Defining the role of the dietitian [in normal nutrition]

I find myself consistently running into successful nutrition businesses helmed by people who are not RDs. I was just at the dentist when I read a profile of Mrs. Canada 2008, who runs a nutrition and fitness consulting firm with an accreditation from the American Fitness Professionals Association, a weight management certificate from CanFitPro and a certification as an emotional fitness coach from the Emotional Fitness Institute. I also recently got hired at a health club where none of the existing nutritionists or new hires are RDs.

Even my nutrition heroes, like Marion Nestle, Michael Pollan and Brian Wansink are not RDs. (Although Nestle has a ridiculously impressive nutrition research background and Pollan is always saying, "I'm a journalist, I shouldn't be telling you what to eat," so I guess it's ok.)

So what am I doing spending four-and-a-half years in school plus writing a national exam to become an RD?

Registered Dietitians certainly have the edge when it comes to clinical nutrition. Whether its our course work, our internships or our professional standards (the Ordre professionnel des diététistes du Québec have their own set just for clinical dietitians), our background is really slanted in clinical nutrition, which is the "[identification of] nutrition problems and [assessment of] the nutritional status of patients; [development of] care plans and [monitoring of] the effectiveness of nutrition interventions; and [consultation of] patients on special diet modifications," according to Dietitians of Canada (DC). But after having a few too many preceptors take year-long breaks or switch jobs near the end of my internship rotations (not my fault, honest!) and my deep desire to get into public health in some way because I believe that everyone (not just those with the highest nutritional risk) has the right to make good food choices, my chances of having/wanting a career in a hospital are relatively slim.

So what else can I do? The DC website lists a bunch of career paths, including that of a consulting dietitian, who "provide expertise in nutrition, diet therapy and food service to individuals, institutions, business and the media. They operate their own private consulting practices or businesses." But again, if so many people can do it without a bachelor's degree in nutrition, without doing an internship, without writing the CDRE, then what's the point?

Point 1: Not surprisingly enough, our edge comes from what we're mostly trained for—clinical nutrition.

Most (if not all) of the other nutrition companies focus on weight loss and tout general effects of "Feeling better!", "Having more energy!" or "Finally fitting into that wedding dress!" While it is highly likely that some of their clients will come in with comorbidities like dyslipidemia, hypertension or type 2 diabetes, the approach to this will likely be, "Here's how to eat healthfully and exercise to lose weight and hopefully the problems will fix themselves with the weight loss and healthier lifestyle." On the other hand, dietitians have the knowledge to specifically deal with those problems, in addition to nutritional issues that don't have to do with encouraging weight loss, such as irritable bowel syndrome, chronic obstructive pulmonary disease, eating disorders and allergies.

Point 2: Dietitians have the critical thinking skills to use the newest scientific knowledge in evidence-based practice and are required to engage in continuing education to maintain their accreditation.

I can't say anything about the other nutrition programs that are out there because I haven't been in them, but I can say that so far in my path toward getting my B.Sc, I have done a fair amount of coursework that involves reading and analyzing scientific articles. Even the introductory psychology textbook I'm reading right now from my correspondence course has some thoughtful gems.

[On the 1994 bestseller The Bell Curve:] "Herrnstein and Murray avoided having their data analyses subjected to the critical scrutiny that scientific data must withstand. It is not unusual for scientists to describe their work in a popular book, but doing so normally occurs after the scientists have published many technical articles on a topic, which they then attempt to summarize for the layperson."

At the end of every chapter, there's a "critical thinking" section which teaches the critical thinking skills that are useful for analyzing psychological issues, or any scientific issue for that matter. One of them talked about common fallacies in arguments (irrelevant reasons, circular reasoning, slippery slope arguments, weak analogies and false dichotomies) while another mentioned appeals to ignorance, which is misusing the general lack of knowledge or information on an issue (i.e. no proof of harm, but no proof of benefit either) to support an argument. Ha! How many times has big food tried to pull that one?

Having a service like PEN saves a lot of the legwork, but even then you need to critically read the studies they cite just to be sure everything makes sense. While I'm not ignoring the fact that there are nutritionists out there who do look at the science, there are also some that are out there who get their info from traditional media, which tends to sensationalize, exaggerate and oversimplify study results.

In terms of continuing education, non-registered nutritionists are not held accountable for doing so. The worst case scenario is you might have someone preaching nutritional advice that has already been disproved!

So why aren't more people choosing dietitians, despite surveys that cite that they're the "most trusted source of nutrition information"? Perhaps nutrition and fitness consultants don't cost as much and/or are easier to find, but I personally think the general public does not know the difference. I mean, it took me actually deciding to become a dietitian before I figured out the difference between a dietitian and a nutritionist and the existence of DC, let alone the existence of the Alliance of Canadian Dietetic Regulatory Bodies or the College of Dietitians of Alberta!

DC, all the Dietetic Regulatory Bodies and each and every dietitian out there needs to put in the extra effort to get people to know about our profession and more importantly, what sets us apart from the pedestrian nutritionist. Our current partnerships with the food industry aren't working. Perhaps we need to partner up with other lesser known health professional regulatory bodies, such as the the Canadian Medical Association, the various Colleges of Physicians and Surgeons, or even the Canadian Association of Occupational Therapists, to name a few. This could help increase our credibility, while giving other important healthcare professions their time to shine. We need to get doctors to say, "You have type 2 diabetes. Here's a prescription for Metformin and a referral to a dietitian." (OK, maybe that's not what the clinical practice guidelines say, but you get my drift.) It may have saved my dad from an angioplasty... and it's covered by most many(?) private insurance plans.