The role of dietitians in health care delivery

Introduction

Dieticians are experts in food and nutrition (“dietetics”). They advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal. They work in a variety of settings from clinical to community and public policy to media communications (McDray, 2013).

Registered Dieticians (RD or RDN) are dieticians who meet academic and professional requirements, including earning at least a bachelor’s degree, and fulfilling a specially-designed, accredited nutrition curriculum, passing a registration exam, and completing a supervised program of practice at a health care facility, foodservice organization or community agency. Roughly half of all RDs hold graduate degrees and many have certifications in specialized fields such as sports, paediatrics, renal, ontological, food allergy, or gerontological nutrition. After learning about patients’ health history, favourite foods, eating and exercise habits, an RD will help individuals set goals and prioritize. Follow-up visits often focus on maintenance and monitoring progress.

The majority of RDs work in the treatment and prevention of disease (administering medical nutrition therapy, as part of medical teams), often in hospitals, health maintenance organizations, private practices or other health care facilities. In addition, a large number of registered dieticians work in community and public health settings and academia and research. A growing number of dieticians work with food and nutrition industry and business, journalism, sports nutrition, corporate wellness programs and other non-traditional work settings.

World Health Organisation (WHO) (2010), classified dieticians as professionals who supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits.

The goals of dieticians are to provide medical nutritional intervention, and to obtain, safely prepare, serve and advise on flavoursome, attractive, and nutritious food for patients, groups and communities. Dietary modification to address medical issues involving dietary intake is a major part of dietetics (the study of nutrition as it relates to health). For example, working in consultation with physicians and other health care providers, a dietician may provide specific artificial nutritional needs to patients unable to consume food normally. Professional dieticians may also provide specialist services such as in diabetes, obesity, oncology, osteoporosis, paediatrics, renal disease, and micronutrient research. (Misner, 2006)

Importance of dietitians to the society

According to Hwalla and Koleilat (2004), dieticians translate scientific information about nutrition into practical advice to help people make health-conscious decisions about food. They also assess, diagnose and treat diet-related problems and aim to raise awareness of the link between food and health to prevent future problems. Many dieticians work in different areas where their roles are varied. They may focus on specialist areas, such as diabetes or children’s health, and may also work in community settings. Other dieticians work in the food industry, sport, the media, education and research.

Statistics Canada (2006) pointed out different professional terms are used in different countries and employment settings, for example, clinical dietician, community dietician, dietetic educator, foodservice dietician, registered dietician, public health dietician, therapeutic dietician, or research dietician. In many countries, only people who have specified educational credentials and other professional requirements can call themselves “dieticians” — the title is legally protected. The term “nutritionist” is also widely used; however, the terms “dietician” and “nutritionist” should not be considered interchangeable — the training, regulation and scope of practice of the two professional titles can be very different across individuals and jurisdictions. In many countries, the majority of dieticians are clinical or therapeutic dieticians, such as the case of the United States, the United Kingdom, and much of African countries including Nigeria. In other countries they are mostly foodservice dieticians, such as in Japan and many European countries.

In Nigeria, according to Dieticians Association of Nigeria (DAN) bulletin (2010), dieticians are professionals in the field of Nutrition and dietetic technologists in Nigeria. The practices of dieticians are monitored and regulated by their national body Dieticians Association of Nigeria (DAN) which was established in 2010 with its secretariat currently operating from the Department of Nutrition and Dietetics, Nnamdi Azikiwe University Teaching Hospital, Hospital (NAUTH), Nnewi Campus, Anambra State. The Association is a young association and promotes health through food, nutrition and diet planning. They are working hard with government to establish the Dieticians Registration Council to regulate the professional training and practice of dieticians.

The major aim of the association is to ensure standardization of dietetic practice through accreditation and reaccreditations of recognized dietetic education programmes. It encourages its members to adopt evidence-based, ethical practices and lifelong continuous professional development. It advocates for dieticians in Nigeria and looks forward to providing a quality assurance programme for accredited dietetics education programmes, and dietetic internship. It encourages its members to adopt applied research and best practices in nutrition and dietetics. At the time of this research (March, 2014), there are 250 registered dieticians, 60 associate members and 20 student members.

Dieticians and health care delivery

NHS Careers (2011), classified dieticians in practice into ten (10) major groups. They are;

  1. Clinical dieticians

Clinical dieticians work in hospitals, nursing care facilities and other health care facilities to provide nutrition therapy to patients with a variety of health conditions, and provide dietary consultations to patients and their families. They confer with other health care professionals to review patients’ medical charts and develop individual plans to meet nutritional requirements. Some clinical dieticians will also create or deliver outpatient or public education programs in health and nutrition. Clinical dieticians may provide specialized services in areas of nourishment and diets, tube feedings (called enteral nutrition), and intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN). They work as a team with the physicians, physician assistants, physical therapists, occupational therapists, pharmacists, speech therapists, social workers, nurses, dietetic technicians, and other careers to provide care to patients. Some clinical dieticians have dual responsibilities with patient nutrition therapy and in foodservice or research (described below).

2. Community dieticians

Community dieticians work with wellness programs, public health agencies, home care agencies, and health maintenance organizations. These dieticians apply and distribute knowledge about food and nutrition to individuals and groups of specific categories, life-styles and geographic areas in order to promote health. They often focus on the needs of the elderly, children, or other individuals with special needs or limited access to healthy food. Some community dieticians conduct home visits for patients who are too physically ill to attend consultations in health facilities in order to provide care and instruction on grocery shopping and food preparation.

3. Foodservice dieticians

Foodservice dieticians 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, restaurants, and company cafeterias. These dieticians may perform audits of their departments to ensure quality control and food safety standards, and launch new menus and various programs within their institution to meet health and nutritional requirements. They train and supervise other food service workers such as kitchen staff, delivery staff, and dietary assistants or aides.

4. Gerontological dieticians

Gerontological dieticians are specialists in nutrition and aging. They work in nursing homes, community-based aged care agencies, government agencies in aging policy, and in higher education in the field of gerontology (the study of aging).

5. Neonatal dieticians

Neonatal dieticians provide individualized medical nutrition therapy for critically ill premature newborns. They are considered a part of the Neonatal Intensive Care Unit’s medical team. The neonatal dietician performs clinical assessment of patients, designs nutrition protocols and quality improvement initiatives with the medical team, develops enteral and parenteral regimens, helps establish and promote lactation/breastfeeding guidelines and often oversees the management of infection prevention in the handling, storage, and delivery of nutritional products.

6. Paediatric dieticians

Paediatric dieticians provide nutrition and health advice for infants, children, and adolescents. They focus on early nutritional needs, and often work closely with doctors, school health services, clinics, hospitals and government agencies, in developing and implementing treatment plans for children with eating disorders, food allergies, or any condition where a child’s diet factors into the equation, such as childhood obesity.

7. Research dieticians

Research dieticians may focus on social sciences or health services research, for example, investigate the impact of health policies or behaviour change, or evaluate program effectiveness. They may survey foodservice systems management in order to guide quality improvement. Some research dieticians study the biochemical aspects of nutrient interaction within the body. In universities, they also may have teaching responsibilities. Some clinical dieticians’ roles involve research in addition to their patients care workload.

8. Administrative dieticians

Administrative or management dieticians oversee and direct all aspects of food policy and large-scale meal service operations in hospitals, government agencies, company cafeterias, prisons, and schools. They recruit, train and supervise employees of dietetics departments including dieticians and other personnel. They set department goals, policies and procedures; purchase food, equipment and supplies; maintain safety and sanitation standards in food preparation and storage; and keep records to monitor areas such as budget control and client information.

9. Business dieticians

Business dieticians serve as resource people in food and nutrition through business, marketing and communications. Dieticians’ expertise in nutrition is often solicited in the media — for example providing expert guest opinion on television and radio news or cooking shows, columnist for a newspaper or magazine, or resource for restaurants on recipe development and critique. Business dieticians may author books or corporate newsletters on nutrition and wellness. They also work as sales representatives for food manufacturing companies that provide nutritional supplements and tube feeding supplies.

10. Consultant dieticians

Consultant dietician is a term sometimes used to describe dieticians who work under contract with health care facilities or in private practice, such as used in Canada and the United States. The term ‘consultant’ in this case should not be confused with the identical title reserved for certain medical doctors in countries such as the United Kingdom and Ireland. Consultant dieticians contract independently to provide nutrition services and educational programs to individuals and health care facilities as well as sports teams, fitness clubs, supermarkets, and other health and nutrition-related businesses.

Typical health care activities of dieticians

Tasks vary widely between individual jobs and the areas of employment. For example, community dieticians and those working in public health may see a much wider range of patients in a variety of settings.

The activities a dietician may be involved in include:

  • Educating and advising a wide range of patients with diet-related disorders on the practical ways in which they can improve their health by adopting healthier eating habits;
  • Calculating patients’ nutritional requirements using standard equations based on assessments of blood chemistry, temperature, stress, mobility and other relevant factors;
  • Analysing the nutritional content of food (including new products, if you work in the food industry);
  • Delivering group sessions to a variety of audiences, including children and patient groups;
  • Working as part of a multidisciplinary team in hospitals or in a community setting to gain patients’ cooperation in following recommended dietary treatments;
  • Educating other healthcare professionals (doctors, nurses, biochemists, social workers, care workers and community workers) about food and nutrition issues;
  • Advising hospital catering departments about the specific dietary requirements of patients;
  • Running clinics in hospital outpatients departments or general practitioners’ (GP) surgeries for patients who have been referred by hospital consultants, GPs or health visitors;
  • Advising athletes and sportspersons on how diet can optimise performance and recovery from injury;
  • Educating sportspersons to understand the physiology and biochemistry of different types of exercise and the role nutrition has in these processes;
  • Writing reports and case notes and maintaining accurate records; carrying out visits to people’s homes, including nursing homes;
  • Preparing information packs, flyers and other promotional materials;
  • Advising the food and pharmaceutical industry.

(NHS Careers, 2011).

Required qualifications for dieticians

In most countries, competent performance as a dietician requires formal training at a higher educational institution in food and nutritional science, nutrition education, dietetics, or a related field. Their education in health science involves scientific based knowledge in anatomy, chemistry, biochemistry, biology, and physiology.

While the specific academic and professional requirements to becoming a fully qualified dietician differ across countries and jurisdictions, as these are adapted to the needs of the individual countries and the opportunities available, common academic routes include:

  • A bachelor degree in Dietetics which typically requires four years of postsecondary studies; or
  • A Bachelor of Science degree and a postgraduate diploma or master’s degree in Dietetics.

In addition, dieticians may be required to undergo an internship to learn counselling skills and aspects of psychology. The internship process differs across countries and jurisdictions. (WHO, 2010)

Reasons why people should visit dieticians regularly

A dietician is your food doctor. They provide information regarding food and nutrition and enable people to live a healthy life. Nutrition is a science and qualified nutritionists provide evidence based nutritional advice i.e. advice based on results of scientific research.

We all have different eating habits, medical history and fitness levels so one diet cannot be suited for all. A qualified dietician can plan customised diets for each individual based on their health, medical, physical and psychological status.

With the advent of internet, there is abundant information about food and nutrition. Each individual is loaded with unclear and contradictory information about which food is good or bad for health. This excess information leads to confusion and an individual is left unsure as to what and how much to eat. Also, internet and newspapers are often flooded with a new fad diet which if followed without consulting a dietician may lead to nutritional deficiencies.

A dietician is an expert on food who can interpret the available information, evaluate its authenticity and deduce if there is any scientific reliability on the same. A qualified dietician can help an individual in many ways. Here’s how people can benefit from a dietician’s help.

  • Influences the food choices and eating habits of an entire family starting from pregnancy followed by childhood into adulthood and old age.
  • Clears misconceptions one has about food and gives clear direction about what to eat, how to eat and how much to eat.
  • Lifestyle related disorders such as diabetes, obesity, osteoporosis, etc. are on the rise. A dietician plans a healthy, balanced diet for normal, healthy individuals and helps prevent these disorders.
  • Plans diets for patients suffering from illness such as diabetes, cardiac disease, thyroid, tuberculosis, gastro-intestinal problem, osteoporosis, Crohn’s disease, celiac disease, etc. and facilitate their quick recovery and road to good health.
  • A balanced diet plan can also enhance the process of recovery from a surgery.
  • Helps individuals gain or lose weight in a healthy way without any side-effects or nutritional deficiencies.
  • Helps athletes, children and those interested in fitness to eat better and healthier to achieve their goals and improve their performance.
  • Increasing number of individuals are diagnosed with several nutrient deficiencies such as Vitamin D, Vitamin B12, iron, calcium, etc. A qualified dietician helps prevent or combat these deficiencies by planning a balanced meal rich in these nutrients.

To sum it up, one needs to consult a qualified, professional dietician not just to lose weight but to gain health. (Neha, 2014).

References

DAN (2010). Dieticians Association of Nigeria (DAN) Bulletin (2010) Vol.1. Nnewi: Oge Jeff Publishers.

Hwalla, N. & Koleilat, M. (2004). ‘Dietetic Practice: The Past, Present and Future.’ Eastern Mediterranean Health Journal, 10(6):716-730.

McDray, K. (2013). Dieticians do more than tell you what to eat. Retrieved Mar. 8, 2014 from Chicago Tribune

Website:http://articles.chicagotribune.com/2013-01-18/classified/chi-role-call-dietitians-do-more-than-tell-you-what-to-eat-20130118_1_dietitians-offer-term-nutritionist-nutrition-information

Misner, B. (2006). “Food Alone May Not Provide Sufficient Micronutrients for Preventing Deficiency.” International Society of Sports Nutrition 3(1): 51–55.

Neha, S. (2014). The Health Site: 8 reasons you need to consult a qualified professional dietician. Retrieved  on Mar. 10, 2014 from Health India. Website:http://health.india.com/fitness/8-reasons-you-need-to-consult-a-qualified-professional-dietician-k214/

NHS Careers (2011). National Health Service: Careers in detail – Dietician. Retrieved on Mar. 8, 2014.

Website:http://www.nhscareers.nhs.uk/explore-by-career/allied-health-professions/careers-in-the-allied-health-professions/dietitian/

Statistics Canada (2006): National Occupational Classification 2006 — D032 Dieticians and Nutritionists. Ottawa: Century Publishers. Canada.

WHO (2010). Classifying Health Workers. Geneva: World Health Organization.

WHO (2011). Resolution WHA55.23. Diet, Physical Activity and Health. In: Fifty-fifth World Health Assembly, Geneva, 13-18 May 2011. Volume 1. Resolutions and decisions, annexes. Geneva: World Health Organization, (document WHA55/2011/REC/1):28-30.

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