THE FINAL HELPING Neil Donnelly Neil is a Fellow of the BDA and retired Dietetic Services Manager. His main areas of interest are weight management and eating disorders.
Over a ‘dietetic lifetime’ of 50 plus years, I have seen many patients, met many colleagues, encountered many changes and expressed many views . . . In this penultimate Final Helping I shall share some final thoughts before giving some further thought to my ‘lifetime top 10 dietetic moments’ in my final column next month. When I was a boy, there were no ‘fat kids’ in my class in primary school. All the way through secondary school there was only one boy in the class who would possibly be considered overweight… just. What happened in the intervening years? Well I think you can all work out the answer. Did successive governments and food retailers play a part I wonder? One provided the means to simplify our eating behaviour and one realised too late that just setting unachievable targets to reduce obesity was not the answer. Obesity…a word once never heard, and mentioned only once in the Manual of Nutrition published by MAFF in 1966. It stated, ‘Individuals vary in their propensity to get fat, usually because they differ in the activity of their daily life.’ It continued, ‘Appetite is also a factor and obese people tend to have a larger one than thinner people.’ Hmm! It was finally realised that managing the now ‘obesity epidemic’ alone could quite easily bankrupt the NHS, and still can. What did health professionals such as our small profession do? Well, not enough probably and dare I say that the handing out of diet sheets (as per my own training) was probably not that effective. I don’t think anyone or anything could have stopped the ‘March of Obesity’ because there were too many overwhelming
commercial forces at play controlling both our eating habits and our behaviour. Our own profession was developing sideways with more dietitians becoming specialists in other areas and weight management became far less attractive or rewarding to work in. I personally found it richly rewarding. During my first job in Dietetics, I coined my own ‘weight management pathway’ which I tried to follow with patients, simple stages which necessitated a degree of contact and a degree of commitment (on both sides). My previous role as a dietitian working for Slimming Magazine had confirmed to me that the best results in a slimming club environment were achieved by the bestor most-liked group leaders (who had to set an example in their own life and be and maintain a ‘healthy weight’)…not the diet sheet. It’s a bit late, but here is my personal ‘let’s ion it out’ plan, first used in 1974, which was discussed at the first patient/dietitian meeting (usually 30 minutes): Information. Explanation. Education. Motivation. Castigation (support). Realisation. Three minutes or so on each and then free speech! For my part, when I was undertaking my Fitness and Fatness Final Year Dissertation (1969), I weighed 10st 4lbs, had a 30-inch waist, 36-38 chest and was five feet four and three quarter inches tall. Today I’m still five feet four and three quarters inches. 36-38 chest, prefer a 32 inch waist and this morning weighed 10st 4 lbs on my scales. Yes, I know! See you next time for my final Final Helping. www.NHDmag.com June 2017 - Issue 125
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THIS IS HUGE After months of coping with the sleepless worry and heartbreaking cries of his cow’s milk allergy, suddenly, a little moment like this doesn’t seem so little after all. • Proven efficacy – hypoallergenic and has been shown to relieve symptoms1,2 • Proven to be well tolerated – 96% of infants tolerated Similac Alimentum3 • Palm oil and palm olein oil free – supports calcium absorption and bone mineralisation4 SIMILAC ALIMENTUM. FOR BIG LITTLE MOMENTS.
REFERENCES: 1. Sampson HA et al. J Pediatr 1991;118(4): 520-525. 2. Data on file. Abbott Laboratories Ltd., 2013 (Similac Alimentum case studies). 3. Borschel MW and Baggs GE. T O Nutr J 2015;9:1-4. 4. Koo WWK et al. J Am Coll Nutr 2006;25(2):117-122. IMPORTANT NOTICE: Breastfeeding is best for babies, and is recommended for as long as possible during infancy. Similac Alimentum is a Food for Special Medical Purposes and should be used under the supervision of a healthcare professional. Date of preparation: July 2015 RXANI150143