Friday, 6 August 2010

Obesity week

Not much in the way of obesity this week, but I've been working hard on a presentation about 'Healthy Eating for Older Adults', and trying to make a start on my Case Study.

I'm finding the presentation challenging because I know too much, and I need to simplify it down or else it won't fit into the hour I've been allocated. Actually, my contact at the venue suggested it might need to be less than an hour, because the audience might find that a bit too long, so I'm guessing they are adults who are pretty old, or infirm, or both. Apparently they still cook and shop independently, so I'm going to do a section on food labels, as well as focusing particularly on fluid and fibre for the constipated among them.

My supervisor had a look at my draft presentation and said she liked it. She made a few suggestions for interaction, e.g. a quiz. I wasn't keen on a quiz, but I've now changed the presentation quite drastically, and the main section is now about comparing a lunch of beans on toast, soup and bread, sardines on toast or cheese on toast. It still needs cutting down, though - I might have to lose the section on the Eatwell Plate.

I can't remember whether I've mentioned that I've found someone who's agreed to be my Case Study, but I'm being very cautious about writing about real patients on this blog. The Case Study is a piece of work where I document the patient's medical and social history and treatment, and discuss the justification and reasoning behind the dietetic input. I have to present this formally in a meeting of the department, which is assessed.

I'm starting to work a little more actively with patients, given that I'm a little more familiar with what's expected and how to do things. I've now carried out quite a number of independent consultations, mostly in outpatient settings, where I've done the whole thing including follow up letters to the referrers. We use checklists that are misleadingly known as 'Assessment Tools', whereby the supervising dietitian observes our work, and indicates whether we have met professional standards or need to make improvements. Three of these outpatient consultations and the one consultation with my inpatient Case Study have been formally assessed using the Assessment Tools.

I'm not doing too badly - the communication side of things was always likely to be good, given my previous jobs and my mature age, but it's not entirely trivial to remember all the 'rules' and avoid the pitfalls. It is too easy to make assumptions, e.g. that people know that salt should be restricted to control blood pressure, or assuming that everyone eats or drinks something in the morning. Writing in the dietetic record and the medical notes is the hardest thing, requiring entries to contain all the relevant information, in the right order, without crossing anything out, but in just a few lines. I am incredibly slow at this at the moment - avoiding repetition and deviation simply induces hesitation.

In terms of obesity, I did have a chat to the Program Manager about their adult weight loss programme that has been developed for local delivery, called 'The 10% Challenge'. It's a 12-week course available free on the NHS to people whose BMI is 25 or more, which seems an absurdly low threshold. I didn't quite understand how they aren't overwhelmed by demand, but I found out that unlike smoking cessation and cholesterol treatment, GPs have no weight loss or BMI targets, so are not funded specifically for weight management. This would certainly make the programme less competitive in terms of GP funding for participants.

I also spent some time with someone in charge of the weight loss programs for families including a child who needs to lose weight. The obesity team have also loaned me a pedometer and given me a free T-shirt, and thus won me over. I'm not hard to please, although I'll have to sneak the T-shirt past the clothes police, aka Lola II.

Other news: I have had another birthday, and made myself a wheat-free and gluten-free banana cake with cream filling and chocolate ganache topping. I used Doves Farm flour and it worked so well that I actually forgot that it was 'special' as I took the beautifully raised cake out of the oven. My wheat-intolerant badminton-playing friend was delighted, as she usually has to miss out on any treats going round.

Mr A has also had a birthday, and we treated ourselves to a trip to the local sushi restaurant. It was not a great experience - the food was fine but service a bit flaky, and the cost too high to overlook this. On the way home Mr A expressed a desire for more food, so we diverted via a local Chinese restaurant. It was so salty that he told me today he thought he would have palpitations, and although I only had some prawn crackers and a spring roll I drank half a litre of water during the night without needing to get up and get rid of any of it.

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