Diet right: Check qualifications on dietitans and nutrionists
Kathy Spears of Fresno, Calif., put off going to a doctor for years, despite feeling progressively worse.
But when she turned 65 and Medicare kicked in last August, Spears turned to one who diagnosed her with severe thyroid disease and diverticulitis. The doctor, who prescribed thyroid medication, told her she was also prediabetic, overweight, with high cholesterol and multiple food intolerances.
Spears decided to see registered dietitian Amber Bryant at highly rated Peachwood Medical Group in Clovis, Calif. Six months later, she says she’s 20 pounds lighter and feeling better. “It’s accountability and awareness,” Spears says of her biweekly sessions with Bryant, who charges $200 for eight sessions and $10 for follow-up visits or $50 for one-time consultations. “I have to tell her everything I’ve been eating and how I feel, so I try to stick with it. Amber pushes me forward, but she’s never been anything but supportive.”
Discerning what diet experts do and don't do
Spears’ positive experience echoes most Angie’s List reports on diet experts, which consumers most often seek out to lose weight or control medical conditions. “The epidemic of obesity and chronic disease, and the growing understanding of nutrition’s primary role in a person’s health has led consumers to rapidly step up demand,” says Corinne Bush, a certified nutrition specialist in Bedminster, N.J.
Credentials for dietitians and nutritionists vary greatly, yet most perform similar services, such as creating custom meal plans, checking food journals, and suggesting diet changes to boost health and help clients avoid food they shouldn’t eat.
However, nutritionists operate without oversight in a majority of states, according to the Commission on Dietetic Registration. Registered dietitian Lona Sandon warns some nutritionists have little to no formal nutrition education and may ask patients to fork over big bucks for unnecessary or unsound tests and products they sell.
“Anyone can call themselves a nutritionist,” says Sandon, who teaches at highly rated UT Southwestern Medical Center in Dallas. “That’s scary, because they don’t understand the medical aspects of diet and could cause some real problems.” She warns against seeing any nutritionist with only a web-based degree or one from an unaccredited school or program.
Sandon is also an Academy of Nutrition and Dietetics spokeswoman, which claims registered dietitians — the vast majority of its membership — are the most highly educated nutrition professionals. “Dietitians are clinically trained to provide medical nutrition therapy and understand how nutrition and disease interact,” Sandon says. “Non-RD nutritionists are not. At best, most only have knowledge and training to provide basic nutrition information for overall health.”
Certified nutrition specialists like Bush argue they’re more educated than most dietitians because a CNS requires an advanced degree (in fact, many are doctors, chiropractors or nurses), and are better trained to treat people with chronic, lifestyle or aging-related disease, versus the RD acute-care approach in institutions like hospitals. “It’s the clear choice for most consumers,” Bush says.
Always check the license, credentials
No matter who you choose, Sandon says to make sure the nutrition professional is licensed. Forty-four states, plus the District of Columbia, regulate dietitians on some level. Twenty-four of those states license or certify both dietitians and nutritionists — with a broad range of requirements. Some, for example, only regulate providers with “certified” in their titles. Six states have zero legal oversight of any kind of dietetic professional.
How to decode diet expert credentials
Bush, who serves on the Certification Board for Nutrition Specialists’ legislative committee, says the CNS designation isn’t as widely known and her goal is to get CNS recognized by more state licensing laws. “The credential is somewhat newer, founded in 1993,” she says.
Even as most diet-related reports on Angie’s List are glowing, some members recount bad experiences. Fairfax, Va., member Marian Sanders rated Advanced Chiropractic of Virginia poorly after she went to chiropractor John Pinto for neck pain and says he recommended a cleansing diet of chicken and fish, plus purchase $200 supplements from him.
“I don’t believe that’s sound medical treatment,” Sanders says. “I have no dietary concerns.” Pinto, who’s certified by the Chiropractic Board of Clinical Nutrition, didn’t respond to interview requests.
Sandon says providers who recommend you buy their supplements or other services should raise a red flag. It’s a violation of the RD code of ethics to do so. But while a CNS must also adhere to a code of ethics to maintain certification, Bush says there’s no restriction on selling supplements or additional services. In fact, most nutritionist certifying groups — including the CBCN — do not prohibit such practices.
Highly rated Steven Novil in Evanston, Ill., dispenses holistic nutrition guidance but says he doesn’t sell the products he recommends because it’s a personal conflict of interest. Novil holds a Ph.D in nutritional sciences and homeopathy and practices as a naturopathic provider. Member Judy Rudis paid him $250 for three sessions after experiencing sleep issues and a lack of energy.
“He balanced my chakras and gave nutritional advice,” she says. “What really impressed me was he didn’t try to sell me any of the remedies he recommended.”
Ultimately, deciding who to see comes down to training and experience, so ask about qualifications and verify credentials come from an accredited agency. Check that the professional is in good standing if licensing is required, and ask about client references.
Most importantly, find a provider with whom you mesh well. “Ensure your personalities and beliefs about nutrition are a good fit,” Bryant says. “Weight and diet are very personal and sometimes emotionally charged issues, so you want someone who sets you at ease.”