Dietitians, Nutritionists & Health Coaches
Welcome to my first blog post! Since I’m a dietitian, I thought explaining what a dietitian is and how dietitians differ from other health and wellness practitioners would be a good place to start. Let me preface the conversation by saying this, though – all of the roles I am about to mention are valid and none are superior. Yes, there are very different educational backgrounds, levels of expertise, and scopes of practice; however, when these roles are used properly and provide accurate information, they can work really beautifully to support each other and meet consumer needs. Okay, let’s dive in.
So, I’m a registered dietitian...but I am also a nutritionist. I also love to step into my role as a health or wellness coach! My friends and family members often call me a nutritionist, it’s easier to say- I get it, or ask me why I say I’m a dietitian and not a nutritionist, or if they should listen to what a health coach said, etc. etc. There are a lot of different titles seemingly representing the “same services.” They really aren't the “same services,” though. Again, I am not here to say one job is better than another, is more lucrative than another, is more desirable than another, etc. I’m just saying that there’s a lot of nutrition information in the world being provided by a lot of people. So, let’s clear up the title confusion, check where our nutrition information is coming from, and be empowered to decide which practitioner can meet our individual needs.
Registered Dietitian Nutritionist
Formal Education, Training & Minimum Requirements:
Completion of a 4-year bachelor’s degree through an Accreditation Council for Education in Nutrition and Dietetics (ACEND)-accredited program including the completion of didactic education
1200 hours of supervised practice, aka the Dietetic Internship
Completion of the Registration Examination for Dietitians *this provides national licensure and certification
State Licensure
Annual registration maintenance
Compliance with a Professional Development Portfolio
75 continuing education credits every 5 years
Credentialed by the Commission on Dietetic Registration (CDR)
**A minimum of a graduate degree will be required sit for the registration examination for dietitians beginning January 1, 2024.
To cover the basics, dietitians are trained in the science of nutrition and dietetics and may provide medical nutrition therapy (MNT) to manage a disease, injury, or a condition. MNT is evidence-based practice that follows the Nutrition Care Process to provide holistic and individualized nutrition care to individuals or groups. This means that when you work with an RDN, the RDN is going to be providing in-depth nutrition assessment and reassessment, identifying a nutrition diagnosis (or a nutrition “problem”), working with you to establish nutrition interventions to impact the nutrition diagnosis, and periodically monitoring progress and evaluating the interventions set in place all through the lens of nutrition evidence that is supported in research. MNT cannot be provided by a NDTR, nutritionist, or wellness/health coach as MNT is outside of the scope of practice of these roles. However, a dietitian may provide all services that an NDTR, nutritionist, or wellness/health coach provides. To recap, here’s a list of some services that may be provided by a dietitian in various settings:
Medical Nutrition Therapy
Nutrition Education
Nutrition Consultation
Health and wellness coaching
Individualized meal plans appropriate for medically-prescribed diets and therapeutic diets
Tube feedings (typically in a hospital setting)
Specialized intravenous solutions (typically in a hospital setting)
Specialized oral feedings
Identification of potential food-drug interactions
As a side note, Licensed Independent Practitioners (LIPs) may refer you to a dietitian for many different reasons. LIPs meaning- Advanced Practice Registered Nurses (APRNs), Physician Assistants (PAs), Doctors of Osteopathy (DOs) and Medical Doctors (MDs).
Nutrition and Dietetics Technician Registered
Formal Education, Training & Minimum Requirements:
Must meet minimum education requirements by 1 of 3 routes:
Completion of an associate degree at an accredited program + 450 hours of supervised practice through an ACEND- accredited Dietetic Technician Program
Completion of a 4-year bachelor’s degree meeting didactic education requirements at an ACEND- accredited program + 450 hours of supervised practice under an ACEND-accredited Dietetic Technician Program
Completion of a 4-year bachelor’s degree + completion of Didactic Program in Dietetics at an ACEND- accredited program
Completion of registration examination
Annual registration maintenance
Compliance with Professional Development Portfolio
Completion of 50 hours of approved continuing education every 5 years
May be credentialed as BS-DTR or BSNDTR after completion of a 4-year degree
Credentialed by the CDR
Nutrition and Dietetics Technician Registered, NDTRs help RDNs out a lot. Personally, I am beginning to see NDTRs used more frequently across facilities because they are such a great asset to the nutrition field! NDTRs work under an RDN when engaged in direct patient or client care. The RDN completes all steps of the Nutrition Care Process; however, the RDN may assign the NDTR steps of the Nutrition Care Process to complete. Projects and documentation completed by the NDTR may require review and approval by the RDN, depending on the task and the setting. Here are some services that can be provided by the NDTR:
Nutrition Education
Individualized meal plans appropriate for medically-prescribed diets and therapeutic diets
Nutrition consultation, as appropriate
Observation of RDN services
All registered dietitians are nutritionists and coaches but not all nutritionists and coaches are registered dietitians.
Nutritionist
Here’s where the lines typically begin to blur in the scope of practice and the services offered. A nutritionist studies nutrition and may provide education or counseling regarding nutrition principles. A nutritionist may or may not have an academic degree in the study of nutrition and may or may not work in the field of nutrition. Practically speaking, your nutritionist may relay the US Dietary guidelines and say, “It’s recommended for Americans to eat 5-10 servings of fruits and vegetables per day. Here’s how…” It is not within the scope of practice for a nutritionist to say, “To manage your diabetes, you should decrease your carbohydrate intake and here’s how..” One sentence is providing education regarding a nutrition principle and one is starting to provide MNT. As you can see, it’s pretty easy for the lines to be blurred. Nutritionists are not credentialed by the CDR and are not required to complete ACEND-accredited, didactic education, or supervised practice. A nutritionist’s education and certification are dependent upon the program in which he or she chooses to be certified through. Don’t get me wrong- there are great programs out there that build wonderful and impactful nutritionists! However, because nutritionists are not credentialed by the CDR, it leaves more space for misinformation to be communicated to consumers. More on this in a second.
Health or Wellness Coach
Health or wellness coaches are certified to motivate people to make health choices that will improve health outcomes or decrease health risks. A coach may guide clients through implementing behavior change, providing education regarding disease prevention and management, and laying down some health education research. Here’s the caveat though- a health coach may only provide advice as he or she is nationally credentialed. This means that a coach may only provide these services as the letters behind his or her name allows (i.e. registered dietitian, physician, psychologist, etc.) So if your health coach is providing medical advice and is not credentialed to provide medical advice…that’s a sticky situation. Like nutritionists, coaches are not credentialed by the CDR and are not required to complete ACEND-accredited, didactic education, or supervised practice. A coach’s education and certification are dependent upon the program in which he or she chooses to be certified through.
Now let’s go back to our “sticky situations” and credentialing. As I said RDNs and NDTRs are credentialed by the CDR whereas nutritionists and health or wellness coaches are not. I am not saying this is a bad thing. I want to be very real with you- I’m not saying dietitians are the end-all-be-all or that everyone should be a dietitian or choose to work with a dietitian. With that said, one of the main functions of the CDR is to protect the consumer by ensuring that RDNs and NDTRs are providing ethical, evidence-based care within their scopes of practice. Since nutritionists and coaches are not required to have licenses or certifications that are held by the CDR, the CDR is not able to monitor this licensure or hold it to the same practice standards. The standard to which the certification of a nutritionist or coach is held and monitored varies depending on the program it was obtained from. Some programs may have more strict guidelines on their licensure and certifications and some may have less strict guidelines. Because those guidelines are not always clearly communicated to the consumer, there’s a higher “risk” for misinformation to be presented to the consumer from a nutritionist or coach than from an RDN or NDTR. That’s not to say that if you consult with a nutritionist or coach you’ll be given inaccurate information. It’s not to say if you consult with an RDN or NDTR you’ll be provided with information and counseling that is 100% practical for you and your goals.
Here are key things to consider when choosing the appropriate professional for you:
What do you need help with? What is the nutrition problem or goal that you have identified?
Is the practitioner qualified to address your concerns? Does this identified nutrition problem or goal relate to a medical disease, injury, or condition? If so, you’ll likely want to pursue an RDN for MNT.
Do you feel comfortable with taking advice from the practitioner given his or her educational background, training, credentials, personal experience, and professional experience?
What is your price range?
Does the practitioner listen to your needs and your goals and identify how he or she can help you pursue and achieve those needs and goals?
Is it a good fit? Do you vibe with this practitioner? Do you feel comfortable with this practitioner?
Resources:
Academy of Nutrition and Dietetics. Definition of terms list. 2017. https://www.eatrightpro.org/-/media/eatrightpro-files/practice/scope-standards-of-practice/academydefinitionoftermslist.pdf