Efad newsletter september 2016

September 2016

The Voice of

European Dietitians President's Message

This quarter's newsletter is full of really interesting information about the activities of dietitians. It comes after a very full and successful International Congress of Dietetics held in Granada, Spain. A huge congratulation and thank you to the Foundation of Spanish Dietetics and Nutrition for organising such a wonderful conference. One of the symposiums at the Congress about raising the awareness of hydration in Europe, which EFAD is supporting, is summarised in this newsletter. In this photo, I am pictured with the key speakers.

EFAD also held a successful General Meeting of its member associations and adopted a new Strategic Plan 2017-­‐2021, which is forward looking, as you would expect. I have written a short paper on the future of dietetics in Europe to inform the development of the plan and it follows this message.

Dietitians, as you will see, have been very active in promoting their work in the area of obesity.

Joan Gandy Olle Melander Anne de Looy You will find a report showing the

Isabelle Guelinckx

Pauline Douglas work of our European Specialist Dietetic Network (ESDN) Obesity with the European Association for the Study of Obesity (EASO) in the European Obesity Summit that took place in June. On the same topic of obesity, the Hungarian Association of Dietitians describe their GYERE (children's health) initiative in the city of Dunaharaszti. Both reports demonstrate a leadership role by dietitians. I was also at a recent meeting of the Joint Action for Physical Activity and Nutrition (JANPA), which is a European initiative targeting obesity in children. Prof Maria Hassapidou is leading one of the work packages.

Also in this full newsletter is a report on new behavioural change videos which are now available on the EFAD website and also our first dedicated report on the European Dietetic Action Plan (EuDAP) from Germany. Come on other countries …..what is going on in your country? I cannot wait for the next newsletter there is so much more to be shared between dietitians in Europe!

Anne

Anne de Looy, President of EFAD, Professor of Dietetics, Plymouth University, England

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Dietitians & Dietetics in Europe Where are we going?

Recently EFAD has looked to the future as part of our strategic planning process. Looking around Europe we cannot ignore the profound changes that have occurred in healthcare recently.

We anticipate that resources will become more and more restricted, non-­‐communicable diseases will increase, and technology will advance rapidly. So what is the vision for dietetics and dietitians in the next 30 years or so in Europe?

Smits (2012) writing in the European Commission report ‘Global Europe 2050’1 says ‘business as usual is not an option: incremental changes, small adjustments to the current policy framework will not do the job’. At first dietitians may find it hard imagining how change and such

things as a low-­‐carbon economy in Europe2 will affect our environment, economies, food supplies and services. But as dietitians we have a unique scientific knowledge of health, food and nutrition together with an important understanding of the psychosocial dimension of human behaviour.

Dietitians are already changing the way they work. Here are some aspects that we already see and some we may see into the future:

1 There will be further investment in prevention services delivered at a primary health level and the integration of care pathways and prevention packages. Inequalities will probably widen and spending on health and healthcare systems will come under increasing pressure to cope with demand. Dietitians of the future will increasingly be primarily delivering personal care but also

teaching others3 how to manage food as a tool for their health. Kluge (2012) has predicted that there will be a decrease in the number of health professionals due to difficulties in recruiting and

retaining workers4 but this this will only add to the need for dietitians as educators about food and health.

2 The need to reduce healthcare costs, food supplies and provided effective nutrition and health education will mean dietitians are able to show how much they contribute to prevention and treatment.

3 New care-­‐delivery models for health will rely increasingly on social media and dietitians will shift from single interventions to packages of interventions. Dietitians are already investing in the delivery of this form of care and can be the innovators of the future. A greater reliance on the use of genomics technology can bring issues of data security as well as moral dilemmas for which dietitians are able to provide advice and insight.

1

Robert-­‐Jan Smits, Director-­‐General for Research and Innovation, European Commission, writing in ‘Global Europe 2050’ https://ec.europa.eu/research/social-­‐sciences/pdf/policy_reviews/global-­‐europe-­‐2050-­‐ report_en.pdf 2 www.roadmap2050.eu/ 3 For example, healthcare practitioners, doctors, nurses, midwives, caterers, carers, parents, employers, restaurant managers 4 Hans Kluge, WHO, speaking at the 15th European Health Forum, Gastein www.ehfg.org/intranet/app/webroot/uploads/presentations/files/uploads/b73215d3f813389b8e91586a5 25207.pdf

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4 Dietitians increasingly work between systems of healthcare, industry and provision of services in the community. Maximising health gains through this integration of service will also see the integration of food and nutrition into policies such as health, transport and water.

5 Technological and other service innovations will empower users and encourage self-­‐ management of lifelong health promotion actions, eg engaging older people in physical, mental and social activities. Dietitians will be seen to initiate, manage and use innovations that are seen to have a direct impact on economic, health and social development. For example, dietitians will use modelling and projections of food, shopping, cooking, food production and other future scenarios to ensure food safety, reduce waste and calls on healthcare systems.

6 As healthcare moves increasingly into the community environment the fundamental unity of nutrition, food and the psychosocial dynamics that affect people and their health becomes even more important. Dietitians are well placed to respond to this change as well as more specialization for dietitians in medical/clinical interventions and consultations.

In summary, over the next 30 years, the scenario for dietetics will focus on prevention, primary/community care, and nutrition education, using technology as an essential means of communication and collecting data that will inform cost-­‐effective healthcare and societal wellbeing.

This future presents a challenge to higher education (HE) to modify their traditional curriculum biased towards science and clinical subjects as medical education has done. National Dietetic Associations likewise will critically assess changes in their countries and draw on best practice from elsewhere and show a real leadership role. A shifting role for dietitians in Europe means that Associations and HE will need to empower colleagues together to work in multi-­‐ faceted workplaces, lead innovations using technology, understand their fundamental role in collecting and analysing data and contribute to change in policies concern food, nutrition and health. For example: • Food service dietitians will enhance their role by increasingly take on leadership in public health and influence food availability in domestic and public places. They will collect evidence to demonstrate their contribution to health improvement.

• Clinical dietitians will remain fundamental to healthcare, but become increasingly specialist and demonstrate their cost effectiveness in view of many competing calls on healthcare resources.

• Primary care dietitians are pivotal in bringing change in the delivery of better health through food and nutrition over the next 20-­‐30 years. Marketing this service is crucial.

• Public health dietitians are identified as leaders in nutrition education, technological innovations and managing resources as well as contributing to policy direction.

Wherever we start from, the future for dietetics and dietitians requires us all to be prepared to shape the future. There is no doubt the future will be as strong as our commitment to change as an individual, an association, an institute of higher education or EFAD and at this time looking forward we can see a very exciting time for dietetics and the profession.

Anne de Looy

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EFAD Presentation at Obesity Summit

Members of the European Specialist Dietetic Network (ESDN) Obesity were actively involved in the European Obesity Summit, hosted jointly by the European Association for the Study of Obesity (EASO) and the International Federation for the Surgery of Obesity (IFSO).

This inaugural Summit took place over four days in Gothenburg and attracted about two thousand scientists, doctors, dietitians, paramedics, psychologists and surgeons, as well as the very active EASO Patient Council.

As part of an ongoing collaboration between ESDN Obesity and EASO, we are part of the Nutrition Working Group (NWG). Together we chaired a session on energy balance and answered the question: does the body adjust its energy expenditure after people have lost weight? The answer is no: patients typically people start eating more after they have kept to a diet for some time. This has to do with the hunger and satiety centre in the hypothalamus that creates more appetite when people lose weight. The newest drugs to tackle this problem, eg Liraglutide, achieve good results but are prescribed only for those with diabetes so far.

Our second presentation showed how the amount of fatty tissue in the body increases the risk of developing cardiovascular disease (CVD). Whether the fat is subcutaneous or visceral does not have a great impact, whenever the fat is abundant the risk of CVD increases. The level of adiponectin, a compound released by the visceral and abdominal fat, is a marker for the increased risk of CVD.

The last speaker, Gabriela Roman of the NWG, presented the results of the questionnaire that they sent to all Centres of Excellence of Obesity Management (COMs) about the way that they manage obesity. The response was lower than we had hoped, but gave some insight.

Because of the low response rate and because the questions gave little information about the way dietitians manage obesity, ESDN Obesity plans to reissue the questionnaire this autumn to European dietitians who specialise in obesity.

Ellen Govers, ESDN Obesity

European Specialist Dietetic

Network (ESDN) on Obesity

Our specialist dietitians are in the news and contributing to important debates across Europe. The EFAD Editorial Board welcomes responses to this debate about classifying obesity as a disease.

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Hungary EPODE (Ensemble Prévenons l'Obésité Des Enfants) Together Let's Prevent Childhood Obesity

Obesity is a growing public health issue in Hungary that affects nearly 70% of adults and more than 20% of children. The number of obese children in Hungary has tripled in the last 20 years. To overcome the obesity epidemic, WHO recommends changes in lifestyle by promoting healthy eating habits and physical activity in all socio-­‐economic groups.

The GYERE (“Children’s Health”) program aims to prevent childhood obesity in the city of Dunaharaszti by changing the behaviour of the whole family, its environment and the local community norms. The Hungarian Dietetic Association began a 3-­‐year pilot of GYERE in 2014.

This was done in cooperation with the Semmelweis University, Faculty of Health Sciences, the National Institution for Children’s Health and the State Secretariat of Health in close collaboration with other local political and private partners, eg the local municipality, schools and the healthcare system. The Coca-­‐Cola Foundation sponsors the program.

The GYERE program adopts the EPODE four pillars approach for the early engagement of children, and involvement of all stakeholders, including families and communities: • a strong political commitment • support services inspired from social marketing techniques • mobilization of resources including public-­‐private partnerships • evidence including a multidisciplinary evaluation

To measure results, we collected anthropometric data at baseline and we will repeat this at the end of the project. The baseline survey found that 27% of children aged 6-­‐12 were either obese or overweight. We found the peak in obesity/overweight was in 10 year-­‐old girls (31%) and also significant in 12-­‐year old boys (27%). As part of health education, five thematic campaigns have been implemented so far. The themes are: fruit and vegetables, healthy hydration, protein sources, grains, milk & dairy. We also highlighted the importance of physical activity. The program is using various communication channels to reach all children in the city below 18 and their families. These channels include classroom lectures, drawing and recipe competitions, GYERE menus in school canteens, Facebook posts and educative articles.

The GYERE pilot will end in 2017 and aims to reduce prevalence of obesity in the intervention group (vs. control) by at least 5 % via significant improvement in lifestyle and health consciousness of the whole local community. In the meantime the Hungarian Dietetic Association already has started the second GYERE Program in the eastern and more disadvantaged region of the country in Szerencs, as part of the Nestlé Healthy Kids Program.

Jolan Kubanyi President, Hungarian Dietetic Association Zsuzsanna Szucs Executive Committee Member, Hungarian Dietetic Association ________________________________________________________________________________ EFAD Newsletter September 2016 www.efad.org Page 5 of 14

Collaboration to Embed Hydration in the Knowledge and Daily Practice of Dietitians

At the 17th International Congress of Dietetics in Granada earlier this month, EFAD held a scientific symposium entitled “Water, hydration and fluid for sustainable health: what do we know?” EFAD President, Anne de Looy chaired the symposium, which was developed with Danone Nutricia Research and focused on the current knowledge on fluid intake requirements and how to translate this knowledge into practice.

In the first lecture, Joan Gandy presented the current European Food Safety Authority (EFSA) recommendations on fluid intake and the rational behind them.

Isabelle Guelinckx presented the result of a recent study showing that according to the dietary reference values set by EFSA (1), 50% of the women and approximately 60% of the men are at risk of an inadequate fluid intake (2). A similar study showed also that the intake of juices and sugar-­‐sweetened beverages range from 25% to 50% of total fluid intake in children and adolescents (3).

Olle Melander explained why reducing vasopressin levels by increased water intake, might have protective effects for the development of cardio-­‐metabolic diseases (4).

Finally, in a very comprehensive overview, Pauline Douglas showed how this hydration knowledge could be integrated into the daily practice of dietitians, using simple tips and accessible tools.

This was the opportunity for EFAD to share the first results of the European Healthy Hydration Awareness Campaign (EuHHAC). EFAD and Danone Nutricia Research have developed ________________________________________________________________________________ EFAD Newsletter September 2016 www.efad.org Page 6 of 14

this campaign to inventory the knowledge of hydration amongst dietitians, define any gaps in this knowledge and develop an educational tool to anchor hydration as part of continuous education and daily practice of dietitians.

The preliminary results show that about 50% of dietitians have no up-­‐to-­‐date knowledge on hydration. Only 20% of the dietitians who responded brought the advice on hydration into practice due to practical problems and lack of guidelines on how to do this. Over 120 conference delegates attended this very dynamic symposium. There was clearly great interest in this topic, showing that hydration is more than ever a key topic for dietitians and highlighting the need to develop educational resources and tools adapted to the expectations of dietitians for daily practice.

References 1 EFSA Panel on Dietetic Products, Nutrition, and Allergies (2010) Scientific opinion on dietary reference values for water EFSA Journal 8(3) 1459 2 Guelinckx I et al (2015) Intake of water and different beverages in adults cross 13 countries Eur J Nutr 54 (suppl 2) S45-­‐S55 3 Inglesia I et al (2015) Total fluid intake of children and adolescent: cross-­‐sectional surveys in 13 countries worldwide Eur J Nutr 54 (suppl 2) S57-­‐S68 4 Melander O (2016) Vasopressin, from regulator to disease predictor for diabetes and cardiometabolic risk Ann Nutr Metab 68 (suppl 2) 24-­‐28

Marijke van Abbema Project Officer EFAD EuHHAC Working Group

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Evidence-­‐Based Behaviour Change

Supporting dietitians using behaviour change in practice, EFAD has now published an evidence-­‐based, behaviour-­‐change section on the website. It includes practical information on a number of behaviour change techniques relevant to dietitians, but the emphasis is on illustrative videos demonstrating how these techniques can be applied in practice.

From science to practice, the resources have been developed from a research collaboration between the University of Bath, the European Food Information Council (EUFIC), and EFAD. We have reviewed the scientific literature on behaviour-­‐change theory for weight loss, and used the Behaviour-­‐Change Techniques Taxonomy to engage with dietitians from across Europe. This work has revealed a number of behaviour-­‐change techniques currently used in practice and also those that dietitians in Europe wish to know more about.

Working closely with European dietitians has been at the core of the project. An interactive workshop took place during EFAD’s annual conference in 2014 in Athens, Greece, followed by an online survey, which was completed by 589 European dietitians between February & March 2015. Next, we consulted the members of EFAD’s European Specialist Dietetic Network (ESDN) Obesity: Maria Hassapidou, Ellen Govers, Tanja Callewaert, and Hilda Mulrooney. Finally, we developed demonstrational videos in collaboration with dietitians from University Hospital Southampton, UK, who also played the role of the dietitians you see in the videos. Daniel Buchholz (German Dietetic Association), and Chloé De Smet (Professional Union of French Speaking Graduated Dietitians) also provided expert input on both the concept of the online resources and video outlines.

The end result is a practical tool that aims to bridge the gap between the theory and practice of behaviour change. It contains four different scenarios of nutrition-­‐counselling sessions in which the various behaviour-­‐change techniques are demonstrated. Short clips accompanied by commentary provide guidance on how the different techniques can be applied.

We still consider this a pilot and would love to receive your feedback for improvement. If you wish to share your thoughts, please send an email to secretariat@efad.org. The resources are currently available only in English.

Raymond Gemmen Nutrition & Health Manager EUFIC, Belgium

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Germany The EuDAP Questionnaire First Results from a Survey of Dietitians

Background

The European Dietetic Action Plan (EuDAP) {1) aims to reduce nutrition-­‐related health risks in the European population. WHO (Europe) developed it on the basis of the 'European Food and Nutrition Action Plan 2015-­‐2020' (EFAD, 2015) {2} -­‐ later translated into German [3]. There are five objectives in EuDAP: 1. To ensure that healthy food and nutrition is accessible, affordable, attractive and sustainable 2. To promote the gains of a healthy diet and nutritional support throughout the life course, especially for the most vulnerable groups in clinical settings and the community 3. To use dietitians as educators and experts in community and clinical settings to advise the general population, other health professions, authorities, mass media and industry 4. To invest in establishing the effectiveness of dietitians in the delivery of better health through improved nutrition 5. To strengthen governance, alliances and networks for a Health-­‐in-­‐all-­‐policies approach

Methodology

We developed an online questionnaire in order to find out how dietitians engage in the prevention of non-­‐communicable diseases in Germany and meet the five EuDAP objectives above {4}. By 2020, the questionnaire also aims to assess the use of the Nutrition Care Process in 50% of VDD members [5]. Via the newsletters of the German Association of Dietitians (VDD), 2500 members had access to a link to an anonymous SurveyMonkey questionnaire (March & June 2016) [6,7]. Additionally, in the annual VDD conference we shared the link during the international session [8]. The VDD presidents approved and tested the survey. We will repeat the research every year until in 2020 in order to learn about any improvements that dietitians make in addressing EuDAP objectives.

Response

By 19 June 2016, 203 dietitians had answered the questionnaire completely (8% of total population). An additional 95 answered partially (4%). Of those that responded, most were in nutritional therapy, dietetic counselling or nutrition care teams; 66 (22%) had no job specialisation; 88 (30%) worked mainly or partly in kitchens.

Results

The following results highlight various aspects of the EuDAP objectives: • Of 238 dietitians who responded in this area, 42 (18%) were involved in 'schemes to promote healthy diets in schools', 128 (54%) undertook ‘actions in their workplace’, 66 (28%) were involved in 'promoting/advocating for consumer-­‐friendly labelling', 115 (48%) were involved in 'advocating for restricted advertising of unhealthy products' and 153 (64%) were active in 'promoting attractive healthy food in all catering outlets'.

• 181 dietitians frequently updated worksheets (guidelines, material for dietetic counselling, curricula, recipes, etc). Of these, 166 (92%) reflected on such activity and 41 (23%) said ________________________________________________________________________________ EFAD Newsletter September 2016 www.efad.org Page 9 of 14

•

•

•

that reflection did not apply to them.* The evaluation of therapy quality and reflection showed similar results.

80 dietitians reported that phone contact with patients was common. 47 used apps and 28 used online counselling. 40 practitioners with more than 10 years experience used new media. There were only 27 positive answers out of 219 on cost-­‐effectiveness. Only 10 of these reported their results to their management.

Of 216 dietitians, 83 (38%) measured the effectiveness of dietetic therapy on quality of life.

48 dietitians (22%) said that this objective did not apply to them. Dietitians typically measured effectiveness using questionnaires. 33 dietitians (16%) used the results to demonstrate the effectiveness of their teams.

Of 208 dietitians, 91 (44%) had engaged in lobbying for healthy nutrition.

Lobbying Arnt Steffensen from Norway gave a recent presentation on lobbying [9] and a report of his earlier lobbying activities may be found in the March 2015 edition (page 2) of this newsletter.

Conclusion This is the first time that the VDD had surveyed all dietitians in Germany. Comparable European data has not yet been published. As the response rate was very low, this survey can only be suggestive of further research. However, the survey will be repeated in other European countries and the results shared during the EFAD conference in Rotterdam in 2017.

* Learning about reflection will be part of the VDD conference programme in 2017.

Ursula Lukas, Klinikum Bielefeld Mitte Manuela Thul, EFAD Honorary Treasurer The authors are the leads in international affairs at VDD References [1] WHO Europe (2014) European Food and Nutrition Action Plan 2015-­‐2020 www.euro.who.int/en/publications/abstracts/european-­‐food-­‐and-­‐nutrition-­‐action-­‐plan-­‐20152020 Accessed on 28.08.2016 [2] EFAD (2015) European Dietetic Action Plan (EuDAP) www.efad.org/eudap Accessed on 28.08.2016 [3] Thul M (2016) EuDAP -­‐ der Europäische Diätetik Aktionsplan [translation: EuDAP -­‐ The European Dietetic Action Plan] Diät & Information 2 6-­‐7 [4] Lukas U, Thul M, Köpcke U (2016) Fragebogen zur Bestandsaufnahme von Leistungen im Bereich Prävention und gesunder Ernährung, die von Diätassistenten in Deutschland erbracht werden [translation: Questionnaire to assess for performance of dietitians in Germany in the area of prevention and healthy nutrition] [5] Lukas U (2016) Bekanntheit und Verwendung des "G-­‐NCP" in Deutschland -­‐ Erhebung des Ausgangszustandes [translation: Awareness and use of the G-­‐NCP in Germany -­‐ collection of the initial state] Diät & Information 4 6-­‐7 [6] VDD Newsletter März 2016 (translation: VDD Newsletter March 2016) www.vdd.de/data/newsletter/vdd-­‐newsletter-­‐0216/ Accessed on 30.08.2016 [7] VDD Newsletter Mai 2016 (translation: VDD Newsletter May 2016) www.vdd.de/index.php?id=415 Accessed on 30.08.2016 [8] VDD (2016) 58. Bundeskongress, Der Patient zwischen Medizin und Menschlichkeit (translation: 58. congress, The patient between medicine and humanity), congress programme, 22/23.04.2016 Wolfsburg [9] Lukas U (2016) How to understand and use politicians for dietetic purposes Diät & Information 3 26

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United Kingdom

Practice-­‐Based Evidence in Nutrition (PEN)

Where should dietitians be looking to find information about food and nutrition?

As a profession, it is our responsibility to untangle the myths and misconceptions using an evidence-­‐based approach. As experts in food and nutrition, we need to make sure we are always one step ahead and are using only the best available evidence to inform our practice.

Tools to improve your search for information include Practice-­‐based Evidence in Nutrition (PEN bda.uk.com/pen), a quick and easily-­‐searchable system for dietitians that contains everything from weight management and inflammatory bowel disease to liver disease and paediatrics. PEN's unique selling point is that it is not just simply a list of research papers about a particular area of dietetics. PEN collates all the available evidence and gives you an accurate and succinct overview (or summary) on a particular dietetic topic. So instead of trawling the internet for answers, save yourself time and look at PEN first!

PEN in Practice

To show you how PEN can help you in your dietetic practice, take a look at the two ‘Knowledge Pathway’ (or topic) examples below:

Bariatric Surgery ‘Knowledge Pathway’ Diabetes Nephrology ‘Knowledge Pathway You are immediately presented with a list of You are immediately presented with a list of practice questions (and answers), which practice questions (and answers) which include: include: Does the consumption of a low-­‐protein diet Do adults with mild to moderate obesity who increase the risk of protein energy malnutrition undergo bariatric surgery have a greater in individuals with diabetes and nephropathy? total/sustained weight loss than individuals What effect does a low-­‐protein diet have on the following non-­‐surgical interventions for weight progression of nephropathy in individuals with reduction? Does pre-­‐operative weight loss diabetes? result in greater postoperative weight loss & In individuals with diabetes, does the source of improved operating procedure outcomes (eg dietary protein effect the management of operative time, complication rate, length of nephropathy? stay) in adults undergoing bariatric surgery?

In individuals with diabetes, does the Does bariatric surgery impact pregnancy consumption of polyunsaturated fatty acids outcomes in women of childbearing age? affect the progression of nephropathy?

In the morbidly obese adult population, does In individuals with type 2 diabetes, does bariatric surgery compared to non-­‐surgical treatment of hypertension result in the interventions for weight reduction, result in a reduction of diabetic nephropathy? higher prevalence of eating disorders? Does Is weight loss an effective strategy to improve exercise following bariatric surgery result in kidney function in individuals with diabetic greater weight loss than bariatric surgery nephropathy? alone?

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Are you new to Bariatric Surgery or would like Are you new to Diabetes -­‐ Nephropathy or a refresher? Click on the ‘Background’ section would like a refresher? Click on the which includes sub-­‐headings such as: ‘Background’ section which includes the History and types of bariatric surgery following sub-­‐headings: Complications Diabetes/Glucose Intolerance Background

Chronic Kidney Disease Background Alternatively, click on the ‘Related Tools and

Resources’ for a variety of documents to help Alternatively, click on the ‘Related Tools and support your dietetic practice.

Resources’ for a variety of documents to help

support your dietetic practice.

Finally, for a brief overview of the Bariatric Finally, for a brief overview of the Diabetes -­‐ Surgery ‘Knowledge Pathway’ and Nephrology ‘Knowledge Pathway’ and recommendations according to the strength of recommendations according to the strength of the evidence, click on the ‘Evidence Summary’. the evidence, click on the ‘Evidence Summary’.

For example: For example: [B] The following conclusions are supported by [C] The following conclusions are supported by fair evidence: limited evidence or expert opinion: ‘‘Systematic reviews conclude bariatric surgery including gastric bypass, gastric banding, ‘‘For individuals with diabetic nephropathy, gastroplasty, sleeve gastrectomy or meta-­‐analyses of clinical trials have shown bibilopancreatic division with duodenal switch a significant effect of a…’’ is more effective than ..…’’

[C] The following conclusions are supported by ‘‘A protein intake equal or lower than the RDA limited evidence or expert opinion: (0.8 g/kg/day) has been shown in some studies ‘‘Observational studies suggest attending to have…’’ support groups after bariatric surgery is

associated with a greater degree of …..’’ ‘‘Randomized controlled studies of the effect of [D] A conclusion is either not possible or a low-­‐protein diet (0.6 to 0.8 g protein/kg/day) extremely limited because evidence is on the nutritional status of individuals with unavailable and/or of poor quality and/or is diabetes and nephropathy have applied…’’ contradictory:

‘‘The influence of social support outside of support groups, such as perceived family support or the number of confidants, on weight loss and weight-­‐loss maintenance post-­‐ bariatric surgery is ..….’’

For more information please visit the PEN pages on the BDA website www.bda.uk.com/pen/home

Sammie Gill Policy Officer (Evidence-­‐Based Practice) BDA

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Save the Date

www.efadconference.com Deadline for submissions for the next Newsletter: 30 November 2016 to: editor@efad.org See Editorial Policy and Guidelines for Authors on the next page

www.efad.org European Dietitians ________________________________________________________________________________ EFAD Newsletter September 2016 www.efad.org Page 13 of 1 4

Editorial Policy

The EFAD Editorial Board comprises the Honorary Vice-­‐President, the Secretary General and one member of the Executive, with assistance from the non-­‐executive Editor. The Board will decide the content of each Newsletter and their decision is final. Articles should reflect EFAD's core values: fairness, openness, non-­‐discrimination, collaboration and independence. The Editorial Board welcomes suggestions from members for improving and developing the Newsletter. In order to reflect EFAD’s mission statement, articles for the Newsletter should always refer to ‘dietitians’ or ‘dietetics’ in the text.

Guidelines for Authors

• • • •

Please read previous editions of the Newsletter available at: www.efad.org/everyone/3147/5/0/32 Your article should be in English and emailed to me, Terry Hyde: editor@efad.org Your article should be about 500 words (2,500 characters with spaces), but can be up to 1000 words if it is particularly important.

Please send your own photographs or ones that are copyright-­‐free or free-­‐to-­‐use for non-­‐ commercial purposes.

Who is the audience?

This is the first and most important question that any editor or author must answer before they start work. I will edit all articles to meet the needs of a very wide audience: undergraduate students, dietitians, academics, Ministers of Health and senior figures at WHO European Region. The first language of most of our readers will not be English. Therefore, I will also edit to ensure that the writing is concise, the meaning is clear and the language is free of bias. I will use plain English, modern English usage and open punctuation.

What is plain English?

Some of the principles of plain English are: • use short words rather than long words • write in short sentences rather than long ones • use the active verb rather than the passive, eg 'I edit the Newsletter” not “The Newsletter is edited by me' • use lists where possible • avoid jargon, acronyms and abbreviations In science and education, the last point is the most difficult to follow. All of our readers will know what EFAD and EU and UN means (and probably WHO), but how many will know what FNAP means? For more information on plain English, go to www.plainenglish.co.uk

What is modern English usage?

English is a living language in constant change; in particular it absorbs words from other languages and treats them as its own. New words arrive every day and others drop out of use. Existing words change their meanings or develop extra meanings. A few years ago, the only thing that could be stored in a cloud was water vapour, but now…. Spellings and constructions also change. So, in modern English usage the word ‘lifelong’ is written as one word (no space, no hyphen); similarly with the words ‘online’ and ‘website'.

Part of my job is to reflect these changes in usage and spelling etc. For more information on modern English usage, see Burchfield RW (2004) Fowler's Modern English Usage 3rd Ed Re-­‐revised OUP Oxford.

What is Open Punctuation?

Open punctuation reduces the number of keystrokes needed to type a document. It does this by removing unnecessary punctuation and capital letters. So: Ph.D. → PhD B.Sc. → BSc e.g. → eg Dr. → Dr ..Doctors, Dietitians and Physiotherapists... → ...doctors, dietitians and physiotherapists...

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