The science and profession of nutrition and dietetics is based on the application of foods and nutrition to promote health and treat disease. Most dietitians and nutritionists work in clinical, community, public health, or food service settings. Others work as consultants or researchers, in the food industry, in university, worksite, medical school, home health, or fitness center settings. Some persons work for world or regional health organizations. At least a bachelor's degree in dietetics, foods, and nutrition is needed to practice as a dietitian or a nutritionist. Dietetic technicians need an associate's degree.
Clinical dietitians, also known as medical nutrition therapists, usually work in a hospital setting as generalists or specialists and as part of a health care team. This person is responsible for using diet to treat disease and as part of the treatment plan. Clinical dietitians assess needs, manage the nutrition care of patients, and conduct individual or group counseling sessions. In almost all settings in the United States, a dietitian must be registered (R.D.) to practice medical nutrition therapy.
As generalists, clinical dietitians may rotate through, or work in a variety of the clinical settings, such as the medical and obstetrics areas. As specialists they have additional training. Some dietitians may also be Certified Diabetes Educators (CDE) or Certified in Nutrition Support (CNS).
Community Nutritionist refers to persons that work in community programs that are funded by governmental organizations or private groups. The terms Public Health Nutritionist and Nutrition Educator usually refer to persons that are employed by governmental health agencies. These persons do one-to-one counseling, conduct assessments, design, implement, and evaluate programs. Some are involved in the screening, surveillance or monitoring of community programs.
Dietitians involved in food service work in hospitals, schools, and long-term care facilities. They have responsibilities related to the day-to-day preparation and delivery of foods, food acquisition, employee supervision, and fiscal matters. Advanced-level practitioners manage program budgets, design marketing strategies, promote programs, or initiate collaborative ventures, such as a joint program with a local clinic or health club.
As nutrition has gained popularity, so have the opportunities for innovative and entrepreneurial practice. Many nontraditional areas of practice are emerging, especially in the area of consultation. Nutritionists work in mass media, rehabilitation, sports, law, marketing, pharmaceuticals, and wellness settings. Entrepreneurs participate in a variety of creative activities, such as development of materials, creation or editing of newsletters or websites, or in the use of new technologies to promote nutrition.
For example, a consulting nutritionist may work at a long-term care facility on Mondays, see individual clients at a medical clinic on Tuesdays, spend Wednesdays and Thursdays writing articles for the local newspaper, and provide "brown-bag lunch" lectures to employees of a local company on Fridays.
Academic (Didactic) and Supervised Practice Training
In the United States, preparation for the dietetic profession is a formal process. The Commission on Accreditation of Dietetics Education (CADE) has two career paths for persons who wish to be eligible to take the national Registration Examination. In the more common path, students complete a baccalaureate degree and then a supervised practice experience (internship). In the second path, students complete a coordinated undergraduate program (CUP), in which they work on the baccalaureate degree requirements and the supervised practice simultaneously. In either path, the student must complete academic (didactic) and supervised practice (internship) training.
Didactic training emphasizes theoretical knowledge and is generally achieved by completing a baccalaureate-level degree from a CADE-accredited program in a college or university. The supervised practice component is an internship. The student rotates through a series of preplanned learning experiences in community, clinical, food-service, and selected specialty practice settings. Upon successful completion of these two elements of learning, the individual becomes eligible to take the national Registration Exam. Related professions include culinary careers (e.g., chefs) and the food sciences.
Knowledge and Skills
Nutritionists and dietitians have a basic knowledge of nutrition, nutrient needs throughout the life cycle, medical nutrition therapy, food service, food and consumer science, health education, and food habits and behavior. They have assessment, counseling, program design, marketing, and management skills. Some have advanced training in specialty areas such as pediatric nutrition, nutrition support, or diabetes education.
Registration and Licensure in the United States
The terms nutritionist and dietitian are sometimes used interchangeably. In most cases a nutritionist, or nutrition educator, works in a community or health-promotion setting, while a dietitian works in a clinical setting. In international health and nutrition programs, the term nutritionist is generally used, and training, activities, and levels of responsibility can vary greatly. However, some U.S. states have licensure laws that define the requirements and scope of practice for a nutritionist. Persons who wish to practice in these states must meet the eligibility requirements to obtain a license.
Dietitians in the United States are credentialed by the profession's accrediting body, the Commission on Dietetic Registration (CDR) of the American Dietetic Association (ADA), as registered dietitians (RDs). Dietetic technicians, who assist in program service and delivery, are credentialed as dietetic technicians, registered (DTR). In some settings, such as long-term care facilities, DTRs may be responsible for day-to-day operations, with guidance from a consulting dietitian.
Judith C. Rodriguez
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