Dietitians or Nutritionists…the world of nutrition is confusing with lots of conflicting information. Even the titles of nutrition experts are confusing! Look at internet articles, thumbtack, or even social media and you’ll see a number of nutrition related titles. However, how do you know who has the background to back up what they’re saying? Prepare to learn for how to disseminate who is legit, and who should be taken with a grain of salt. We cover a lot of ground in this article, so pull up a chair, grab a drink, and prepare yourself!
Say “Dietitian” and some people could probably infer what that person might do or specialize in. Say “Nutritionist”, however, and almost everyone will assume that this denotes an expertise in nutrition. This has become a problem because “Nutritionist” generally isn’t a regulated or protected title. This isn’t always the case, but I’ll get to that shortly). It is, however, a more commonly recognized title than “Dietitian”. In fact, my sister-in-law, who has been a nurse for years, admitted to knowing nothing about dietitians. If nurses are largely in the dark, how can the public be expected to know? Because ‘Nutritionist’ is so widely known, the Academy of Nutrition and Dietetics allows Dietitians to use the RD (Registered Dietitian) or RDN (Registered Dietitian Nutritionist) credential. This is to help Dietitians take back the power and recognition associated with the term ‘Nutritionist’.
But there’s still a difference…right?
Would you want your doctor to only have an undergraduate degree? No experience under their belt before actually getting that MD? Only their own assurance that they know what they’re talking about? I’m guessing that’s a no. Dietitians are medical professionals and therefore have guidelines to meet as well. These consist of three basic components:
Dietitians have strict standards to meet in each of these areas. Nutritionists do not. In the dietetics world, Nutritionists get a really bad reputation for being ‘uneducated’ and ‘quacks’. Some consider them to be on-par with those who are trying to sell multi-level-marketing products.
Until recently, I would have said the same thing (despite being a licensed Nutritionist myself….again, we’ll get to that later). However, a heated Reddit post got me thinking and made me slightly more sympathetic. The gist was that there are people who have advanced degrees, PhDs, etc. who are more interested in the chemistry, biology, and physiology of nutrition than in actual clinical practice. Therefore, they know a TON about food and how it effects our bodies, but had no reason to pursue the RD credential. This is because it’s really only required if you plan on working with people. If they want to do the behind the scenes work in the lab, then the credential doesn’t hold much value. Therefore, they should be able to legitimately call themselves nutritionists.
I agree….BUT these people are very few and far between. They also likely aren’t the ones you see promoting their counseling services on website and social media. That’s where the…other ones…come in. These are the people who give the title nutritionist a bad name. They are the ones who maybe read a book or some articles because they are interested in nutrition. If they’re really ‘committed’, they may have taken some online course to earn a certificate. These are also the ones who heavily promote their methods and expertise without what is considered sufficient background. Here is what sets those nutritionists apart from registered dietitians.
This is where it all begins. To make sure that nutrition experts are knowledge in crucial areas, there are standards to be met.
As of January 1, 2024 a Master’s degree is the minimum allowed to earn the title.
The curriculums must be accredited by the Accreditation Council for Education in Nutrition and Dietetics. They are heavy in biology, microbiology, chemistry, biochemistry, anatomy, physiology, counseling skills, and lots and lots of specialized nutrition courses.
Many universities are moving toward a structure that does away with the pathway that led from a B.S. to getting matched and accepted for an M.S and/or internship. They’re combining them so that a student can expect to do a solid six years of schooling with the internship within that time frame.
Furthermore, RDs are required to complete continuing education units during a 5-year learning cycle. A total of 75 hours are required with some areas, such as ethics, being mandatory. The other hours are at the RDs discretion based upon their area of practice, interests, etc. This requirement helps keep RDs up to date with the latest research, improve their clinical skills, and broaden their practice abilities.
Since there really isn’t much title protection, almost anyone can claim to be nutritionist. Education is what the individual wants to make of it. It can literally just involve reading some articles, having an interest in the field. It could also involve taking some unaccredited courses from sites like Udemy, Teachable, Coursera, etc.
On the flip side of things, organizations like Precision Nutrition or those that offer personal trainer certifications often have a certification in nutrition. They develop their own curriculum, standards, and tests for their own certificate. Some of these are actually really good! The only downside to these are that they aren’t nationally recognized by any credentialing organizations. This means that if you have a nutrition certification from something like ACE, ISSA, NASM, Precision, etc., gyms will love it but healthcare facilities may not.
In other words, because there are no standards for what kind of education a nutritionist needs, there’s a huge spectrum. Some may really know their stuff while others may get their information from the trends on social media. That’s why if you want to work with a nutritionist, take a few minutes to look into their education background and the rigor involved.
The second part of the formula in the making of any good medical provider is supervised practice. This shows that the person is able to demonstrate the skills they learned about in a classroom setting.
We RDs had to endure a minimum of 1200 unpaid hours of supervised practice (yes – I’m salty about the unpaid labor aspect of this). This is where the rubber hits the road. If you complete an academic program that doesn’t include this part, it’s necessary to go through an excruciating matching process in order to complete this. While 1200 hours are the minimum, many programs go above and beyond that. I’m fairly certain that the Ohio State University (where I did my coordinated Masters & Dietetic Internship) boasted around 1500 hours.
Supervised practice also has to be accredited and overseen by Dietitians. The experiences are competency based, so there are specific knowledge, skills, and abilities that the intern has to demonstrate during their rotations. These rotations are in various areas such as inpatient, outpatient, food service, community, long-term care, etc. They can also involve specialized focuses like tube-feeding, pediatrics, weight management, eating disorders, dialysis, and intensive care.
These experiences are what help students find where they belong. By being exposed to a variety of settings, they can find their strengths, interests, and passions. While I was still in undergrad, I thought I wanted to end up in a research setting. However, once I got into my rotations, I learned that I excel and love being in outpatient where I get to talk to and coach patients every day.
Unless the individual is located in a state that requires licensure for nutritionists that contains an internship aspect, this is not a thing for them.
Like I mentioned before, these internships are generally unpaid (there are a few that offer a stipend, but it’s usually pretty minimal). This is usually a huge roadblock for those on the path to an RD. Let’s face it – it’s tough to work for 10-12 months without getting paid AND actually having to pay for the privilege of getting those practice hours. There are many who have completed the educational portion of the requirements but were unable to do the supervised practice. This makes them knowledgeable about nutrition, but they can’t complete the requirements to become an RD. They’ll often take up the title of Nutritionist at that point.
To put it all together, most professions have a national board exam to pass…doctors, lawyers…the nutrition field is no different
After completing their degree and supervised practice, an RD2BE (as they are affectionately known) has to receive a verification statement from their institution to be eligible to sit for the exam.
The exam is multiple choice and can vary in length. It will be a minimum of 125 questions with 100 being scored and 25 being pre-test questions or up to 145 questions with 120 scored and 25 pre-test. Oh, and those questions – they’re adaptive. Get one right and the next one is harder…get one wrong and the next might be easier.
The questions come from four domains: Principles of Dietetics, Nutrition Care for Individuals and Groups, Management of Food and Nutrition Programs and Services, and Foodservice systems. Dietitians are really well rounded when it comes to food and nutrition knowledge and the exam demonstrates that.
The exam is scored on a scale of 1-50 and a 25 is required to pass. HOW is it scored? How many questions does that equate to? Since it’s an adaptive exam, it’s honestly a mystery to us but likely involves some sort of algorithm based upon the question difficulty.
To give you an idea of what its like, in 2020, the Commission on Dietetics Registration that 68.4% of first time test takers passed. Of the test takers who failed their first attempt and sat for the exam for a second (or third, or fourth) time, 34.5% passed.
Like everything else so far, there are no standardized requirements. Now, there are online programs that boast certifying nutritionists after their program. However, with Nutritionist not being a protected title for the most part – this is their own thing that doesn’t have anything to do with the national exam.
I really do want to reiterate, however, that people who take nutrition certifications from good organizations likely get a really good primer in nutrition. Oftentimes they will be tested on concepts that are more geared toward coaching practices rather than the nitty-gritty science behind nutrition. This isn’t necessarily a bad thing, especially given the differences in scope of practice.
How and what practitioners are legally allowed to do is determined by their scope and standards of practice. These tend to vary by state, so loopholes exist for those determined to exploit them. However, they are designed to keep patients and clients safe by ensuring that practitioners are not trying to do things that are outside of their area of expertise.
Every seven years, the credentialing agency known as the Commission on Dietetic Registration revises the scope and standards of practice. This document defines how dietitians do what they do in a safe, legal, and comprehensive fashion. This helps to keep everyone in their lanes of specialty so that we don’t have malpractice issues. The entire document is available for download if you’re interested in reading the whole thing.
For the RDN, scope of practice and standards of practice are a comprehensive framework describing the competent level of RDN practice and professional performance expected from RDNs across all practice levels or settings. The scope of practice focuses on food, nutrition, and dietetics practice, as well as related services developed, directed, and provided by the RDN to protect the public, community, and populations; enhance health and well-being of patients/clients and communities; and deliver quality care, services, programs, and products. The scope of practice for each RDN has flexible boundaries that is defined by the individual RDN’s education, training, credentialing, experience, and demonstrated and documented competence.
Commission on Dietetic Registration. (2024, January 2). Revised 2024 Scope and Standards of Practice for the Registered Dietitian Nutritionist.
Dietitians have defined scopes of practice because they are considered allied medical professionals. Medical Nutrition Therapy is a primary component of what they do to help patients/clients manage acute and chronic health conditions.
Every state is going to be slightly different in this matter based upon their laws. According to the AFPA Licensure document “Illinois law allows an unlicensed person to provide “general nutrition information and encouragement of general healthy eating choices.” North Carolina allows “general nutrition information on food, food materials, and dietary supplements.” In Iowa, this is written as “routine education and advice regarding normal nutritional requirements and sources of nutrients.”
Even personal training organizations like ACE and NASM, who certify their own nutritionists, provide an explanation of what can and can’t be done regarding nutrition education. Generally, “personalized” nutrition is a no-no. This includes creating meal plans, recommending specific nutrient requirements, and trying to perform medical nutrition therapy for conditions like hypertension, high cholesterol, diabetes, etc. General, healthy eating recommendations that are promoted by agencies like the Government via things like MyPlate are fine, though!
They’re out there, but where? Who you will find will be based upon where you look as having or lacking credentials will be a big factor in where someone can practice.
We are all over the place!! We’re in the nooks and crannies of all long term care facilities, grocery stores, food manufacturers, schools, hospitals, private practices, sports clinics, sports teams, marketing companies, research centers, government, and way more. Our diverse knowledge gives us a huge range of fields in which to work.
You’ll find a lot of these practicing independently or in clinics that promote naturopathy and therefore don’t require medical credentials. I’ll say again that some nutritionists are very well educated and know what they are talking about. However, without the RD credential, they are unable to work in locations like hospitals, etc. that require a licensed professional. In general, these are the people you’ll find via Facebook, Instagram, Thumbtack, in the gym, etc.
Everyone has topics that they are passionate about. Specialty certifications and advanced credentials allow those who practice in a specific area to take a board exam (after demonstrating sufficient time in the field) to verify that they are considered an expert in that area.
There are a variety of specialties a Dietitian can have. The CDR (Commission on Dietetic Registration), the credentialing body that oversees the use of the RD and RDN credentials provides additional specialty certifications. These include: Pediatric, Renal, Gerontological, Oncology, Sports, Obesity & Weight Management, and Critical Care Nutrition.
To qualify for these specialty certifications, a dietitian must meet additional requirements:
Those are just from the CDR. There are many other specialties an RD can pursue with certifications to go along with them in areas such as intuitive eating, eating disorders, diabetes education, nutrition support, lactation counseling, and more.
If you look around, a LOT of nutritionists will boast that they specialize in things like holistic nutrition & wellness. I’ve seen people suggest that they are better than an RD because they take a holistic, rather than an analytic approach to care.
As my good southern friend would say ‘bless their hearts’ as many a nutrition professional will tell you, being “an official expert” doesn’t make you cold and calculating. We all (or almost all) take a holistic, or whole person, approach to nutrition and wellness. We’re trained in seeing how interrelated everything is. I, myself, take this approach with my metaphysical health coaching
It’s also important to note that A CERTIFICATE IS NOT A CERTIFICATION. Say that with me again. A certificate simply show that you’ve completed a class or course. It’s important to understand that anyone who makes a class or course for profit can create a piece of paper you receive at the end to make it seem ‘official’. It’s a statement of education. This is not the same as certification. Certification involves passing an exam and meeting industry standards. They will be acknowledged by an agency the oversees the standards of the field. So be wary.
Let’s face it – no one likes paying for health care. This is where insurance comes in and where some very hard lines are drawn in the sand.
Only Registered Dietitians qualify for reimbursement through insurance. Coverage for who and what is honestly always changing as we fight to have more conditions covered. Typically, individual plans decide what they will cover. Some only cover certain conditions like Diabetes, Kidney failure, or obesity while some cover general nutrition counseling. Others will only cover a patient if they are referred by a physician, so it pays to check with your insurance provider if you are interested in seeing an RD.
insert uncontrollable laughing coming from every insurance provider everywhere
Enough said. Without it being regulated, insurance companies generally won’t reimburse for someone who isn’t a licensed medical professional.
This is where things get messy as every state has different rules. In some states, anything goes – there is no regulation so anyone can call themselves a nutritionist and provide nutrition recommendations. If you’re looking at nutritionists in these places, it’s imperative that you check education, experience, etc. for someone who is touting their ability to offer nutrition services.
In other states, it’s required to be licensed in order to use the title of Dietitian or Nutritionist, but the actual practice isn’t regulated.
The most strict states require licensure to provide any form of nutrition therapy or general nutrition education. Unfortunately, a lot of people aren’t aware of these laws, which are designed to protect the public. Whether it’s to manage a health condition or to improve general wellness, people who offer to counsel patients about nutrition without the proper credentials can get into loads of trouble.
….and no….a ‘nutrition certification’ from a personal training program or something similar DOES. NOT. COUNT
To become licensed in a state to practice nutrition therapy, one typically has to:
That’s the minimum to receive a license. In a lot of states, Dietitians are registered as LD or ‘Licensed Dietitian’, but in some states, such as Montana (where I’m located), our licensure is as a Nutritionist. HOWEVER, you have to be a Dietitian to receive licensure as a Nutritionist.
Now in the world of telehealth, things get even trickier. Laws state that a practitioner has to be licensed in the state where their client is located. There are a few exceptions where temporary licenses can be granted in special circumstances. If states have reciprocity (RD’s currently licensed state has equal laws to another in question), it get easier. Generally, a practitioner has to apply for and receive a license for each state individually.
Many state medical board websites will allow anyone to search for a provider by name to ensure that they hold a current license. If you’re thinking about seeing a provider and want to make sure that they are legal to practice, check out your state’s medical licensing board.
This truly depends on your needs and what is most important to you. As someone who has painstakingly gone through the years of schooling, the months of practice, and the passing of a national exam – of course I’m going to be partial to recommending Registered Dietitians. They are the only ones with the background and expertise to LEGALLY provide nutrition therapy for chronic conditions. However, they also have a large focus on wellness and weight management. They should be sought for any nutrition counseling, regardless of whether you are generally healthy or working to improve a health condition.
As I mentioned earlier, some Nutritionists are super knowledgeable but for whatever reason didn’t pursue an RD. I can’t emphasize the importance of checking backgrounds, education, etc. enough. If you’re considering working with a Nutritionist, for your own sake, please do your due diligence and check their information.
As a side note – when I’ve discussed only applies to the US. Other countries have different nomenclature, requirements, etc. and I don’t want to compare apples to oranges.
Just Remember
“Every dietitian is a nutritionist but not every nutritionist is a dietitian”
