THIS PAGE IS UNDER CONSTRUCTION

Specialist Dietetic Services: Adult Dietetics

Inclusion criteria:

Urgent (to be seen within 8-12 weeks)

• Patients who are malnourished / at risk of malnutrition
• Eating disorder BMI <25kg/m2
• Post-operative dysphagia (e.g. liquid diet only)
• Newly diagnosed type 1 diabetes
• Liver disease with ascites and/or malnutrition /weight loss
• NASH (with cirrhosis)
• Pancreatic enzyme insufficiency, malabsorption

Routine (to be seen within 18 weeks) 

• PCOS
• Obesity where first line treatment has been unsuccessful – BMI > 30 to 40 with co-morbidities (Patients with severe / complex obesity, refer to Specialist Weight Management Service at UHCW)
• Known food allergy / intolerance to ensure adequate nutritional intake
• Chronic Fatigue Syndrome
• NASH (nil Cirrhosis)
• Hyperthyroidism / Hypothyroidism
• Low Salicylate diet
• GORD
• Hyperlipidaemia if needing more dietary information, if underweight or obese (for first line dietary advice see BDA foodfacts hearthealth
• Dietary related nutritional deficiencies & malnutrition
• Diverticular disease
• Dysphagia for texture modification advice
• Type 2 diabetes not wishing / not appropriate to attend DESMOND. This includes under 18, not able to understand enough English for group education, deaf but unable to lip read
• Diabetes poorly controlled (HbA1c >58mmol/l) and related to diet
• Type 1 diabetic for carbohydrate counting review / change to basal bolus regimen or declined attendance at CARBS-4-1 programme
• Patients starting on GLP-1 for dietary review
• Inflammatory bowel disease for advice on dietary management of symptoms or nutritional support (Irritable Bowel Syndrome where one to one counselling is required. Offer first line advice from BDA foodfacts IBS before referral)
• Bile Acid Malabsorption/Diarrhoea
• Pancreatitis
• Dietary advice for patients with ileostomies and colostomies
• (Patients with intestinal failure should be referred to Dr Nicola Burch)

Procedures & Treatments

• Nutritional Assessment
• Nutritional and dietetic advice
• Eating behaviour modification
• Dietary counselling

Exclusion criteria:

• Children under 16 years old
• Patients not requiring dietary advice
• Patients newly diagnosed with Type 2 Diabetes will be invited to the DESMOND programme for dietetic advice.
• Confirmed coeliac disease on diagnosis and for annual reviews (Gluten free diet should not be commenced until diagnosis confirmed by biopsy). These patients should be referred to the Dietitians at UHCW Coeliac Clinic.
• Referrals for IBS where coeliac disease has not been excluded will be rejected (NICE CG61)
• Referrals for altered bowel habit

Pre-referral Requirements:

• Weight
• BMI
• Weight History
• Past Medical History
• Presenting Complaint
• Full list of medication
• Relevant scans/investigations performed
• Relevant blood results
• Any safeguarding issues
• Can the patient attend clinics
• Transport required
• Interpreter (and which language)
• Any other special requirements?

If the patient would like a text reminder please remember to update the patient contact details with their mobile number.

Consider further advice using the advice and guidance facility.

When considering referral, priority should be given to patients with a new diagnosis, previous dietetic advice, motivation to make lifestyle changes

Alternative referral services:

• Paediatric Dietetics service for under 16 year olds
• Adult Specialist Weight Management

 

About Specialist Adult Dietetic Service

Adult Dietetics (Gastroenterology)

Inclusion criteria:

Urgent (to be seen with 8 weeks)

• Liver disease with ascites and/or malnutrition /weight loss
• NASH (with cirrhosis)
• Pancreatic enzyme insufficiency, malabsorption

Routine (to be seen within 18 weeks)

• Inflammatory bowel disease (e.g. Crohn’s disease, Ulcerative Colitis) requiring advice on dietary management of symptoms or nutritional advice to achieve ideal weight
• Irritable Bowel Syndrome where one to one counselling is required (majority of IBS patients can be seen through group sessions – refer to the Dietitians at UH for FODMAP clinic). Consider first line advice from BDA foodfacts IBS prior to dietetic referral.
• Bile Acid Malabsorption/Diarrhoea
• Pancreatitis disease
• Dietary advice for patients with ileostomies and colostomies (Please note: patients with intestinal failure should be referred to specialist MDT clinic with Dr Burch)

Procedures & treatments:

• Nutritional Assessment
• Nutritional and dietetic advice
• Dietary counselling

Exclusion criteria:

• Children under 16 years old
• Patients not requiring dietary advice
• Diabetes as the main reason for referral – refer to Dietitians working within the Community Diabetes Service based at Newfield House.
• Patients newly diagnosed with Type 2 Diabetes will be invited to the DESMOND programme for dietary advice.
• Patients with fatty liver disease requiring advice for weight loss should be referred to the Adult General Dietetics clinics
• Confirmed coeliac disease on diagnosis and for annual reviews (Gluten free diet should not be commenced until diagnosis confirmed by biopsy). These patients should be referred to the Dietitians at UH for the coeliac clinic.
• Referrals for IBS where coeliac disease has not been excluded will be rejected (NICE CG61)
• Patients who can be seen within Adult General Dietetics clinics and do not meet the above criteria.
• Referrals for altered bowel habit

Pre-referral requirements:

• Weight
• BMI
• Weight History
• Past Medical History
• Presenting Complaint
• Full list of medication
• Relevant scans/investigations performed
• Relevant blood results
• Any safeguarding issues
• Can the patient attend clinics at UHCW?
• Transport required
• Interpreter (and which language)
• Any other special requirements?

If the patient would like a text reminder please remember to update the patient contact details with their mobile number.

Alternative referral services:

• Paediatric Dietetics service for under 16 year olds
• Adult General Dietetics for non-gastroenterology specific patients.
• Adult Specialist Dietetics for more complex patients
• Adult Diabetes for diabetes patients
• Specialist Weight Management

Bariatric Surgery: Adult Specialist Weight Management Dietetics 

Inclusion criteria:

• General adult patients with a BMI >35 with co-morbidities or >40 without.
• South Asian patients can be referred with a BMI > 35 without co-morbidities.
• Infertility and PCOS that fits in with the above two criteria.

Urgent (to be seen by dietician within 4 weeks) following bariatric surgery:

• Acid Reflux
• Night time cough
• Recurrent Chest Infections
• Regurgitation

Routine: (to be seen within 18 weeks) – referred to Dr Barber’s clinic Diabetes and Endocrinology)

• General adult patients with a BMI >35 with co-morbidities or >40 without.
• South Asian patients can be referred with a BMI equal to or greater than 35 without co-morbidities.

Routine Dietetic referral only (Patients who have previously had bariatric surgery):

• • Nutritional deficiencies
  • Poor weight loss
  • Symptomatic – dumping syndrome

Procedures & Treatments

• Nutritional Assessment
• Nutritional and dietetic advice
• Eating behaviour modification
• Dietary counselling

Exclusion criteria:

• Children under 16
• Patients with a BMI <35

Pre-referral Requirements

• HbA1c
• Fasting Glucose
• U&E’s
• Lipid Profile, TFT’s, LFT’s within last 2 months
• Weight
• BMI
• Weight History
• Past Medical History
• Presenting Complaint
• Full list of medication including any insulin doses
• Relevant scans/investigations performed
• Relevant blood results
• Any safeguarding issues
• Can the patient attend clinics?
• Transport needed
• Interpreter (and which language)
• Any other special requirements?

If the patient would like a text reminder please remember to update the patient contact details with their mobile number

Consider further advice using the advice and guidance facility.

When considering referral, priority should be given to patients with a new diagnosis, previous dietetic advice, motivation to make lifestyle changes

Alternative Referral Services:

• Paediatric Dietetics service for under 16 year olds
• Adult Dietetics Service.

Specialist Weight Management Service before surgery

Information for people thinking of having laparoscopic weight loss surgery

Diabetes

Adult Dietetics Clinic (Diabetes)

Inclusion criteria:

• Newly diagnosed type 1 diabetes (Urgent to be seen within 4 weeks)
• Type 2 diabetes not wishing to attend/not appropriate to attend DESMOND. This includes under 18, not able to understand enough English for group education, deaf but unable to lip read (Routine to be seen within 18 weeks)
• Diabetes not adequately controlled (HbA1c >58mmol/l) and related to diet
• Type 1 diabetic requiring carbohydrate counting review or change to basal bolus regimen or declined attendance at carbs for 1.
• Individuals’ commencing on GLP-1 and requiring dietary review.

Procedures & Treatments:

• Nutritional Assessment
• Nutritional and dietetic advice
• Eating behaviour modification
• Dietary counselling

Exclusion criteria:

• Children under 16 years old
• Patients not requiring diabetes dietary advice
• Patients newly diagnosed with Type II Diabetes will be invited to the DESMOND programme, where they will receive dietetic advice.

Pre-referral Requirements

• Weight
• BMI
• Weight History
• Past Medical History
• Presenting Complaint
• Full list of medication
• Relevant scans/investigations performed
• Relevant blood results
• Safeguarding issues
• Can the patient attend clinics?
• Transport needed?
• Interpreter (and which language)
• Any other special requirements?

If the patient would like a text reminder please remember to update the patient contact details with their mobile number.

Consider further advice using the advice and guidance facility.

When referring to dietician, priority should be given to patients with a new diagnosis, considering previous dietetic advice, and motivation to make lifestyle changes.

Alternative referral services:

• Paediatric Dietetics service for under 16 year olds
• Adult Gastroenterology clinic
• Adult Specialist Dietetics for more complex patients
• Adult General Dietetics Service
• Specialist Weight Management

Carbs-4-1 Type 1 Diabetes Education

Diabetes: how to take control UHCW leaflet

Healthy Eating With Diabetes (Type 1&2) UHCW leaflet

Type 1 Referral For Dietetic Advice

Newly diagnosed patients (within a year of diagnosis) will be invited to attend Step by Step.

To be eligible for the CARBS 4-1 course, patients must manage their Type 1 diabetes using a basal-bolus regime (2 different insulins, at least 4 injections a day).

The team will need to assess patients with learning difficulties and mental health issues before accepting them on the course.

Type 1 Referral Form

Renal Dietician

Renal dietician Leaflet

Coventry MacMillan Dietician

Coventry MacMillan Dietician