Have you ever wondered what a dietitian is, or how a dietitian is different than a nutritionist? Have you asked what a dietitian does? I answer these questions here.
As you may know, I am a registered and licensed dietitian. I have been practicing for over 11 years now and have experience in the acute care hospital setting, outpatient setting and the long term rehabilitation setting. I have also done some public speaking presentations.
There is a lot of nutrition information on the internet. Asking who is providing you with nutrition information and why they are qualified to do so are important questions to ask. Registered dietitians offer a unique background and expertise in nutrition.
Dietitians receive their credentials through the Academy of Nutrition and Dietetics (formerly known as the American Dietetic Association). The Academy of Nutrition and Dietetics (AND) is the largest organization of nutrition professionals. As noted on their website, “The Academy is committed to improving the nation’s health and advancing the
profession of dietetics through research, education and advocacy.”
You can read more about the Academy at https://www.eatright.org/.
How does an individual become a registered dietitian?
Firstly, the individual needs to pursue a minimum of a bachelor’s degree from a program that meets ASCEND criteria. ASCEND is the accrediting agency of the Academy of Nutrition and Dietetics; it ensures that nutrition and dietetics programs meet certain quality requirements. Many students (and dietitians) go on to complete a master’s degree or a PhD. (Interesting fact: the minimum education requirement will change to a master’s degree by 2024).
Next, after earning their degree, the individual must then complete a dietetic internship. (Sometimes internships are combined with an undergraduate or graduate program). Dietetic internships are likened to a residency for dietitians! Interns complete at least 1,000 supervised practice hours.
I completed my undergraduate degree at Dominican University and then completed a combined graduate degree and internship at Rush University Medical Center.
When I completed my rotations during my internship I was required to rotate through the acute care setting for inpatients in a hospital, the community setting, and also the food service management setting.
Lastly, an exam through the commission on dietetic registration (CDR) is taken. Depending on which state the dietitian lives in they may also be licensed to practice. I live in Illinois and all dietitians must have a license to practice dietetics in IL. Dietitians must also participate in continuing education to keep their license and credentials. Dietitians are required to get 75 hours of continuing education every 5 years. This is often achieved through seminars, specialty training programs and reading into new research.
What does a dietitian do?
Perhaps one of the best ways to describe what a dietitian is, is to describe the kind of work they do. Dietitians work in a variety of settings. Like many other dietitians I know, I have experience working in different settings and have enjoyed experiencing different ways I can use my degree and training. Here are some examples of what you will find a dietitian doing (although this is not an exhaustive list!).
The acute care setting
These dietitians are part of the medical team and work alongside many other health care professionals in a hospital. For example, they work alongside doctors, nurses and nursing
assistants, speech and language pathologists, and pharmacists. In the acute care setting dietitians assess patients who have not been able to meet their nutrition needs and they treat malnutrition. Treatment may include education, supplementation to help patient better meet their calorie and protein needs, tube feedings when a patient cannot meet their needs with eating, and/or parenteral nutrition which is nutrition through an IV.
An example of an inpatient who would require a dietitian’s help would be someone who is sedated and is on a ventilator due to difficulty breathing. This patient would not be able to eat by mouth and would need a tube feeding. After figuring out the patients nutrient needs, the dietitian would decide which tube feeding formula to use and how much to give to the patient each day.
For a second example, imagine a patient who has severe burn or pressure wounds and needs additional protein, calories and vitamin/mineral supplementation to promote wound healing.
Lastly, consider a patient that has a blockage in their intestines and has not been able to eat anything for several days. In this situation the patient would not even be able to use a tube feeding, they would require parenteral nutrition through an IV; the dietitian would prescribe the nutrients that the patient should receive through the IV.
The outpatient setting
Dietitians may work with individual patients or groups of patients with similar conditions. The dietitian educates the patients and provides medical nutrition therapy. Medical nutrition therapy (MNT) is nutrition based treatment for people with different short or long term health conditions. Additionally, dietitians in this setting may provide meal plans, assist in goal setting and also provide follow up appointments to help the patient track progress and trouble shoot.
Among many conditions, some common health care conditions or needs patients may come to an outpatient dietitian for include diabetes, heart disease, weight management, sports nutrition needs, or stomach conditions such as celiac disease, IBS or IBD.
Long Term Care
Dietitians in long term care provide nutrition care for individuals who are staying in nursing homes and rehabilitation centers. Similarly to an acute care inpatient dietitian, long term care dietitians provide treatment for malnutrition by means of education, supplements and tube feedings. These patients often have special nutrient needs related to wounds, poor intake, and management of chronic diseases. The dietitian provides initial care and follows up with the patient regularly for as along as the patient resides in the long term care facility. These patients may become well known to the dietitian as many of the patients live in the long term care centers.
Patients who need dialysis for kidney failure are followed by a dietitian at the dialysis center. These patients require close monitoring of certain minerals that are greatly affected by diet. Dialysis patients also need assistance in meeting protein needs, limiting fluids, and managing other chronic diseases that often accompany kidney failure. Dietitians provide ongoing education, monitoring and support for dialysis patients.
Public health care settings
Dietitians may work with communities or groups of people instead of individuals. They may provide nutrition services that are specific to groups of people that have unique needs. For example, a dietitian at WIC will help promote education and good nutrition to low income families. Public health dietitians may help promote public health policies that promote well being of groups of people. These dietitians may also provide educational presentations to groups or businesses, produce educational materials related to nutrition and help create guidelines such as the dietary guidelines for Americans.
Food service management
Dietitians who pursue this route for their career focus on management in a food service establishment. For example, they may manage the kitchen that prepares food for patients in a hospital or long term care facility. Dietitians may also manage food service in school or hospital cafeterias. Responsibilities often include managing kitchen staff, ordering food and kitchen supplies, and also tube feeding formulas and supplements needed for patients. They also ensure that proper sanitization and cleaning standards are being met in the establishment continuously. Dietitians in food service also manage the menus in health care and school settings to make sure the menu items meet specific nutrition requirements.
To continue improving the care that patients receive in the health care setting, and to improve knowledge on healthy eating for the general public, research is vital. Dietitians that pursue research help patients receive nutrition care that continuously improves.
Some examples of research that a dietitian may contribute to include which nutrient helps prevent which disease, or how much of a certain nutrient is needed for different people based on age gender or ethnicity, or which groups of people tend to eat the most sodium. They may also research things like what methods are best when educating individuals about weight management, or how much fiber is safe to give to patients in the ICU. These are all studied and researched by dietitians and other health care professionals alike. Dietitians conduct research experiments and use analytical skills to figure out what outcomes are significant, which ones need to be studied further, and which outcomes should be implemented in practice. The papers that are written are often published in medical or food and nutrition journals.
The use of current research to guide clinical decision making is called evidence based practice. Dietitians use evidence based nutrition to provide the most up to date recommendations to their patients/clients. You can read more about evidence based nutrition here.
What is a Nutritionist?
In contrast, the term nutritionist is not a defined profession that is regulated. The label nutritionist is used among people with many different backgrounds and training in nutrition. While some states do have licensure to use the title nutritionist, requirements for licensure as a nutritionist is not consistent among the different organizations that provide this licensure. Additionally, these individuals do not meet the same requirements of the Academy of Nutrition and Dietetics and cannot use the title registered and/or licensed dietitian.
You may have noticed that dietitians may use both RD or RDN as their credentials. RD stands for registered dietitian and RDN stands for registered dietitian nutritionist. So while a dietitian is considered a nutritionist, they are also a registered (and may also be licensed) dietitian. It sounds confusing! I always tell people who are looking for nutrition advice to seek out a nutritionist who is a registered dietitian.
Dietitian are your best resource for nutrition information
There are a lot of different career paths a dietitian can take, and that is one reason why I love being a dietitian! I hope this post give you a clear answer to the question, “what is a dietitian?”
Dietitians have a unique education and training, and are your best resource for nutrition information. Follow along as I share more about nutrition!