Changing of the German Dietitian Law
  • Country – Germany

    The German Dietitian Association (VDD) was founded in 1957 and represents almost 1/3 of the estimated 15.000 dietitians working in Germany. The VDD is the only professional association for dietitians in Germany, representing its members politically, in society and industry. Furthermore, the VDD provides a wide range of services for the members, including accredited programs in further education and specialisation of dietitians and provides legal services.

    Due to an increasingly unified Europe and the demographic changes of society, especially in the western world, the VDD is facing challenges concerning the work field and education of dietitians. These challenges have mainly influenced the political activities of the VDD in the last decade. The main activities of the VDD work focuses on the following topics:

    Changing of the German Dietitian Law

    Dietitians are considered health professionals in Germany and consequently are protected by federal law. The first dietitian law was established in 1937 with the last major revision taking place in 1994, following German unification. The dietitian law regulates, among other things, the content of the educational syllabus, the state registered schools where dietitians are taught and the professional title. The statutory goal of the education of dietitians in Germany is to enable them to take personal responsibility for the independent provision of diet therapy and nutrition counselling. The political activities of the VDD are primarily focused on changing the professional title and the academic recognition of dietitians in Germany.

    In 2010 a survey of members of the VDD conducted by the Berlin School of Public Health (BSPH) showed that the work fields of dietitians in Germany do not differ from those of dietitians in other European countries. Furthermore, the protected professional title of “Di√§tassistent” (literal translation “Diet-assistant”) does not reflect the level of autonomy with which German dietitians provide services to their clients and causes problems in the recognition of the profession outside Germany. For these reasons the VDD is demanding that the title be changed.

    Although the education of dietitians broadly meets the competencies described in the “European Dietetic Competences and their Performance Indicators” (EFAD 2009) the state exam does not lead to a Bachelor degree, which is a situation believed to be unique to the education of health professionals in Germany. Therefore the VDD is working on a concept to establish academic programs for qualified dietitians. The Federal government will be responsible for implementing the necessary changes.

    Diet therapy as a “remedy”

    Since 2001 legal regulations have been established to protect clients and patients from frivolous nutrition consultants. These regulations only concern the refund of expenses through the statutory health insurance (SHI) in regard to participation in courses in preventive nutrition. Refunds for counselling in special diets (diet therapy) are not regulated and depend on the SHI.

    As a result of a legal action submitted by the VDD in 2000 the "Federal Social Court" (BSG) declared that dietary intervention is a therapy. Now the "Federal Joint Committee" (G-BA) has to decide if dietary intervention will be adopted in the "Guideline on Remedies". If adopted dietary therapy will become an obligatory element of outpatient care in Germany, funded by the SHI if necessary. The G-BA has not made any decision to date.

    Within the last decade, which has been dominated by the political activities of the VDD, a lot of goals have been achieved. Hopefully other countries and associations can benefit from the experiences gained by the VDD over the years. From the VDD perspective, it seems that it is sometimes easier to establish something new within a system than to try to change certain parts of a system, especially when these parts are old and traditional. The education of dietitians (as other health professionals) has a long and traditional history, stemming back to the so called “theoretical chefs” who were the forerunners of dietitians in Germany at the end of the 19th century. So the dietetic profession can look back on a long tradition. However, professions and work fields change and in an increasingly unified Europe and time of globalisation one of the main goals for the dietetic profession is to work together to achieve the highest quality of nutritional health worldwide. The drastic differences in the nutritional situation of the populations within the member states of ICDA show how important the work of dietitians is. Therefore the work and support of organisations and networks such as the European Federation of the Associations of Dietitians (EFAD), the Thematic Network for Dietetics (DIETS) and the ICDA is very important and should be strengthened and expanded.

    Daniel Buchholz, MPH, RD