Nutrition Professional of the Month: Dr Elizabeth Weekes

Dr Elizabeth Weekes is a Senior Consultant Dietitian at Guy’s and St Thomas’ NHS Foundation Trust and Honorary Lecturer in the Nutritional Sciences Division at King’s College London. More recently, she accepted a part-time Senior Clinical Lectureship at University College London Hospitals NHS Foundation Trust conducting her own research and supporting other allied healthcare professionals in launching their clinical academic careers. She was also the Lead of the PENG Nutritional Requirements Guideline Group. We caught up with her recently to find out more about how she has successfully combined a career in clinical dietetics with academia.

• Hi Liz, thanks for joining us. Please could you tell us a bit about yourself?

Before qualifying as a dietitian I completed an undergraduate degree in Anthropology at University College London. I then had a short career as a Personnel Manager in the NHS, based in the then East Anglian Regional Health Authority in Cambridge.

I’m the mother of two adult children, both of whom have recently flown the nest.  I am a keen outdoor swimmer and walker and I love adventurous holidays; in March I travelled around Iceland in a camper van with my partner.  I practice Iyengar yoga, love watching movies and am currently trying to reduce my carbon footprint by avoiding flights as much as possible (resulting in some VERY long bus and train journeys).

• Could you talk us through your career journey to date?

I qualified from Leeds Polytechnic with a Postgraduate Diploma in Dietetics more than 30 years ago.  I’ve worked in teaching hospitals throughout my career (Addenbrooke’s Hospital Cambridge, John Radcliffe Hospital Oxford, Royal Free Hospital London), and finally joined Guy’s & St Thomas’ NHS Foundation Trust (GSTT) on a three-month, part-time contract in 1996 – I am still here after more than 20 years.

I specialised in nutritional support early on in my career and have clinical and research experience in this area across all care settings. Early experience was gained in enteral and parenteral nutrition and ICU in acute care but more recently my focus has been on food-based and supportive interventions in the community.

I started my PhD studies after I’d been in clinical practice for nearly ten years, and I undertook two major projects; the design and validation of a nutrition screening tool (pre-MUST) and the evaluation of dietary counselling in people with chronic obstructive pulmonary disease (COPD).

Since completing my PhD I have led projects in a number of care settings aiming to improve the detection and management of malnutrition and have developed a number of new skills, e.g. Cochrane-trained systematic reviewer, guideline development and health economic analysis.

Professionally, I have been associated with the Parenteral and Enteral Nutrition Group (PENG) for most of my career including being a tutor and lecturer on the Clinical Update Course for more than 15 years and writing the requirements section of the Pocket Guide for the past 20 years.

I recently completed a four-year Clinical Lectureship funded by the National Institute for Healthcare Research (NIHR) where I lead a large, observational study designed to explore the impact of malnutrition on older people in the community.

• Did you always intend to combine your clinical career with academic research?

No, however, I always questioned my clinical practice and was constantly asking why we were doing things the way that we did.  As a Basic Grade (Band 5) dietitian, I was probably very annoying, however, I was lucky to gain research experience early in my career while I was working at Addenbrooke’s Hospital. I undertook two studies under the guidance of Prof Marinos Elia, measuring energy expenditure in patients who had suffered a brain injury or a stroke and setting up the first home delivery service for tube-fed patients.  This experience whetted my appetite for research and when, a few years later, a flyer advertising NHS funding for AHPs to undertake a PhD was brought to my attention by my manager at GSTT, I knew this was an opportunity not to be missed.

• What does a typical day of work involve?

I’m definitely not a lark so I’m not worth anything until I have had a substantial breakfast and my first cup of strong coffee.  I am currently undertaking data analysis for my observational study so much of my time is spent in front of a computer, however, this is interspersed with preparing and delivering lectures to undergraduates and postgraduates and with regular supervision of my PhD and Masters students.  I’m also travelling around the country quite a bit at the moment as we disseminate the new PENG Guidelines on estimating nutritional requirements.  Since I am currently spending so much time sitting down in my job, my day always ends with a long walk home.

• We understand that you were the Lead of the PENG Nutritional Requirements Guideline Group. Could you tell us what this role involved?

This project was funded by PENG and was undertaken using a formal guideline development process.  My role involved putting together a team, training and supporting the team, designing the research questions and leading on the conduct of the systematic reviews. We then pulled together the evidence and assessed the quality before making our recommendations.  The whole process took nearly two years.

I would like to thank Bruno Mafrici, Dr Clare Soulsby, Jo Cope and Danielle Judges for being such a great team to work with and also Dr Alison Culkin for her work on the fluid and electrolytes section and Dr Christine Baldwin for systematic review support.

• Could you talk us through some of the changes to the PENG Pocket Guide to Clinical Nutrition since the recent update?

The new recommendations are now based on clinical studies where resting energy expenditure (REE) was measured in patients with acute or chronic illness.  In the previous edition of the Pocket Guide we recommended a method that relies on data generated for use in healthy populations (i.e. Henry BMR prediction equations).

Instead of using the factorial method (estimating BMR using the Henry equation and adding factors for metabolic stress, physical activity and diet-induced thermogenesis), we now recommend dietitians base their estimates on energy values per kg body weight or per kg fat free mass (FFM), with the addition of a combined factor for diet-induced thermogenesis (DIT) and physical activity (PA) if appropriate.

We also updated the protein requirements section by undertaking a systematic review of clinical guidelines.

• How can dietitians stay updated with the latest changes to the PENG Nutritional Requirement Guidelines?

Members of the PENG Guideline Development Group have been doing (and will continue to offer) presentations and workshops at local study days at BDA branches, special interest group meetings and at universities across the UK.  We have also uploaded resources to the PENG website and have included worked examples in the Pocket Guide chapter.

• As part of your NIHR Clinical Lectureship, you are leading a large, observational study designed to explore the impact of malnutrition on older people in the community. Please could you tell us more?

The study (NUTRICOM) aims to find out how malnutrition impacts on community-dwelling older peoples’ use of health and social care resources and how it impacts on their quality of life and ability to perform everyday activities.  It also provides us with data on how malnutrition is currently detected and managed in the community, and by whom.

Data collection ended in April 2019 and we have data on 570 community-dwelling participants, each of whom was visited at home four times over a period of one year.  The data we have collected is now being used by my PhD student to inform the design of new nutritional interventions in falls services.

• What’s been the biggest challenge(s) you’ve faced throughout your dietetic career?

Throughout my career, maintaining a healthy work/life balance has always been a challenge.  With my feet in three camps (clinical, research and teaching), and with a tendency always to say “yes” when asked to contribute to or lead an exciting new project, this has been a constant issue.  I am lucky to have been supported throughout my career by my partner and two daughters, all of whom are great at keeping me well-grounded with their idiosyncratic sense of humour and wise advice.

• What are the most rewarding aspect(s) of your job(s)?

The most rewarding aspect of my job is working with others who share my passion for research that is firmly based in clinical practice.  In particular, I would like to mention my long-term collaborators Dr Christine Baldwin and Prof Peter Emery at King’s College London, but also my more recent collaborators, Prof Mary Hickson (Plymouth University) and Prof Jane Murphy (Bournemouth University) in the UK and Prof Marion van Bokhorst de van der Scheuren and Dr Hinke Kruizenga in the Netherlands.

I very much enjoy working with and learning from my PhD and Masters students, junior staff and undergraduates as they take their first steps into research. Watching them flourish and develop their own areas of knowledge and expertise never ceases to provide me with great pleasure and satisfaction.

For the curious, a clinical academic career is a perfect opportunity to constantly learn new things. Over the past five years I have learnt new skills in the areas of health economic analysis, guideline development and realist review methodology, and early next year I will be learning how to undertake qualitative research.

One of the greatest perks of my role is the opportunity it provides to combine attendance at international conferences with exciting and challenging holidays, e.g. attendance at the 2018 ASPEN conference in Las Vegas was combined with a 3-day camping trip down into the Grand Canyon with my eldest daughter and recent attendance at the ESPEN Conference in Krakow was followed by a hiking trip in the Tatra mountains with my partner.

• And finally, do you have any advice to other dietitians who are interested in combining a clinical career with academic research?

There are increasing opportunities for dietitians and other AHPs to combine a clinical career with academic research, e.g. through the NIHR fellowship programmes.  If you are interested, ask for help and support from people who have been through the process themselves.  We have all been through the highs and lows of a clinical academic career and it can often help when you realise that you are not alone.

Learn to juggle and hone your time-management skills.  There will be constant pulls on your time and you will have to make tough decisions about priorities.  An ability to think flexibly and creatively, while having your eyes on the ultimate goal, are essential attributes to any successful researcher.

Before setting off in research, get a sound grounding in clinical experience and listen to, and question, your patients and colleagues. This will help you to identify relevant research questions that are important to patients and their carers.

Finally, make sure you surround yourself with senior clinicians and supervisors who are interested in your ideas and your personal development, and who will be willing to provide you with practical support and advice.  A clinical academic career can be tough but the challenges and rewards are well worth the effort.