GPs well placed to talk about balanced diet

Diet and weight can be difficult topics to broach with patients. Dr Frankie Phillips explains how to start.

While any number of self-styled 'experts' - and some genuine ones - are on hand to give advice on nutrition, diet and lifestyle, GPs are in a position to give an authoritative opinion and encourage patients to take healthy dietary advice on board.

GPs are on the front line and have a crucial role in giving appropriate advice, directing pat- ients to useful sources of information, and identifying those who may be at risk of obesity.

It is estimated that as much as a third of all ill-health in the world today can be attributed to environmental factors, particularly poor diet and smoking.

Malnutrition is often thought to be synonymous with undernutrition and weight loss, but obesity is another state of malnutrition - it is 'overnutrition'.

In the UK, obesity is increasing at an alarming rate and it has been estimated that by 2050, 60 per cent of men and 50 per cent of women will be obese. The government's three-year healthy living campaign Change4Life has been launched to tackle this major health issue.

Discussing diet
The low levels of nutrition education doctors receive can leave many struggling with providing effective dietary information.

What actually constitutes a 'good diet' can be difficult to pin down. Asking 'how is your diet?' is unlikely to bring forth useful information, but it may be a way to approach a subject outside the constraints of a typical consultation. This could prove a vital first step in the primary prevention of obesity in people who are at risk, or a starting point for those already affected.

Typical at-risk groups who can be targeted with such a first step include children with overweight parents, women after pregnancy or patients with mob-ility issues after injuries that are likely to increase their weight. Just mentioning food in a consultation indicates its essential part in life. This alone gives an important message to patients.

What is a balanced diet?
A healthy, balanced diet is one that contains an adequate amount of all nutrients essential to the body, to protect health and prevent nutrition-related health problems and diseases.

In the UK, specific nutrient deficiency diseases are rare; the main problem is dietary imbalance. Healthy eating advice should focus on having a good balance of protein, carbohydrates and fats, with a target of around 35 per cent of energy or less coming from fat - 11 per cent or less from saturated fat.

To translate these figures into actual foods, guidelines for a healthy diet have been developed by the Food Standards Agency (FSA). The FSA has developed a plate model, the Eatwell plate, showing approximate proportions of different food groups that constitute a healthy diet.

The plate is divided into five food groups: fruit and vegetables; bread, cereals and potatoes; milk and dairy foods; meat and fish (and vegetarian alternatives) and finally, foods containing sugar and fats.

The proportion of the plate given to each food group gives an indication of how much of each food group would provide a balanced diet over a week.

Although useful visually, there has been criticism of the lack of portion guidelines; only fruit and vegetables has a guide for number of portions to be consumed. The five-a-day fruit and vegetables message is strongly promoted, with a website dedicated to encouraging people to 'just eat more'.

Useful advice
The FSA has also suggested eight tips for eating well for adults (see box, page 31). More information can be found on the Eatwell website.

The overall message is that all foods can contribute to a healthy diet, but it depends on the proportion. This is particularly true for treats and snacks, which can be energy dense and often contain a lot of fat or sugar, or both.

It is perfectly possible to get adequate amounts of all of the nutrients needed by the body from food alone and a poor diet cannot be 'patched up' by a supplement. However, some people who have particularly high nutrient requirements may need supplements (women in the earliest stages of pregnancy need extra folic acid, elderly people need extra vitamin D and so on).

If a supplement is necessary, dietitians advise that a generic multivitamin and multimineral supplement providing 100 per cent of the RDA of a range of nutrients is most appropriate.

Practical resources
Dietitians use a detailed diet history to ascertain the quality of diet and pinpoint problem areas. However, asking a patient to keep a food diary, recording all the food and drink they consume for a few days, can be revealing and identify patterns of eating that may be changed.

Having a handful of resources that can give patients reliable advice about diet can fill the information gap. The British Dietetic Association and the British Nutrition Foundation produce free unbranded fact sheets on a range of issues, from information about food labelling and cholesterol to more specific advice about diet and osteoporosis or eating for a healthy heart.

GPs have a pivotal role in helping patients identify their need for healthy eating and lifestyle advice. By having useful resources available and bringing the subject of diet into a consultation, GPs can act as ambassadors, helping their patients and families enjoy a healthy life.

  • Dr Phillips is an independent registered dietitian based in Devon
FSA tips for eating well
  • Base your meals on starchy foods
  • Eat lots of fruit and vegetables
  • Eat fish - aim for two portions, including one of oily fish, per week
  • Cut down on saturated fat and sugar
  • Try to eat less salt - no more than 6g per day
  • Get active and try to be a healthy weight
  • Drink plenty of water
  • Don't skip breakfast


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