PERSPECTIVES: Dr ALAN BARCLAY
PUBLIC HEALTH NUTRITION COMPARED TO PERSONALISED DIETARY ADVICE
Diet-related health conditions like obesity, type 2 diabetes, heart disease and certain cancers (e.g., bowel) are increasing all around the globe and governments are struggling to cope with their economic costs as are individuals with their social, psychological and financial costs.
Strategies for reducing their burden range from public health nutrition at one end of the intervention spectrum, using a systems approach to sustainably re-shape the food and nutrition supply, and at the other, there is personalized dietary advice ideally provided by suitably qualified health professionals like dietitians and nutritionists. While the two are not mutually exclusive, they often do play complimentary roles.
Public Health Nutrition
The epitome of public health nutrition is the federal government’s Dietary Guidelines that provide advisory statements for the general population (i.e., healthy children, adolescents and adults). They are very similar around the globe. Australia’s most recent version published in 2013 advises people to:
- Be physically active and choose amounts of nutritious food and drinks to meet energy needs.
- Drink plenty of water and enjoy a wide variety of nutritious foods from the five food groups every day:
– plenty of vegetables, including different types and colours, and legumes/beans
– fruit
– grain (cereal) foods, mostly wholegrain and/or high fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
– lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
– milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years). - Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
- Encourage, support and promote breastfeeding.
- Care for your food; prepare and store it safely.
The Guidelines stated aims are to:
- promote health and wellbeing;
- reduce the risk of diet-related conditions, such as high cholesterol, high blood pressure and obesity; and
- reduce the risk of chronic diseases such as type 2 diabetes, cardiovascular disease and some types of cancers.
They are primarily used by health professionals, policy makers, educators, food manufacturers, food retailers and researchers, so they can find ways to help people eat healthy diets.
In theory, Dietary Guidelines apply to all healthy people, as well as those with common health conditions such as being overweight. However, they do not apply to people who need special dietary advice for a medical condition like diabetes or heart disease, or to the frail elderly.
In some countries like the USA, they are updated every 5 years and as such they are based on the most recent and best available scientific evidence. Unfortunately, in others, like Australia, they are not updated on a regular basis and may be scientifically outdated.
Personalised dietary advice
Ideally, people with specific diet-related health conditions like obesity, type 2 diabetes, heart disease, cancer, etc… will see a registered/accredited dietitian or nutritionist for personalised dietary advice.
A dietitian/nutritionist assesses your:
- vital statistics (height, weight, waist circumference, etc…),
- biochemistry (blood glucose, insulin, blood proteins, iron status, etc..) and
- eating and drinking habits (diet recall, food frequency, etc…),
to form an overall picture of your nutritional status.
Based on this, they will then work out what area of your diet needs improvement, if any, and what changes can be made based on your own:
- personal goals (weight loss, weight gain, blood glucose, pressure, cholesterol, etc…),
- food preferences,
- family situation,
- cultural background, and
- finances.
Depending on your needs, a structured menu plan may be provided, tailor-made to your own unique requirements.
Shopping lists, information sheets and other written materials (e.g., booklets) may also be provided, depending on your own personal needs.
Follow-up appointments cover how well you are feeling and how you are managing with your dietary changes, assessment of your vital statistics and biochemistry, and general progress towards your goals, trouble‑shooting and further refinement of your personalised eating plan.
It is easy to see that public health nutrition epitomised by Dietary Guidelines is by necessity very different from personalised nutrition advise provided by a qualified health professional. Unfortunately, sometimes debates about what constitutes a healthy diet get heated and the two are conflated, with some fad diet advocates erroneously believing that dietitians/nutritionists simply advise everyone regardless of their personal circumstances to follow the latest version of the Dietary Guidelines. The reality is that both public health nutrition and personalised dietary advice can help people purchase healthy, affordable foods to ensure they enjoy a sustainable diet that will help them achieve optimal health, whatever their circumstances.
Read more:
Alan Barclay, PhD is a consultant dietitian and chef (Cert III). He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).
Contact: You can follow him on Twitter, LinkedIn or check out his website.
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