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A dietitian or dietician (dietitian is the preferred spelling within the dietetics profession) is an expert in food and nutrition. Dietitians help promote good health through proper eating. They supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. In a medical setting, a dietitian may provide specific artificial nutritional needs to patients unable to consume food normally. Dietary modification to address medical issues involving dietary intake is also a major part of dietetics. The goals of the dietary department are to provide medical nutritional intervention, obtain, prepare, and serve flavorsome, attractive, and nutritious food to patients, family members, and health care providers.

In many countries only people who have specified educational credentials can call themselves "dietitians" ' the title is legally protected. The term "nutritionist" is also widely used; however, the term nutritionist is not regulated as dietitian is and is not an accurate term to give to a dietitian. People may call themselves nutritionists without the educational and professional requirements of registered dietitians. A nutritionist is not a dietitian, as a dietitian is registered to a national board and accredited and a nutritionist is neither.

Different professional terms are used in different countries. Dietitians are valuable members of the medical multi-disciplinary team providing nutritional knowledge and acting as consultants to other health care professionals.

[edit] Types of dietitians

The majority of dietitians are clinical, or therapeutic, dietitians. Clinical dietitians review medical charts and talk with patients' families. They work with other health care professionals and community groups to provide nourishment, nutritional programs and instructional presentations to benefit people of all ages, and with a variety of health conditions. This is accomplished by developing individual plans to meet nutritional needs. These plans include nourishment, tube feedings (called enteral nutrition), intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN), diets, and education. Clinical dietitians provide individual and group educational programs for patients and family members about their nutrition and health.

[edit] Dietitians in practice

[edit] Clinical dietitians

Clinical dietitians work in hospitals and other health care facilities to provide nutrition therapy to patients according to the disease processes, provide individual dietary consultations to patients and their family members and also conduct group educations for other health workers, patients and the public. They coordinate both medical records and nutritional needs to assess the patients and make a plan based on their findings. Some clinical dietitians have dual responsibilities with medical nutrition therapy and in foodservice, described below. In addition, clinical dietitians in smaller facilities will also provide or create outpatient education programs. They work as a team with the physicians, physician assistants, physical therapists, occupational therapists, pharmacists, speech therapists, social workers, nurses, Dietetic Technicians, and Volunteers to provide care to the patients.

[edit] Community dietitians

Community dietitians work with wellness programs and international health organizations. These dietitians apply and distribute knowledge about food and nutrition to specific life-styles and geographic areas. They coordinate nutritional programs in public health agencies, daycare centers, health clubs, and recreational camps and resorts. Some community dietitians carry out clinical based patient care in the form of home visits for patients who are too physically ill to attend consultation in health facilities.

[edit] Foodservice dietitians

Foodservice dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess and plan foodservice processes in health care facilities, school food service programs, prisons, cafeterias and restaurants. These dietitians will also perform audits of their departments, train other food service workers and use marketing skills to launch new menus and various programs within their institution. They direct and manage the operational and nutrition services staffs such as kitchen staffs, delivery staffs and dietary assistants or diet aides.

[edit] Gerontological dietitians

Gerontological dietitians are specialist in nutrition and aging. They are Board certified in Gerontological Nutrition with the American Dietetic Association. They work in government agencies in aging policy, and in a regulatory capacity in the oversight of nursing homes and community-based care facilities. They work as Consultants in Nursing Homes, and in higher education in the field of Gerontology (the study of Aging.)

[edit] Pediatric dietitians

Pediatric dietitians provide health advice for persons under the age of 18.

[edit] Research dietitians

Research dietitians are mostly involved with dietary related research in the clinical aspect of nutrition in disease states, public aspect on primary, secondary and sometimes tertiary health prevention and foodservice aspect in issues involving the food prepared for patients. Many registered dietitians also work with the biochemical aspects of nutrient interaction within the body. Research Dietitians normally work in a hospital or university research facilities. It should be noted that some Clinical dietitian's roles also involve research other than the normal clinical workload. Quality improvement in dietetics services is also one area of research.

[edit] Administrative dietitians

The Administrator, manager, or director of a dietetics department or nutrition services program acts as head of the dietitians. They also hire, train, direct and supervise employees and manage dietary departments. Administrative dietitians may also apply procedure and policy as part of their management job.

[edit] Business dietitians

Business dietitians serve as resource people for the media. Dietitians' expertise in nutrition is often taped for TV, radio, and newspapers'either as an expert guest opinion, regular columnist or guest, or for resource, restaurant, or recipe development and critique. Dietitians have served as show hosts on major television stations and as drive-time radio news anchors. Dietitians write books, appear on television cooking channels, and author corporate newsletters on nutrition and wellness. They also work as sales representatives for food manufacturing companies that provide nutritional supplements and tube feeding supplies.

[edit] Consultant dietitians

Consultant dietitians work under private practice. The title 'consultant' in this case should not be confused with the identical title given to certain medical doctors in countries such as the United Kingdom and Ireland. The term consultant in this instance is synonymous with the title attending as used in countries such as the United States. Consultant dietitians contract independently to provide nutrition services and educational programs to individuals, nursing homes, and in health care facilities. As recent studies have shown the importance of diet in both preventing and managing disease, many US states have moved towards covering medical nutrition therapy under the Medicaid/Medicare making consulting a much more lucrative option for dietitians due to insurance reimbursement.

[edit] Other nutrition workers

These designations apply principally to the US although the generic classifications are likely to be applicable elsewhere.

[edit] Registered Dietetic Technicians

Dietetic Technicians, Registered (DTR), also commonly known as "Diet Techs", possess a specialized Associate Degree from Community College programs which are accredited by the Commission on Accreditation of Dietetics Education (CADE) of the American Dietetic Association. In many settings they work alongside Registered Dietitians, and like Registered Dietitians, they have in-depth knowledge of nutrition. They must complete a dietetic internship with a minimum of 450 supervised practice hours in the areas of Food Service Theory and Management, Community Dietetics, and Clinical Dietetics. They must also complete a national registration examination administered by the Commission on Dietetics Registration (CDR) of the ADA. Although the DTR is an independently credentialed nutrition practitioner, when performing clinical dietetics, they must work under the supervision of a Registered Dietitian. In addition, some states have current legislation specifying the scope of practice for the DTR.

Effective June 1, 2009, a new pathway to becoming a Registered Dietetic Technician has been made available by the Commission on Dietetic Registration. Students may take the DTR licensing examination without attending an internship after completion of a Baccalaureate degree granted by a US regionally accredited college/university, or foreign equivalent, and completion of a Commission on Accreditation of Dietetics Education (CADE) Didactic Program in Dietetics (DPD) or Coordinated Program in Dietetics (CP). ^[1]

[edit] Dietetic Technicians (Unregistered)

Dietetic Technicians are not required to be registered and have the same job duties as DTRs. Many employers do not require their Dietetic Technicians (DT) to be registered. Dietetic Technicians are nutrition professionals that may have a significant range in education level. The minimum requirement for a DT is obtaining an AAS degree in Human Nutrition from an accredited college. Many DTs have a Bachelors or even Masters Degree in Human Nutrition. Some working DTs are awaiting entry into dietetic internship programs on their career path to become dietitians, benefiting from valuable work experience as Diet Techs.

[edit] Dietary assistants or dietary aides

Are responsible for assisting and carrying out the medical nutrition therapy prescribed by the Dietitians and to ensure that food for the patients as instructed by the Dietitians are carried out correctly by checking menus against recent diet orders before tray assembly begins and being physically present in the kitchen plating-lines at meal hours. Dietary aides in some countries might also carry out a simple initial health screening for newly admitted patients and only inform the Dietitians if any screened patients requires a dietitian's expertise for further assessments or interventions.

[edit] Dietary clerks

Dietary clerks perform clerical tasks such as entry and maintenance of dietary requirements to a database. They also track financial information, such as the number of meals served each day.

[edit] Dietary managers

Dietary managers are responsible for retail, catering and tray lines. If an operation is large, there may be one or more managers to help in directing the dietary workers.

[edit] Dietary workers

Dietary workers prepare the food and meal trays in the kitchen. They check for accuracy and completeness. They also maintain the storage area for food supplies and ensure practice of sanitary procedures. Dietary workers are trained on the job and can work in any commercial kitchen.

[edit] Dietary hosts

Dietary hosts or hostesses deliver and bring back the meal trays to patients. They distribute and collect menus and help the patients to make complete selections.

[edit] Required qualifications and professional associations

A dietitian's education in health science involves significant scientific based knowledge in anatomy, chemistry, biochemistry, biology, physiology, nutrition, and medical science. In addition to this scientific instruction, dietitians must undergo an internship to learn counseling skills and aspects of psychology.

There are a few different academic routes to becoming a fully qualified registrable dietitian:

• A professional bachelor degree in Dietetics which requires four years of studies

or

• A bachelor of science degree and a postgraduate diploma in Dietetics

or

• A bachelor of science degree and a master's degree in Dietetics

Internship is also essential to become a fully qualified Dietitian. The internship process differ in different countries.

[edit] USA

In the US nutrition professionals include the registered dietitian (RD) and the "dietetic technician, registered" (DTR). These terms, as well as simply dietitian, are legally protected terms regulated by the American Dietetic Association (ADA).

Dietitians are registered with the Commission on Dietetic Registration (the certifying agency of the ADA) and are only able to use the label "Registered Dietitian" when they have met strict, specific educational and professional prerequisites and passed a national registration examination.

Besides academic education, registered dietitians must complete at least 1200 hours of practical, supervised experience through an accredited program before they can sit for the registration examination. In a coordinated program (CP) students acquire internship hours concurrently with their coursework. In a didactic program (DP) these hours are obtained through a dietetic internship that is completed after obtaining a degree.^[2]

In both programs the student is required to complete several areas of competency including rotations in clinical, community, long-term care nutrition as well as food service, public health and a variety of other worksites.

Once the degree is earned, the internship completed, and registration examination passed, the individual can now use the nationally recognized legal term, Registered Dietitian and is able to work in a variety of professional settings. Most states require additional licensure to work in most settings. To maintain the RD credential, professionals must participate in and earn continuing education units (often 75 hours every 5 years.)

[edit] Canada

In the United States and Canada the Dietitian, Registered Dietitian (RD), etc. are similarly protected titles. The professional association in Canada is the Dietitians of Canada. The US equivalent of it is American Dietetic Association.

In Canada, each province has an independent professional college (for example, The College of Dietitians of Ontario) which is responsible for protecting the public and regulating the profession. The colleges are entirely funded from licensing fees collected from dietitians. Each college must have both public and professional members, and is empowered to investigate and censure (when malpractice/negligence is found) members of the profession who breach either their scope of practice or harm/endanger the health of a patient/client, and receive a complaint against them from a member of the public or another health care professional. To practice as a registered dietitian within a province, a dietitian must register with the college and obtain a license. The activities of the college are governed by legislation passed by the provincial government. It is the presence of this regulatory body which distinguishes registered dietitians from nutritionists in Canada.

In Canada, the colleges also set the minimum entry requirements for admission into practice as a registered dietitian. Requirements to entry into practice as a dietitian include a four year undergraduate degree from an accredited university (which includes courses in science, foods, nutrition, management, communication and psychology/sociology, among others), a 10 - 12 month supervised practice period (called an internship) and successfully passing a board exam in nutrition and dietetics.

[edit] Australia

Accredited Practising Dietitians (APDs) in Australia gain their qualifications through university courses accredited by the DAA (Dietitians Association of Australia). In order for patients to receive a rebate from Medicare or Private Health insurance APD status is required. APDs are Dietitians engaged in the Continuing Professional Development program offered by the DAA and commit to uphold the DAA Code of Professional Conduct and Code of Ethics.

Dietitians who do not wish to join the DAA may participate in the DAA's Continuing Professional Development Program without being a member of the DAA and in this way can still hold APD status. However, under new rules (which commenced 1 July 2009), health care providers must either have statutory registration or be members of their national professional association to obtain a provider number. This means all private health funds will require private practitioners applying for provider numbers to be DAA members (not just 'eligible' for membership). More information about the new rules can be obtained at http://www.comlaw.gov.au/ComLaw/Legislation/LegislativeInstrument1.nsf/framelodgmentattachments/728B2E067A609724CA25746A00272158

[edit] References

[edit] External links

• International Confederation of Dietetic Associations
• The American Dietetic Association
• The Commission on Dietetic Registration
• The British Dietetic Association
• Dietitians Association of Australia
• List of articles on "nutritionist" at Quackwatch, demonstrating the unregulated use of the word
• Di�«tist - Dutch Dietitian
• French Dietitians Association
• Indian Dietetic Association
• Student-Run DTR Exam Study Forum