Dietitians serve up sound food advice

by Lori Rypka

As obesity rates continue to increase, it seems there are gurus at every corner doling out what they claim is the latest and greatest nutrition information and selling a product or supplements to offer a miracle cure.

March is National Nutrition Month, and the American Dietetic Association, along with its affiliates, including the Maryland Dietetic Association, urge people looking for nutrition advice to go to the qualified experts -- registered dietitians.

Registered dietitians hold at least a bachelor's degree, have completed a supervised practice program and passed a registration exam. They must maintain continuing education for certification. Some dietitians also use the generic term nutritionist, but Jennifer Schmiel, executive director of the Maryland Dietetic Association, warns that not all nutritionists are RDs.

Schmiel said one of the main focuses of the MDA is to promote the registered dietitian as the nutrition professional. "A lot of people say they are a nutritionist, but don't have the credentials," she said.

Often, those noncredentialed persons may want to teach an agenda, she said, adding that often they will attempt to sell the consumer a host of herbs and supplements promising results.

Having this certification protects the consumer by defining the scope of practice of the dietitian or nutritionist: only licensed dietitians or nutritionists may practice Medical Nutrition Therapy, the treatment of a disease or condition with diet. Consumers who seek nutritional advice should make sure the person they consult with is both a registered and licensed dietitian/nutritionist, Schmiel said.

Part of a medical team

Most of the dietitians work as part of a medical team to help people in the treatment and prevention of disease. But, dietitians may also work in the community for programs like WIC or Meals on Wheels, in hospitals, HMOs and other health care facilities, academia and research, as well as managers of food service operations within schools, correctional institutions and health care facilities.

Melissa Bosslet [Majumdar], an dietitian with the practice EB Nutrition in Rockville, said most of her clients come in with weight or health issues, such as gastrointestinal disorders. Her practice gets the majority of its clients from physician referrals as well as patient-to-patient referrals.

RDs often work with a physician to create an overall program for the client to achieve his or her goals, Bosslet said. These dietitians attempt to find the root cause of a problem and use the most natural methods to address it.

Dietitians do not subscribe to a specific diet as a one-plan-fits-all. Plans are based on a client's lifestyle, budget and preferences, within healthy guidelines. These nutrition professions are also not the "food police," Schmiel said. "We aren't going to say that you can never eat a certain food again," she said. They take into account what a person likes and what changes the client is willing to make.

When it comes to compliance, there is a greater likelihood that a client will follow the plan if there are scheduled follow-up appointments, Bosslet said. In addition to increased compliance, the client and dietitian can work together to address any minor issues that come up along the way, she added. "Then it's not a diet, they make it a lifestyle."

The majority of patients who come to Bosslet have tried many of the fad diets that promise great weight loss, but fail to teach lifelong lessons on how to maintain a healthy weight. There are some truths in diet books, Bosslet said, but no program takes a person's entire system into consideration. RDs understand biochemistry and how the body works, and combine that with how the body works with proper nutrition.

Healthy people benefit

Due to the way health care insurers view the services provided by dietitians, those appointments are not covered, unless in the event of diabetes or kidney disease. Bosslet cites this as one of the reasons dietitians are often underused. Also, people don't consider discussing nutrition while they are seemingly healthy. A healthy person could benefit from a plan that may actually help to keep potential future diseases at bay, she said.

Just as it is important to find a connection between a person and a therapist, the same type of connection is needed with a dietitian. "You need to be connected to your dietitian. Food is, as much as it is what you are eating, so tied to your emotional and cultural side," Bosslet said.

Dealing with food issues is much like therapy, and it's important to have someone to confide in, she added.

"Everyone comes to us at a different stage of change and readiness," Bosslet said.

Making a change, even in a person ready for change, is not always easy. "If it were easy, then everyone wouldn't have a problem losing weight," she said.

Often, people think that just by coming in they are doing the work, but the hard work is what they have to do on their own, she said. So even if someone is only ready to make a couple of changes, rather than a whole overhaul of their nutrition, it's worth it to see an dietitian and start there, she said.

March 23, 2010 - Frederick News-Post.com