F2F
FACE TO FACE
Director: Child-nutrition.co.uk Ltd
Ursula meets amazing people who influence nutrition policies and practices in the UK.
Judy grew up in New Zealand, but moved to Sydney, Australia to complete her higher education. She won a scholarship and completed a BSc in biochemistry and pharmacology, and then a post-graduate diploma in Nutrition and Dietetics. During her student holidays, and for the first year after graduation, she worked at the Prince Henry Hospital in Sydney. “It was a really sprawling hospital terrain, but it was on a cliff overlooking a beach, so offered great ocean views,” said Judy. She then moved to Europe and had two nutrition research jobs, firstly, to Bordeaux in France, following her husband’s career move to study oenology (the science of wine production), where she put on a white coat and worked in a laboratory studying insulin and pancreatic function. Later, at the Institute for Child Health in London, she worked on balance studies in infants, researching trace element metabolism. There was never a problem with her Australian dietetic qualifications; Judy has been UK based ever since her arrival in the late seventies. She weaved in and out of a wide variety of London hospital posts with the increasing theme of paediatrics. “I particularly enjoy working with young children and their parents, because dietetic guidance is often pivotal to the improvement of a medical condition and parents are usually very keen to follow advice,” said
Judy. She smiled when I questioned whether this was not the case for other dietetic encounters. She held one of the first specialist posts looking after infants and children who were HIV+ and described the challenges of previous drug regimens, which induced anorexia and often required nutrition support measures. One mother was most anxious about the stigma of enteral feeding for her child, but was reassured when Judy set out the wide variety of medical diagnoses (other than HIV+) that benefited from nutrition support. During a budget and staffing review of this hospital job, she was informed that the post of paediatric dietitian was counted as nonessential. Although there was never a confirmation of redundancy, she felt the insult of her post being marked as ‘not needed’, so decided to apply for a community nutrition post. In addition to supporting GP clinics and working with schools and other groups, she became increasingly involved in freelance projects, as well as writing. She claims early-adopter status for dietitian-with-a-website, setting up a consultancy to support individuals seeking advice on child nutrition issues. Other than medically complex conditions, themes are often eating behaviour difficulties, such as fussy or disordered eating. “It is great to be able to use my kitchen with children, to show and try foods, or measure out sample quantities. My usual
Ursula meets: JUDY MORE Government consultant on infant/child nutrition BDA Paediatric Group – past Chairman Ursula Arens Writer; Nutrition & Dietetics Ursula has a degree in dietetics, and currently works as a freelance nutrition writer. She has been a columnist on nutrition for more than 30 years.
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consultations are at least one hour, so there is enough time to consider all aspects in detail and find ways to give pragmatic support,” she says. Judy reports that most young children with fussy eating behaviours may be hypersensitive to the tastes and textures of some foods, and there is often some family history. Recommending nutrient supplements takes away some anxieties over inadequate intakes; she advises against discussions that are guilt-inducing or faultfinding. In many cases limited food choices are a stage in development and, provided parents model food diversity and enjoyment, most children normalise food choices. From 1999 to 2002, Judy was the chairman of the BDA Paediatric Group. It was during this time that several paediatricians reported rising rates of rickets and concerns were raised over the limited availability of suitable vitamin D supplements. Judy was invited to consult for the then Department of Health (DH), to advise on the reintroduction and promotion of the Healthy Start vitamins. “There was only one nutritionist employed at DH and it was a frustration that decisions to support this project seemed so tangled and slow. The contract to bid for the project seemed unattractive to companies and the system to distribute the vitamins from the single warehouse was unreliable. Fortunately, the Healthy Start scheme is now better supported,” she said. During that time, she also provided paediatric nutrition consultancy to DH, including website copy and amending the publication Birth to Five. In 2011, Judy wrote the book Infant, Child and Adolescent Nutrition: A Practical Handbook, and has also contributed chapters to several textbooks, including the definitive Clinical Paediatric Dietetics. As a member of the Infant
and Toddler Forum, she has authored many of their resources. Judy also provides consultancy to companies and organisations and lectures on paediatric nutrition themes to dietitians and other healthcare professionals. So, what should dietitians advise on childhood obesity? Judy feels that large portions of food have become normalised and that there should be more vigorous efforts to communicate less-is-more. “Parents need to moderate their own portions, with the sharing of regular nutritious meals rather than constant snacking and allowing more time to support eating together and eating slowly,” said Judy. “There is strong promotion and marketing of less healthy foods to young children, which should be curtailed. I am especially concerned when parents give their children (ursine shaped, flavoured, extruded) snacks, thinking that because they are not sweet, they are healthy.” Could some of the promotion of quick-and-easy foods be because consumers seem to value convenience the most, I asked? We agreed that both push and pull forces contributed to the current range of less-than-healthy foods given to children, but that many poor choices were due to confusion and mixed messages. Judy is currently supporting the development of food portion size guidance for paediatric dietitians, to address childhood obesity. Children have the least control of their diets, but suffer the greatest consequences to health, if food intakes are unbalanced and bizarre. “That is why I love paediatric dietetics so much. Because it is critical.” And I am left to wonder. Did Judy’s ‘critical’ mean very important? Or did it mean condemnatory of the many inadequate food mixtures and diets given to children in the UK? Both are true, of course.
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www.NHDmag.com April 2019 - Issue 143
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