Consumers seeking health guidance must be protected from those who are not educated or licensed and do not receive ongoing professional development. Many members of the ICDA including the Academy of Nutrition and Dietetics in the United States are grappling with questions about the manner in which non-registered dietitian nutritionist professionals are providing medical nutrition therapy and similar services.
Whether these individuals refer to themselves as health coaches, nutrition counselors or something else, it is critical to know whether they have the necessary qualifications and competencies to ensure the health and safety of patients, clients and other consumers. This aligns with ICDA’s support for “increased awareness of standards of education, training and practice in dietetics and more adoption of evidence-based practice.”
The Academy’s Board of Directors recently adopted a policy stance recognizing the value of protecting a legislated scope of practice and ensuring only qualified individuals provide certain nutrition care services such as MNT:
Individuals including but not limited to those working as health and/or wellness coaches must meet the minimum qualifications needed to be 1) licensed as a dietitian in states with licensure or 2) a registered dietitian nutritionist in states without licensure to provide medical nutrition therapy unless such practice is inherent to his or her professional licensure scope of practice.
Medical nutrition therapy is an evidence-based application of the Nutrition Care Process, which RDNs are uniquely trained and qualified to provide.
The provision of MNT (to a patient/client) may include one or more of the following: nutrition assessment/re-assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring and evaluation that typically results in the prevention, delay or management of diseases and/or conditions.
The Academy recognizes that other qualified persons may assist the RDN in providing MNT. But the RDN must ensure that these individuals, whether or not they are credentialed by the Commission on Dietetic Registration, are qualified to perform the tasks delegated to them. To the extent the MNT provided is limited to primary prevention, other practitioners, including nutrition and dietetics technicians, registered, may be qualified and effective in providing care.
The Academy recognizes that health coaches, when limited to activities for which they are qualified, can be a valuable resource for patients struggling to achieve lifestyle changes. However, many people in the United States and in other countries simply do not know that many health coaches or personal trainers do not have the educational background to address anything beyond general non-medical nutrition education and cannot effectively (or often legally) provide medical nutrition therapy.
Without predetermined, objective standards for education and training, there is no guarantee that health coaches can protect the public and provide safe, effective outcomes. Legislatively defined standards for licensure allows for a mechanism to ensure that those who are not RDNs have met required standards for education and training.
The Academy accepts its responsibility to offer guidance to outside organizations whose members seek training and credentialing to provide nutrition care and education. In so doing, we can protect consumers through the establishment of adequate, defined minimum credentials for practice.
The Academy’s board determined that relevant Academy departments should work with other nutrition and stakeholders to evaluate various credentials held by health coaches for their credibility and ability to protect consumers and effective positive health outcomes. CDR is uniquely qualified to evaluate credentialing and should engage outside stakeholders (e.g., coalitions, credentialing organizations, professional associations) when those groups are establishing scopes of practice for their members or proposed credentials that overlap with or relate to the scope of practice for RDNs and NDTRs. To facilitate international practice, we must continue our work to achieve similar standards and reciprocity among countries when possible.
NDAs should note that the most effective time to influence these stakeholders is often when they are first considering developing educational and credentialing programs if the potential exists to overlap the scope of practice (especially the provision of medical nutrition therapy) for RDNs and NDTRs.
When an NDA is approached to engage in dialogue or help establish minimum credentials to perform MNT, credentialing and practice experts within the NDA should be consulted for guidance and comment.
For more information on the Academy’s stance on this issue, please contact
Academy of Nutrition and Dietetics