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This article describes some of these conditions and details the adjustments to foods, feeds and fluids that might need to be made. However, nutrition can also be important in managing patients with established conditions, including:. Many of these patients will spend time in hospital, where they will be cared for by a range of healthcare professionals.
Pamela Mason is a freelance pharmaceutical journalist and scientific adviser to the Health Supplements Information Service. Citation: Hospital Pharmacist , Vol.
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Eating Disorders. Food Allergies and Intolerances. Diet is complex. Simple public health messages can never convey a full understanding of how to construct a healthy diet. Knowledge dissemination in isolation will not achieve sustained dietary improvements. Adopting a better diet requires an understanding of how a current diet might be improved which requires detailed knowledge of the nutritional composition and role of individual foods and food groups, but also contextualized for the individual.
This complexity points to the need for individualized dietary advice by a trained and skilled practitioner. A recent review of dietary interventions found that the likelihood of achieving desired behavior change and improved diet quality is greater where qualified dieticians are used Opie et al. Accredited Practicing Dieticians are equipped to provide current, evidence-informed nutrition advice and are trained in counseling skills that can address ambivalence and barriers to change, using empowering approaches. While it is desirable to provide high quality information to the public about healthy diets and a better informed consumer will improve the signals to the food industry Segal, a , b , Watts and Segal, ; population health approaches are not an alternative to funded access to individualized dietary advice and support, but rather a complement.
Most health systems, even those with a strong commitment to universal coverage and public funding, limit subsidized access to dietetic services, whether in the community or hospital in-patient or out-patient settings. Unlike medical and nursing, it is difficult to find international comparisons of access to dietetic services. This was equal to 1. Additional dietetic positions are needed to ensure access to dietetic services for those with, or at risk of, diet related health conditions. Highly subsidized dietetic services are needed in the community as part of multi-disciplinary primary care teams delivering chronic disease management and prevention and in the hospital in-patient and out-patient settings.
If dietetic services are available only on a fee-for-service basis, many in need will fail to access these services, to the detriment of their health, with flow-on implications for the health system and the wider economy. Failure to access multi-disciplinary best practice care is widely reported and funding and delivery arrangements are implicated Watts and Segal, Dieticians need to be available in hospital in-patient and out-patient settings to support patients to adopt healthy eating behaviors.
And yet, they are typically regarded as expendable in the face of the inevitable budget pressures. Best practice care would dictate that all cardiac rehabilitation patients, pregnant women especially those who are obese , mental health patients, persons with diabetes and patients with other conditions for which diet is an established risk factor, have access to individualized professional dietetic services. This simply is not happening in either public or private hospital settings, despite evidence that many dietetic interventions are effective and cost-effective Dalziel et al.
Dieticians are also needed to work in institutional settings that serve food, many of which involve highly vulnerable populations to improve food quality, for example aged care facilities, preschools, prisons, etc. Access to high quality professional dietetic advice and support must be a core part of any comprehensive strategy to improve population diet. Any attempt to introduce punitive taxes will create winners and losers. The losers will be highly vocal in resisting change, regardless of the potential public benefit. This is the nature of vested interest.
Where there is any doubt about the ability to define and target unhealthy foods, political hurdles are magnified. This is illustrated in the Denmark fat tax example. This response ignores the context in which people make choices.
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This is demonstrably violated in relation to diet, where the wider community bears in part the costs of poor diet quality in higher health care expenditures and lower workforce productivity, costs which suppliers of unhealthy foods fail to bear. There is every reason for governments to intervene. It is demanded by the pervasiveness of market failure Segal, Unfortunately those who stand to gain from an effective strategy to improve diet quality are inevitably less vocal, partly because losses and potential gains are not viewed equally and partly because the general population, which stands to gain, is more diffuse and less powerful.
Furthermore the average citizen does not necessarily understand how current distortions are damaging their health. Those who stand to gain most, are persons suffering from, or at risk of, diet related disease, as well as farmers and retailers growing and selling predominantly whole foods. Dieticians would also benefit from expanded employment opportunities. However, none of these groups constitute powerful lobbies.
If punitive taxes were part of the strategy it could be revenue neutral. But, diet-related illnesses are the major cost on health budgets and also on the economy in lost productivity, lost production and welfare dependency from premature mortality and disability from mental and physical illness. The potential payoff from improving the eating behaviors of the population is thus considerable. If policies target persons with current diet related conditions, or at high risk, returns on the investment will accrue almost immediately.
For example, a dietary intervention to improve eating behaviors in obese pregnant women would deliver health benefits and budget savings within months, through expected lower rates of gestational diabetes and better mother and child outcomes Thorton et al.http://www.stringrecordings.com/img/math/in-search-of-the-truth.php
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It is time to get serious about developing and implementing national nutrition strategies that are capable of effecting change. Dietetic services need to be viewed as part of core heath service delivery and funded at a level that supports access to individualized dietetic services by persons at risk and with current chronic conditions.
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While there is considerable pessimism about the ability to improve diet quality across a population, the absence of any comprehensive approach to date, rather gives room for optimism. It is not that we have tried and failed. It is that we have not tried and failed. The evidence is clear—diet affects health and is modifiable.
Food and Nutrients in Disease Management
Accumulating evidence from intervention studies with long term follow-up demonstrate that eating behaviors can change. But that individualized clinical advice and support is required from highly skilled and trained professionals. If a comprehensive nutrition strategy were adopted, the promise is a substantial improvement in diet quality, better health and wellbeing and lower health care costs.
All that is needed is political will and some upfront investment with likely early payoff. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. National Center for Biotechnology Information , U. Journal List Front Pharmacol v. Front Pharmacol.
Published online Aug Opie 2. Rachelle S. Author information Article notes Copyright and License information Disclaimer. This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology. Received Apr 14; Accepted Jul The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these terms. This article has been cited by other articles in PMC. Abstract Poor diet quality is implicated in almost every disease and health issue. Keywords: nutrition strategy, dietician services, diet quality, population health. Diet Quality and Health It is uncontentious that diet quality has a major impact on health. Aims Given the poor quality of the average diet, it is clear that current approaches to improving public nutrition are failing.
A core task is to describe the components of a healthy diet—what to eat more of; and what are unhealthy foods to eat less of. In Australia, public nutrition campaigns have been very poorly funded, in effect limiting any possible chance of success and have focused almost exclusively on promoting fruit and vegetable consumption, largely ignoring the issue of unhealthy foods. While successful marketing campaigns for example to reduce road traffic accidents , have been very well resourced millions of dollars compared with a few hundred thousand. These campaigns have also been supported by powerful legislative elements—in the case of road traffic accidents including mandatory seat belt legislation, large speeding fines with potential loss of license, all well-enforced.
Developing a system that is informative and correct but also simple has proved elusive, despite considerable research and debate on this issue The core challenge is to create a system of labeling and nutrition information panel that consumers can understand and interpret in the context of their whole dietary pattern. While the simplified systems may seem appealing they all suffer from the complex nature of diet quality.
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