Anne de Looy

Greater professional empathy leads to higher agreement about decisions made in the consultation

OBJECTIVE To examine the relationship between professional expression of empathy and agreement about decisions made in the consultation. METHODS Consultations between 86 individuals with diabetes and four dieticians were audio-recorded. Immediately following consultations patients and dieticians independently reported decisions made in a booklet. Audio-recordings were coded directly for empathy using an amended version of the empathic communication coding system (ECCS). RESULTS Empathy correlated significantly with patient and professional agreement about decisions made in the consultation (τ=.283, p=.0005). Multiple regression analysis indicates that for each dietician the greater the empathy the higher the level of agreement about decisions (p<.0005). Professional empathic response to patients statements of challenge was a significant factor in increasing agreement about decisions (p=.008). CONCLUSION Results support the hypothesis that greater professional empathy will result in greater agreement about decisions made in consultations. PRACTICE IMPLICATIONS Findings have implications for empathy training and provide guidance on the communication skills needed to support expression of empathy. Patient and professional agreement about decisions made provides a simple marker of effectiveness and highlights the importance of empathy as a seminal component of professional communication skills during a patient consultation.

Comparing advice to decrease both dietary fat and sucrose, or dietary fat only, on weight loss, weight maintenance and perceived quality of life

Abstract This study compared two types of dietary advice on weight loss, weight maintenance and quality of life in Scottish women. One hundred and twenty-six overweight/obese sedentary women were randomly assigned to either: Group 1, reduced energy, fat and sucrose; Group 2, reduced energy and fat only; or Group 3, control. Subjects were followed up at 3 months and for a further 6 months weight maintenance. Groups 1 and 2 reported a decrease in energy intake, percentage energy fat, and increase in percentage energy total carbohydrate and protein (P < 0.001). Group 1 reduced percentage energy sucrose at 3 months (P < 0.001) but not at 9 months. Groups 1 and 2 lost body weight (2.81 kg [standard error of the mean, 0.406] and 2.6 kg [standard error of the mean, 0.506], respectively), body fat (P < 0.01) and reported increased quality of life (P < 0.05). Group 2 reported more positive changes. Both interventions were successful for weight reduction, and were maintained medium term. The associated increase in quality of life may be indicative of longer term compliance, predicting successful weight maintenance.

Weight loss on an energy-restricted, low-fat, sugar-containing diet in overweight sedentary men

With the increasing prevalence of obesity in the United Kingdom, the search for an effective weight reducing diet is a priority in helping to reverse this trend. A 12-week dietary intervention study was carried out to test the effectiveness of an energy-restricted, low-fat, sugar-containing diet on weight loss in sedentary overweight men. The study also aimed to assess eating behaviour, to measure change in attitude towards sugar-containing foods and to measure the impact of the study on perceived quality of life. Subjects were recruited from three UK cities; Edinburgh, Birmingham and London. Seventy-six men, aged between 25 and 60 years, completed the study. Baseline diets were assessed by a 7-day diet diary. Compliance to the subsequent dietary advice was measured on four occasions post intervention, by 4-day diaries. Measures of body weight status were also monitored. Eating behaviour, attitudes towards sugar-containing foods and quality of life were assessed by questionnaire. Significant reductions in body weight (5.2%), body fat (11.2%) and waist:hip ratio (3%) were observed following reported dietary changes that included a reduction in reported energy intake of 3.2 MJ/day (770 kcal/day), a reduction in the percent energy from fat (from 38.1% to 26.2%), an increase in the percent energy from total carbohydrate (from 44.4% to 54%) and from protein (from 17.3% to 20.6%). Subjects scored relatively highly for dietary restraint and emotional eating, and were strongly influenced by external eating cues. On completion of the 12-week study, subjects had a more positive attitude towards sugar-containing foods and perceived an improved quality of life. It is concluded, therefore, that including sugar-containing foods in a weight-reducing diet may be an effective strategy to achieve a palatable, low-fat, high-carbohydrate diet, which promotes weight loss in overweight individuals.

Integrating mobile technology with routine dietetic practice: the case of myPace for weight management

The field of Mobile health (mHealth), which includes mobile phone applications (apps), is growing rapidly and has the potential to transform healthcare by increasing its quality and efficiency. The present paper focuses particularly on mobile technology for body weight management, including mobile phone apps for weight loss and the available evidence on their effectiveness. Translation of behaviour change theory into weight management strategies, including integration in mobile technology is also discussed. Moreover, the paper presents and discusses the myPace platform as a case in point. There is little clinical evidence on the effectiveness of currently available mobile phone apps in enabling behaviour change and improving health-related outcomes, including sustained body weight loss. Moreover, it is unclear to what extent these apps have been developed in collaboration with health professionals, such as dietitians, and the extent to which apps draw on and operationalise behaviour change techniques has not been explored. Furthermore, presently weight management apps are not built for use as part of dietetic practice, or indeed healthcare more widely, where face-to-face engagement is fundamental for instituting the building blocks for sustained lifestyle change. myPace is an innovative mobile technology for weight management meant to be embedded into and to enhance dietetic practice. Developed out of systematic, iterative stages of engagement with dietitians and consumers, it is uniquely designed to complement and support the trusted health practitioner-patient relationship. Future mHealth technology would benefit if engagement with health professionals and/or targeted patient groups, and behaviour change theory stood as the basis for technology development. Particularly, integrating technology into routine health care practice, rather than replacing one with the other, could be the way forward.

Practice learning a prelude to work: studies by DIETS2

Purpose – The aim of this study is to describe placement learning opportunities for student dietitians related to future fields of work. Design/methodology/approach – An online questionnaire determined the variety and duration of pre-qualifying practice placements across Europe. Responses from members of the Thematic Network DIETS2 in Europe (n = 39) were analysed. Findings – A response rate of 61 per cent from 19 countries (39 higher education institutions or national dietetic associations) is reported. Four sub-types of placement are used by the respondents for pre-qualifying dietetic students. Placements are in public health, education and social care (28 per cent); clinical (27 per cent); catering (20 per cent) and others (25 per cent), including the food industry. Median number of weeks in the location was 12 for clinical settings; 5 for health, education and social care; 4.5 for in catering and up to 7 weeks in other locations. Research limitations/implications – If dietitians and nutritionists are ...

Thematic Network DIETS mapping dietetic education in Europe 2006-2009: comparisons to the European Academic and Practitioner Standards for Dietetics

Abstract Background In 2002 a study by the European Federation of Associations for Dietitians revealed that the education of dietitians prior to entry into the profession was quite diverse across Europe. An EU supported Thematic Network ‘Dietitians Improving Education and Training Standards’ (DIETS) had, as one of its objectives to study and then support change in dietetic education through its partners in 30 countries in Europe over the period 2006-09. This study compared educational practices in Higher Education Institutes that teach dietetics between 2007 and 2009. Methods The study was longitudinal repeated measure in design. An online questionnaire was developed to record the current academic curricular and structure of the practice placements as well as programme recognition in the country concerned. The study also asked about ECTS calibration and use of certain reference materials in the design of the curriculum for example the European Academic and Practitioner Standards for Dietetics. The questionnaire was sent to all Higher Education Institutes that were partners of the DIETS Network in 2007 and 2009. Results Responses yielded an analysable sample of 35 in 2007 and 41 questionnaires in 2009 representing a response rate of about 60% of HEIs in partnership with DIETS. Changes in calibration status was observed in 37 (90%) of HEIs compared to 21 (60%) over the two years. Four countries acquired national standards for the recognition of dietitians and their education. Dietetic placement length still falls short of the recommendation in seven countries but the diversity of placements offered to students is to be valued. Two subjects, public health/promotion and reflective learning (research) are now being taught in more HEIs over the two year period but immunology, genetics, management and leadership and marketing are taught in less than 60% of HEIs in both 2007 and 2009. Conclusions There have been positive changes demonstrated in dietetic education in Europe between 2007 and 2009. The work of the Thematic Network can be seen in promoting the importance of ECTS calibration, educational standards, placement preparation and teaching and the breadth of the curriculum. National authorities, higher education and professional associations will continue to improve the preparation of dietitians so they can contribute fully to improve the future nutritional health of Europe.

Exploring the quality of European dietetic practice placements

Purpose – The purpose of this paper is to evaluate the quality of dietetic practice placements in European higher education institutions (HEIs). Design/methodology/approach – An online questionnaire was used to investigate adherence to the European Dietetic Practice Placement Standards. Supporting documents were assessed against the “Guide to best practice” criteria. Findings – The questionnaire response rate was 39 out of 67 DIETS2 partners, representing 19 European countries. According to the questionnaire, the majority of HEIs have a formal agreement regarding roles and responsibilities on practice placement. They have clear learning outcomes, policies, standards and procedures to test, approve and monitor practice placements. However, less than half HEIs provide support and training for supervisors. Practice placement documentations from 16 European HEIs were assessed against the 15 “Guide to best practice” criteria. Only 1 HEI met all 15 criteria. The range of the rest HEIs fell between 1-14 criteria...

Integrating behaviour change techniques and digital technology for dietitian support in weight management cases

As obesity is increasing in Asia we investigated factors associated with being overweight in a random household survey of 1410 residents aged 18–93 from Macau, China. Demography, physical activity and sleep, alcohol and dietary patterns were surveyed by interview administered questionnaire. Height, weight and blood pressure (SBP and DBP) were individually measured and blood samples were taken on a sub-sample (n = 569) and triglycerides, glucose and cholesterol (LDL and HDL) were analyzed. In this population 38 % were overweight (BMI ≥ 24) and 9 % obese (BMI ≥ 26). Demographically BMI increased with higher age (β = 0.16 p < 0.001); lower social class (β = −0.07 p < 0.001) and being married (β = 0.12 p < 0.001). Independent behavioural associations with increased BMI were; less sleep (β = −0.15 p < 0.001); less physical activity, measured as total METs/ day (β = −0.10 p = 0.009) and more alcohol consumption (β = 0.10 p < 0.001). Interestingly, less meat (β = −0.04 p < 0.001), and milk consumption (β = −0.08 p < 0.001) were also associated with higher BMI. Independent metabolic associations with increased BMI were increased SBP (β = 0.16 p < 0.001), DBP (β = 0.08 p = 0.002), higher LDL (β = 0.17 p < 0.001), higher triglycerides (β = 0.07 p < 0.001), higher glucose (β = 0.05 = 0.01) and lower HDL(β = −0 .23 p < 0.001). The major findings of this study in Macau are that obesity is increasing compared to mainland China and this is reflected in impaired metabolic blood values and increased blood pressure rates. Increased physical activity, less sitting and better sleep and drinking habits may help reduce 160 Abstracts obesity reviews