Let Dietitian be Dietitian.

Let Dietitian be Dietitian.

Too many people want to do the job of a dietitian.

The doctor who sees patients who have out-of-control diabetes. The personal trainer who works with an overweight client. The 60-year-old man who runs a marathon. The mom who raises three healthy kids.

Just about everyone has something to say about healthy eating and provide diet advice, and in some cases, write blockbuster books about diet. Never mind if they have had any formal training in nutritional science.

I always wonder what all this means to people who go to school, get formal training in nutrition science, and pass board exam such as the registered dietitians (RD)?

The irony is there are a lot of willing buyers, consumers, and fans of such “expert” or should I call “quackery” advice. I can name quite a few best seller diet books that are written not by registered dietitians or persons trained in nutrition science.

What is odd is that you don’t see such rampant quackery practice in other heath fields: for example, do you hear people in the grocery store trying to give advice on how to perform brain surgery, but you hear a lot of chatters about the food that cures cancer?

Perhaps one of the reasons these unofficial diet experts are allowed to flourish and even be relatively successful commercially is the justification that everyone eats, and that somehow this qualifies the earning of the title “nutrition expert”. The fact that everyone has the lived experience in eating and feeding and thus earn the license to write diet books and dispense diet prescription is absurd. Yet, as a society we embrace such practice, especially when the perpetrator is a celebrity who lost 30 pounds in 30 days, or a medical doctor who graduated from an Ivy league school.  

Back to my question: what does all this mean to the dietitians? How does dietitian as a profession survive and thrive in such a crowded field that is filled with a lot of self-taught gurus, half-truths and sometimes crap?

Registered dietitians have far too many competitors! But the real deal should rightfully be the RDs and the licensed nutritionists. They must be accorded the same kind of respect all other medical specialists are given and to play the role they deserve in healthcare.  

What doctors and physicians should do is to refer patients to RD like a medical specialist, and not to take over the job of dietitian. Too many times, I hear doctors trying to give diet advice to their patients, though the intention may be good (time saving, or since they are already here, why not just tell them), when what they should do is to REFER. Physicians and medical practitioners are generally quite good at respecting professional boundaries and making references to their colleagues. It would be wonderful if they do the same for RDs or have the admin or budgetary support to have RD on staff. This is the only way to minimize nutritional misinformation or quackery, and most important of all, to provide the intervention the patients really need.

Am I for the effort to educate medical doctors about nutrition? Absolutely Yes. Do I support the call for building nutrition 101 classes in the medical school curriculum? Absolutely Yes. But the goal of such education is NOT to have doctors take over the job of dietitians. The goal is to have doctors be the allies of dietitians, and do the following:

a) Advocate for dietetic profession: Hopefully they would have been so sold with the idea of connection between diet and disease from the nutrition classes they will be taking.

b) Refer patients to dietitians:  they would have been so convinced that RD is an independent, irreplaceable, and legitimate medical profession to consider RD as a permanent and must-have team member.

c) Push for a change in our medical care reimbursement system to include diet intervention

Nothing is free in healthcare. If the service is not billable, it will be difficult to scale it.

Diet intervention must be a reimbursable service, especially for diet-related diseases, which are plentiful. Food-is-Medicine must be led by RDs as they’re the true experts in all matters relating to food and diet. They are the best practitioner to develop and implement diet-disease prevention services and programs. But such ideologies must be supported by doctors and other members of the healthcare team. Only when this happens can we see the elevation of RD as a medical profession and make Food-is-medicine a scalable service.

Let dietitian be dietitian. 

Yen Ang, DrPH, MS, MPH, RDN