“We should be as kind to ourselves as we are to others”

This week we chat to Tabitha Hume, a registered clinical dietitian in private practice, to find out why she became a dietitian, what she enjoys most about the work she does and what the challenges are:

Why did you become a Registered Dietitian?

I danced very seriously when I was at high school (ballet) and fell prey to the eating disorder monster. When I went to UCT, I started out studying BSc with an aim to genetic engineering, but then someone mentioned that dietetics was offered as a post-grad honours degree and my interest was piqued. I changed my BSc subjects to physiology and psychology and then was equipped for dietetics. I had a very strong interest in the physiological development of metabolic problems and so when I started my honours thesis on the hyper-metabolic response of paediatric burns patients, I was in heaven! Then after honours, my huge thirst for knowledge blessed me with a research and lecturing post at Wits Physiology Department, doing my thesis on carbohydrate and insulin metabolism, which was incredible. I knew I was in the right career when I started private practice and saw how rewarding it was, helping people with disordered eating and eating disorders completely lose their fear and anxiety of carbohydrates and remain skinny whilst eating a LOT.

So, it was really an evolution into dietetics, but a perfect fit!

What do you enjoy most about the work you do? What are the most satisfying moments?

I love interacting with people. I see myself as a bit of a teacher. Watching as the penny drops with people is very rewarding. Seeing previously restrictive people turning into satisfied eaters with a genuine passion for eating, and losing weight or stabilising muscle mass makes me feel like I’ve helped both body and mind, and made a positive difference. My most satisfying moments are probably seeing my past anorexic and bulimic patients enjoy food, socialising, eating with their families, and moving on to inspire other eating disorder sufferers with lecturing, blogging and mentoring. That’s paying it forward and I feel blessed that I am able to be part of that journey.

What has been your career highlight?

I think this answer has two parts: The first was the success of my first three books. Then, the second highlight has been slow: working my way back up from complete financial and emotional ruin after being accused of malpractice in 2001. However, the exoneration and my ongoing passion for helping people recover has put me back in the practice seat and made me stronger in the process. I’m proud of that.

What are the most challenging aspects of your career?

There are 3 main challenges, which hit me every day.

  • The fact that everyone and anyone dishes out conflicting and pseudoscientific dietetic advice and that the public is not protected against this. More disease and death is being caused by confusion, yo-yo dieting, eating disorders and orthorexia arising directly from ‘diet gurus’ who have little or no physiological or medical background. Because the public sees these ‘diet gurus’ and registered dietitians as equal authorities and equally qualified to dispense dietetic advice, I sometimes feel angered that I am forced to highlight the vast difference in qualifications there are. It’s crazy that we are forced to ‘convince’ patients that we are the experts. After all, someone with a rotator-cuff injury would not question a physiotherapist on what advice she received from her personal trainer!
  • Apropos the above: I also find it very challenging that medical aids still don’t see the massive value in dietetic therapy. This hinders the patient from obtaining the full scope of care that they actually need from a dietitian, and this incomplete process leaves the full lifestyle change open to failure, further exacerbating lost faith in dietetics.
  • With the plethora of rubbish advice available to people, much of the limited time in consultation is spent trying to teach complicated physiological concepts so that they can understand and thus ‘trust’ the advice we give, because it is often so contrasting to what is fashionable and the latest fear-mongering fad. Patients so often say, “I need to spend a whole day listening and understanding because only with understanding it ALL can my enormous fear of food be undone.” We, as dietitians, shouldn’t have to do this. We should be able to guide, direct and heal. Not have to spend patients’ valuable time convincing them that eating normal food is OK.

How do you cope after a day of nutrition disaster and bad eating choices?

I speak to myself kindly, as I would to a child who made mistakes. We all do things for a reason, and I show myself WHY I made those mistakes, and rapidly make small adjustments to address that problem for the future. As soon as I let guilt in, my tendencies to be mean to myself start, and this simply starts a complicated restrict/defiance pattern in my eating which is not healthy. We should be as kind to ourselves as we are to others.

What are the three things that you think people should stop saying when they meet a dietitian?

  • “Are you sure? Everyone else seems to be saying that blah blah blah (insert pseudoscientific rubbish)”.
  • “I know what I should be doing I just can’t seem to have the discipline”. …..Um, no! If you don’t have the discipline, it’s probably because you are doing it wrong!
  • I won’t need much time with you… just give me a diet sheet of what I can and can’t eat”.

What should clients look out for when deciding which dietitian to work with?

I think this is a very difficult one to answer, seeing as most dietitians have equal qualifications. I’d say that because patients usually require a lifestyle change (and that is a fairly personal process), finding a dietitian with whom the patient ‘clicks’ on a personality level is very important to motivation and trust.

What is your favourite dish and your favourite treat food?

Undoubtedly a hot lentil curry with chutney and tons of fresh coriander!

My favourite treat food would be warm apple pie! (Vegan of course!)


Is a Career as a Dietitian for You?

Dietetics, the field of nutrition, health and the application of science-based nutrition knowledge offers a variety of distinctive career opportunities that goes beyond the usual view of the dietitian as someone who simply helps others lose weight. If you have interests in health, food, healthy lifestyle and science, you may well find your niche in this growing profession.

“A dietitian is a registered healthcare professional who is qualified to assess, diagnose and treat nutritional problems, as well as to advise on preventative nutritional strategies,” says Maryke Gallagher, registered dietitian and President of ADSA, the Association for Dietetics in South Africa. In South Africa, the minimum qualification for a dietitian is a four-year BSc degree and one-year of community service. To practice dietetics in the country, one must be registered with the Health Professions Council of South Africa (HPCSA). A registered dietitian is, therefore, a recognised expert in evidenced-based nutrition. This scientific expertise is vital in today’s world where there is an abundance of unscientific health and nutrition information, as well as a plethora of fad diets and nutrition gimmicks.

While dietitians are certainly the ‘go-to’ people for those battling with overweight and obesity, there is a lot more to the career than just sharing weight reduction and management expertise. What we eat has significant impacts on many other diseases and health conditions. Whether therapeutic nutrition or preventative nutrition, dietitians promote good health and wellbeing for all. There is much scope to tailor a career in dietetics to your personal passions. You may be interested in focusing on children’s health, maternal health, food allergies or eating disorders, or on some of the many medical conditions that require a dietitian’s management such as diabetes, heart disease, HIV/AIDS and intestinal disorders. In addition, when it comes to sports, nutrition also impacts on performance, and dietitians may often play integral roles on the teams managing high performance sportspeople.

Without doubt, there is a high need for registered dietitians in South Africa. While infectious disease such as HIV/AIDS and TB continue to be prevalent in South Africa, non-communicable diseases like heart disease, strokes, cancers and diabetes are actually the main causes of deaths (1). Yet up to 80% of heart disease, stroke and type 2 diabetes and over a third of cancers could be prevented by adopting a healthy lifestyle, such as eating a healthy diet, keeping physically active and avoiding tobacco products (2).   South Africa is ranked the most obese country in sub-Saharan Africa(3). Alarmingly, two out of three women and almost one in three men are overweight or obese, and almost 1 in 4 children aged 2-14 years are overweight or obese in South Africa(4). On the opposite side of the coin, chronic under-nutrition is also prevalent with 1 in 4 children aged 0-3 years suffering from stunting, a condition where a child grows to be small for their age due to poor nutrition(4). There is also a high incidence of micronutrient deficiencies, particularly vitamin A and iron, in South African children and women of reproductive age(4). South Africa has high levels of food insecurity with around 1 in 4 food-insecure South Africans experiencing hunger and a further 1 in 4 at risk of hunger(4).

Dietitians may work in a variety of settings with different areas of focus:

Private practice – like other health professionals, dietitians can set themselves up to consult privately with patients who need advice on nutrition therapy and support to make healthy eating a lifestyle change.

Hospitals – known as clinical dietitians, these practitioners primarily work in hospitals consulting with patients who are referred to them by doctors or other healthcare professionals. Their role in a patient care team is to assess and individualise nutrition therapy (whether an appropriate special diet, tube feed or intravenous feed) as an integral part of recovery or palliative care.

Community – these dietitians may be employed in the public sector, or by NGOs or community-based organisations. Their focus is generally on the promotion, protection and support of breastfeeding; growth monitoring and the prevention of malnutrition; nutrition promotion and education; promotion of healthy lifestyles to address non- communicable diseases; prevention and treatment of vitamin and mineral deficiencies; and addressing food insecurity issues.

Institution-based – dietitians also work in food service management providing healthy and specialised diets to people living in institutions such as senior homes, school hostels, welfare care centres, prisons and health care facilities. Their work includes planning, costing and developing menus; controlling implementing, evaluating and overseeing food service systems; and managing special dietary requirements.

Industry/Corporate – there are varied roles for dietitians in the food, retail, healthcare and pharmaceutical industries. They may advise on current food labelling legislation, nutrition regulations and the nutritional analysis of food items; be involved in product development; share latest developments and trends in nutrition; participate in nutrition-related marketing activities; lead corporate wellness programmes and conduct literature reviews.

Research/Academia – dietitians employed by educational institutions are involved in continuously providing new evidence-based nutrition information through on-going research and teaching and are responsible for the training of new nutrition professionals. 

Media/Publishing – in the Information Age, there is opportunity for dietitians, who have important knowledge to share, to generate expert content providing nutrition advice, latest evidenced-based nutrition news and views, commentary on nutrition issues and inspiration for healthy eating.

Do you have what it takes?

Maryke advises that a career in dietetics will suit those who:

  • are interested in food and health
  • enjoy and have a flair for Science
  • would be fulfilled by a caring, helping profession
  • are lifelong learners who are attentive to the on-going developments in Science
  • are able to translate scientific knowledge into practical advice
  • are comfortable in the role of the expert and like sharing knowledge with others
  • have strong inter- and intrapersonal skills
  • have a positive attitude and the ability to motivate others
  • have empathy, understanding and tact

 

 

References
  1. Mortality and causes of death in South Africa, 2014: Findings from death notification / Statistics South Africa. Pretoria: Statistics South Africa, 2015
  2. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011
  3. World Health Organisation. 2015. Global Health Observatory Data Repository. Accessed June 2015. http://apps.who.int/gho/data/node.main.
  4. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, et al. South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: Health Sciences Research Council, 2013.

 ABOUT ADSA

ADSA, the Association for Dietetics in South Africa is one of the country’s professional organisations for registered dietitians.  It is a registered non-profit organisation served by qualified volunteers. The Association represents, and plays a vital role in developing the dietetic profession so as to contribute towards the goal of achieving optimal nutrition for all South Africans.  Through its network of ten branches ADSA provides dietitians with the opportunity to meet and network with other professionals in their provinces. Through its comprehensive Continuing Professional Development (CPD) system, ADSA supports dietitians in meeting their mandatory on-going learning, which is essential to maintain their registration status with the Health Professions Council of South Africa (HPCSA). Visit: http://www.adsa.org.za