coeliac watch into research
Calling on GP
by Dr Amelia A Lake,
targets to
Senior Lecturer in Food &
Nutrition, Applied Biosciences,
diagnose
School of Applied Sciences
Coeliac
Dr Amelia A Lake trained as a dietitian and worked in the NHS before taking
disease
up a research post with Newcastle University where she completed a PhD and
held a National Institute for Health Research Postdoctoral Fellowship on the
theme of Obesogenic Environments. Amelia is currently a Senior Lecturer in Food
and Nutrition at Northumbria University and her research interests include the
Currently, one in 100 obesogenic environment, the workplace, food environments and food choice.
people in the UK has co-
eliac disease but only one
All Change
in eight, or 12.5 percent,
of these has been diag-
Change is a topic which seems to feature a rather lot in
nosed. There is no cure or
my vocabulary and my research; for example dietary
medication for coeliac
change, longitudinal change, change in food availability,
disease and the only
change in food environments, change in habits follow-
Dr Chris Steele MBE hands in a
treatment is a life-long,
ing cohabitation... However, this month for me there has
petition on coeliac disease to
strict gluten-free diet.
been a non-dietary change. I have moved from my post
10 Downing Street
Without a gluten-free diet,
at Newcastle University to take up a Senior Lectureship in
coeliac disease can lead to infertility, multiple miscarriages,
Food and Nutrition at Northumbria University. Therefore,
osteoporosis and bowel cancer.
rather than my usual focus on individuals’ changes in
Currently GPs do not have a target in their contract to behaviours, I have been tackling changes in offices, IT sys-
diagnose coeliac disease. By including a target into the QOF, tems, acronyms and all that goes with moving institution!
GPs would have to deliver better diagnosis rates of coeliac Change is a critical element of our work as dietitians. In
disease. This would reduce the number of people at risk of se- practice we are frequently trying to change everyday behav-
rious long-term health problems and help find the missing half iours, to suggest changes in lifestyle, shopping patterns, eating
a million people who have coeliac disease but don't know it. behaviours, etc. This change can be at a range of different
Dr Chris Steele MBE and resident doctor on ITV’s This Morn- levels. From focusing on an individual, their family, or trying to
ing has been Ambassador of the charity, Coeliac UK, for the change food availability and accessibility at an environment
past three years. Ironically, in January 2010, Dr Steele an- level – for example changes in school meals or in workplaces,
nounced live on ITV’s This Morning that he had been tested or even the example of changing foods available in shops
and subsequently diagnosed with coeliac disease. (an example of this is the Change for Life convenience store
At the beginning of February, Dr Steele handed in a peti- project). In terms of product development and food produc-
tion to 10 Downing Street, calling on the Government to help tion, change is always on the horizon. However, how easy is it
improve the diagnosis of this debilitating disease. The petition, to change behaviours and taste preferences? The difficulty of
signed by 8,783 people, is asking the Government to find the change is an issue dietitians are familiar with.
500,000 people in the UK who are at risk of serious of damage
to their health from undiagnosed coeliac disease by intro- Foodscape change
ducing a target for diagnosis of the disease in the Quality and Exploring how a change in food availability and acces-
Outcomes Framework (QOF) of the GP contract. sibility can influence wider behaviours is a fascinating topic.
“I have supported the need to raise awareness of diag- I recently went back to a workplace where, as part of an
nosing coeliac disease for many years but never thought intervention, we had been giving free fruit to employees for
that I would be diagnosed myself!’ said Dr Steele. “It is a a period of nearly six months. It is interesting to note how by
condition often overlooked and misdiagnosed by GPs, changing the office environment through the provision of free
which has resulted in half a million people in the UK currently fruit was a trigger for other health behaviours. At a broader
undiagnosed. Consequently, people can suffer unnecessar- level, the accessibility and availability of food is seen as an
ily for many years which can also lead to an increase risk of important factor in influencing food choice. We know that
osteoporosis and bowel cancer. in the UK the foodscape has changed dramatically over
“There is also the possible increase cost to the NHS 20 years and that, alongside this change, there has been a
caused through undiagnosis, by ongoing repeat visits by rapid increase in rates of overweight and obesity (1). Howev-
patients to their GP,” he added. “We also know of people er exploring how this change influences individual behaviours
having unnecessary operations such as gall bladder remov- is a challenge.
al when a simple blood test could start the road to diagno- In order to develop effective interventions to enable
sis; so I urge the Government to include a target for coeliac individuals to change their behaviours and to sustain the
disease into the Quality and Outcomes Framework.” changes they make, we need to understand dietary change,
The symptoms of coeliac disease range from the mild to the and factors influencing dietary change, both at individual
severe and vary between individuals. Symptoms include abdom- and environmental levels.
inal pain, nausea, constipation, diarrhoea, tiredness, anaemia, For me, the boxes are now un-packed and the recent
headaches, mouth ulcers, weight loss – but not in all cases, skin change will soon become my regular routine. Then I can go
problems, depression, joint or bone pain and nerve problems. back to my normal activity and research focus of trying to
The NICE guidelines on the diagnosis of coeliac disease understand processes of change.
were published in May 2009. For more information go to
1 Burgoine T, Lake AA, Stamp E, Alvanides S, Mathers JC, Adamson AJ. Changing food-
www.coeliac.org.uk/niceguidelines scapes 1980-2000, using the ASH30 Study. Appetite. 2009;53(2):157-65
NHDmag.com Mar '10 - issue 52 33
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