Do AHPs find it hard to swallow?

Joyce Thompson
Dietetic Consultant in Public Health Nutrition
NHS Tayside
Joycethompson@nhs.net

I can appreciate that you may well be thinking you are about to read something on dysphagia which is undoubtedly a very important clinical issue. But no that’s not today’s topic. Instead I want to draw your attention to an increasing irony which stems from the highly successful food and drinks industry. Whilst the industry seemingly counts on people’s ignorance to actively push waistline-busting, high fat, high sugar and nutrient poor drinks and snacks on them, what is getting harder to swallow is our own ‘do as I say not as I do’ approach!
But before you raise your hackles and fast forward to the ‘reply’ button (and please do because I really want to know what you think) let me expand on this seemingly contentious statement and centre on the fact that the majority of registered AHPs work for public sector organisations.

It remains shocking but not necessarily newsworthy anymore that the majority of the UK population is overweight or obese – six out of ten of us by the way – and the prevalence of nutrition-related disease such as cardiovascular disease, type 2 diabetes, and some cancers, remains high and potentially preventable. But being able to make appropriate lifestyle choices (I am talking about what we eat and drink and, how active or sedentary we choose to be), is definitely not easy in today’s obesogenic environment. And whilst we may quibble about whether or not the NHS is the best place to tackle obesity, what is certain is that solutions to the problem must go beyond blaming the individuals struggling with this condition. So in this blog I am focusing on the AHP work place.

We know that the work place has great potential as a setting for improving the health of the population. For many AHPs the work place is an NHS setting such as a hospital. In the context of retail facilities within the NHS, there is a great opportunity to influence the behaviours of staff, patients and the public because of the ease of constant access to a large number of people, many of whom already suffer from overweight or obesity and long term nutrition-related diseases or, are at risk for such adverse health effects. This can be positive or negative. Unfortunately the current business model appears to be the latter. It is aimed at achieving maximum profit and the reality is that we see an excess of undesirable high fat, high sugar items which are heavily marketed to vulnerable patients, visitors and staff. I fear that there are many examples throughout the UK to illustrate the point where fast food, coffee shop and confectionery chain outlets are located on NHS premises, along with their aggressive sales tactics pushing less healthy products down our throats. But perhaps there are also examples to the contrary where healthier choices are actively marketed and high fat, high sugar items are not marketed. Please let me know either way. Are there other business models that might be operating? Are there examples of good practice in retailing and specifically examples of what happens in other countries? Is there a social enterprise retail model that might be an exemplar for use in the NHS? Has anyone made a case about vulnerability and excess diet-related health in more disadvantaged groups in NHS premises? And on a wider lens how can the synergies between nutritional adequacy, environmental sustainability and economic goals balance within this context?
And what about our own professional practice within the work place? It is widely recognised that our health and social care systems are unsustainable without radical transformation and that we must work more upstream to prevent problems arising rather than concentrating solely on trying to fix them. Linda Hindle, Lead AHP at Public Health England said that AHPs ‘must take every opportunity to create the environment, conditions, information and support to help individuals and communities change their behaviour to enjoy better health and wellbeing’. Yup – as registered healthcare professionals, AHPs can help achieve this transformation! But there is no silver bullet solution and it’s a combination of actions that are needed. For example AHPs can make every patient contact count by being able to:

• Raise the issue of lifestyle.
• Share some practical key messages about food, nutrition and physical activity.
• Sign post to different support services such as weight management and physical activity opportunities.

Plus, we’ve all heard the old adage ‘do as I say and not as I do’. AHPs are often viewed by the general public as role models for health and promoting healthy lifestyles should play a key role in our own professional practice ………but we don’t always practice what we preach do we? For example have a think about the following suggestions:

• Meetings and hospitalities – include fruit and not just biscuits (better still do without the biscuits!)
• Working lunches – arrange for ‘healthier options’ such as pulse based soups, sandwiches with low fat fillings and fruit, and avoid the fatty sausage rolls and ‘deep fried’ nibbles.
• Conferences & training sessions – ask for the above (there is usually a dietary needs box which you can use) and provide feedback on the food and drinks provision (positive or otherwise) on the evaluation.
• Celebrations and gifts for teams – a fruit basket is much better that than tins of chocolate sweeties!

What more can AHPs do to change the reality under our work place noses of, an excess of undesirable high fat, high sugar items being heavily marketed, promoted and/or offered to vulnerable patients, visitors and staff? Answers on a postcard please.

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