dietitian

Dietitian/ Nutritionist

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It is easy to confuse the terms dietitian and nutritionist.  In many countries , the title nutritionist is not subject to professional regulation.   Any person may call themselves a nutrition expert,whereas the title of dietitian can be used only by those who have met specified professional requirements. One way to distinguish the two is to remember all dietitians are nutritionists, but not all nutritionists are dietitians.

A Registered Dietitian Nutritionist (RDN)  is an expert in areas of food and nutrition. RDNs are accredited by the Academy of Nutrition and Dietetics.  A Registered Dietitian Nutritionist has completed an undergraduate program in nutrition and also a one year clinical internship program. Registered Dietitian Nutritionists must pass a national exam administered by the American Dietetic Association. Registered Dietitians must also maintain their registered status through continuing education and advanced degrees/certifications for areas of specialization. Examples of specializations include certification as a cardiac dietitian, nutritional support dietitian, sports nutrition, or a certification for diabetes education.

RDNs are the food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living. RDNs use their nutrition expertise to help individuals make unique, positive lifestyle changes. They work throughout the community in hospitals, schools, public health clinics, nursing homes, fitness centers, food management, food industry, universities, research and private practice. RDNs are advocates for advancing the nutritional status of Americans and people around the world.

Nutrition and dietetic technicians, registered — NDTRs — are educated and trained at the technical level of nutrition and dietetics practice for the delivery of safe, culturally competent, quality food and nutrition services. They are nationally credentialed and are an integral part of health care and foodservice management teams. They work under the supervision of a registered dietitian nutritionist when in direct patient/client nutrition care; and they may work independently in providing general nutrition education to healthy populations.

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A dietitian is an expert in dietetics or human nutrition and the regulation of diet. A dietitian alters their patient’s nutrition based upon their medical condition and individual needs. Dietitians are regulated healthcare professionals licensed to assess, diagnose, and treat nutritional problems.

A registered dietitian (RD) or registered dietitian nutritionist (RDN), is a dietitian who meets all of a set of special academic and professional requirements, including:

  • the completion of a bachelor’s degree with an accredited nutrition curriculum
  • satisfactory performance on the registration exam
  • an internship at an approved health-care facility, foodservice organization, or community agency

Roughly half of all RDNs hold graduate degrees.

and many have certifications in specialized fields such as sports, pediatrics, renal, oncological, food-allergy, or gerontological nutrition. After learning about a patient’s health history, favorite foods, eating and exercise habits, the RD helps the person to set goals and to prioritize. Follow-up visits often focus on maintenance and monitoring progress.

Most RDs work in the treatment and prevention of disease (administering medical nutrition therapy, as part of medical teams), often in hospitals, health-maintenance organizations, private practices, or other health-care facilities. In addition, a large number of registered dietitians work in community and public-health settings, and/or in academia and research. A growing number of dietitians work in the food industry, journalism, sports nutrition, corporate wellness programs, and other non-traditional dietetics settings.

World Health Organization Designation

Dietitians supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. The goals of dietitians are to provide medical nutritional intervention, and to obtain, safely prepare, serve and advise on flavorsome, attractive, and nutritious food for patients, groups and communities. Dietary modification to address medical issues involving dietary intake is a major part of dietetics (the study of nutrition as it relates to health). For example, working in consultation with physicians and other health care providers, a dietitian may provide specific artificial nutritional needs to patients unable to consume food normally. Professional dietitians may also provide specialist services such as in diabetes, obesity, oncology, osteoporosis, pediatrics, renal disease, and micro-nutrient research.

Different professional terms are used in different countries and employment settings, for example, clinical dietitian, community dietitian, dietetic educator, foodservice dietitian, registered dietitian, public health dietitian, therapeutic dietitian, or research dietitian. In many countries, only people who have specified educational credentials and other professional requirements can call themselves “dietitians” — the title is legally protected. The term “nutritionist” is also widely used; however, the terms “dietitian” and “nutritionist” should not be considered interchangeable — the training, regulation and scope of practice of the two professional titles can be very different across individuals and jurisdictions.

In many countries, the majority of dietitians are clinical or therapeutic dietitians, such as the case of the United States, the United Kingdom, and much of Africa. In other countries they are mostly food service dietitians, such as in Japan and many European countries.

Clinical Dietitians

Clinical dietitians work in hospitals, nursing care facilities and other health care facilities to provide nutrition therapy to patients with a variety of health conditions, and provide dietary consultations to patients and their families. They confer with other health care professionals to review patients’ medical charts and develop individual plans to meet nutritional requirements. Some clinical dietitians will also create or deliver outpatient or public education programs in health and nutrition. Clinical dietitians may provide specialized services in areas of nourishment and diets, tube feedings (called enteral nutrition), and intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN). They work as a team with the physicians, physician assistants, physical therapists, occupational therapists, pharmacists, speech therapists, social workers, nurses, dietetic technicians, and other careers to provide care to patients. Some clinical dietitians have dual responsibilities with patient nutrition therapy and in food service or research.

 

Community Dietitians

Community dietitians work with wellness programs, public health agencies, home care agencies, and health maintenance organizations. These dietitians apply and distribute knowledge about food and nutrition to individuals and groups of specific categories, life-styles and geographic areas in order to promote health. They often focus on the needs of the elderly, children, or other individuals with special needs or limited access to healthy food. Some community dietitians conduct home visits for patients who are too physically ill to attend consultations in health facilities in order to provide care and instruction on grocery shopping and food preparation.

Food Service Dietitians

Food service dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess and plan food service processes in health care facilities, school food service programs, prisons, restaurants, and company cafeterias. These dietitians may perform audits of their departments to ensure quality control and food safety standards, and launch new menus and various programs within their institution to meet health and nutritional requirements. They train and supervise other food service workers such as kitchen staff, delivery staff, and dietary assistants or aides.

Gerontological Dietitians

Gerontological dietitians are specialists in nutrition and aging. They work in nursing homes, community-based aged care agencies, government agencies in aging policy, and in higher education in the field of gerontology (the study of aging).

Neonatal Dietitians

Neonatal dietitians provide individualized medical nutrition therapy for critically ill premature newborns. They are considered a part of the Neonatal Intensive Care Unit’s medical team. The neonatal dietitian performs clinical assessment of patients, designs nutrition protocols and quality improvement initiatives with the medical team, develops enteral and parenteral regimens, helps establish and promote lactation/breastfeeding guidelines and often oversees the management of infection prevention in the handling, storage, and delivery of nutritional products.

Pediatric Dietitians

Pediatric dietitians provide nutrition and health advice for infants, children, and adolescents. They focus on early nutritional needs, and often work closely with doctors, school health services, clinics, hospitals and government agencies, in developing and implementing treatment plans for children with eating disorders, food allergies, or any condition where a child’s diet factors into the equation, such as childhood obesity.

Research Dietitians

Research dietitians may focus on social sciences or health services research, for example, investigate the impact of health policies or behavior change, or evaluate program effectiveness. They may survey food service systems management in order to guide quality improvement. Some research dietitians study the biochemical aspects of nutrient interaction within the body.  In universities, they also may have teaching responsibilities. Some clinical dietitians’ roles involve research in addition to their patients care workload.

Administrative Dietitians

Administrative or management dietitians oversee and direct all aspects of clinical dietetics service, food policy and/or large-scale meal service operations in hospitals, government agencies, company cafeterias, prisons, and schools. They recruit, train and supervise employees of dietetics departments including dietitians and other personnel. They set department goals, policies and procedures; procurement, equipment and supplies; ensure safety and sanitation standards in food service; and administer budget management.

Business Dietitians

Business dietitians serve as resource people in food and nutrition through business, marketing and communications. Dietitians’ expertise in nutrition is often solicited in the media — for example providing expert guest opinion on television and radio news or cooking shows, columnist for a newspaper or magazine, or resource for restaurants on recipe development and critique. Business dietitians may author books or corporate newsletters on nutrition and wellness. They also work as sales representatives for food manufacturing companies that provide nutritional supplements and tube feeding supplies.

Required qualifications and professional associations

In most countries, competent performance as a dietitian requires formal training at a higher educational institution in dietetics involving food and nutritional science, nutrition education and medical nutrition therapy.  Their education in health science involves scientific based knowledge in anatomy, chemistry, biochemistry, biology, and physiology.

While the specific academic and professional requirements to becoming a fully qualified dietitian differ across countries and jurisdictions, as these are adapted to the needs of the individual countries and the opportunities available, common academic routes include:

  • A bachelor degree in Dietetics which typically requires four years of post-secondary studies; or
  • A bachelor of science degree and a postgraduate diploma or master’s degree in Dietetics.

In addition, dietitians may be required to undergo an internship to learn counseling skills and aspects of psychology. The internship process differs across countries and jurisdictions.

Associations for dietetics professionals exist in many countries on every continent.

In the United States, nutrition professionals include the dietitian or registered dietitian (RD), as well as “dietetic technician” or “dietetic technician, registered” (DTR) (see below). These terms are legally protected, regulated by the Academy of Nutrition and Dietetics which registers and confers professional credentials. The Academy also recognizes and certifies certain specialty areas, such as in Gerontological Nutrition.

Dietitians are registered with the Commission on Dietetic Registration (the certifying agency of the Academy) and are only able to use the label “Registered Dietitian” when they have met specific educational and professional prerequisites and passed a national registration examination. Besides academic education, dietitians must complete at least 1200 hours of practical, supervised experience through an accredited program before they can sit for the registration examination. In a coordinated program, students acquire internship hours concurrently with their coursework. In a didactic program, these hours are obtained through a dietetic internship that is completed after obtaining a degree. In both programs the student is required to complete several areas of competency including rotations in clinical, community, long-term care nutrition as well as food service, public health and a variety of other work sites.

Once the degree is earned, the internship completed, and registration examination passed, the individual can use the nationally recognized legal title, “Registered Dietitian”, and is able to work in a variety of professional settings. To maintain the RD credential, professionals must participate in and earn continuing education units (often 75 hours every 5 years).

In addition, many states require specific licensure to work in most settings.

As recent studies have shown the importance of diet in both disease prevention and management, many US states have moved towards covering medical nutrition therapy under the Medicaid/Medicare social insurance programs, making dietetics a much more lucrative profession due to insurance reimbursement.

In the United States the “governing body” of Dietetics practice is the Academy of Nutrition and Dietetics (formerly the ADA). This group is made up of approximately 72,000 members nationwide who support each other and develop their Professional Portfolio together.

 

References

  1. The spelling with “c” is listed first in UK dictionaries, for example Oxford, Longman, and Collins. The American English versions of Oxford and Collins list the spelling with “t” first.
  2. Lee, Jason (2013-01-18). “Dietitians do more than tell you what to eat”. Chicago Tribune. Tribune Media Services. Retrieved 2014-11-20. ‘Registered dietitians offer a wide array of professional knowledge and experience in a variety of settings from clinical to community and public policy to media communications,’ says Dee Sandquist, a registered dietitian and spokesperson for the Chicago-based Academy of Nutrition and Dietetics.
  3. http://www.clinicalnutritioncenter.com/meet-our-medical-weight-loss-professionals/registered-dietitians-nutritionists/registered-dietitian-vs-nutritionist
  4. “Dietetics FAQs”. University of Maryland College of Agriculture and Natural Resources. University of Maryland. Retrieved 20 April 2016.
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  6. http://www.merriam-webster.com/dictionary/ician
  7. http://encyclopedia2.thefreedictionary.com/dietician
  8. http://medical-dictionary.thefreedictionary.com/dietician
  9. Oxford
  10. Longman
  11. Collins
  12. American Heritage and Webster’s New World dictionaries
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  40. Conestoga College. In British Columbia, Langara College of Vancouver offers a diploma program for dietetic technicians with a focus on foodservice management. Also the Canadian Healthcare Association, based out of Ottawa, offers a certificate in foodservice management for diet technicians. Program Details: Dietetic Technician. Accessed 2 August 2011.
  41. Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics.
  42. Government of South Australia. TAFE South Australia: Nutrition Assistant (Dietary Aide). Accessed 2 August 2011.
  43. CBsalary. Medical Diet Clerk Salary. Accessed 2 August 2011.
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  46. Canadian Society of Nutrition Management. Accessed 2 August 2011.
  47. advocate Health Care. Food service worker registry. Accessed 2 August 2011.
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