Inspirational Story

How do you become a dietitian?

At school, I loved sciences, especially biology and chemistry so I chose biology, chemistry, physics and maths at A level. I was not sure what I wanted to do and was thinking of becoming a teacher. My biology teacher asked me to consider university. Nobody, in my family, had been to university before but my teacher was very encouraging. I had no idea what course to do but biochemistry and physiology seemed to fit in with my interests.

I was amazed when I was accepted to study biochemistry/physiology combined degree at Leeds University. I wasn’t sure that I would be good enough but I worked hard and was as good as my colleagues. In my second year, I started to wonder what I would do afterwards. Although I loved my course, I did not want to work in a laboratory and I realised that I enjoyed working with people. My friend, who was doing the same course, said she was thinking of being a dietitian. She explained what she knew. I started to find out about dietetics and I arranged to visit the dietetic department at St James’s hospital. I spoke to the dietitians and then I applied to do a postgraduate diploma in dietetics at Leeds Polytechnic (now Leeds Beckett University). I was accepted so once I graduated, I then went to Leeds Polytechnic.

Why Dietetics? And why specialise in Obesity?

I loved the dietetics course as it was the perfect way of combining my love of sciences with working with people. Many medical conditions can affect nutrition. For instance, people with type 2 diabetes may need help in managing their dietary intake to control their blood sugars; people with inflammatory bowel disease may need advice on their diet to make sure that they can meet their energy and protein needs. Dietitians work in range of settings including hospitals and the community.

I chose to specialise in obesity and when I first started working in this area, at Leeds General Infirmary (LGI), we were one of only 5 specialist medical obesity clinics in the UK. In addition, the surgeons were also performing bariatric and metabolic surgery. This operation helps people with severe and complex obesity to lose weight and also to improve other health problems, such as type 2 diabetes and sleep apnoea. Our surgeons were pioneers in this type of surgery in the UK and so this meant that I was also the first UK dietitian to be working with these patients. The bariatric and metabolic surgery works by altering gut hormones. This results in people feeling fuller with smaller amounts of food; however, it also decreases the absorption of micronutrients such as iron, calcium, vitamin D, and vitamin B12. Consequently, support and advice from a specialist dietitian is important. I find obesity a fascinating area to work in and I enjoy supporting people with obesity in their weight loss journeys. To help me support patients, I have undertaken further training in communication, motivational interviewing and cognitive behaviour therapy. This enables me to support patients to overcome barriers to moving forward. To me, my job combines eating, nutrition, psychology, and science.

How do you progress to consultant dietitian? And what is that like?

At Leeds Teaching Hospitals NHS Trust, our medical and surgical obesity services work closely together. The medical team consists of an obesity physician, dietitians, physiotherapist and liaison psychiatrist. The surgical team consists of bariatric surgeons, dietitian and liaison psychiatrist. I worked in both teams and it was agreed that I would lead the combined multidisciplinary team. This meant that all obesity referrals came to me. I would triage them deciding which ones were appropriate and which ones we needed further information on or would reject. In team meetings, when it was thought that a patient may be going forward for bariatric surgery, I would collect all the information and present the patients’ cases for discussion. I would then communicate the decisions to the patients and their GPs.

For many years, I was at the top of my clinical grade. My head of dietetics suggested a few times that I should apply to have my post regraded. Eventually, I decided that I would apply. I had to gather the information to evidence what I did. I submitted my application. It took a long time before I learned of the decision. I found out afterwards that my head of dietetics had been round and interviewed all the physicians and surgeons that I worked with. They all supported my application and I was awarded a high clinical grade, which was later matched to “Consultant Dietitian”. My physician and surgeon colleagues recognised that I was undertaking advanced practice and making decisions which made their work easier. They treated me as an equal partner.

A typical week for me would consist of medical obesity clinics (3/week), surgical obesity clinics (3/week), multidisciplinary team meeting (1/week) plus teaching and office work. In the medical obesity clinics, the focus would be on helping people to make dietary and lifestyle changes. In the surgical obesity clinics, before surgery, the focus would be on preparing people and their families for the bariatric surgery and then helping them with the reintroduction of food and different food textures after surgery. I would also request nutritional bloods and make changes to vitamin and mineral supplements. There would still be a focus on dietary and lifestyle changes. I was also active in student training and education and training of healthcare professionals. In addition, I was an active British Dietetic Association Trade Union representative and Staff Side Council secretary so I attended regular meetings between Staff Side and senior management.

I applied twice to the National Institute of Health and Clinical Excellence to be on the obesity guidelines committee and so was a member of the clinical guidelines produced in 2006 and 2014. I was a member of the British Obesity and Metabolic Surgery Society (BOMSS) and was elected as a representative onto the committee. I served two terms of office before standing down in 2020. When I joined the committee, I suggested that we needed guidelines for the nutritional management of patients undergoing bariatric surgery. The surgeons agreed and asked me to lead the work. At the time, I was doing my masters, surveying current practice of BOMSS members with respect to what they were doing in looking after the nutritional needs of patients. I was able to use this to lead the development of the guidelines which were published in 2014. I recently led the development of its update and these were published in Obesity Reviews in 2020. The guidelines make recommendations to clinicians about what nutritional measurements they should be making before someone has surgery, which nutritional blood tests to do after surgery, what vitamin and mineral supplements to prescribe and how to correct nutritional deficiencies. These guidelines help to improve patient care.

In 2017, the International Federation or Surgery of Obesity and Metabolic Diseases (IFSO) was holding its annual conference in London. BOMSS invited me onto its organising committee and I was invited to give a number of presentations. Before the conference, the chair of IFSO Integrated Health Committee invited me to be her Vice Chair and I was then invited onto the IFSO Executive Board. In 2019, I became the Chair of the IFSO Integrated Health committee. I now lead a committee of dietitians, nurses, physiotherapists, psychologists, researchers working to improve the knowledge, education, research and networking of integrated health members so that together we can improve patient care, across the world.

Throughout my career, I have been an active member of the British Dietetic Association (BDA). I have been involved in running our local branch and at a national level, I chaired the Research committee. I am proud to have led the development of the first BDA book “Getting Started in Research and Audit” to be published in the British Library. The highlight of my career was being awarded Fellowship of the BDA for my services to dietetics.

So, what do I do now?

I was becoming extremely busy as in addition to being active in IFSO, I was asked to be a co-opted Trustee of the Association for The Study of Obesity. I am also a member of Trial Management Groups. I feel passionately about the training and education of others and felt that there was not enough time to work full-time in the NHS and do everything.

I made the difficult decision to “retire” from my NHS post, but negotiated an unpaid honorary contract with Leeds Teaching Hospitals.

I am mentoring dietitians and I am also involved in the development of European and international guidelines so I am still a regular user of our hospital library.

I was involved in a large national research submission which was successful, so I will have a part-time paid contract back in the NHS. I am actively involved in the education and training of others, nationally and internationally. This is online at the moment but I am looking forward to travelling again.