OPINION: Dietitians are more than salads and weight loss

Nutrition is fundamental to health and wellbeing and as such dietitians remain committed to serve and protect the nutrition agenda of South Africa.

Be honest. If you think about dietitians, you think about salads and weight-loss, right? It’s okay, we don’t blame you. Dietitians do want you to eat more vegetables and be healthy by managing your weight, because we care about health. But we also want you to know that good nutrition is about much more than salads, and that we can help a whole lot more.

In recent months, as the Covid-19 pandemic and resulting economic meltdown unfolded, South Africa’s broken food system was exposed, emerging as the hunger epicenter with an estimated 15 million people (over 25% of the total population) of South Africans having inadequate access to food, an increase of nearly 1.3 million people following the Covid-19 outbreak, according to a recent OXFAM report. 

Dr Chantell Witten, a registered dietitian with the University of the Free State, serves as the Chairperson of the Child Health Priorities Association and the Nutrition Lead for the South African Civil Society for Women’s Adolescents’ and Children’s Health, explains that since the beginning of the lockdown a major activity has been to advocate for women’s and children’s food and nutrition security.  

“Earlier on in the lockdown there were major efforts to engage government and thought leaders to engage on food and nutrition security because intuitively, we knew that any disruption to food for women and children would have negative consequences for their health and nutrition”.  

She continues, “South Africa has an Integrated Food and Nutrition Strategy that needs to be actioned if we want to truly ensure optimal nutrition for all.  It is food and nutrition programming capacity that is needed at all levels in all sectors to bring the strategy to bear on people’s right to food.  Right now, we are seeing inadequate, uncoordinated piece meal responses to the food and nutrition crisis in South Africa.’

The World Health Organization (WHO), the Lancet and the Global Alliance for Nutrition have called on governments and all sectors of society to not neglect the food and nutrition agenda for women and children as these have far reaching consequences. It is well documented that children who are sub-optimally fed in their first two years of life are more likely to become overweight later in life, which puts them at a higher risk of lifestyle disease such as diabetes and heart disease, comorbidities negatively associated with Covid-19 survival rates. 

Poor nutrition will thus not only affect individuals’ immediate nutritional status and ability to fight the virus, but also our ability as a nation to survive similar disease in future. Moreover, how will we rebuild our economy when it is proven that sub-optimally fed children are less likely to reach their full mental, physical and economic potential, and our already burdened health system is put under even greater pressure? 

Paramount to good nutrition is optimal food quality and quantity. While we know that South Africa produces enough food for all, inequitable access to food and deepening economic poverty, calls on multi-sector engagement to bring collective skills and expertise to bear on the food and nutrition crisis unfolding. So where do dietitians come in? Research the world over, has shown that nutrition skills and competencies are lacking in the training of medical professionals. Dietitians fill this gap but are not always adequately consulted because of how we are portrayed. Perceptions and understanding of the role of dietitians are rather low.

Here are some examples of how dietitians are contributing to and promoting public health and nutritional wellbeing.

Dietitians support policy and programs

“Dietitians are uniquely positioned to support the integration of food systems for optimal health and nutrition outcomes. They are also skilled to translate policy directives into tangible food and nutrition interventions such as infant and young child feeding programmes, food production such as the production and promotion of the orange-fleshed sweet potato, and the regulatory environment on food labelling and marketing,” explains Prof Edelweiss Wentzel-Viljoen, an extra-ordinary professor and researcher in nutrition from the North-West University.  

Dietitians help in food relief

Calculation of calorie needs and nutrient adequacy of meals and food packs is the competency of a dietitian and dietitians have been assisting NGOs and civil society organizations to provide nutrient adequate meals and food relief. 

“Humanitarian Aid in the time of Covid-19 has had many faces. Dietitians have been engaged in varied activities from consults with civil society on meal planning, menu costing and food safety, all in the face of donor constraints,” says Baheya Najaar, a registered dietitian and volunteer with Gift of the Givers.  Najaar continues, “Sadly, in many instances where the expertise of dietitians was not used, it resulted in inferior meal offerings which only offered satiety but lacked essential nutrients. 

“This situation over an extended period results in compromised health and nutrition, aggravating the susceptibility to infections and disease”. 

She has also been approached for advice to ensure that the infant and young child feeding regulations were not violated by donors and recipient organizations.

Dietitians in foodservice units in hospitals

Providing adequate and efficient foodservice systems for field hospitals and quarantine facilities is another major undertaking for dietitians in the public health sector. As explained by Dr Hilary Goeiman, Nutrition Manager of the Integrated Nutrition Programme in the Department of Health, Western Cape government, “An effective dietetic service as part of the multi-disciplinary patient care team provides optimal therapeutic nutrition which improves patient health outcomes, shortens the length of stay in hospital and improves the recovery process.” 

Dr Goeiman says patient care starts with food systems to provide nutrition adequacy, and to assess, monitor and evaluate nutritional requirements of patients. 

“This cannot be delivered without dietitians. We all know that poor nutrition has negative impact on health, more so for sick patients.” 

During Covid-19, dietitians have also been asked to step-in to assist hospitals as foodservice staff became infected or affected by Covid-19 to ensure that patients received meals. Many dietitians also assisted with administration at testing sites supporting the outreach with contact tracing of positive covid-19 cases.

Dietitians helping children

A public outcry and even a court order to re-instate the National School Nutrition Programme which is hailed as an imperative response to children’s education rights and a much needed response to the food needs of children has been in the spotlight. 

Verona Witbooi is a registered dietitian who co-ordinates the National School Nutrition Programme (NSNP) for the Province of the Eastern Cape, providing meals to 1.6 million learners. Her role in the NSNP requires her oversight and supervision of the financial management, monitoring and evaluation of NSNP delivery targets. At the forefront of reaching delivery targets is to ensure effective food delivery systems with the best food quality and food safety measures to protect children’s health and nutrition.

These varied skills and competencies are imperative to support South Africa to successfully beat the Covid-19 pandemic, to protect the health and nutrition of her citizens and help the country reach the Sustainable Development Goals.  However, these stories are often not told in the media. 

Liezel Engelbrecht, registered dietitian and former editor and journalist, knows that the media is a powerful tool for shaping what people think about. “Unfortunately, dietitians are often only contacted for information related to the nutritional value of food weight loss tips. We can do all that, but also so much more.”

Two recent articles , reporting on the role of dietitians ironically further highlighted the need to highlight the role of dietitians. The articles were accompanied with pictures of salads, in a time when hunger and food shortage is affecting millions of households. “This doesn’t really make us look like the nutrition rock stars we are.”

We salute the efforts of all frontline workers and remind our political and thought leaders that nutrition is fundamental to health and wellbeing and as such dietitians remain committed to serve and protect the nutrition agenda of South Africa.

Chantell Witten, Liezel Engelbrecht, Baheya Najaar Hilary Goeiman, Verona Witbooi, Christine Taljaard-Krugell, Annatjie Smith, Edelweiss Wentzel-Viljoen

This article was originally published on health24.com on 4 August 2020.