Respect the rd
Guest blogger Emma D’Arpino gives a breakdown on the role of a Registered Dietitian.
What does it take to work as health care professional? How many years of school? How many student loans? How many hours breaking down in the library with your head drowning in biochemistry? How. Many. Tears. Well, it depends. Years of education and experience usually occur before entering the professional career of healthcare. Although various individuals within the healthcare field have gone through years of schooling, clinical rotations and breakdowns, a single member of the interdisciplinary team does not know everything.
As a nutrition and dietetics student, I was required to take a full year of anatomy and physiology. I learned a lot about the way bones move, how muscles contract and dissected the cardiovascular system of a cat. So, does this year’s worth of education allow me to provide exercises for a patient who just had a hip replacement? Absolutely not. That would be the role of the physical or occupational therapist. We are all paying the bills and the large amount of time in the library to get a specific degree, and although some prerequisites overlap in the science world, this does not give other colleagues a free pass to incorrectly prescribe outside of their appropriate practice.
Specifically, this confusion is quite common when individuals believe that medical doctors are the experts of, well, everything. Especially when it comes to nutrition, eating behaviors, and food intake.
Over the past decade, medical systems have voiced the importance regarding the level of nutrition education that a doctor should obtain. Results of a nationwide survey revealed that the average course work exposure on nutrition and dietetics during medical school is 22.3 hours. A. DAY'S. WORTH. A day’s worth of nutritional education is presented to medical students to prepare for their profession. This realization is important! IT IS HUGE. However, despite the press, it is actually unlikely that doctors need more than this, which is what The British Medical Journal attempts to explain. As a dietetic intern with 2 months left to reach my credential as a registered dietitian, I think an even bigger realization needs to be revealed:
Registered dietitians are the nutrition experts.
Yes, more nutritional education can be given to medical students, however, this should not be replaced by the role of the dietitian.
The role of the registered dietitian is simply undermined. What should be highlighted in the nutrition education of a medical student is when to consult a registered dietitian, which may be needed more often than not. Physicians lack the authoritative five to six years of nutritional education and clinical experience that registered dietitians are required to complete before taking the national board examination. Registered dietitians have the power to improve quality of life through food and nutritional supplementation through populations of all ages.
This mentality carries further than the clinic or hospital. There is indeed more to the nutrition field than the rigorous academic work and challenging clinical field sites; studying the practice of nutrition and dietetics also tends to invite the frustration of the misunderstanding towards the degree itself. In fact, there is current litigation pending over whether or not you need a degree to practice in the nutrition space. And I have to admit "obtaining that license would be 'incredibly burdensome', including going to get a second degree and paying multiple fees", because I've done it.
Whether you're on the floors of the hospital, or scrolling through your phone on social media, in order to Respect the RD, let’s set some things straight:
Nutritionists vs. Dietitians. The public is constantly looking to improve their lifestyle with “healthy food” and lots of exercise. Nonetheless, this need for change is usually aided by the internet; easy, inexpensive, and accessible. Some websites are even self-curated allowing anyone to submit information for the world to see, no education or experience required. I could sign up right now and describe all the amazing places to eat in Thailand when the closest thing I have to the culinary culture is the Pad Thai I ordered from a restaurant five minutes away from my apartment. More often than not, popular posts as these are written from sources such as personal trainers, journalists, doctors, and even nutritionist health coaches. How do these health coaches or nutritionists differ from dietitians? Registered dietitians receive formal training in regard to nutritional information, medical dietetics, biochemistry and motivational interviewing. In order for an individual to have those two, maybe three letters after their name (RD, RDN) they must earn a bachelor's degree, complete 1200 supervised hours within an Accreditation Council for Education in Nutrition and Dietetics (ACEND) Dietetic Internship, and have passed the Commission on Dietetic Registration national exam.
Speaking as an individual who earned a Bachelor’s of Science in Nutrition & Dietetics and is currently enrolled in an ACEND dietetic internship, I must say, it is quite frustrating when someone confuses my five years of academic achievement and clinical experience with a blog or social media account written by a fitness enthusiast. You know, the ones who are #hashtagging away about how the sugar found in fruit is solely causing you to gain weight (hint: it doesn't).
Why the simple blog post method doesn’t work. Generally, the people giving advice or writing blog posts are well intentioned. I believe they truly want to help people get and stay healthier. Yet, many of these sites actually provide information that is inaccurate, and even dangerous. Blogging sites are typically what appear on Google’s forefront when you type your question into the search bar. These are great to read for funny, relatable posts or intense life hacks but should definitely be marked absent when searching for nutrition education. Their sole purpose is creating these obscure headlines to grab your attention, and literally make your jaw drop onto your keyboard:
10 Ways To Lose 10 pounds in 10 Days
5 Reasons To Cut Fruit From Your Diet
6 Proven Benefits of Apple Cider Vinegar
You read headlines stating “Tofu: The New Superfood!” but before you reach the grocery store shelf it supposedly causes cancer. How many almonds can I have? 10 or 12? Does it matter? Wait there is 14 grams of fat in this?! Dark chocolate prevents heart disease, wait so does red wine! Diets screaming not to eat grains, or legumes and to not even THINK about eating dairy. Spilling facts about “bloating” and “too much fat” or "not enough fat". It is a never-ending roller coaster and you think to yourself, “How did I get on this ride and where is the emergency exit so I can go back to my bread and cheese?” It is confusing, stressful, and can totally suck the fun out of food. It also sets you up for failure, because the bar is always changing.
Aside from the fact that these headlines are written from (often) non-credible sources, they’re also written as the rule for everyone. Approximately half of the United States suffers from heart disease, however, not all of them love broccoli, can eat whole grains, or drink their coffee black. Everyone is different, and this is where the standard blog post method lacks. It is not personalized, failing to fit the specific needs and wants of the individual. Besides needing a solid understanding of the physiology behind the medical conditions of our time, behavior change is also a key component with dietary interventions. Registered dietitians are the health professionals that work one-one-one with learning the patient’s medical history, goals, expectations, and overall outcomes towards success. Again, not the role of the physician or your famous blogger on Instagram.
We do it all and are held accountable. Seeing a registered dietitian can teach innovative techniques in the kitchen or grocery stores. They can also help with finding affordable food that fits an individual's budget or a family of seven. Or maybe you need help making a breakfast that can get you out the door on time but won’t make you ravenous before lunch. Studies have shown that registered dietitian interventions have also improved patient outcomes. You’re probably thinking…“Okay, well can’t anyone just give that advice?” Registered dietitians have the appropriate knowledge to guide you through your wellness journey. They are the experts within medical nutrition therapy for an array of lifestyles and diseases... whether you have celiac disease, renal complications from Type 2 Diabetes or trying to find the best post-workout snack, a dietitian is the one who can help. The advice registered dietitians provide is evidenced-based being supported by clinical studies and the education received not only during the years of education and internship experience, but also working within the jobs obtained afterwards - positions that your nutritionist or Cross-Fit trainer are unable receive. We are required to continuously add to our learning, completing tens of hours of added education each year. And our licensure is on the line if we make a mistake. This is the major difference from those who were just given an online certificate, or even worse, those who use blogs or social media solely as their source of knowledge.
Food is medicine. Just as medicine is managed by highly credentialed professionals, food is powerful and deserves the same imperative supervision. Many times, health professionals and the public forget that, sometimes, food does more than your prescribed pill bottle or overpriced supplement. According to the Center for Disease Control and Prevention, the number one cause of death in the United States is cardiovascular disease, commonly known to the public as heart disease. Risk factors of heart disease includes age, gender, ethnicity, and more important than not, the human diet. The consumption of sugars, excess fats, and lack of fruits and vegetables contribute towards the risk of this number one killer in America. But the answer's easy right? Just replace your afternoon donut with a bag of carrots. So simple, even a blogger could do it.
Perhaps most importantly, within the clinical setting, dietitians truly are responsible for nourishing the body. Maybe the patient has dysphagia and cannot swallow or is unable to even properly digest foods due to a bowel obstruction. When this occurs how do they receive nutrients in order to survive? Dietitians are taught in school how to properly calculate IV nutrition therapy, also known as Total Parenteral Nutrition (TPN). This is something specific to our licenses. Medical physicians and nurses are not taught how to calculate this specific form of nutrition and depend on us to calculate this for the patient. Tube feedings and TPN are crucial to the role of the dietitian in the hospital, allowing the patient to receive the proper nutrient and aid in overall recovery. You wouldn't want someone with a weekend certificate mixing that blend if you ever found yourself in the ICU.
Bottom line: You would not let a dentist deliver your newborn, just as you probably wouldn’t call your plumber to cut your hair. Registered dietitians are the nutrition experts. The knowledge and tools gained throughout the process of becoming a registered dietitian enables us to support you and your individualized dietetic needs. We are here to fill your plate with truthful and knowledgeable information and to answer all the confusing questions that may come along. Over the years we have taken countless exams, coursework, and pass a clinical residency to become credentialed health professionals, but more importantly, to help you. We want to guide and empower you and take you further throughout your journey while educating you along the way. Trust us. We are the experts.
Emma D’Arpino is a current dietetic intern at Aramark Healthcare in Philadelphia with plans to become a Registered Dietitian in the summer 2018. Emma enjoys photography and spending time with her sassy bulldog Stella. Visit her website: www.emmadarpino.com and check out her beautiful photography on instagram: @emmadarpino.