Sunday, February 24, 2019

What Is It That I Do, Exactly?

Since lots of people have asked over the past couple years what exactly a dietitian does, here's my stab at providing an answer to that question:

I spent the past two years studying nutrition, which means I took several classes studying the ins and outs of metabolism (how your body breaks down and uses various nutrients and a little bit of where things can go wrong in that process). I also took classes looking at public health nutrition, epidemiology, biostatistics, how to teach nutrition (typically focused on group settings), nutrition counseling (lots of motivational interviewing and more focused on individuals), chronic disease and nutrition, and nutrition in acute care. We had one class that brought in various speakers from different fields and focused on how we feed a growing world population and how climate change will impact that. Another was essentially a book club, reading books about different aspects of food in our society. And so on.

All of that, plus my capstone project, earned me a master's degree. But I also had to go through a 1200-hour internship to be eligible to become a registered dietitian/registered dietitian nutritionist (RD or RDN - they mean the same thing, it's just personal preference as to which you use). The internship is to develop the skills you need to practice as an RD, complete several more assignments with each rotation, as well as introduce you to a variety of potential practice areas. Because there are a lot of places you can work when you're an RD:

  • Hospital, inpatient
  • Hospital, outpatient
  • Outpatient clinic not connected to a hospital
  • WIC (Women, Infants, Children)
  • Private practice (one-on-one counseling or maybe some group classes/sessions)
  • School dietitian
  • Long-term care/retirement community/assisted living
  • Veteran's Affairs
  • Military
  • Sports teams
  • Public Health agencies
  • Kidney centers
  • Food service - might be in a hospital or might be at other large food service operations
  • Industry - this could be anywhere from the dairy council to companies that produce tube feeding formulas
  • Home care company - these companies help people who need nutrition via tube or IV while living at home

There are probably others I'm forgetting, but the above a fairly extensive list. I didn't rotate through all of these work environments during my internship - usually I spent about 3 weeks at each site I went to. I did a community rotation at a camp for kids with type 1 diabetes and a WIC rotation. I spent 20 weeks doing inpatient and outpatient at hospitals (10 with adults, 10 pediatric - this was my chosen concentration). I also did management and food service rotations in a hospital, since I wanted to work in a hospital and our director was able to get me those rotations in that setting. Peers in my cohort spent time in dialysis (kidney) centers, eating disorder clinics, public health, schools, outpatient clinics, and private practice - you try to tailor some portions of the internship to your personal interests. After completing the degree and the internship, you have to take the RD exam (and get licensed by the state if that's something your state has) before you can practice.

What you end up doing depends a lot on the patient population you're working with. Food service management can include menu planning, waste assessments, purchasing, decisions around cafeteria layout, etc. WIC is primarily working with people who are pregnant and children under age 5. You assess growth and iron status, provide some nutrition education, and provide WIC checks for specific foods like milk, whole grains, fruits/vegetables, etc. Depending on your state and clinic location you might be able to provide referrals to a lactation consultant, social worker, or community health nurse (the WIC clinic I was at was able to provide all of these). In a hospital you could work in oncology, trauma, surgery, transplant, eating disorders, biochemical genetics (inborn errors of metabolism such as phenylketonuria or urea cycle disorder), etc. Sports dietitians work with athletes to optimize their intake for their particular athletic needs. And so on. Personally, I enjoy the hospital setting, especially working inpatient.

Finally, it's important to remember that, while dietitian is a protected term, nutritionist is not. In my opinion, if you want advice about your diet, nutrition, and especially how diet and any specific medical condition interact, you should definitely be looking for a dietitian. Once you find that, make sure they're a dietitian who specializes in your needs - because there are so many directions a dietitian can go with their career, not every dietitian will be the best fit for every person's needs.

Hopefully that helps answer some questions friends and family have had. If you have any others, feel free to ask in the comments!

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