The value and variation of dietitians

It wasn’t my dream to be a dietitian. My plan was to be a physician. I am fascinated by the body and I am not a natural born foodie or cook – I was raised on Stouffer’s lasagna, Hamburger Helper, and frozen pizza. However in junior high, chronic disease in my family and frustration with my body drove me on a health kick. I devoured every nutrition and fitness tip I could find in magazines – trying to figure out the “secret” to eating. Ultimately I realized that my dream was really to help people prevent and manage their health, without medications.  ​So I became a personal trainer and tumbled down the path of dietetics. Here’s what I’ve learned along the way and why my practice is more than what you think. 

The term “nutritionist” is not a licensed or credentialed term. Anyone can be called a “nutritionist,” regardless of their background and training. 

A “registered dietitian” (RD) is a standardized, national credential. Some dietitians are often called “nutritionists” because it’s easier to say, but the “RD” is the real title to look for.
It refers to someone who has …

1. Completed a 4 year undergraduate degree in dietetics / nutrition / food science at an accredited program (CLICK HERE for undergrad sample curriculum) 
2. Completed a supervised, standardized learning experience of at least 1200 hours in clinical nutrition, food service management, and community nutrition  (CLICK HERE for details)
3. Passed a board exam
4. Maintains approved continuing education credits

​In states that allow for state licensing, you’ll also find the credential “LD” or “licensed dietitian” behind the RD. RDs are technically the only profession with the scope of practice to 1.) tailor nutrition recommendations to manage/ treat health conditions and 2.) bill insurance for nutrition counseling. However you’ll find plenty of other professionals walking / crossing the scope of practice line – however legally they’re really not supposed to.

RDs have a diverse career path. Most commonly you’ll find them in hospitals / clinics / private practices counseling patients. Or you might find them managing food service systems in hospitals / schools / institutions or working in business. 

​Most RDs also have a master’s degree and / or additional credentials / specialized training.  For example, in addition to being a registered dietitian, I am also a certified personal trainer, certified diabetes educator, and hold a master’s degree health communication (aka, public health with a focus on marketing to change behaviors). It means I took far too many additional classes and maintain even more hours of continuing education…resulting in a mouthful of alphabet soup of “MA, RD, LD, CDE, cPT.” ​

All that foundational learning is helpful to understand how to apply chemistry and business lessons. But like any other health profession, your nutrition “practice” is where you begin to really understand whether or not that “ideal diet” works for humans in the real world. 

General nutrition recommendations are pretty easy to come by these days. A quick search on google for “healthy eating” pulls up over 860,000,000 results…and another 35,800,000 videos.  And most people have the general knowledge of “eat more fruits and vegetables”…”choose whole grains”…”eat lean protein”…etc.

But what’s more complicated are the debates about the “best” diet or preaching a new food / product. These conversations are driven by individual belief / perception / marketing rather than science (for more about this intersection of helping others eat better, check out my previous blog post here). Answering questions about the debates are where a degree in nutrition and experience with real people and research really come in handy. 

​Granted this is what a RD is trained to do, but that doesn’t mean it’s always happening. Every person practices differently. Additionally, some dietitians are more cognitive in their approach (eg, teaching people about food, food chemistry, how to read labels, categorizing “good” and “bad” food) as opposed to behavioral (eg, understanding and exploring the role of food in a person’s psycho social circumstance). Neither style is superior per say, but rather a distinction. What’s become clear to me over the years is that “teaching” a person about food has little impact upon their actual life if you don’t also take into consideration / explore…

• whether or not their basic human needs are met (more details in this blog post)
• the influence of their emotions and relationships on their thoughts and beliefs on cognition (more below) 

A phenomenal dietitian / nutrition therapist /  eating disorder expert Marci Evans breaks down this dynamic relationship in a helpful way that I will paraphrase and hopefully do remote justice (forgive me Marci). Think about our relationship with food like a tree. You have surface level aspects like meal planning, fact, lists, and the influence of environment. That’s all cognitive – we can “learn” best practices. But what we “know” and our ability to execute it is affected by our thoughts and beliefs which are in turn informed by our deeper psychological/emotional roots. Too often people focus on cognitive change (making the leafs grow) but you won’t have a very strong / nourished tree without attention to the tree as a whole. 

All dietitians are trained to do the surface level work (leaves). But I’m very interested (and feel it’s crucial) to pay attention to the trunk and the roots. I’m not trained to influence or explore the roots per say (that’s the role of a therapist). However, it’s incredibly helpful in the rest of the work to help nourishing the tree as a whole. It’s common to spend an entire session talking about a client’s job, partner, or trauma because those variables have a tremendous influence on what, where, when, and how they eat. It means that when I’m working with a client, I’m not just looking for dietary recalls or food “choices” but instead behaviors and emotions surrounding food (below). 

Not every patient who walks in my door is ready, willing, able to do the work it really takes to nourish the whole tree. Additionally, not every clinic / insurance allows for the time it takes to really dive in. It’s easier (and emotionally cleaner) to focus on the leaves – give a bunch of rules, structure, and education that may or may not match the whole person. But that’s why diet culture is so appealing! We all just want a quick answer that takes the least work. Digging in the dirt takes a lot of work and time and sometimes you uncover worms.  ​

Becoming a dietitian took a lot of work and my practice is MUCH more than what you’ll find on google. The value and the skill comes from the experiences after the classroom. The classroom gives dietitian tremendous skill in understanding and applying chemistry to change the body’s physical condition. However, not every dietitian is trained to touch on the human experience.