It seems that few people in the general public, or even some medical practitioners, really understand the difference. While the two titles and roles can overlap sometimes, there are some very key differences.
As a student at Ryerson, I was part of the Dietetic Students' Advocacy initiative, through which dietetic students across Canada started a conversation to encourage greater funding for internship programs, and greater public access to dietitians and information about the profession. Recently, the DSA released a video demonstrating how little is known about dietitians in the general public. Please note: the people interviewed were, generally, Ryerson students not in the nutrition program. Obviously, asking different demographics would have produced different results. However the responses that people gave are really not much different than what I've been hearing since I first told people "I'm going back to school for nutrition".
This video made me sad. And frightened.
A dietitian I volunteered with once said something that really stuck with me, and this video made me think of it: "it's hard to do for a living what most people do as a hobby". Everyone has an opinion about food and nutrition, whether or not its actually based in any kind of scientific evidence or research. It scares me to think that most people get their health information from a Google search, and have a sense of distrust of dietitians and conventional medical practitioners (i.e. (paraphrased) they'll make me follow Canada's Food Guide. I don't eat grains or dairy, so I can't follow CFG. And I teach nutrition in schools, so I know that that's what they'll make me do because its government mandated.). While I wouldn't expect this population to necessarily understand the difference between a dietitian and nutritionist (very confusing concept for most people I talk to), I thought that they would at least have considered that nutrition professionals are involved with work outside of just weight loss, commercial weight loss clinics like Dr. Bernstein, and be just about "fixing your diet" in the short term.
So what does a dietitian do anyway? And what's the difference between a dietitian and a nutritionist?
Please note that the following information applies to Canadian regulations. It may or may not reflect the regulations in other countries where the term "nutritionist" and "dietitian" may refer to very different things.
The term "Registered Dietitian" or "R.D." is a protected title in Canada. These individuals have met the educational requirements of Dietitians of Canada (the national professional association of dietitians in Canada that manages accreditation requirements and continuing education), have completed a one-year internship at an accredited clinical facility, and have written and passed a regulatory exam demonstrating that they possess the qualifications and competencies needed to practice dietetics in a safe, research-based manner. Dietitians are educated in many facets of nutrition, including science (chemistry, biology, physiology, etc), food science and development, management and food services, health sciences, human development, food security, population health and public health practices, research, and many others. The dietitian's role is to educate and influence the populations s/he works with, using evidence-based practice. This means that the information that a dietitian uses to make an assessment or provide advice is grounded in research. Dietitians are regulated provincially by a college (e.g. the College of Dietitians of Ontario), which requires that all dietitians practice with a standardized code of ethics and responsibilities, and provides the public with a governing body to present appeals and complaints to if there is an alleged malpractice. The college provides both public protection and protection for RDs.
"Nutritionist" is not a protected title in most provinces (some dietitians use the title "registered nutritionist", which is protected in some provinces. It is not a title recognized by law in Ontario). A nutritionist may or may not have the educational qualifications of a dietitian (i.e. an undergraduate degree in health and food sciences), or may have received a diploma from a holistic nutrition institute, however the title is unregulated, meaning that no accredited educational benchmark has been set. Most nutrition colleges recommend that a high school diploma has been achieved, however a university degree is not a requirement. Holistic nutritionists undergo a 50 hour internship process, and write a national exam, however the exam is unregulated. Nutritionists are not regulated health professionals - this means that a nutritionist does not report to a governing professional college. Some nutritionists do have initials behind their name (such as CHN, RHN, RNC and RNCP), which are provided by the school that the nutritionist attended, not by a regulatory body. Only registered dietitians can use the letters RD (or in some provinces, RDt, PDt, RDN in New Brunswick, or DtP in Quebec).
Dietitians may work in hospitals and physician's offices, in government offices and public health, in foodservice management, product development, or any number of other places where food knowledge is used. Many have private practices or work with the media. You might see a dietitian for many reasons, such as weight loss and help developing or maintaining a healthy diet, food allergies, medical diagnoses (e.g. diabetes, heart disease, cancer, kidney disease, etc), infant health and pre/postnatal health, and any other reason that you might need advice with diet, food preparation, food safety, and your health. Because they are unregulated, nutritionists are not able to work in as wide a variety of places. Nutritionists often open private practices or may practice alongside other alternative health providers, and often appear in the media. You might see a nutritionist for some of the same reasons as you would a dietitian, however their approach to treatment will be very different. It isn't that one is right and one is wrong - but the advice may be very different. For example, when assisting a patient with food allergies or sensitivities, the nutritionist's first line of treatment might be to begin an elimination diet or cleanse system, whereas the dietitian might use modifications to Canada's Food Guide to ensure that the patient is eating adequately while avoiding their known allergen(s). Nutritionists often recommend cleanses or detox programs or use of particular nutritional supplements to clients, while the dietitian would recommend a balanced diet that supports digestive and immune health, and makes modifications for specific health concerns (e.g. diabetes, hypertension, etc). Dietitians can also work collaboratively with your doctor (nutritionists would not have access to your MD's records), which can be especially beneficial for people with complex diseases or multiple diagnoses.
Because doctor referrals are often given for counseling with a dietitian, it is usually covered by provincial health care plans, or if you are seeing a dietitian with private practice without a referral, it is often covered by private health insurance plans. Nutritionist counseling is not usually covered by private health insurance, and not covered with provincial health care.
Whether you choose to see an RD or a nutritionist is very much a personal choice. I would like to believe that there is some overlap between the two professions, and that collaboration would be beneficial to our clients/patients. However, it is very necessary to understand the distinction between the two before making a choice to see an RD or a nutritionist.
And, it's spelled D-I-E-T-I-T-I-A-N in Canada, not "dietician" :)
What are your thoughts on the DSA video? Have you ever seen a nutritionist or dietitian, or would you have known the difference between the two words?
