60 second interview: Caroline Dakers

Caroline Dakers, a specialist dietitian in the weight management team at NHS Lothian, recently took on the role of dietetic team lead for our child healthy weight programmes in the Borders and Lothian. Building on the work of the strategic service leads in each area, Caroline seeks to further enhance connectivity and shared learning across the region – ensuring services are shaped around the needs of local families and meet the national standards. Caroline tells us why she’s more than up for the challenge and what she hopes the year ahead will hold as she works towards these aims.

 

1. Tell us about your dietetics experience and why you’re passionate about supporting families to lead a healthy lifestyle…

I graduated in dietetics from Robert Gordon University in 2009 and was very fortunate to go straight into a job in the NHS. Originally I was down in NHS Middlesbrough, Redcar and Cleveland, and then moved up to NHS Tayside to work in child healthy weight and adult weight management. I took a brief year out in 2017 to go and work as a dietitian in Bermuda (which has the second highest obesity rates in the world) for a year – coming back to join the team at NHS Lothian. This has given me a wealth of experience. I remember when I first applied to be a dietitian and my grandpa asked me why I wanted to be a dietitian. My very simple answer at the time was: ‘well everyone has to eat!’ But this still rings true today. Maintaining a healthy lifestyle is very challenging and there’s so many barriers to doing so – particularly considering the environment that we now live in. So being able to help navigate someone through that minefield is really important and if we can support children and young people to adopt a healthy lifestyle from an early age then I think that’s really rewarding. This support can hopefully then help them to go on to reduce their risk of developing conditions like type 2 diabetes and other health conditions later in life.

 

2. How have you and the team at NHS Lothian been supporting patients throughout Covid-19? And what has been their feedback?

Get Going, our group healthy lifestyle programme for young people and their families, has unfortunately been on pause as a result of Covid-19. We have however continued to support families through one-to-one virtual sessions. This has of course brought with it many challenges, but also a number of positives. I wanted to share some feedback from one of the families I’ve been supporting in Lothian, to help shed some light on what participating in the programme online has been like throughout the pandemic:

Participating in the programme online:

“The support we’ve received so far from the team at NHS Lothian has been very helpful. Due to the pandemic, all appointments have taken place via video call which has actually been a really positive experience. In some cases we’ve found that taking part online has made things a lot easier. We even dialled into one appointment from our car as couldn’t get home in time! Our teenage daughter has engaged more with the online sessions and felt less stressed by the idea. Caroline has also been fantastic and connected with our daughter straight away.”

Challenges:

“We experienced some initial challenges trying to support our daughter to understand the importance of the guidance we’re giving her and how it will improve her health and wellbeing. This has been particularly critical throughout Covid-19 as she’s no longer walking to and from school every day, participating in activities with friends or getting the same amount of exercise. The materials Caroline and the team have provided us with really help to show our daughter that our guidance (e.g. screen time limits, going to bed reasonable, drinking lots of water, reading before bed and exercising daily) is not just something we’ve come up with to punish her but the advice of professionals. And for her own benefit.”

Benefits:

“Caroline and our daughter worked on ways forward including a sleep plan, exercise routine, healthy eating, relaxation techniques and most importantly – how certain foods and activities (or lack of) affect how she feels. Our daughter then recognised and admitted that certain things do have an impact on her mood and has started to make some changes or agree to trial them until her next review. This has been a great turning point.”

“The support and backup from a healthcare professional has made the most difference to us as parents. We are now on the same page as our daughter and able to work together as a family. Having regular check-ups has really helped to motivate our daughter too – as she puts the effort in ahead of a call.”

Impact on family’s life to date:

“The programme has had a hugely positive impact on us as a family. It’s particularly helped me (mum) to manage portion sizes and persist gently with trying to sneak more vegetables, fruit and salad in to our meals. Whilst our daughter doesn’t eat everything, she has generally kept on board with the guidance provided by Caroline – and we are definitely seeing some positive changes.”

 

3. Why were you interested in supporting the dietetics teams to deliver enhanced child healthy weight services in the Borders and Lothian?

Moving into this role was a natural progression for me as I’ve been developing lots within my NHS Lothian role already. It’s a real opportunity for me and the local teams to share all of our knowledge and experience. I’ve worked in the child healthy weight service at NHS Tayside and NHS Lothian, so I’m really fortunate to have lots of child healthy weight experience already. I wanted to take some of that learning to the Borders to help them to consolidate all of their hard work to date and develop a specialist child healthy weight service. It’s going to be a real challenge; a real experience – but I’m looking forward to the year ahead and continuing to work together in new ways. I’m under no illusion that it is going to be easy but like a challenge and have already had colleagues rooting for me across the region. It will be interesting to see the overlap in services but also find opportunities to learn from each other where we’re doing things differently. What works in Lothian may not work in the Borders, and vice versa, so making sure we localise services where appropriate is key – whilst capitalising on our regional approach.

 

4. What do you hope to achieve in this role over the next year?

Over the next year I plan to continue developing the Lothian service, measuring this against our gap analysis. Looking at where we can improve things, reduce health inequalities and make the service more accessible. In the Borders, it’s very much getting my feet under the table – understanding what’s in place, what needs to be put in place and the pathway in order to achieve that. So creating the Tier 3 service for children and young people from scratch – through the development of referral pathways and criteria, referral forms and creating new links. There’s already an established local partnership in the Borders so getting involved in this and understanding what the different professionals need from the service. I also want to look at the bigger picture to understand what the local population needs from a child healthy weight service. A lot to achieve – but I’m confident we can do it.

 

5. What do you see as the biggest a) barrier and b) opportunity to reducing childhood obesity levels across the East of Scotland? And in what ways has Covid-19 impacted this?

It’s a bit of a double edged sword. Engagement with families is really challenging. We’ve broken down some of those barriers by introducing Near Me options for virtual engagement rather than face-to-face. However we’re finding that our attendance rates for online sessions aren’t the best sometimes because there’s so much going on in people’s lives right now, particularly when schools have been closed. Families just don’t have the time or energy and sometimes forget about their appointments – particularly when they don’t have to physically come in to see us. Throughout lockdown, we know a lot of families have struggled with being at home. This has led to increased snacking and heightened anxiety levels, along with a little bit of comfort or emotional eating. And it’s had a big impact on our children as well. They’re missing out on that social interaction with their friends and learning that they would usually gain at school. They might sleep in a bit later, skip breakfast, lack motivation…and this can all have a huge impact on their health. An even bigger barriers is the obesogenic environment that we live in – where it is much easier to make unhealthy lifestyle choices than it is to make healthy ones. And that really comes down to this whole systems approach that we’re exploring – from political and social change, to including supermarkets and the role that all of us need to play. We can’t fault a family for making an unhealthy lifestyle or meal choice because it’s a cheaper way to feed their family. But we can try to work with organisations and supermarkets to better support families. Initiatives like the super six – offering quality, cheap fruit and veg or ‘wonky vegetables’– being rolled out by some budget supermarkets is really helpful. They’re trying to make healthy food more fun and engaging which is great. Some are even giving away free fruit to children so that they can munch on this as they walk around the supermarket with their parents. So there’s change coming and it seems like there’s change already happening – but it’s a real challenge in and something that we’ll need to dedicate even more time to advancing in light of the pandemic.

 

6. How do you feel working together as a region will help us to advance change?

Having that wider support system in place is really important and the shared learning that comes with this. So for instance Fife have implemented a great initiative, is that something that we could be doing in Borders or Lothian? We have a pretty well established service in Lothian – so can we share some of our documentation. Resources or learning from our programmes? That cross-network of learning across the region has been fantastic and will continue to support all of us. But I feel it goes wider than that. We’re also making contact with NHS Boards outside of the region, supporting each other to establish or enhance services. Since the national standards came into play and our partnership was created – there’s been a real commitment to working together regionally and nationally. Which I’m sure is here to stay.

 

7. What do you enjoy doing outside of work? 

I have a 15 month old Dalmatian, who is as cute and as much of a horror as she’s ever been. She’s full of mischief and lots of sass – keeping me on my toes. Over the last year I’ve been exploring different walks locally across West Lothian and also getting in to Edinburgh when restrictions have allowed. I’ve actually felt really lucky as I’m now very close to my mum and my sister – having moved away from them shortly after leaving school. Over the past year I’ve been taking care of myself, spending time with my family (where possible) and looking after my dog. In normal times I’m a huge fan of going out to meet friends, having a good laugh, going to the cinema and theatre. Lockdown has made me realise how much I’d taken all of this for granted and really brought home the importance of those connections. I’m definitely looking forward to enjoying this again now that restrictions are easing.

 

8. Tell us an interesting fact about yourself…

I’m British, but actually spent the first few years of my life abroad. I was born in Dubai, moved to the USA with my family and then back to Scotland when I was 3 years old.