Patricia Thompson | Good nutrition important to fight ailments
The threat of a second wave of COVID-19 has the nursing association worried about the shortage of hospital beds and the impending increased workload for their members. While the country is doing a great job of disseminating messages to the population regarding hygiene practices, many Jamaicans are still not compliant.
Many of COVID-19 patients who reach hospital are the elderly and those with nutrition-related chronic disorders (NCDs) such as obesity, diabetes, hypertension and others. Moreover, they also are likely to have extended hospital stays thus increasing the cost of care and a higher death rate, leaving families to mourn, along with facing great financial costs.
In a presentation by Dariush Mozaffarian at the virtual conference of the American Society for Nutrition (ASN) recently, indicated hospital statistics of persons most likely to reach hospital for the various NCDs are those with, among others, severe obesity, heart failure, type 2 diabetes and hypertension.
He suggested that it is time that nutrition intervention be recognised as the most effective means of prevention and treatment to reduce the cost of hospital care.
The most current overweight/obesity rate for Jamaicans was 60 per cent in females and 40 per cent in males. Most of the cases with diabetes are type 2 and this is conditioned by obesity. Jamaican data since the 1970s (Thorbourne, 1975) indicated that diabetes in obese patients could be controlled with diet alone (as the first line of therapy) and obviate the need for medication. This has had international corroboration time and again as well as for the other NCDs.
Also, medical therapy must be complemented with changes in diet and activity, to control these conditions optimally. Undoubtedly, making the lifestyle changes are not easy but will pay the most dividends. Doctors continue to prescribe medication as the first line of intervention because of the unavailability and inaccessibility of qualified dietitians and nutritionists in the hospitals and public health sector, respectively. The Government had responded by freezing the few available posts and not increasing professional posts for dietitians and nutritionists. Trinidad & Tobago has 37 senior dietitian posts within their public hospitals, giving a dietitian to patient ratio of 1:65.
At the Western Regional Hospital, the current ratio for such posts is one dietitian to 300-400 inpatients, and hundreds of outpatients and 500 beds at the Kingston Public Hospital.
While general messages are useful in making persons aware that nutrition intervention is important, this is often after they are already obese or have contracted an NCD. As the need increases, the graduates in dietetics and nutrition from our universities, like other health professionals, have resorted to migration or seeking employment in other spheres.
More government posts are urgently needed for dietitians and nutritionists to mount a suitable response in fully improving the quality of healthcare to the population. In addition, intervention must be continuous and progressive just like with any medical therapy since non-adherence (once the patient feels better) may result in relapse. Nutrition intervention must be personalised. In the same way that medication requires different doses of different types of medications taken at different frequency from one patient to another and with changes as time progresses, it is the same with diet.
When a suitable metabolic effect from food is desired, it is not enough to just cook nice-tasting meals. The diet must be tailored for different types and doses of medication, individual nutritional needs and preferences. Just imagine, 500 hospital patients as being the patrons sitting in a restaurant, requiring different amounts of salt, fat, calories all at the same time and within the menu options available.
Hospital caterers/contractors need the guidance of the personnel in the Department of Dietetics to ensure that each patient’s food prescription is individualised, just like nurses do for the medicine. There are different levels of dietetic personnel and different specialities to perform each of the specialised roles, just like the different levels of nurses and medical specialities in an institution.
If we do not manage the nutrition of our people in a more coordinated fashion, then obesity, NCDs and the COVID-19 pandemic will hit us severely.