Real solutions, practical advice
A fascination with evidence (or lack thereof) kick-started Dr Lesley MacDonald-Wicks' journey into higher education.
“I actually started out wanting to study a double major in Biology and Chemistry – I was interested in complementary medicine.
“People have been using these remedies for thousands of years, but back then not many academics were doing any research to see whether there was any real evidence to say that it was working.
“But then when I sat down to look at the UON course guide, and I came across Nutrition and Dietetics and thought, ‘Actually, maybe that’s what I want to be studying’.”
After graduating from her undergraduate degree and working for a few years in clinical practise, Lesley came back to UON to undertake her PhD with Professor Manohar Garg.
“I have a long history of really enjoying studying.”
“My starting point was around dietary fat intake, and that's one of the cornerstones of my research - I've weaved in and out of that area throughout my career.
“But what my PhD really gave me was an interest in what has been successful in treating Chronic Disease.”
While exercise, nutrition and psychology are all vital areas to consider, we want the advice given to people to be based on rigorous scientific analysis and discussion rather than anecdotes.
“When it comes to the challenge of obesity and diabetes, we’re not really winning yet.”
This search for evidence for real, practical and effective advice is what motivates Lesley’s research, especially for mothers and their babies.
Gestational diabetes is the condition that occurs when a woman experiences high blood sugar levels throughout their pregnancy. While it’s not entirely driven by lifestyle factors, overweight and obese patients are more vulnerable.
The condition puts babies at a higher risk for a number of well described complications, but the effects on the mother, especially long term, can be side lined.
“What often happens is these women see their obstetrician six weeks after the birth and then no one mentions their condition again.
However, the reality is that the condition puts patients at an increased risk of going on to develop type 2 diabetes.
Lesley is looking for ways to help patients mitigate this risk. This involves extending patient care beyond the pregnancy, as well as ensuring pre-natal care is meeting individual patients’ needs.
The most important meal of the day?
Although eating breakfast is often encouraged as a means to boost metabolism and maintain weight loss, the systematic evidence is lacking.
“This is some of the major anecdotal based advice that many clinicians use, but the actual evidence isn’t there.
“It's plausible that eating breakfast will kick start your metabolism and reduce your need to eat at morning tea. And there’s evidence from longitudinal studies that people who eat less maintain their weight loss outcome for longer than others - but why?
“These people who eat breakfast are probably more likely to eat a wide range of balanced foods. They’re likely to be in employment because they can afford to eat breakfast. They’re likely to have good organisational skills because they shop regularly.
“Are we just observing a clustering of these health-related behaviours?
“When we conduct randomised control trials, what we can do is pinpoint one thing and test against a controlled environment.”
There is good evidence for the Mediterranean way of eating
An extension of Lesley’s research interests is chronic disease prevention and treatment using diets such as the Mediterranean Diet. “I’m interested in this dietary pattern as it has such good evidence that it works so well in the prevention and management of chronic disease, but why does it work? I think it might be the type of dietary fat and antioxidants in this dietary pattern and the effect on oxidative stress.”
“What we eat can really nourish us and might stop the course of a disease path, managing or preventing the complications of chronic disease” and I am wondering if this is also true in mental health, especially in the area of cognitive decline in the elderly.
Starting on the right path
What underpins each of Lesley’s research interests is the search for practical and effective advice that can help people along their personal journey of chronic disease management.
“For many years, dietitians have educated people on what they needed to do - but that's not sufficient.
“We have to immerse ourselves in these people's lives and find the habits – eating and exercise- that are mitigatable and help them make those changes.
“That's hard! That's really hard work. For the patient and for the clinician.”