Why APDs should be the specialists of choice for people needing advice for medical conditions.
Dietitians (or Dieticians) are highly trained individuals and we are specialists in the application of medical nutrition therapy. This year it has been 10 years since I qualified from the University of Wollongong in Australia. Here in Australia, we study either a 4 year undergraduate degree in Nutrition & Dietetics straight out of high school – or if you are like me, a combined Undergraduate Science and Business degree, and then a Masters degree in Nutrition & Dietetics + research thesis.
Much of our Dietitian training centers around medical knowledge, scientific research around nutrition, and taking individual dietary histories, action planning and solution designing for an individual depending on their medical condition and nutrition status. We study the human body and biochemistry as well as metabolism and food in order to get a good understanding of the role nutrition can have to protect against illness and in reducing the progression of medical conditions like obesity and diabetes. We also train in hospital before we graduate.
As a dietitian working in hospital, I see a variety of clients from different areas and it is never the same day twice. Our work in hospitals is a given since we know malnutrition can be a consequence of hospitalisation or long illnesses.
Today for example, I was referred a client by one of the Geriatricians I work with for optimisation of energy after she was admitted to hospital quite weak, and having been unable to eat for several days at home.
She is on several different types of medication and has a cancer of her bile duct which has affected normal food digestion and absorption. We discussed her usual weight, diet and made a plan for her to preserve her en
ergy, muscle mass and strength.
She was great in that she was able to eat still, compared with some other patients who might require feeding via a nasogastric tube or special intravenous like drip called Total Parenteral Nutrition (TPN).
Contrast that with this afternoon and I have just seen a 50 year old male client who had an elevated Glucose Tolerance Test for weight loss with a background familial late onset diabetes. He is otherwise well and healthy, and wants to lose weight to allow him to be fitter and healthier. He told me that his personal trainer yelled at him for eating muesli in the morning because of the sugar content. I find this pretty unreasonable advice especially given that this client is bordering on type 2 diabetes but it is not uncommon for Personal Trainers to provide restrictive dietary advice. He needs the right advice to navigate his current situation and a meal plan which can provide nourishment and reduce the risk of advancement to diabetes, which unbalanced eating can sometimes do. This client is already feeling tired given his health status, and was considering restricting his intake of breakfast until he came to see me today.
Nutritionists, which have more of a whole food approach, might work more at a general population or public health level, or on a project basis within a food company. Nutrition Australia has a voluntary register for nutritionists which you can check out here http://www.nutritionaustralia.org/national/resource/nutritionist-or-dietitian
The Nutrition Society of Australia does too, look one up here http://nsa.asn.au/find-a-registered-nutritionist/
Nutritionists can study at the University level, and I became a Nutritionist before I became a Dietitian. Usually a Dietitian is also qualified as a Nutritionist, but it is never the other way around. Today there are many Tafe style, Diploma level courses offering qualifications of sorts which do not give the same level of academic vigour and scientific inquiry into Dietetics as a 4 year undergraduate University degree, or Graduate level qualification, however this title is not protected by any laws here and therefore this means that anyone could call themselves a Dietitian even if they are not someone who has gone to University, done the study, and qualified for their degree without being prosecuted for doing so.
Even though our title is not protected legally, our credentialing body, the Dietitians Association of Australia keeps a register of all Accredited Practising Dietitians (APDs) and holds us accountable for our work. We also have to complete a mentoring program to qualify as an APD when starting out, and then we must complete 30 hours of professional development education each year to retain our credentials. See this link to find an APD in your area. http://daa.asn.au/for-the-public/find-an-apd
I’ve been very lucky and been able to travel and work in other countries since qualifying for my degree back in 2006 from Wollongong University. In the United States, there are licensure laws which exist within the individual states to reassure consumers that they are accessing dietary advice from individuals with an the right education and experience. Their system is different depending on the state and the licensing laws around the Registered Dietitian credential. I worked pro bono and did a lot of voluntary work in the US in my travels there, and did not work in hospital as I did in the UK., so my work there had more of a public health and community focus. I learnt a lot from these experiences and I loved my time in the United States.
In the United Kingdom, the term Registered Dietitian (RD) is protected by the Health and Care Professions council and anyone using this title without the relevant qualification to match it could be subject to prosecution and a fine of up to 5,000 pounds. Read more about it here https://www.hpc-uk.org/aboutregistration/protectedtitles/
Overall, reflecting on the last 10 years, I can definitely say that my education began when I first stepped onto University grounds and it has continued each year since with every different role I have undertaken both here and in the UK. I relish my role as a Dietitian and it is always a pleasure to assist people to optimise their health and live happier and healthier lives.
The final point about dietitians vs. nutritionists are that we are recognised by Australian Health Funds, Medicare, and the Department of Veterans affairs and have item numbers we can use under Medicare. Most comprehensive health funds cover dietitian visits as well with some funds paying up to 55% back on our fees. The sad thing is that some health funds have started to cover nutritionists and naturopaths now, not only dietitians as they once did. Shame on you health funds.
So before going to visit someone who uses either of these terms, check if they are registered with an appropriate credentialing body, check your health fund and your coverage level. But most of all, enjoy the experience. We are here to empower and assist you to optimise your nutrition.