In Defense of Dietetics

Health is improved by raising the bar, not lowering it

This week saw the release of a piece entitled, “It’s Time for Missouri to Legalize Diet Advice” written by Shoshana Weissmann through RStreet. In summary, it offered the following argument. Missouri is suffering from a health-related crisis augmented by the strict nutritional laws permitting only a select few (namely, dietitians) to jump in the fight. Furthermore, the piece argues, dietitians bear responsibility for the state of these health issues by not actively breaking down the laws which offer exclusive rights of practice.

While dietitians are not strangers to insinuations of this nature, this is one of the more disingenuous and poorly thought out arguments I’ve ever read on the subject of nutritional licensure. It takes minimal effort to deconstruct this piece for little more than a smear effort aimed at high-jacking career qualifications.

To begin, it is a bit of an oversell to call Missouri’s licensure laws “…some of the strictest nutritional laws in the country.” Aside from the fact that Missouri is one of 35 states in the Union with similar laws, Ms. Weissmann misses the point that such licensure protects scope of practice, not simply title. The Center for Nutrition Advocacy reports:

“This law is a Licensure with Exclusive Scope of Practice. Only a licensed dietitian can provide any form of nutrition care including medical nutrition therapy… This law does not apply to those licensed in as a health profession whose scope of practice covers nutrition care. [Italics added]”

Any credible profession must define its scope of practice, granted through some form of certification, credential, or legally backed entitlement. Otherwise, what claim or point of authority does any profession have? What is to stop me from practicing medicine, or constructing a building, or picking up a gun and calling myself an officer of the law?

Critics will counter this argument by summarily dismissing the gravitas and value imbued through training and education in dietetics. It’s not like practicing medicine where you can kill someone, they say. If not in proximity to a physician, standards of practice are not necessary. Indeed Ms. Weissmann argues this very point:

“…licensed dietitian groups are quick to invoke images of non-licensed individuals dispensing quack diet advice to uninformed clients. The problem with this argument is that the data utterly fails to back it up.”

Oddly, she does not cite any evidence in support of her patently false claim. Bad dietary advice can, and often does, lead to serious medical consequences. Where it does not harm health immediately, bad dietary advice is useless and frequently costs people their precious time and money.

This past week, researchers in the United Kingdom released a study on the validity of content offered by the nation’s most popular social media gurus. Among these, only one person consistently offered accurate information regarding weight loss, with the others consistently offering either inaccurate or misleading information. (The one by the way… a registered nutritionist with a degree)

Avoidable hospitalizations for diabetes — those brought on by poor glucose control and dietary mismanagement — accounted for 36% of all diabetes hospitalizations in the United States.

What about diets sold and promoted as “clean dietary practices”? A study concluded that compared to control recipes found online, these “clean recipes” were often misleading consumers in their claims of health superiority.

What about weight loss? The U.S. weight loss market in 2017 was estimated to be worth $68.2 billion — and growing. But the evidence shows this to be a big waste of money. The nation’s BMI has remained steady over the past decade. Furthermore, many studies now demonstrate how these “quick-loss” interventions fail in the long run. There is initial weight loss, but the majority of people regain this weight in the space of two years.

The height of absurdity in this piece comes from arguing for a lax on licensure so that personal trainers and health coaches can tell clients to “eat more veggies and less carbs.” I still cannot read that statement without shaking my head. If you truly believe that this constitutes professional nutritional advice, all I can say to you is this. Life exists outside of a gym.

The scope of educational training in dietetics encompasses behavior modification, maneuvering limited resources, simplifying data for practical applications, establishing patterns in setbacks, promoting autonomy through education, counseling skills, culinary training, and this doesn’t even touch on medical nutrition therapy. Wanting people to “eat more vegetables” is an argument for free Wifi internet access (where such nuggets of wisdom reside). This is not an argument to upend a hundred years of research in a profession.

Finally, there is this insidious claim that dietitians are not so concerned with patient health and safety as they are with closing ranks on the market. While we certainly could consider the Missouri dietitians’ median salary of $49,590 to back this, I have alternative theory. Never mind staying in your lane, we are not going to let anyone hijack the vehicle as a consequence of people not knowing what they do not know.

This unabashed and tactless slander falls short as we consider just exactly what virtues these alternative health coaches and personal trainers possess. Why are their motives for patient and client care so much purer than a dietitian’s? Would they mind dietitians “crowding” the field of personal training, simply because we think we can do it?

Nobody has a right to upend any scope of practice, regardless of how many blogs and chatrooms are visited. You want to do what dietitians do? Join us by getting the training and education. If not, than propose an alternative within your scope of practice. We look forward to more professionals engaging in the fight by raising the bar, not lowering it.

1. Center for Nutrition Advocacy. (2019). Missouri. Retrieved from http://nutritionadvocacy.org/missouri.

2. Independent. (2019). Social Media influencers give bad diet and fitness advice eight times out of nine, research reveals. Retrieved from https://www.independent.co.uk/news/health/social-media-weight-loss-diet-twitter-influencers-bloggers-glasgow-university-a8891971.html.

3. Dickinson, K. M., Watson, M. S., & Prichard, I. (2018). Are Clean Eating Blogs a Source of Healthy Recipes? A Comparative Study of the Nutrient Composition of Foods with and without Clean Eating Claims. Nutrients, 10(10), 1440. doi:10.3390/nu10101440.

4. Ahern, M.M., & Hendryx, M. (2007). Avoidable hospitalizations for diabetes: comorbidity risks. Dis Manag, 10(6), 347–355.

5. Salman, B., Hussain, M., Shafique, K., Imtiaz, S., & Dhrolia, M.F. (2018). Risk factors of hospitalization among chronic kidney disease patients in tertiary care hospitals — A single-center experience. Saudi J Kidney Dis Transpl, 29(5), 1150–1158.

6. Market Research (2018). Top 6 Trends for the Weight Loss Industry in 2018.

7. Wadden, T.A., Butryn, M.L., & Byrne, K.J. (2004). Efficacy of lifestyle modification for long-term weight control. Obes Res, 12, 151S-162S.

8. Dulloo, A.G., & Montani, J.P. (2015). Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview. Obes Rev, 16, 1–6.

9. NutritionED.org (2019). Missouri Nutritionist Certification. Retrieved from https://www.nutritioned.org/missouri-nutritionist.html.

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