Dietetics

Also called Dietitian, Nutrition support

The only nutrition professional whose title is protected by law. Referral is under-used, and malnutrition is far more common than anybody expects.

What it is

Dietitians assess and treat nutrition as a clinical problem: in malnutrition, dysphagia, diabetes, chronic kidney disease, coeliac disease, inflammatory bowel disease, cystic fibrosis, eating disorders, ARFID and cancer.

Dietitian is a protected title regulated by the Health and Care Professions Council. Nutritionist and nutritional therapist are not, and anybody may use them. That distinction matters most for the people with the least margin for bad advice.

The commonest reason to need one in this library is not obesity. It is unintentional weight loss: in older people, in dementia, after a stroke, during cancer treatment, and in anybody whose swallow has changed. Around one in three people admitted to hospital in the UK is at risk of malnutrition, and most of it is picked up late or not at all.

Signs you might notice

Signs that a dietitian is the right referral: clothes and rings becoming loose, unintentional weight loss, food being left, coughing on food or drink, meals taking a very long time, or a person avoiding whole food groups.

In children, faltering growth, extreme food selectivity, or a diet narrow enough to risk deficiency.

In long-term conditions, blood results drifting in a way that diet changes: potassium and phosphate in kidney disease, glucose in diabetes, iron and B12 in bowel disease.

A weight loss of more than five per cent in three to six months, unplanned, is a referral rather than something to watch.

How it can affect day-to-day life

Food is not only nutrition, which is what makes this hard. Reducing somebody's diet to a set of targets, or handing them a supplement drink instead of a meal they enjoy, tends to fail on the second day.

Supplement drinks are prescribed far more readily than a dietitian is called, and food-first approaches usually work better and cost less: fortifying ordinary meals, more frequent smaller plates, and eating with other people.

For someone with dysphagia, texture-modified food is often unappetising and served without care, and people stop eating for that reason rather than any clinical one. It can be made well; it usually is not.

Weighing people matters and is skipped constantly. A weight recorded monthly is what turns "she seems smaller" into a referral.

Supporting someone well

Weigh regularly and write it down. Trends are the whole diagnostic tool.

Ask for a dietitian referral by name rather than accepting supplement drinks as the answer.

Try food first: fortify with full-fat milk, cheese, cream and butter, offer small frequent plates, and make mealtimes social.

Check teeth, dentures, mouth ulcers, dry mouth and thrush before concluding somebody has lost their appetite.

Check the person can physically manage: the plate, the cutlery, the position, the time given.

If the swallow has changed, ask for speech and language therapy as well; the two professions work as a pair.

Check that anybody giving nutrition advice privately is a registered dietitian.

Where to get help

A GP practice, or directly through the team already involved in a long-term condition. Many hospital and community services accept referrals from nurses and therapists as well as doctors.

British Dietetic Association publish reliable food fact sheets and hold a directory of registered dietitians.

Health and Care Professions Council register for checking anybody's credentials.