Editor-In-Chief: C. Michael Gibson, M.S., M.D. 
A dietitian (sometimes spelled dietician) is an expert in food and nutrition. Dietitians help promote good health through proper eating. They also supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. The goals of the dietary department are to obtain, prepare, and serve flavorsome, attractive, and nutritious food to patients, family members, and health care providers.
In the US nutrition professionals include the registered dietitian (RD) and the dietetic technician, registered (DTR). These terms, as well as simply dietitian, are legally protected terms regulated by the American Dietetic Association (ADA). Some RDs or DTRs call themselves nutritionists. However, the term nutritionist is not regulated, as dietitian is. Persons may call themselves nutritionists without the educational and professional requirements of registered dietitians. Dietetic technicians are not the same as dietitians in terms of responsibilities and qualifications. Different professional terms are used in other countries.
In the U.S., dietitians are registered with the Commission on Dietetic Registration (the certifying agency of the ADA) and are only able to use the label "Registered Dietitian" when they have met strict, specific educational and professional prerequisites and passed a national registration examination.
Types of dietitians
The majority of dietitians are clinical, or therapeutic, dietitians. Clinical dietitians review medical charts and talk with patients' families. They work with other health care professionals and community groups to provide nourishment, nutritional programs and instructional presentations to benefit people of all ages, and with a variety of health conditions. This is accomplished by developing individual plans to meet nutritional needs. These plans include nourishment, tube feedings (called enteral nutrition), intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN), diets, and education. Clinical dietitians provide individual and group educational programs for patients and family members about their nutrition and health.
Clinical dietitians work in hospitals and other health care facilities to provide medical nutrition therapy to patients according to the disease processes, provide individual dietary consultations to patients and their family members and also conduct group educations for other health workers, patients and the public. They coordinate both medical records and nutritional needs to asess the patients and make a plan based on their findings.Some clinical dietitians have dual responsibilities with medical nutrition therapy and in foodservice, described below. In addition, clinical dietitians in smaller facilities will also provide or create outpatient education programs. They work as a team with the physicians, physical therapists, occupational therapists, pharmacists, speech therapists, social workers and nurses to provide care to the patients.
Community dietitians work with wellness programs and international health organizations. These dietitians apply and distribute knowledge about food and nutrition to specific life-styles and geographic areas. They coordinate nutritional programs in public health agencies, daycare centers, health clubs, and recreational camps and resorts. Some community dietitians carry out clinical based patient care in the form of home visits for patients who are too physically ill to attend consultation in health facilities.
Foodservice dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess and plan foodservice processes in health care facilities, school food service programs, prisons, cafeterias and restaurants. These dietitians will also perform audits of their departments, train other food service workers and use marketing skills to launch new menus and various programs within their institution. They direct and manage the operational and nutrition services staffs such as kitchen staffs, delivery staffs and dietary assistants or diet aides.
Gerontological dietitians are specialist in nutrition and aging. They are Board certified in Gerontological Nutrition with the American Dietetic Association. They work in government agencies in aging policy, and in a regulatory capacity in the oversight of nursing homes and community-based care facilities. They work as Consultants in Nursing Homes, and in higher education in the field of Gerontology (the study of Aging.)
Research dietitians are mostly involved with dietary related research in the clinical aspect of nutrition in disease states, public aspect on primary, secondary and sometimes tertiary health prevention and foodservice aspect in issues involving the food prepared for patients. Many registered dietitians also work with the biochemical aspects of nutrient interaction within the body. Research Dietitians normally work in a hospital or university research facilities. It should be noted that some Clinical dietitian's roles also involve research other than the normal clinical workload. Quality improvement in dietetics services is also one area of research.
Administrative, or manager or Director of Dietetics Department or Nutrition Services are sometimes also known as Manager instead of Director depending on the size, number of dietitians in the department and also the organizational structure adopted by the Health facilities or Hospital. Director or Manager acts as head of the dietitians. They also hire, train, direct and supervise employees and manage dietary departments. Administrative dietitians may also apply procedure and policy as part of their management job.
Business dietitians serve as resource people for the media. Dietitians' expertise in nutrition is often taped for TV, radio, and newspapers -- either as an expert guest opinion, regular columnist or guest, or for resource, restaurant, or recipe development and critique. Dietitians have served as show hosts on major television stations and as drive-time radio news anchors. Dietitians write books, appear on television cooking channels, and author corporate newsletters on nutrition and wellness. They also work as sales representatives for food manufacturing companies that provide nutritional supplements and tube feeding supplies.
Consultant dietitians work under private practice. They contract independently to provide nutrition services and educational programs to individuals, nursing homes, and in health care facilities. As recent studies have shown the importance of diet in both preventing and managing disease, many US states have moved towards covering medical nutrition therapy under the Medicaid/Medicare making consulting a much more lucrative option for dietitians due to insurance reimbursement.
Other nutrition workers
These designations apply principally to the US although the generic classifications are likely to be applicable elsewhere.
Dietetic Technicians or diet tech are a registered and licensed support professional responsible for assisting and carry out medical nutrition therapy under the direct supervision of a registerd dietitian. Most are employed with hospitals or long term care facilities.
Dietary assistants or dietary aides are responsible for assisting and carrying out the medical nutrition therapy prescribed by the Dietitians and to ensure that food for the patients as instructed by the Dietitians are carried out correctly by checking menus against recent diet orders before tray assembly begins and being physically present in the kitchen plating-lines at meal hours. Dietary aides in some countries might also carry out a simple initial health screening for newly admitted patients and only inform the Dietitians if any screened patients requires a dietitian's expertise for further assessments or interventions.
Dietary clerks perform clerical tasks such as entry and maintenance of dietary requirements to a database. They also track financial information, such as the number of meals served each day.
Dietary managers are responsible for retail, catering and tray lines. If an operation is large, there may be one or more managers to help in directing the dietary workers.
Dietary workers prepare the food and meal trays in the kitchen. They check for accuracy and completeness. They also maintain the storage area for food supplies and ensure practice of sanitary procedures. Dietary workers are trained on the job and can work in any commercial kitchen.
Dietary hosts or hostesses deliver and bring back the meal trays to patients. They distribute and collect menus and help the patients to make complete selections.
A dietitian's education in health science involves significant scientific based knowledge in anatomy, chemistry, biochemistry, biology, physiology, nutrition, medical science. It is these strong foundations in advanced scientific knowledge and a internship that equipped with counseling skills and aspects of psychology enable a Registered Dietitian to assess, analyze, intervene, and educate a patient in relation to the diet and disease.
It can be said that in an interdisciplinary team (consisting of the physician, dietitian, speech therapist, physiotherapist, occupational therapist, social worker, and nurses), the physician and the dietitian are the two health professionals with the most well-rounded knowledge on human biochemistry and physiology.
There are a few different academic routes to becoming a fully qualified registrable dietitian:
- A professional bachelor degree in Dietetics which requires four years of studies
- A bachelor of science degree and a postgraduate diploma in Dietetics
- A bachelor of science degree and a master's degree in Dietetics
Besides academic education, registered dietitians must complete up to a year long dietetic internship of at least 900 hours through and accredited program before they can sit for the registration examination. The dietetic internship requires the intern to complete several areas of competency including rotations in clinical, community, long-term care nutrition as well as food service, public health and a variety of other worksites.
Once the degree is earned, the internship completed, and registration examination passed, the individual can now use the nationally recognized legal term, Registered Dietitian and is able to work in a variety of professional settings. Most states require additional licensure to work in most settings. To maintain, the RD credential, professionals must participate in and earn continuing education units 75 hours every 5 years.
USA & Canada
In the United States and Canada, the Dietitian, Registered Dietitian (RD), etc. are similarly protected titles. The professional association in Canada is the Dietitians of Canada. The US equivalent of it is The American Dietetic Association.
In Australia, the qualified dietitian is called Accredited Practising Dietitian (APD)
- Ask the Dietitian
- International Confederation of Dietetic Associations
- The American Dietetic Association
- The British Dietetic Association
- Dietitians Association of Australia
- List of articles on "nutritionist" at Quackwatch, demonstrating the unregulated use of the word
Cleft lip and palate Microchapters
Dietitian On the Web
American Roentgen Ray Society Images of Dietitian
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