ABSTRACT
COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.
ABSTRACT
COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial.
ABSTRACT
Promoting good nutrition is essential to tackle current and emergent health crisis. For instance, non-communicable diseases (NCDs) are responsible for about 70% of deaths globally, with high intake of sodium, red meat, refined sugars and/or ultra-processed foods and low intake of whole grains, legumes and fruits raking among the top dietary risks for NCDs related deaths. Diet also play an important role in emergent health crises, as illustrated during the Covid-19 pandemic, where those who are malnourished and/or present underlying NCDs have more severe and deadly outcomes. Despite that, limited progress is being made toward the United Nations Sustainable Development Goals (SDGs) on malnutrition and NCDs.Nutrition is linked with other modifiable risk factors for chronic diseases such as physical activity, sleep, mental well-being, substance abuse (e.g., alcohol and smoking) and environmental factors. The complexity of foods and their constituents and the multitude of factors involved in the aetiology of NCDs make dissecting the relative contribution of risk factors and interventions on disease onset and progression a challenging task. Understanding the interrelation between traditional risk factors that are established already and lifestyle risk factors will allow us to offer a more holistic approach to human well-being. Rigorous and innovative research that harnesses the power of large datasets and multiple research methods is needed to support the development of coherent theories in nutrition and risk identification and management. It is also necessary to connect this innovative research with the complex needs of individuals and systems. For example, the Covid-19 pandemic has exacerbated food insecurity (i.e., not being able to access foods that are safe and nutritionally appropriate for one’s health) in multiple ways, including disruptions at the system level, such as interruptions and delays across food chains and increased food prices or individual level, including job losses and lack of access to food. In the UK, research has shown that ethnic minorities groups, those limited by health problems/disabilities, food sector workers and households with children were at increased risk of experiencing food insecurity. In some parts of Africa, conflicts, displacements, and droughts are additional factors contributing to the high prevalence of food insecurity, further exacerbated during the Covid-19 pandemic. The idea that ‘Nobody ever just needs food’ highlights that addressing food insecurity and malnutrition requires multisectoral solutions to resolve underlying causes of the problem.Public and private sectors play an important role in addressing the burden of malnutrition but goals and responsibilities must be transparent, focused on public benefit, and collaborative. Systems-based approaches where nutrition and health are prioritized should be also employed. While changes in systems, policies and services can be triggered by community demand and advocacy, education and training are necessary to promote capacity for change and sustained impact. Quality data on food, nutrition and health can support this behavioural shift through the identification of problems and gaps. There is a need to establish a data foundation which enables the development of a science-based approach upon which statistically backed actions can be derived. This is particularly difficult with nutrition where much is dependent on observational data and longitudinal cohorts are scarce. Advancing our knowledge through research partnerships and data sharing will allow us to provide convincing evidence to policy makers as well as the public. Ultimately, improving data literacy among relevant stakeholders is also needed to enable accurate interpretation and relevant action. Advancing our knowledge through research partnerships and data sharing will allow us to provide convincing evidence to policymakers as well as patients. Programs such as the NNEdPro’s International Knowledge Application Network Hub in Nutrition (iKANN), can facilitate this collaboration, while also curating nutrition data, evidence and training resources.
ABSTRACT
BackgroundFollowing considerable interest in the relationship between obesity and COVID-19, the UK Government have released a policy paper: ‘Tackling obesity: empowering adults and children to live healthier lives’.1 This response may be focused on a limited and potentially historical view of overweight and obesity. We consider the complexity of the condition, its determinants, and co-existing conditions.2ObjectivesWe sought to gain consensus iteratively, using implementation framework thinking, to advocate for the appreciation of a wider, more complete understanding of the existing science behind obesity and the appropriate strategies needed to address it.ResultsWe identified four strategic points and provided recommendations for more comprehensive coverage and greater impact: 1. Improving focus and messaging 2. Understanding drivers of food choice and nutritional status 3. Promoting healthy eating from early years 4. Addressing the complexity of obesityDiscussion1. Effective messaging should be inclusive, collaborative and non-judgemental, promoting co-participation in the development of messages used in public national campaigns.3 2. Higher rates of obesity are observed in socioeconomically deprived groups who rely on food assistance programmes, in which nutritional quality could be improved through involvement of nutrition professionals.4 In order to influence behaviour, basic food literacy and financial management skills could be developed, while subsidies for healthier alternatives may complement taxes on less healthy foods.5 3. Advocating for better education on food science and nutrition from early learning sectors will promote increased awareness early in life.6 This could be augmented by reinstatement of initiatives like the healthy start programme. 4. Human health is multi-dimensional, therefore focussing on a single-metric risks oversimplifying this complexity and undervaluing the importance of healthy behaviours, even those not directly associated with weight.7 Instead, we should consider positive lifestyle habits, rather than a narrow focus on weight or BMI alone for the individual, informed by existing and accepted scientific findings.ConclusionAn integrated systems approach ought to be developed with a multipronged intervention strategy, targeting food production, supply and environments as well as marketing to improve availability of as well as accessibility to more nutrient-rich but less energy-dense foods. These combined with appropriate food education for consumers would enable more consistently healthy food choices.AcknowledgementsNNEdPro Virtual Core and Global Innovation Panel;Nutrition and COVID19 TaskforceReferencesUK Government - Tackling obesity: empowering adults and children to live healthier lives. July 2020.Foresight, Obesity Systems Map. 2007.Language Matters: Language and diabetes. 2018.Fallaize R, Newlove J, White A, Lovegrove JA. Nutritional adequacy and content of food bank parcels in Oxfordshire, UK: a comparative analysis of independent and organisational provision. J Hum Nutr Diet 2020;33:477–486. https://doi.org/10.1111/jhn.12740Garcia A, Reardon R, Hammond E, Parrett A, Gebbie-Diben A. Evaluation of the ‘eat better feel better’ cooking programme to tackle barriers to healthy eating. International Journal of Environmental Research and Public Health 2017;14(4):380. doi:10.3390/ijerph14040380Oostindjer M, Aschemann-Witzel J, Wang Q, Skuland S, Egelandsdal B, Amdam G, et al. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´s diet and food consumption? A cross-national comparative perspective. Critical Reviews In Food 2016.Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez M, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 2010;34(1):14–19. doi:10.2337/dc10-1288
ABSTRACT
The COVID-19 pandemic disrupted agri-food and health systems, increasing the risk of food insecurity, malnutrition, and related health problems. To develop a global pandemic impact picture around agri-food and health systems. Cross-sectional web-based survey with closed- and open-ended questions. Food, nutrition, and health researchers/practitioners from an international network were recruited as representatives of populations they serve. Two reminders to complete the survey were sent. Groups vulnerable to food insecurity and government actions were mapped, along with the impact of the pandemic on food production, distribution, and access, and offer of nutrition services. Descriptive statistics and content analysis summarized the data. Thirty individuals from Africa, America, Asia, Oceania, and Europe responded (11.85%). Most were from nutrition and dietetics (43.3%) or medicine (26.7%), working in research (50%) and with >10 years experience (62.1%). Informal/temporary workers (83.3%), older adults with chronic diseases (73.3%) and children eligible for school meals (53.3%) were found to be vulnerable to food insecurity. Commonly cited government actions were support for hand sanitation (53.3%), assistance to school-aged children (46.7%) and direct food provision (43.3%). About 50% saw community-led actions as important solutions. Only 16.7% mentioned remote delivery of nutrition services in primary care. Open-ended questions revealed that economic shocks, reduced investment, lack of staff/staff illnesses, transit restrictions, markets/stores closure or panic buying contributed to food production/distribution constraints. Reduced food availability, with unemployment/reduced purchasing power, increased food costs, lack of food security programmes or food emergency services contributed to food/nutrition insecurity. Nutrition services were reduced, suspended, or deprioritised. Several factors contributed to agri-food systems disruption and various government actions were implemented globally. Nutrition services offered in the healthcare context deserves further exploration. As the pandemic continue this provide a blueprint for a nutrition education/awareness programme to mitigate those risks based on knowledge gaps in policy and practice. NNEdPro Global Centre for Nutrition and Health. [ABSTRACT FROM AUTHOR] Copyright of Journal of Nutrition Education & Behavior is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
BACKGROUND: This paper describes the impact of COVID-19 during the first month of containment measures on organisations involved in the emergency food response in one region of the UK and the emerging nutrition insecurity. This is more than eradicating hunger but considers availability of support and health services and the availability of appropriate foods to meet individual requirements. In particular, this paper considers those in rural communities, from lower socioeconomic groups or underlying health conditions. METHODS: Semistructured professional conversations informed the development of a questionnaire which gathered insights from five organisations involved with the emergency food response in the South East, England, UK. Descriptive themes were derived though inductive analysis and are further discussed in relation to UK government food support measures and early published data. RESULTS: Four themes emerged from conversations, including: (1) increasing demand, (2) meeting the needs of specific groups, (3) awareness of food supply and value of supporting local and (4) concerns over sustainability. All organisations mentioned changes in practice and increased demand for emergency food solutions. Positive, rapid and innovative changes helped organisations to adapt to containment restrictions and to meet the needs of vulnerable people. Although concern was raised with regards to meeting the specific needs of those with underlying health conditions and the sustainability of current efforts. CONCLUSION: Considerable gaps in food provision were identified, as well as concerns regarding increased long-term food and nutrition insecurity. The paper makes recommendations to improve nutrition security for the future and considers the lessons learnt from the COVID-19 pandemic. The generalisability of these early insights is unknown but these real-time snapshops can help to direct further research and evaluation.