Dietitian vs Nutritionist

PART 1

Slide 1 (00:16)

My name is Alex and I have a master's in Public Health. R.E. is up there instead of R.D.

R.D. is normally the status for a registered dietician. I will actually be taking the dietetic R.D.

exam, which is the final step of the process on Monday. So, I've accomplished all of the

necessary background and that's just what they...

Slide 2 (00:40)

They don't let us say R.D. soon to be, but you're supposed to say R.E. – Registration

Eligible. So, that's that.

Slide 3 (00:47)

A little bit of my background. I got my bachelor's in genetics at University of California,

Davis.

Slide 4 (00:54)

I didn't really know exactly what I wanted to do besides something in sciences and that's

what I ended up with. I took a couple of years off after that, sort of still trying to figure out what

I wanted to do because I didn't want to pay for another degree without really knowing what I

wanted to have a profession in.

Slide 5 (01:12)

I applied to the University of Michigan School of Public Health. I actually have a dual

masters.

Slide 6 (01:19)

Both of them MPH's, but one of them is in human nutrition dietetics and then one of them

is in health behavior/health education. I actually stayed... That's a two year program that I stayed

for a third year to get the dual degree in.

Slide 7 (01:31)

Then following that I pre-selected for my internship, which I'll go through later in the

slides.

Slide 8 (01:39)

I did my internship at the University of Michigan Health System and the School of Public

Health there.

Slide 9 (01:45)

I just got hired and started about a month ago here. My official title is Health Promotion

Specialist.

Slide 10 (01:51)

But, I'm focused on healthy eating and physical activity promotion on campus. I also

hope to be doing a little bit more consultation as a dietician in the future. So, how do you become

an R.D.?

Slide 11 (02:04)

Registered dieticians are food and nutrition experts. They have to meet certain criteria in

order to be official R.D.'s. They have to complete a bachelor's degree and that bachelor's degree

can be in anything. As you can see on the bottom of this slide, you can have it in economic,

business, any science, physiology, dance, music - whatever you want.

Slide 12 (02:29)

But, there are required courses that would probably not be in a lot of those majors and so

you sort of have to do that outside of another bachelor's degree if you want to be eligible to

become a dietician. A lot of campuses do have nutrition bachelor's degrees. Actually, I looked it

up. There's about 220 campuses in the nation that offer a bachelor's in nutrition. So, that's sort of

ideally what you'd want to do because you can go directly from a bachelor’s in nutrition to doing

the dietetic internship and then taking the exam. I didn't take that course which sort of added a

little bit of time but also got me another degree. The Academy of Nutrition and Dietetics, what

used to be called the ADA, is in charge of sort of choosing their requirements for programs that

are eligible to let you eventually take the exam.

Slide 13 (03:34)

The program is called ASCEND and those are the people who basically decide whether

or not the program is decent enough.

Slide 14 (03:41)

So, there are programs that are offered that are not ASCEND certified. They may require

you to take extra courses or... I'm not exactly sure how complicated it is, but I know that it's more

complicated if you try to become a dietician at a not ASCEND certified school.

Slide 15 (04:01)

So, these are the classes that you have to take to be eligible to go into a program like I did

as a masters.

Slide 16 (04:11)

These are the classes that you would have to take along with your bachelors if they

weren't included. They're basic science courses with the addition of something like anatomy and

physiology, which may not be in a regular biology degree program. For the most part, I think of

my class of twenty nutrition students, I think there was only about three students who had not

already completed all these requirements before they started the program. You can get

exceptions with some programs to take one or two of these courses while you are doing your

master's program. Although, I think those are usually things like the sociology, anthropology,

psychology, anatomy, things at the bottom as opposed to... You need to have the basic calculus

and organic chemistry because those are integral in knowing nutritional sciences.

Slide 17 (05:11)

So, after you have that bachelor's degree you have to do an internship. The internship is

anywhere from six to twelve months depending on whether or not it's a full-time program or a

part-time program.

Slide 18 (05:27)

Usually, the goal is or the required number of hours for that program is 1200. So, it's sort

of... Different programs have different requirements that get you to that 1200 goal. The

internships, depending on where you go, vary drastically. The internship that I did was sort of

community focused, so it was a lot more working at places at food banks and Meals on Wheels,

as well as a little bit of working in hospitals. You also have programs that are primarily clinical

work in a hospital or food service where you're working in a cafeteria setting. But, that really

depends on which program you apply for. Then finally, upon finishing that internship, you need

to pass a national examination.

Slide 19 (06:26)

And that is a 2 1/2 hour computerized exam, similar to a lot of tests you take these days:

GREs and I don't know what the SATs are doing these days.

Slide 20 (06:45)

But, I can't tell you too much about that because I haven't taken it yet. But, I've heard that

the sooner after you finish your internship you take it the better. So, that is a good question. So,

one thing that I hear commonly from people who have taken the test is that they studied so many

things and they only got asked questions primarily about 20% of what they studied. That can

cover anything from biochemistry, organic chemistry, food service questions asking you what

temperature does this need to be cooked to. It can ask you things about... Let's see what else...

Like, the processes of a business and how you assess need in a community. Unfortunately or

fortunately, dietetics covers a lot of different areas of employment and so, I believe there are

something like 8-odd sort of specialty areas that you sort of have to know about. It's... I believe

it's sort of luck of the draw on sort of what you get on the test. Oh yeah... And the final thing I

that, once you take the exam you have to continue taking these continuing education courses or

credits.

Slide 21 (08:26)

There are different things you can do throughout your lifetime to maintain the R.D.

status.

Slide 22 (08:31)

Unfortunately, it's not like a lifetime membership. That can be going to conferences. That

can be reading books and writing a report and turning it into somebody. That can be going to

workshops - whatever your employer offers. It can be a lot of different things. And they really

don't want it to be a hard thing for you to continue your education. It's something that you

should... that everybody, I think, should want to do throughout their lifetime is to continue to

stay on top of the topics that they are interested in helping people with.

PART II

Slide 1 (00:00)

So, these are the programs in Florida. Unfortunately, USF is not one of them. But, getting

the bachelors - you can get it at UF, UNF, FSU or FIU. A coordinated program is a program like

what I did, where I didn't...

Slide 2 (00:17)

My bachelor's was not in nutrition and I needed to get some nutritional courses in on top

of having an internship. Which meant everything was in one school in one place and that was

good for me. Yeah, so basically you get a graduate degree as well as fulfilling the requirements

for the R.D. exam. There are only about 54 programs in the country right now that are

coordinated programs. They do tend to be a little bit more challenging to get into and

competitive. Mainly because you have a lot of people going back and changing their degree like

I did, where they didn't know they really wanted to go into nutrition but now they're deciding

that. With the economy being as it's been, people are considering that a lot more. Yeah. So, there

are two places in Florida, FIU and Keiser that have those coordinated programs.

Slide 3 (01:23)

So, this is a snapshot of the AND website.

Slide 4 (01:29)

This is where you can see what schools have each of these programs. So basically you

can click on this coordinated program: the dietetic program, dietetic internship, and didactic is a

different thing. You can search through by state and it'll give you all the programs and sort of the

requirements for applications for that. I encourage you to check out the AND website if you are

interested at all in being an R.D. because they have a lot of good resources.

Slide 5 (02:00)

So, has anyone ever heard of an R.D.N.? So, R.D.N. is relatively new. The academy has

decided that... It's essentially an optional title that they're adding to the R.D.

Slide 6 (02:18)

It doesn't require any other further education or testing.

Slide 7 (02:26)

It basically is trying to differentiate a dietitian and a nutritionist, to show all dietitians are

nutritionists but not all nutritionists are registered dietitians.

Slide 8 (02:33)

Unfortunately there tends to be some sort of bad feelings sometimes between dieticians

and nutritionists. Essentially anybody can call themselves a nutritionist. There's no required

degree or certification. It's basically saying somebody who has some knowledge about nutrition.

I think that the two get confused a lot of the times. Not to say that nutritionists may not be as

knowledgeable about nutrition. They may very well be. But, the R.D. sort of gives you a promise

that that person has gone through a program that is certified and that they know everything that

they should know.

Slide 9 (03:23)

So, how much do we make? Not too much. Unfortunately, public health is not the place

to go if you want to be making big bucks. But, the average annual or mean annual wage for a

dietitian in 2012 was $56,000, lowest 10% earned about $34,000 and the highest about $76,000

or $78,000. The highest paying dietitian jobs tend to be in out-patient care or private

practice/private care services were basically you’re going to everybody's houses and in helping

them with their daily tasks

Slide 10: (04:05)

But the highest number of jobs is usually in hospitals and nursing homes.

Slide 11 (04:11)

This is actually increasing as the baby boomers get a little older. The demand is

increasing there. Eleven percent of dietitians are self-employed.

Slide 12 (04:22)

Not too many. It's hard to be self-employed in anything. But, yeah... So, 11% and then

20% work part-time. Yeah... I have to put that thing at the bottom. Basically, things vary from

country to region to state, etc.

Slide 13 (04:42)

So, according to the Bureau of Labor Statistics, dietitian jobs are projected to grow by

21% in the next 10 years which is great for us. That means more jobs and there's sort of more of

an emphasis on preventative health, which is one thing that a lot of dietitians do or health

educators especially.

Slide 14 (05:00)

Hospital employment is not really supposed to change. But like I said, nursing home,

residential care and sort of smaller clinics will probably see a lot more people.

Slide 15 (05:14)

Also, with the Affordable Care Act and the treat and reduce obesity act that was in 2013,

we're expecting to see a lot more preventative care covered which means more jobs for dieticians

as well.

Slide 16 (05:30)

So, these are the potential places that dietitians can work. It's pretty expansive. In a

hospital setting you're going to be working with...

Slide 17 (05:42)

When I work with patients accessing their nutritional statuses, which can be a big

challenge… I, myself, don't really prefer the clinical setting. I like the education components as

opposed to here's what you need to eat and not eat and you may not make it through the night if

you don't. I don't like that. So, if you like that sort of fast-paced stuff, hospitals can help you with

that. Sports nutrition... You can work for a professional sports team, something like that. Those

jobs are sort of few and far between. You can also... At bigger high schools and colleges work as

a sports nutritionists.

Wellness programs, that's what I'm doing. Increasingly, more and more companies are

offering wellness programs for their employees as well as universities expanding their wellness

programs for their students because as I hope most of you know, we need to be focusing on

children and younger people to keep them from being unhealthy as opposed to focusing too

much on the people who are already unhealthy. You have to balance it out. I'm not telling you to

not care about your parents, but really, the young ones are our future. So, we have to work in the

prevention.

Private practice, as I said, 11% of dieticians do that. They have it in their home or they

have... Depending on where they live, they can an office of their own. It just requires a lot more

start-up costs. Community public health settings, things like the Health Department WIC which

is Women, Infants and Children. You can work for... I'm blanking on the food... Anybody else

know what foodstamps is now called? SNAP. You could work for SNAP, which is the food

assistant program. Things like that. Those are very high-volume jobs. You're going to see a lot of

people. Again, you're probably not going to make big bucks. But, if you really see the benefit of

helping large populations, that's where you want to do it.

Universities... Our other dietitian that works with the wellness education also works in

student health services as a dietitian. If you want to see her… Just a little plug. You're not going

to pay more than $10 ever and you can go schedule a session in the student health. I would just

call and setup an appointment. Research... There are some dietitians who choose to do research,

usually community-based research as opposed to in the lab. But, there's definitely nutritional

sciences that people can go in. I don't know a lot of registered dieticians who want to do

laboratory research because you don't really cross in terms of what you're studying. It’s pretty

limited.

Food service - a lot of food service environments, especially in hospitals have a dietitian

there to help in meal creation and production. A lot of dietitians end up being food service

managers for larger facilities. And then in the food industry… Boo… Hiss… Even though the

food industry may be considered the villain a lot of the time, at least in the nutrition field, there

are dietitians that work for big food companies and try to help market healthier products and sort

of change some ideas in terms of some of the food that's offered.

PART III

Slide 1 (00:00)

There's also specialty certifications that you can get after you get your R.D. if you have a

specific focus if you really like working with kids (pediatric), sports, old people (gerontological

nutrition), kidneys (renal nutrition) and then oncology...

Slide 2 (00:20)

Actually, oncology nutrition is the newest one added to this list. So, cancer nutrition is

becoming an expanding field of research.

Slide 3 (00:30)

So, a day in the life of what I do...

Slide 4 (00:37)

So, counseling, one-on-one nutrition questions, helping people figure out meal plans,

exercise plans, behavioral change, what they can take out of their kitchen, what they need to put

into their kitchen, how to cook things - that's all of what happens in one-on-one sessions.

Slide 5 (01:00)

Presentations like this and also presentations in the dorms, presentations at student

groups, basically the topics can range to really whatever people are interested in learning in

terms of nutrition and wellness in general.

Slide 6 (01:15)

Outreach... We do a produce of the month.

Slide 7 (01:21)

How many people have seen the table at BullMarket where we hand out free fruit

sometimes? Yeah! Whoo! We're trying to expand that program and get more fruit out there and

people actually walking around with the fruit. But, “Produce of the Month” is an attempt to get

people to try new fruit and vegetables that they haven't tried before. So, try more fruits and

vegetables. Then we also have a program that's once a month called “Cooking with a Dietitian”

and that's in the student health annex. You have to sign-up online. But, it's a cool, small... I think

it's usually 10-15 students and then 1 or 2 dietitians there cooking something healthy and

basically showing you that you can eat healthy on a budget and it can be delicious too. You also

get a free cookbook that was made my students a couple of years ago with that.

Slide 8 (02:18)

So, program and campaign planning. A dietician can work for a non-profit or something

like that, working towards more wellness and health goals.

Slide 9 (02:26)

Often times that may include planning major programs or campaigns to reach the

audience. One of my jobs on campus actually is program and campaign planning, trying to get

you guys to exercise more and to eat less pizza and other free food that they serve at BullMarket.

Slide 10 (02:49)

And yes, community-interaction partnership.

Slide 11 (02:53)

An example of this is I've been in contact with the Botanical Gardens on campus and

there's a community garden collaborative as well in Tampa. Basically, community partnerships

are things where you can have a mutual benefit with a community partner, whether that be a

farm, whether that be another health organization, whether that be elementary schools and sort of

provide each other with support or education.

Slide 12 (03:25)

And then as I mentioned earlier, continuing education is something that I do.

Slide 13 (03:31)

I consider sort of reading the news cycle on health also part of my continuing education. I

think while I disagree with probably 75% of articles that get posted on Yahoo and other websites

in terms of what they promote nutritionally and how they go about it, I think it's important for a

dietitian to also know what the public is seeing and how they're getting their nutrition answers

and knowledge so that we can sort of work to make sure that they’re getting the right tidbits out

of that article or TV show or Dr. Oz - don't get me started there.

Slide 14 (04:22)

So, this is the wellness education website. Besides nutrition stuff we have a lot of other

things that you can access here.

Slide 15 (04:29)

Also, the wellness center is a great place to go for massages or for... We have a really

cool thing called an in-body machine which will give you your body fat percentage and give you

an analysis of sort of your muscle mass and things like that. That's another cool thing that I get to

do here on campus. We have hours every day and you can come. I get to sort of do these one-on-

one drop-in sessions where you can ask questions about your print-out that you'll get with that

information as well as just general quick nutrition advice and questions. I know, stop with the

promotions.

Slide 16 (05:10)

But, we also have twice a month a class called "Eat Smart, Live Smart.” It's in the MSC.

It's just sort of a quick nutrition question and answer thing that you can attend. It's free and I

think it's worth it.

Slide 17 (05:29)

We also have nutrition counseling like I said, in the student health services.

Slide 18 (05:33)

You can call and get an appointment there.

Slide 19 (05:37)

Any questions?

Slide 20 (05:44)

So, I suppose that you could be looking for a job at the FDA or the USDA, is where I'd

directly go. But you can also... I mentioned some governmental programs like the Women,

Infants and Children, like the SNAP program. Those are all government-based programs that

focus on wellness. I imagine that probably the CDC has some nutrition-related... If you wanted

to go more into the research aspect you can look for jobs in the CDC. Health and Human

Services is always looking for people to help them with their reports on national wellness and

surveying.

I actually don't know too many people myself who have gone into personal training. I

think I notice a lot more personal trainers sort of adding nutrition advice to their programming

and I would say there are probably more personal trainers who fall into the nutritionist category

because they don't want to go back to school. I do think that... I know of one person who got his

dual degree in exercise physiology and so he is doing sort of more of the personal trainer...

Yeah... as well as dietitian thing. But yeah, for the most part and I'm sure this varies depending

on the program... I would say probably dietitians, if they're going to go through all of this process

they'll focus on the nutritional components.

Anything else? Yes, I can’t give you any statistics but they're pretty competitive. One

thing I forgot to mention and I don't know why this didn't make it to the slides. I mentioned that I

pre-selected for the internship. What that means is basically because I was in the master’s

program at Michigan, I could apply basically for early admission to the internship because it was

in the same place. It didn't guarantee that I would get in, but it was like a 90% thing. But, the

other option is to... Basically you fill out an application, you pick up the top three or four that

you want, you get matched. I know that the matching is low. I think it’s 40% or something like

that. It's getting more and more competitive because wellness is increasing in popularity. More

and more people are wanting to be in the nutrition field. So, the programs haven't expanded quite

enough to supply all of those people. Not to say that it's impossible because... So, as long as you

have a strong essay... I think the essay is the important part.

PART IV

Slide 1 (00:00)

Ideally. Yes. So, clinical encompasses quite a few different things, but yes. You will be

working with some tube feeding, as well as general nutritional assessment of most patients. So,

that's why I put the ideally. Ideally, the nutrition is included in the team that is with a patient. So,

that would usually include the main physician, the medical students, the other person that's in-

between a medical student and a physician, and a pharmacist and a dietitian. I think more and

more hospital settings are working towards having that health management team. Unfortunately,

the dietitian... At least in what I noticed when I was in the hospital in my internship, is not

always able to go around with that team and see every patient with the team. They do

communicate via email and message like that. But oftentimes, unfortunately right now the

dieticians are pretty spread thin with how many patients they have to see at one time and so they

just... They have to focus on the nutritional status of the patients on their own as opposed to

being able to go on rounds with the team.

So, this survey that I just talked about, we did one of them in 2011. And the scary thing

that I saw was 45% of males surveyed were overweight or obese and 35% of females were

overweight or obese. We have a relatively sedentary population. That means we do a lot more

sitting around than we do being active. So, that is something that changes based on the school.

Like I said, I'm new here so I don't know too much. I only know what people tell me. But,

supposedly as a school that has a lot more commuters, it's a lot harder to get people to sort of be

active on campus. So, it's sort of about encouraging people to be active at home which is a lot

harder. Also, if you have people commuting a decent distance, that means they're probably going

to stop a lot more for things like fast food on their way home for dinner as opposed to wanting to

cook when they get home. So, does that answer your question? Some of the major concerns

here?

As a dietitian, we are not... We can deal with eating disorders. Usually we're

complimented by a counselor or something like that. You can sort of... You can get a

certification as an eating disorder specialist. I forget the organization that does that. But right

now, at least in my program, we got sort of a minimal education in terms of dealing with eating

disorders. We know the basics of how to counsel people with eating disorders. But, it's

something that I think should be expanded in terms of education.

In Florida there's a state licensure. The only thing that means is that if you have your

R.D. you pay another fee and you fill out a form and then you get your Florida licensure. You

don't have to take another test or anything like that. Most states do not have their own licensure

program but some of them do.

So, it depends on the nutritionist. Basically, a nutritionist is not required to have any

formal degree in nutrition. They can sort of get their... educate themselves wherever they deem

necessary through books or websites, things like that. Essentially, the main difference is that you

know that a registered dietician went through certain classes, has the sort of 1200 hours of

training with other dietician, as well as took an exam showing competence. Nutritionists may be

competent as well but you just don't have any idea because you don't know where they go their

information.

The challenge of being a dietician overseas is that every country has different sort of

nutritional regulations and requirements and recommendations. So yes, there's definitely

dieticians who work overseas. I think it requires a little bit more education in terms of wherever

you're going. You need to make sure that you're licensed or you have the information that the

government or the WHO (World Health Organization) recommends in terms of nutrition. But,

you're also focusing on a lot different... The topics are a lot different when you go

internationally. You're focusing more on under nutrition and malnutrition than you are on over

nutrition like we are in the U.S.

Any other questions? Healthiest fast food option? I actually haven't been around to all of

the facilities. I am actually very impressed with what the dining halls have to offer in terms of

healthy options. In my undergraduate we didn't have a salad bar that had all those different kinds

of things that you could get and we didn't have a guaranteed vegan or vegetarian option all the

time, which I really appreciate that in the dining halls here. In terms of fast food, really I haven't

been anywhere besides the MSC. I would say probably something like a burrito bowl from

whatever that... Moe's... that you could get something with brown rice, extra beans and things

like that.

We briefly covered fad diets and meal replacements. It's something that obviously is a

very popular topic in the general public. Basically, we cover them as we're learning sort of more

about nutritional sciences. We say, "Oh yeah, well, that diet doesn't make sense because this and

this and this." And we do get a lot of questions sort of, especially about protein supplementation

for strength training and Paleo diet is popular these days as a diet. What I tell people usually

when I'm talking about diets in general are that whatever you're doing should be something that

is sustainable. It's not like you're going to be doing it for six weeks and then you're going to go

back to regular eating. You should be eating in a way that you're getting all the nutrients that you

need and you want to keep eating it that way. Usually fad diets you're not able to do that. Does

that answer your question? Anything else? Alright! Well, thanks for having me.