How does a dietitian advise the calorie targets and macro targets?
It is true that there are circumstances where a dietitian would be prescribing a specific energy target however, a lot of the time it is not necessary for clients to count calories/kilojoules or macros.
For many years, diet companies have been advertising caloric targets as the key to weight loss, however, in practice there is no “magic number”.
Conceptually, decreasing energy in via the diet, and increasing energy out via physical activity should lead to weight loss, but there are many other factors which impact our overall health and body composition for example:
- Disease states (also known as injury factors)
- Sleep quality
- Hormones such as insulin
- Activity factors (also known as metabolic rate)
A dietitian differs from a nutritionist as they are able to make evidence-based recommendations which consider these factors.
In most cases, a quality approach to nutrition is most likely to achieve long-lasting results than quantity focus.
Does gender, age, race, medical history change targets drastically?
Gender, age, ethnicity and medical history are among many factors a dietitian will consider as part of the assessment, monitoring and evaluation.
For example, if you were to refer to the Australian Guide to Healthy Eating you can see there are different dietary targets for women compared with men, and also these change from children to adults, and older Australians.
There are equations for working out a person’s nutritional requirements which require data such as weight, height, age and gender.
These equations come from large population studies and are widely used by health professionals to determine requirements.
- Example: Estimated Energy Requirements (EERs) are calculated using Basal Metabolic Rate (BMR) predicted from weight, height and age. The height and/or weight to age ratio may differ markedly in some ethnic groups. In this case, if BMI is in the acceptable range, it would be more relevant to use body weight as the main guide to current energy needs.
For babies and children, we use growth charts to track development over-time. Some parents may be familiar with their Paediatrics/GP/Allied Health talking about the percentile their child’s development falls in.
All parents of children born in NSW receive a free copy of My Personal Health Record (the Blue Book).
This book helps collect this data from birth to early school years. It is a place to record the child’s health, growth, development, illnesses, injuries and immunisations.
During childhood, children tend to vary their food intake (spontaneously) to match their growth patterns. Children’s food needs vary widely, depending on their growth and their level of physical activity.
Like energy needs, a child’s needs for protein, vitamins and minerals increase with age.
Ideally, children should be accumulating stores of nutrients in preparation for the rapid growth spurt experienced during adolescence. Appropriate weight gain and development will indicate whether food intake is appropriate.
Food-related problems Community Therapy might see in young children include “fussy eating”, overweight/obesity, tooth decay and food sensitivities.
Women may face additional hormonal challenges, when compared with men, due to the onset of menstruation, during pregnancy and later in life during menopause.
These changes may require dietary considerations or change to account for additional nutrient requirements.
As our nutritional needs change with different life stages, to remain fit and healthy, it is important to take into account the extra demands placed on your body by these changes.
When it comes to aging, many people eat less as they get older – this can make it harder to make sure your diet has enough variety to include all the nutrition you need.
Additionally, when making dietary recommendations, there are always social and cultural considerations.
Dietary strategies should ideally be practical and tailored to the individual.
There are some health conditions which are more prevalent in individuals from certain ethnic backgrounds. Targets for these are individual specific.
What should I know about label reading?
The Nutrition Information Panel on a food label offers the simplest and easiest way to choose foods with less saturated fat, salt (sodium), added sugars and kilojoules, and more fibre. It can also be used to decide how large one serve of a food group choice or discretionary food would be and whether it’s worth the kilojoules.
As a dietitian we provide clients with education on food groups to help them when they are deciding:
- Whether a food belongs in the five food groups (Grains, Dairy, Meat/Alternative, Fruit or Veg) and is an ‘everyday’ food for eating regularly
- Or a discretionary food best-eaten only sometimes or in small amounts.
We can also help the community to understand The Health Star Rating (HSR) system, which is a front-of-pack labelling scheme developed for use in Australia and New Zealand
HSR aims to ‘provide convenient, relevant and readily understood nutrition information and/or guidance on food packs to assist consumers to make informed food purchases and healthier eating choices’.
The health star rating has a few limitations, as does standard label reading, but understanding these can help people make more informed choices.
A dietitian can also help clients to make sense of nutrition content claims OR health claims and the link a food, nutrient or substance in a food has to the proposed health effect.
Low intakes of protein have been investigated in relation to impaired immune function and growth, as well as to low birth weight.
High protein intakes have been assessed in relation to a number of chronic diseases including cancer, renal disease, obesity, coronary artery disease and osteoporosis.
Speaking to a dietitian can help you to understand the weight of evidence for these claims, and help to make choices about your own health or health risk.
Community Therapy suggests that most people recognise that a high sugar diet is not a healthy diet, but sugar, in general, does have a place within a healthy diet.
For example, the sugars found naturally in certain foods, particularly in fruit and carbohydrate-based foods help to give us energy.
Salt is a very large topic as salt plays many roles in the body.
Briefly, sodium is the primary cation in human extracellular fluid. It has an essential role in the maintenance of key physiological activities such as extracellular fluid volume and cellular membrane potential.
Sodium balance is maintained through a range of physiological systems and hormones. In the absence of a situation where excessive sweating may be occurring, urinary sodium excretion in humans is approximately equivalent to intake. Thus urinary sodium excretion is often used as a biomarker of intake.
There is convincing evidence that as sodium intake increases, blood pressure increases.
Indeed, Australia and New Zealand have pursued public health policy initiatives to reduce intakes of sodium because most people consume excessive amounts.
A desirable target for the population (SDT) falls within a diet that meets nutritional requirements whilst reducing current excess sodium intakes. The SDT also takes into account the current food supply.
Product ‘best-by’ dates
In addition to information about the nutritional content of foods, packaged food should be dated in some way. For example:
- Best before
- Used by
- Packaged on
Date marks give a guide to how long food can be kept before it begins to deteriorate or may become unsafe to eat.
The food supplier is responsible for placing a use by or best before date on food.
Foods that must be eaten before a certain time for health or safety reasons should be marked with a use-by date. Foods should not be eaten after the use-by date and can’t legally be sold after this date because they may pose a health or safety risk. Most foods have a best before date.
You can still eat foods for a while after the best before date as they should be safe but they may have lost some quality.
Foods that have a best before date can legally be sold after that date provided the food is fit for human consumption.
The only food that should have a different date mark on it is bread, which can be labelled with a baked-on or baked for date if its shelf life is less than seven days.
Foods that have a shelf life of 2 years or longer, e.g. some canned foods, do not need to be labelled with a best before date. This is because it is difficult to give the consumer an accurate guide as to how long these foods will keep, as they may retain their quality for many years and are likely to be consumed well before they spoil.
If specific storage conditions are required in order for a product to keep until its best before or use by date, suppliers must include this information on the label, e.g. ‘This yoghurt should be kept refrigerated’. You should also follow any directions for use or cooking instructions that the supplier has put on the label.
Ready to work with Community Therapy?
We hope this article has provided useful information surrounding ideal breakdowns for weight loss and weight gain. If you would like further help from our Dietetics team, please get in touch.
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