What Is the Difference Between a Dietitian and a Nutritionist?

Photo by  Lou Liebau  on  Unsplash

Photo by Lou Liebau on Unsplash

This post is a response to a question from a real life conversation. I think it’s a great question!

When you start talking about dietitians, it’s pretty easy to generalize their education and what their scope of practice might look like. Dietitians are held accountable to their own board and must attend accredited dietetics undergraduate programs, complete an extensive (well over 1000 hours) internship, and pass a standardized exam. They are bound by HIPAA to maintain patient privacy. Dietitians can be found in most medical communities: hospitals, clinics, and private practices.

Nutritionists, however, can represent any level of training or education. It’s like the wild west right now. Many dietitians, by their own right, call themselves nutritionists. But many nutritionists are not dietitians, which means you need to be a little savvy and investigate their backgrounds.

The term “nutritionist” is not regulated the same way in every state. In a couple states, only dietitians may call themselves nutritionists and practice nutrition counseling. But in a fair number of states, your educational background does not dictate whether or not you can legally call yourself a nutritionist and/or practice nutrition counseling. This website has a pretty awesome map that shows you who can and cannot provide nutrition counseling in your state.

Oregon is a great example of this. Pretty much anyone can call theirselves a nutritionist and/or provide nutrition counseling. However, this is not necessarily a bad thing. Based on my observations and time in higher education, in the last decade or so, dietitians have earned a reputation for regurgitating government dietary recommendations, regardless of whether or not those recommendations are evidence based, funded by an agricultural lobby, and/or best suited to a client’s needs. Clients want practitioners who did not regurgitate information. Clients want practitioners who consider the needs of the individual holistically.

The dissatisfaction in the dietetics community’s practices was expressed by the proliferation of non-dietitian nutritionist educational programs. Some of those programs are federally accredited, high quality nutritional training programs, like the one that I went through at NUNM, but others are online courses that anyone with a good internet connection and the money can take.

Some organizations have attempted to created certificates to rival the RD. The only one worth talking about is the Certified Nutrition Specialist (CNS) credential. Applicants are required to hold a masters or doctoral degree from an accredited institution with additional coursework in clinical nutrition and complete at least 1000 hours of relevant, supervised clinical experience prior to sitting for the CNS exam. In Oregon, there are only handful of practitioners with the CNS credential. While NUNM’s master of science in nutrition program makes me eligible to sit for the CNS exam, I will likely not pursue the CNS, simply because I’ll have a doctorate and medical license in two short years. A CNS is not required to practice nutrition, but it does represent a concerted effort in achieving competency (even though there are plenty of competent nutritionists without their CNS).

I have yet to meet a nutritionist who works in a hospital setting, but I have met non-RD nutritionists in private medical offices who work under the supervision of a physician. In states like Oregon and Washington, some can even accept insurance. However, most choose to have their own businesses and do not accept insurance.

It is really important to me that people know what they’re getting themselves into when searching for nutrition counseling help. But just you don’t get the wrong idea, I’m glad that non-RDs can offer nutrition services, because I believe that no one profession should have a monopoly on a service. Health and wellness is a cooperative effort that requires all types of professionals. However, it is easy to run into a nutritionist whose training is sub-par.

Even though I feel like I received appropriate nutrition training and education (the benefit of getting a masters in nutrition and being a naturopathic medical student!), there are a couple conditions that I would personally refer to an RD for dietary counseling—active eating disorders and chronic kidney disease. This list could grow or shrink as I gain more clinical experiences, but for now, I’m happy to refer. It is my belief that if someone has a serious condition and is seeking nutritional support, then the practitioner needs to reasonably demonstrate that they have the appropriate educational background. Pretty reasonable, right?

You can find a high quality nutritionist—I know more than a few; but, unless they are really forthcoming about their education and training, it is on you to ask the important questions. Do they have an accredited degree relevant to their practice? Was all of their training completed online? Was medical nutrition therapy a part of their education? What were the requirements for their certificate, if they have one? Have they completed any supervised clinical hours?

So, a dietician and nutritionist could have zero differences, or they could have 100. Hopefully I provided you with some helpful ways to spot those differences. If you have questions, please send them my way!