- Dietetics as a science includes not only wholesome food as a weight control technique, but also in-depth medical and scientific aspects of human health.
- People still misbelieve dietitian is a doctor visited only by woman with some overweight problems, not necessary for so called normal ones. However this perception is erroneous, as to make one's life sound, mastering awareness of nutrition, its interconnectedness with well-being, health is indispensable to everyone. The consequences of not eating properly besides poorly controllable body weight changes comprise the core problem – severe diseases or exacerbation of chronic ones.
- A dietitian will help in a wide range of health issues: promotion of physical and emotional development in each phase of biological age, disease prevention and treatment, during pregnancy (both before and after), support sportsmen (on a daiky basis or before/after competition), support persons with chronic diseases and in many other cases.
- In Latvia people often feel shy about visiting dietitian, hiding the fact from friends, colleagues, but in many European countries people feel proud of being educated enough to live productively, consulting both with a nutrition specialist, as well as rehabilitation professional and psychologist.
- Another aspect – people in Latvia are still afraid to see a dietitian, as they believe will be tortured by very strict diets, that means not only tiny portions of food but unsavoury as well. Besides 'poor slimmers' will be reproved and admonished for, thus risking getting even deeper sense of guilt. In fact up-to-date approach of dietetics regarding therapy is very broadminded – persons' individual taste, possibilities, daily routine are taken into account. Daily routine has to be changed, but gradually and with positive emotions. This is the only way to permanent result.
Dietitians advice on nutrition related issues in its broadest meaning – on food choice for healthy person in different periods of age, nutrition for underweight or overweight persons, as well as diet appropriate to the disease (see specialists' professional consultation offer).
Consultation, examinations and further visits to a dietitian
First dietitian consultation (conversation and examinations) include:
- health assessment;
- inquiry on former illnesses. Many diseases have influence on metabolism, speeding it up or slowing down. Many drugs also alter metabolism and can also cause vitamin or mineral deficiency;
- weight history inquiry – weight variation through lifetime, previous attempts to influence it;
- physical activity level ascertainment;
- measurements: height, weight, measurement round the hips and waistline;
- evaluation of everyday food in general;
- appointment to required examinations;
- primary diet correction designation;
- agreement on further cooperation (the frequency of repeated consultations is appointed according to person's desire, necessity and possibilities).
Subsequent visits to a dietitian will keep on task in hand from first consultation:
- detailed nutrition analysis;
- everyday food, habits. Relatedness to work and rest periods, financial and practical resources;
- analysis of body weight by bioimpedance method (to receive proper result, some pre-preparation and certain conditions should be observed),
- individual recommendations for the patient on further food and lifestyle corrections to be performed.
Person-related diet principles, practical aspects are mastered successively and the following issues are discussed:
- groups of foodstuffs,
- the recommended proportions of various products in diet
- serving sizes,
- frequency of meals,
- products available in local shops,
- eating at home, preparation of food,
- eating out.
In case of long-term therapy one should regularly see the doctor on average once a month. During the treatment the person masters the appropriate dietary habits little by little. Transition should take place gradually, since it will not be "a campaign for one month", but will result in a new, better life. A person has to accept the new eating habits himself. Together with specialist an optimum model for eating is created for the person concerned. That means the food will meet the needs of the person (his Body Mass Index (BMI), build, age, gender, physical activity, diseases are taken into account), and at the same time, whenever possible, in accordance with his desires, eating habits, favourite dishes, daily routine and financial capabilities. Only this way, working hand in hand, a result can be achieved, but the main thing is to maintain the sustained progress permanent.
Each time one dietary issue is discussed particularly – product group, interconnectedness between eating and psychoemotional sphere, etc.
Food diary is filled periodically, and after analysing it is possible to draw a conclusion on everyday nutritional conformity to needs.
Not all need long-term therapy with dietitian. In some cases one or two visits is enough. For example, pregnant women, vegetarians, recovery period after severe diseases, slightly overweighted people.
Additional examinations a dietitian may prescribe
A variety of examinations that allow to state the endocrine gland activity (thyroid hormones, reproductive sex hormones), hepatic, kidney activity, possible nutrients deficiency in the body (anaemia, depleted reserves of iron, vitamin, mineral deficiency), level of cholesterol and its various forms, blood sugar level, etc. examinations.
Examinations used in dietetics:
- nutrition assessment:body build measurement by bioimpedance method;
- inspection, height, body weight, Body Weight Index (BWI) measurement;
- measurement round hips and waistline. Waist/hips ratio measurement;
- features of probable hormonal abnormalities;
- evaluation of probable nutritional deficiency (vitamin, mineral, protein deficiency);
- indirect measurement of body metabolism (evaluation) by means of a bracelet, – body metabolism, physical activities and lifestyle are monitored.
Patient receives a bracelet to wear round the clock for several days (it is comfy, do not influence routine activities). Data on overall energy consumption are collected (amount of calories within twenty-four hours), energy consumption during physical activity, number of steps per day, duration of physical activities of various degree, duration of rest and sleep. The information obtained helps to create more focused nutritional recommendations.
Body build measurement by bioimpedance method
Prior to measurement, patient has to observe some restrictions (information is provided in advance).
Body composition examination by bioimpedance method
Instructions for patient:
- Do not eat and drink 4 hours prior to examination.
- No physical activities 12 hours prior to examination.
- Do not urinate 30 minutes prior to examination.
- Do not use alcohol 48 hours prior to examination.
- Do not use diuretics 7 days prior to examination.
- Do not undergo examination during a period.
The data obtained:
- fat mass (mass and percentage composition),
- muscular mass (mass and percentage composition),
- fluid content in body (mass and percentage composition),
- fluid content inside and outside cells,
- body cell mass.
This method is very important in body build evaluation, since height and weight ratio themselves are not indicative of adiposity. The amount of muscle mass, body fluid content is of importance. For example, sportsmen may have high Body Mass Index because of enlarged muscle mass. Sickness changes these characteristics as well. In case of fluid retention in body, one might have a normal Body Mass Index, but decreased muscle mass. Prior to plastic surgery manipulations it is important to fix the amount of subcutaneous fat layer as it has to be vacated.
It is essential to repeat this method and evaluate body build in dynamics during nutritional therapy, when body weight and shape are changing.
Cooperation with other specialists
Dietitians cooperate closely with general practitioners, endocrinologists, gynaecologists, cardiologists, sports doctors, phlebologists, proctologists, urologists, gastroenterologists, dermatologists, psychotherapists and of course rehabilitation professionals and beauty clinics specialists.
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