Meet the Dietitian: Community Service Series

By Ilse Gravett

At the end of every stage in our lives, we find ourselves in a tricky position where we need to decide what our next step is. For a 17/18-year-old, it is quite daunting, well it was for me. I had so many different ideas of where I wanted to be and what I wanted to become. Eventually, I applied to study medicine at the University of Pretoria, and dietetics at the North West University. I got accepted for both medicine and dietetics, but I chose dietetics. Deep inside me, I knew that I wanted to do more and be more. Please don’t get me wrong; all doctors are real superheroes and I have a huge amount of respect for each one of them! There were times that I even wanted to be one of them. But it was not until my final year that I realised the honour and privilege of being a dietitian. Being a dietitian, you get to really make a difference in a person’s every-day life. Essentially, everyone needs to eat, and you get to be the expert. You get to work with the sick and the healthy, the individual and the community. So here I am, already in the last week of my community service year.

I got placed in a hospital I have never heard of in a town I didn’t even know existed. St Patrick’s Hospital, Bizana, Eastern Cape. What a blessing! Looking back, I know that I have learned so much – some might even help you on your journey:

  1. Share your knowledge. We forget that information that seems like common sense to us, might prevent severe acute malnutrition in a toddler or help the sweet old lady gain control of her blood pressure.  
  2. Be extra… Okay, not annoyingly extra, but be extra kind and go the extra mile. You have no idea what battle your patient or even colleagues are fighting, so never underestimate the power of that.
  3. Don’t settle for the “lack of resources” excuse. Rural hospitals are challenging on a whole different level. In most cases, you don’t have all the fancy feeds or even a feeding pump. This means you really need to think outside the box and get creative. You are the expert; you can do it!
  4. Focus less on yourself. With this I don’t mean let yourself burn out – please take your break when necessary. But you are doing this year to serve the community. So, don’t always think about how much you can get out of a situation but how much you can give. Once you do that, you will feel how you automatically grow.
  5. Look on the bright side. One of the biggest challenges I had to face this year, was to accept the fact that I will only see “basic” cases. And wow, how my perception of “basic” cases changed. Every case has so much detail to it and a lot that you can master.
  6. Give it time. This is probably the most cliché of them all, but really – give it time. It doesn’t all happen overnight, and that’s okay. Be open to growth and to learn from those who have been there longer. They have a different kind of knowledge that books don’t have.
  7. Enjoy! Make friends with anyone, have inside jokes with the cleaners, get to know all the different cultures, and make every day an adventure.

In the end, it’s all up to you and the choices you make each day. I hope you choose to make it the best 365 days of your life!


We would like to believe there may be small, simple solutions to big problems, but when is that actually true?  The answer is probably, never.  Intractable, extreme issues arise out of complexity, and nothing less than a host of multi-dimensional, cross-functional countermeasures issued at the right time and the right place can bring about sustainable transformation. 

Obesity, a disease characterized by the interaction of genetic, behavioural, metabolic and environmental factors, embodies a complex matter requiring a comprehensive approach.  A quick glance at the South African context (marked with more than 41% of women being obese) highlights that combatting obesity in South Africa will require more than a one size fits all approach. 

This is why advising people who are obese to just consume fewer calories while burning more energy is not just doomed to fail but damaging to vulnerable people.

Obesity is a health condition beyond overweight that soars past trite platitudes. Research has shown that restricting calories while boosting exercise only makes a paltry 3 to 5% difference to sustainable weight loss and weight management.  This is staggering, and it points out that the roots of obesity run deep – in the unseen details of our DNA; in the shadowy intricacies of our individual psychology, and day-to-day, in the banality of our homes, workplaces and communities where bias and shame are uncontested.

World Obesity Day, the 4th of March, is a time to acknowledge the global increase of obesity and its long-term impacts, while providing hope through awareness and education.  Having a loved one on the brink, or all the way down the road, causes all involved parties to grapple with bona fide existential fear.  Obesity puts one at risk for a host of other medical conditions such as non-communicable diseases, and it is too complex to solve with simple calorie restrictions plus exercise.

Dr Christine Taljaard-Krugell, President for ADSA (The Association for Dietetics in South Africa) says, “Simplifying obesity to one cause could prevent effective treatment. It ignores the various root causes such as biology, food, genetic risk, healthcare access, life events, marketing and sleep.  Hence, when tackling obesity as a chronic disease, an evidence-based approach should be followed.  Holistic patient care is critical.  While cutting back on calories and increasing exercise is a relevant start and lays a foundation for healthy living at a healthy weight, it’s not the be all and end all when you’re aiming for sustainable change.  This is a misconception that needs to shift.”

In recognition of World Obesity Day, the National Department of Health has stated that “it welcomes a broader view when it comes to dealing with obesity in South Africa, which is at an all-time high.  Obesity is defined as a prevalent, chronic condition that impairs health, increases morbidity, and renders people prone to relapsing.” 

Obesity care cannot simply be about diet and exercise advice; it should include intensive nutritional therapy led by registered dietitians, physical activity programmes, pharmacotherapy, as well as psychological, and even surgical interventions.  For sustainability, the root drivers of obesity must be dealt with.  These may be genetic and/or psychological drivers that will inevitably scupper calorie-restriction and exercise efforts if they persist as underlying causes.

People living with obesity also face bias and stigma that have major impacts on their life goals and aspirations, and therefore, their well-being.  Here’s a way that we can all help counter the increasing obesity among SA adults and children:  understand the complexity of the issue; don’t assume; don’t judge and don’t give off-the-cuff advice.  Interrogate your own explicit and implicit biases.  Promote and support holistic, professional patient care.  There is a better way.

To find a registered dietitian in your area that can assist in the management of obesity, visit:

The National Department of Health is inviting people to join the World Obesity Day webinar under the global theme “EveryBODY needs Everybody” on 4 March 2020 from 11am to 12pm. Follow this link to register for the webinar.