Problem: dietitian referrals drift into diet sheets — long food lists, no clinical question — while the GP or specialist hunts for the reason. Answer in brief: run every metabolic, renal and cardiac nutrition letter on a 4-paragraph Band-B skeleton (purpose, status, intervention, request) that keeps biochemistry and the question in balance. This guide teaches the skeleton with a worked diabetes referral, and OET Writing for Dietitians — Course 1 trains metabolic, renal, cardiac and rehab letters across 16 topic sections.
The 4-paragraph Band-B skeleton
P1 purpose: who, with what nutrition-related condition, and the question — in two lines. P2 status: biochemistry with trends (HbA1c trajectory, eGFR, lipids), weight trajectory, current diet pattern in two lines max. P3 intervention so far: advice given, adherence, response — what you tried and what happened. P4 request: the precise dietetic question (assessment for structured programme? renal diet planning? cardiac rehab nutrition?) with timeframe. Food detail lives in P2–P3 briefly; it never replaces the question.
Metabolic and endocrine: numbers with direction
Type 2 diabetes, pre-diabetes and NAFLD letters need HbA1c with trend, weight trajectory, liver markers where relevant, medication affecting weight or appetite, and the patient’s readiness to change in one honest line. “HbA1c risen from 52 to 64 despite metformin; weight +6 kg in a year” argues more than any adjective. NAFLD adds alcohol history quantified and liver imaging findings quoted.
Train the skeleton supervised? The full OET Writing for Dietitians — Course 1 covers metabolic, renal, cardiac and post-event rehab nutrition letters across 16 topic sections with mock tests. Explore the course →
Renal and cardiac: restriction with reason
CKD nutrition letters must justify every restriction: potassium trend behind the low-potassium diet, phosphate behind binders-plus-diet, fluid allowance behind the balance chart. Cardiac letters pair lipids and blood pressure with the event (post-MI, post-stroke) and rehab stage. Restrictions without reasons read as punishment; with reasons they read as care — and Content marks follow.
Worked example: new type 2 diabetes referral
Fictional case, newly written: Mrs Adeyemi, 52, newly diagnosed type 2 diabetes (HbA1c 58); BMI 31, weight stable; started metformin; works shifts, eats irregularly; motivated but time-poor; no complications on screen.
Shape: “Thank you for assessing Mrs Adeyemi, 52, newly diagnosed with type 2 diabetes, for structured dietary management.” Biochemistry and context. Metformin and shift-pattern reality. Request: “I would appreciate assessment for a structured programme fitting shift work, with carbohydrate-awareness education; she is keen and will attend.” Honest constraints, precise ask — roughly 170 words.
Four dietitian-letter mistakes
- Diet-sheet letters. Fix: two lines of diet pattern maximum; the question leads.
- Values without trends. Fix: every number gets direction or comparison.
- Readiness omitted. Fix: one honest line on motivation and constraints.
- Generic requests. Fix: name the programme, the planning need or the review question.
FAQs
How much food detail belongs in the letter?
Enough to show the problem pattern (shift meals, sugary drinks, salt use), never a full recall. The dietitian assesses detail; your letter justifies the referral.
Should BMI always appear?
With weight trajectory, yes — one line. A lone BMI without trend or context adds little.
What is in the course?
Sixteen topic sections on metabolic, renal, cardiac and rehabilitation nutrition letters plus the Band-B skeleton, with 5 complete mock tests.
The matching course
OET Writing for Dietitians — Course 1 installs the 4-paragraph Band-B skeleton and runs it across diabetes, renal, cardiac and rehab nutrition — 16 topic sections with 5 mock tests. If your letters list food but ask nothing, train here.
Sources and note
- OET Writing format per the official OET site: oet.com — Writing. Values above are illustrative fiction; follow local protocols in practice and current OET guidance for the exam.
- Course details verified from its public staging page (read-only): 16 topic sections, 5 mock tests.
- Case and letter lines are newly written and fictional; other valid structures exist.
Put this into practice
Compare these course outlines and choose the practice that matches your next goal.
