin A and C and you can consider topping them up with black eye beans or cottage cheese for added protein.

Oatmeal

Oatmeal is an excellent source of carbohydrates and βibre which will keep you feeling satiated for longer periods of time.

Bananas

Bananas are an excellent source of potassium which is usually lost through sweat and excretion of electrolytes.

Walnuts, fruits, flaxseeds and oranges

Walnuts, fruits, flaxseeds and oranges provide an extra boost of immunity and antioxidants for your body. Please do not limit your recommended calorie intake because you want to look a certain way - this could lead to energy deficiency, fatigue and weakness over time.

Exercising releases large amounts of free radicals due to the oxidation process.

Remember to consume plenty of fresh fruit juices and water and stay hydrated because when you run/play sport, you tend to sweat, and this leads to a loss of electrolytes. Similarly, salmon is an excellent nutrient for athletes because it is loaded with muscle-building protein and in addition, bruises and wounds will heal faster. The biggest difference is that sports persons expend much more energy compared to ordinary folks and this is why they must maintain their energy levels.

Activity

Estimated time: 5 - 10 minutes

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10.6 How to become a Nutritionist

The UK government has initiated several efforts not only to ensure that nutritional guidelines are met but also to improve nutritional status of the general British public in different ways.

These initiatives are:

-Promoting specific food choices on the menu such as offering options between healthy foods

-Providing sufficient information so that people are able to make informed decisions about food

-Increasing the price of unhealthy food options while reducing the price of healthy foods in order to make them more accessible

-Partnering with catering contractors to include a greater number of healthy options in the menu

-Reducing the number of fatty/fried foods

-Incorporating the traffic light system in order to highlight the nutrient values in each type of food (the traffic signal labelling system uses red, amber and green to denote unhealthy, moderately healthy and healthy options)

-Providing a nutritional breakdown of foods on the menu

Fact

Nutritionists in the UK earn annual salaries that could range from £ 18,421 to £39, 272 per year depending on experience and job proβile.

Source: www.payscale.com

10.7 Experts and consultants in the field of nutrition.

Let us proceed to understand the different types of experts and consultants in the field of nutrition.

Dietitian

A dietitian is a qualified expert in the science of nutrition and uses their knowledge to help others make positive eating choices for themselves or loved ones. They will make recommendations after carrying out an assessment of your current requirements and will then help you examine different food choices that satisfy your health goals. They treat dietary and nutritional problems at the individual level as well as the public health level, and work with healthy clients as well as those who experience health challenges. They use their up-to-date knowledge to help people implement practical solutions to problems involving health and nutrition.

Dietitians in the UK are regulated by British law and should work according to the prescribed code of ethics. They are responsible for interpreting the science of nutrition and providing advice to clients, patients and caregivers. The objective is to provide expert guidance on matters related to nutrition and help people live healthier, happier and more vital lives. Dietary intervention can often help achieve health goals in a holistic manner.

Nutritionists

Nutritionists are registered with the UK Voluntary Register of Nutritionists and do not require a formal qualification. While dietitians usually work with the NHS-approved clinics, nutritionists can work with clients on a freelance basis. There is an increasing level of crossover between nutritionists and dietitians, and GPs in the UK often work with both.

Nutritionists usually work in non-clinical settings including sports, schools, ofβices, research and the food industry. They usually do not work with patients or people diagnosed with medical conditions or they may work with patients if supervised by a qualified healthcare professional. Similarly, nutritional therapists work with patients to help alleviate discomfort due to health conditions; they often work with clients with weight problems, hormonal issues or bowel disorders. Again, like nutritionists, nutritional therapists need not possess a university degree under UK law.

Career Profile, Duties and Responsibilities of a Nutritionist

The career of a nutritionist is exciting and provides opportunities to help your clients develop better eating habits. Proper nutrition is essential to overall wellness and vitality and helps people live happier lives. Nutritionists play an important role by evaluating your current eating behaviours and patterns and offering expert advice on how to include healthier foods and eliminate foods that are not adding nutritional value to your meals. Nutritionists often work in schools and offices to help ensure that the meals served meet recommended nutritional standards.

The duties and responsibilities of a nutritionist are described below:

-They work one-on-one with clients and offer advice on achieving health goals including weight loss, improvement of immunity or metabolism and nutrition to help alleviate discomfort from various health conditions

-In a one-to-one scenario, nutritionists act as food counsellors who help people plan their meals and diets in a healthy way by making positive choices. The process begins with identification of health goals

-Nutritionists may opt to work with individuals as well as groups in order to guide them regarding nutritious food and healthy eating habits

-They screen, evaluate and assess diet restrictions, nutritional needs and current health recommendations in order to prepare dietary plans

- Nutritionists are often involved in supervising food operations to ensure compliance with quality nutritional standards as well as safety and sanitation guidelines

-They also play active roles in advising patients and caregivers regarding food preparation, planning and diet modification based on nutritional principles

-They also coordinate with healthcare staff and GPs to understand dietary needs of patients

In addition, they are responsible for devising suitable nutritional strategies and recognising behaviours that may require modification. Britain now boasts a multi-cultural and multi-ethnic population and nutritionists can expect to work with different clients from different economic, ethnic, cultural and educational backgrounds. It is also a good idea to be familiar with different foods from other cuisines.

Once you obtain certification in the field of nutrition, you can also consider the following career options:

-Nutrition consultant, corporate nutrition consultant, nutrition and wellness instructor, nutrition writer or a nutrition products sales personnel or entrepreneur.

-Nutritionists also work with food manufacturers and retailers, and work with relief efforts in low income areas.

-As a nutritionist, one of your main objectives involves providing support to your clients as they work towards their health goals. Emotional barriers often come in the way of achieving nutrition goals.

For example

Stress, depression and worry can induce people to eat when they are not hungry.

10.8 Effective Strategies to help your Clients Adhere to their Eating Plans

The following tips help nutritionists provide support to clients following dietary plans.

-Ask them about their health goals

-Nutrition counselling is both a science and an art. It is very important to understand what the client hopes to accomplish by hiring you before you begin the actual process of evaluation and assessment.

-It is very important to get as specific as possible.

For example

Your client may say that they wish to lose weight and look good. You must ask them for specifics, for example, how much do they weigh (ask them to stand on the weighing machine if you need to) and how much weight do they want to lose. Some clients may wish to lose fat or inches. It is important to have realistic and well-deβined goals so that you are able to establish a realistic time-frame to achieve them. As a good nutrition coach, help them to break down long-term goals into smaller goals and this will help plan out the sessions better and make them more productive. Ensure that you do not force the client to adopt goals; they should be able to communicate their objectives to you.

Use lists

Help them create two lists: One list should describe foods that they feel will nourish their bodies and the other list should contain foods that are not good for your health. Encourage your clients to be specific.

For example

If they include 'smoothie' as a healthy food, ask them to write the exact fruits or vegetables that they would prefer to include in the smoothie.

Record important measurements

It is important to record all the important measurements such as weight, arm circumference, waist, hips and so on in order to provide effective counselling. Advise clients to weigh themselves regularly in order to monitor progress on the new meal plan. Many clients are sensitive about weight and may not be comfortable confessing their weight straight away. However, show friendliness and empathy and encourage clients to weigh themselves on a regular basis. Rapid weight gain, for example, is usually due to increase in fat. Rapid weight loss is often due to loss of water. Muscle building is a slower process.

Maintain a food diary

It is extremely important to encourage clients to jot down everything they eat and maintain a food diary. As a matter of fact, it is very difficult to make evaluations and assessments about food intake based on what people say.

For example

Many people may feel that they eat 'too much'. However, this could be completely wrong, and they could be eating much less than they think they do. For example, they could be eating the wrong type of foods instead of the wrong quantity. A detailed food diary replete with details regarding the name of the food, quantity, time of intake, nutrient list and so on, provides comprehensive information regarding food habits. A good nutritionist always relies on a food log to base their suggestions on. In the absence of a food log, suggestions may be vague or ineffective in resolving the issues.

Client's lifestyle and habits

Ask detailed questions regarding the client's lifestyle and habits: Exercise, sleeping hours and workhabits all play important roles in evaluating their needs and goals.

Examples:

A very active client may need to increase muscle and you have to examine their food choices to determine if they are providing the right nutrition. A client who leads a sedentary life may be asked to increase exercise and physical fitness instead of cutting down food. Every client's health goals are different, and you must make it a point to ask each one for details.

The need for client patience

Please explain to clients that they need to be patient and forgiving with themselves while working towards health goals. Success with weight management goals (this could include weight loss, weight gain, muscle gain, or fat loss) is seldom linear; on the contrary, clients often face setbacks during the process. It is your duty as a nutrition coach to help them move past a setback and proceed with their dietary and fitness plans.

One of the most important things is to dispel notions of 'magical results'. Making changes to eating behaviours is an excellent way to achieve health goals, but it does not happen overnight. Clients are often influenced by the number of adverts regarding quick weight loss and fast muscle gain. This is far from the truth: weight and nutrition-based goals require time and it is important to help your clients achieve their goals in a holistic manner. Please refrain from encouraging extreme dieting or exercising in order to lose excess weight or develop muscles. It is important for nutritionists to keep in mind that energy balance and overall wellness is crucial to wellbeing. It is simply not healthy to push your clients towards extreme dieting, because this will strip their body of essential nutrients.

Adopt a patient and understanding approach.

Your objective is to help clients succeed by make better decisions for themselves and it will not happen overnight. As a nutrition professional, it is your responsibility to motivate clients to take charge of their health and change their lives for the better. Be consistent, show interest in your clients and praise them when they make headway towards their goals. Give them time because they may have to work on undoing a lot of bad health decisions in the past.

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MODULE SUMMARY

Older people can enjoy a healthier and stronger life accompanied by improved immunity and cognitive function if they choose to eat well. It is a good idea to increase the number of foods that provide energy at a slower rate and reduce salt, sugars and fats in your daily dietary intake. As we grow older, the body's ability to absorb nutrients reduces and this is why it is a good idea for older adults to eat smaller meals.

Similarly, sports people or those who indulge in high intensity sports may need to consume a higher number of calories compared to others who lead more sedentary lives. They should also drink a lot of fluids to replace water lost due to sweating. You can choose from different careers in the field of nutrition. While dietitians require a formal college degree in order to practice in the UK, nutritionists and nutritional therapists do not need mandatory degrees.

A high-quality course on nutrition can help provide you with the basics that you need in order to help your clients achieve their health goals. Your duties will involve offering guidance on meals, dietary plans and nutrition to different clients including individuals and groups. You will also have the opportunity to work with schools, ofβices and industrial kitchens to evaluate their menu and suggest improvements.