By James Collier BSc (Hons) RNutr - Dietetics.co.uk Co-Owner, Registered Nutritionist & Head Nutrition Consultant www.healthyaction.co.uk
A question frequently posed to me is 'how do I become a nutritionist?' If you're into sports, exercise and healthy living, let's be honest, it sounds like a cool job to have. Well, it is a cool job to have if you do it right – I love my job! However, it does seem that many people are under the impression that training to be a good nutritionist can be done through a few short courses, and any nutritionist worth their weight will tell you that there's a lot more to it than that! Of course, some short courses are available, but these will do little more than expand your own knowledge base and you'll acquire very little in the way of good solid information, and, despite what the course instructors will have you believe, you will be no where near competent enough to hand out professional nutrition advice.
There are different types of nutrition professionals; let's look at the definitions:
This is an unprotected term. Anyone can read a few books or sit on a few short courses and then go and sell their service as a 'nutritionist' with no formal qualifications or registration. Under this title there is no guarantee for the public that the professional is providing sound advice. That isn't to say that there aren't some very credible and experienced nutritionists out there; there are many who have a wealth of knowledge and impart some sound evidenced based advice to their clients.
Dietitian (also Dietician*)
To call yourself a dietitian you have to be registered with the Health Professions Council (HPC – www.hpc-uk.org ) and you will be a State Registered Dieitian (SRD) or simply Registered Dietitian (RD). All of these terms are protected and it is unlawful to sell your services with these terms unless you are registered with the HPC. To be legible to become a dieitian you have to either have an appropriate undergraduate honours degree in nutrition or a post graduate degree in dietetics. The legality surrounding the terms is not there for the benefit of the professional, but to protect the public and assure them that the professional is providing a sound standard of information and advice.
By definition, RDs are uniquely qualified to translate scientific information about food and nutrition into practical dietary advice. As well as providing impartial advice about nutrition and health, dietitians also advise about food related problems and treat disease and ill health. Many dietitians in the UK work in the National Health Service (NHS) and may work in one or more specialist areas. As the title 'dietitian' can only be used by those appropriately trained professionals who have registered with the HPC, those who are not registered are breaking the law if they use the title 'dietitian'.
Dietitians are a profession allied to medicine (PAM) and through the HPC have to adhere to the rules, which include standards like evidence based practice and the rigours of professional portfolios and clinical audit. It is a requirement of registration as a dietitian that you show evidence of continued professional development (CPD) by using the current best practice as it is defined and are keeping up with developments.
The British Dietetic Association (BDA) is the professional body for dietitians, which also acts as their trade union. See www.bda.uk.com
To become a dieitian you can enrol on an undergraduate nutrition degree and during the early part of your course, you'll make the decision whether you wish to train to become a dietitian. Nutrition & dietetics is typically a 4 year undergraduate degree course, which includes some catering and practical dietetic placements at hospitals where you get experience hands on. Following graduation most graduates will go onto work for the Health Service, though some will branch into the private sector and work in industry or freelance. For details of dietetic careers see The BDA website.
(* NB the spelling of 'dietitian' comes under much scrutiny. Dictionaries and texts seem to spell it 'dietician' however the profession spells it 'dietitian'; both spellings are deemed acceptable.)
Registered Nutritionists are full members of The Nutrition Society (see www.nutritionsociety.org). In order to be a member of The Nutrition Society you need a few years post graduation experience working in the nutrition field and references to prove this. This also allows the letters 'RNutr' to be used after the individual's name. At the time of writing this article, there is debate as to whether Registered Nutritionists should also be part of the HPC.
The vast majority of Registered Nutritionists don't work in a clinical setting. It's a common misconception but they are generally employed in the food manufacturing industry, public health, education and private practice as well as other types of non-clinical roles.
Registered Public Health Nutritionist
Like Registered Nutritionists, Registered Public Health Nutritionists are full members of The Nutrition Society. Public Health Nutrition is the application of the science of nutrition for the benefit of the population as a whole, or sub-sections of the population. It encompasses promotion of good health through nutrition and the primary prevention of diet-related illness in the population. Although an important facet of public health nutrition is establishing the relationships between nutrition and health or disease risk at a research level, equally important is nutrition-related health promotion. This includes the type of work conducted by many of the nutritionists working in the food industry and related trade associations, in government, health promotion, and by dietitians working in the community.
Registration usually requires a degree in human nutrition plus a minimum of three years relevant post-graduate experience in public health nutrition. Registered Public Health Nutritionists can use the letter 'RPHNutr'. Associate registration is available for graduates who are in the process of gaining sufficient work experience to apply for full registration. The Nutrition Society accredits degree courses in public health nutrition so that this career path can be selected from the outset. A number of such courses (both BSc and MSc) now exist and details can be obtained from the Nutrition Society.
Nutritional Therapy (NT) could be defined as dealing with the preventative and curative aspects of nutrition, and looks at nutrition as a means of restoring clients to optimum health. NTs aim to evaluate the health status of their client and construct safe, effective nutritional and lifestyle programmes, including supplementation and clinical testing where appropriate. NTs are evaluated by the British Association of Applied Nutrition & Nutritional Therapy (BANT – see www.bant.org.uk) and regulated by the Nutritional Therapy Council (NTC – see www.nutritionaltherapycouncil.org.uk).
Course syllabuses for NT are focused not only on tutoring the student to be a good therapist, but also to have good business skills.
There is a large degree of rivalry between the dietetic and nutritional therapy professions, focused around the fact that dietitians claim that NTs do not focus sufficiently on evidence based practice and that they feel supplements play too great a role in the treatment of disease. Also courses for NT are no where near as in depth as those for dietitians and reputable nutritionists. The aims, however, are broadly the same: identify nutritional weaknesses, assess nutritional status, devise a plan for correction and monitor with the client. But it's the methods of doing this which is where the disagreements arise.
One specific difference is that dietitians are trained specifically to interpret clinical trials and nutritional epidemiology, whereas although NTs may use some peer reviewed studies they do tend to focus on anecdotal evidence in some circumstances. Anecdotal (also known as empirical) evidence is flawed, but is a very powerful motivational tool with clients and patients.
Another difference in the advice given to clients by the two professions is that NTs will also look for a food or herbal alternative to prescription medicine. NTs also criticise modern foods not criticised by dietitians eg modern wheat, production cow's milk, processed vegetable oils, synthetic vitamins, irradiated or GM foods, foods produced with chemical fertilizers, pesticides, herbicides, etc.
The term 'nutrition consultant' is unregulated, but is often used to denote professionalism and to separate the professional from the term 'nutritionist' as, within professional circles, 'nutritionist' is often seen to be less professional and inferior. However, always ensure that someone using the term Nutrition Consultant is of a high standard. At Healthy Action all Nutrition Consultants are Registered Dietitians, Registered Nutritionists or work directly under the supervision of RDs or RNutrs.
Credible Professional Advice
Of course, when a member of the public is looking for a clinician he/she still has to choose wisely, but the fact that 'dietitian' is a protected title means that your quality is more assured, i.e. they have studied a good course at a reputable university, been supervised for a certain amount of clinical experience and continue to be monitored.
Unfortunately you don't get the same assurance with nutritionists, but like mentioned above, this doesn't mean that all nutritionists are of a poor standard.
Conversely, unfortunately, we do have the situation where some RDs aren't giving the quality of information they should be. This may be of no fault of their own, especially in the ever bankrupt NHS where resources are spread thinly and the individual may be so stretched across different areas of dietetics that CPD is difficult to keep on top of. This is potentially a major problem, especially as the BDA campaign for people to be able to 'trust a dietitian'.
One advantage that reputable practicing nutritionists do have over dietitians is that they do have more room for manoeuvre when it comes to what they practice and recommend. Department of Health recommendations are always going to be behind because as studies are released there is a time lag before the information becomes health policy.
Dietitians give advice to their clients based on client needs. As such when given on a group basis, it tends to have to be generalised and acceptable to that audience in order for it to be practical for the clients to actually adhere to the advice given. This is completely different to working in the specialist arena with highly motivated people. It may be the case that the dietitian knows what they are saying is no where near the best thing, but it is a step towards the client taking advice that will be of tangible benefit, whereas with optimal advice, they just wouldn't comply. Information is translated for the general audience into terms that they can accept and understand, and advice is that which can be followed. '5 a day' is a classic example; we know we should recommend consuming more than five fruit and veg a day, but it was considered that five was about as much as could be expected for the UK population, and that it would bring significant health benefits at that level. More is better but low compliance rates when large changes are suggested to mitigate against that sort of advice.
As Registered Nutritionists are registered with the Nutrition Society, it affords some credibility and professionals only make evidence based conclusions. Certainly there are many nutritionists who are not used to reviewing the balance of evidence before making conclusions and it is these unscrupulous practioners who are, unfortunately, the majority and who give the profession a bad name, not least because these are the ones constantly in the media, be it print or on TV. Thus, the public's, and many dietitians', perception of nutritionists is that they are proponents of magic beans.
We have a double edged sward confounded by a degree of 'snobbery' in dietetics. This may not be wholly unjustified, as on the whole dietitians have studied and earned their credibility. However not all 'nutritionists' are bad and many may be Registered Nutritionists, therefore they still have to adhere to professionalism and have formally studied to degree level or beyond. Indeed a significant number of former freelance dietitians have chosen to remove themselves from the dietetic register because they have found the register too restrictive.
An example of this is me. I qualified as a dietitian in 1995 and worked in the NHS in a range of clinical areas until 2002, when I chose to go completely freelance. Then in 2003 I took myself off the HPC register for dietitians. To be registered you have to be in the HPC and pay an annual fee for your registration. I decided to take myself off for personal and professional reasons. I am now not allowed to refer to myself as a 'dietitian', though I can say I have 'qualified as a dietitian'.
I am now a full member of the Nutrition Society and thus a Registered Nutritionist. This affords me some credibility, but is also less restrictive that being a Registered Dietitian. The main thing I do miss is the fact that the term 'dietitian' does carry more professional weight, and it's a term I hold much respect for. However, I pride myself in that I still run my practice in line with what the dietetic profession stands for, and fortunately I have a number of dietetic professional peers who acknowledge this.
It is for this reason why I refer to myself as a 'Nutrition Consultant'; it doesn't have the same unprofessional feel that the term 'nutritionist' is unfortunately maligned with.
Studying Nutrition with a View to a Profession
In order to qualify as a dietitian or as a Registered Nutritionist, you will need to have an undergraduate or post graduate degree in nutrition and/or dietetics. This route takes 4-5 years as a full time student, and is not very practical for many people, especially those in their 20s or older wishing to study nutrition with a view to giving out advice. A course with one of the approved centres for Nutritional Therapy therefore is more appealing to many as they are a lot shorter, but anyone considering this route needs to be aware of the drawbacks discussed above and to note that as a profession nutritional therapy is deemed disreputable.
There is certainly a vacant niche for decent short courses in nutrition. Sure, there are a number out there, but they are not reputably accredited nor are they taught to a good standard. It seems that someone who wants a basic ground in nutrition is very limited in their options. They can attend a short local course, or maybe something affiliated with a personal trainer course, but the knowledge attained will be little more than increasing their own personal knowledge and is far from adequate for becoming a nutrition advisor.
The Nutrition Society (NS) - www.nutritionsociety.org
British Dietetic Association (BDA) - www.bda.uk.com
Health Professions Council (HPC) - http://www.hpc-uk.org/
British Nutrition Foundation (BNF) - http://www.nutrition.org.uk/
British Association of Applied Nutrition & Nutritional Therapy (BANT) - http://www.bant.org.uk/
Nutritional Therapy Council (NTC) - http://www.nutritionaltherapycouncil.org.uk/