Dietitian vs Nutritionist - Which Nutrition Professional Is Right For Me?

Dietitians, nutritionists, certified nutrition specialists, functional health practitioners, holistic health coaches, ......... you're probably thinking, nutrition is confusing enough and now I need to figure out what all these different nutrition titles mean?? Don't worry, I'm here to explain!

Nutrition is an interesting field because there are multiple ways to become a nutrition professional whereas other health fields have more straightforward paths. For example, you either are a doctor or you're not. In most health professions, your title is obtained through licensure. A license is granted by our state and national governments that permits a person to practice within a set scope. This requires that the person meets minimum standards for education, training, professional examination, and continued education. As of when this blog was written, there are only two pathways to receive licensure as a nutrition professional: registered dietitian nutritionist (RDN) and certified nutrition specialist (CNS). Let's start with these two.

Registered Dietitian Nutritionists (RDN)

A Registered Dietitian, recently changed to Registered Dietitian Nutritionist, is often the most recognized professional in the nutrition industry. To become a RDN, one must complete a master's in nutrition, 1200 hours of supervised practice, pass a national credentialing exam, and maintain continuing education.

The schooling and practice to become a dietitian can take anywhere from 6-8+ years in total. Pre-requisite or undergraduate coursework typically includes biology, chemistry, anatomy, physiology, organic chemistry, microbiology, introductory nutrition, and food science. Graduate coursework includes research interpretation, nutrition screening and assessment, food service management, macronutrient metabolism, micronutrient metabolism, counseling, genetics, medical nutrition therapy, and a few specialized classes.

A dietetics student must also participate in supervised practice rotations in the following areas: community nutrition, medical nutrition therapy in both the inpatient and outpatient setting, retail food service, inpatient food service, nutrition education, and a specialty internship where the student can focus on a topic of choice (private practice, sports nutrition, eating disorders, media, etc.).

After passing the national exam, a dietitian must participate in 75 hours of approved continuing education every 5 years to maintain licensure. Dietitians hold a national license and can get state licensure in all 50 states. As of now, dietitian services are the only nutrition service that qualify for insurance coverage. Dietitians can receive additional certifications in specialty fields like functional medicine, sports nutrition, oncology, eating disorders, and more.

Dietitians go into a wide variety of career paths, but are most known in traditional healthcare settings. Legally, dietitians are the only nutrition professional that can work in traditional healthcare and hospital settings and provide all aspects of medical nutrition therapy including nutrition support (tube feeding, IV feeding).

Certified Nutrition Specialist (CNS)

The second path to licensure is a newer path called the Certified Nutrition Specialist (CNS). This pathway is a similar time commitment to the RDN route, with just some differences in course focus. A minimum of a master's degree is required along with 1,000 hours of supervised practice, a credentialing exam, and 75 hours of continuing education every 5 years. A CNS can obtain state licensure in 37 states as of today. What's interesting about the CNS route is that other health professionals with a masters or doctorate degree who are interested in the nutrition specialty can obtain the CNS title as well if they meet certain requirements and pass the exam.

The CNS coursework requires similar courses as the RDN such as nutrition assessment, macronutrients, micronutrients, biochemistry, anatomy, physiology, biology, organic chem, and counseling. The CNS route does not include courses on food service management or certain areas of medical nutrition therapy like nutrition support (tube feeding, IV feeding). In place of these, a CNS can take coursework on alternative therapies like herbs and botanicals. CNSs typically work in private practice on their own or alongside other medical professionals and are often found in the functional medicine space.

Nutritionist

The "nutritionist" label is actually one of the most used titles despite its lack of regulation. There are a large amount of nutrition certification programs that vary greatly in their duration and comprehensiveness. There is no official licensure for the title of a nutritionist which means there are no minimum standards set. So yes, anyone can slap that title on instagram or a website even if they have 0 hours of education. The registered dietitian title was changed recently to registered dietitian nutritionist to signify that while all registered dietitians are considered nutritionists, not all nutritionists are dietitians.

Some states do give RDNs and CNSs protection over their title and scope. This means, that you can only call yourself a nutritionist and/or practice individualized nutrition if you have a license. While other states (like California, New York, and Colorado) let anyone use that title and practice individualized nutrition counseling regardless of their background.

Health Coach/ Health Practitioner

These titles are also not licensed or regulated and therefore no minimum standards are set. Some programs for nutritionists and health coaches/practitioners set minimum standards to become "board certified" which usually requires about one year of training.

A health coach's role focuses on the behavior change aspect of healthcare. A health coach "empowers the client to develop and achieve self-determined goals related to health and wellness." Technically, it is out of the scope of practice for a health coach to recommend or give health/nutrition plans. Instead, the coach is there to help one implement a plan they have set for themselves or that a licensed practitioner provided.

The motivation, tools, support, and accountability are extremely valuable to a health care team because often times it's not enough to just tell someone what to do. Many health coaches go on to obtain further education or pair up with doctors, dietitians, etc. in practice. Some licensed nutrition professionals add health coaching certificates to extend on their counseling skills.

So Which One Is Right For Me?

As a dietitian, I can be biased towards my own profession of course, but truth is, just because someone has a particular title, doesn't mean they are necessarily "good" or "bad" at what they do. There are some amazing nutritionists and health coaches that I would trust with my health over some dietitians and vice versa. Unfortunately though, I do see a lot of unlicensed nutrition professionals practicing way out of their legal scope of practice and no one can really do anything about it because there aren't any laws. This can really put your health in danger.

Here is what I would do when finding the right nutrition professional. First, ask yourself what you need. Do you need personalized nutrition recommendations or do you just need accountability help? If you aren't looking for specific advice, then a health coach might be great for you. If you do need real nutrition counseling then you are deciding between a dietitian, certified nutrition specialist, or nutritionist. If you live in a state that regulates the individualized nutrition practice, you'll want to work with someone that has a license (RD, CNS). If you want to see a practitioner through your insurance or local medical system, you'll be seeing a dietitian.

Don't be afraid to do some research before signing up for nutrition counseling. Look up the person's education, licensure and/or certifications, and work experience. How long did those certifications take? How long have they been working in the field? Do you feel comfortable with that level of experience? Lastly, we can't forget that there are a lot of different opinions when it comes to nutrition so you'll need to find someone whose philosophy resonates with you.

Remember, nutrition is a relatively new field. I expect things will continue to change, and I hope that we continue to define each role and establish standards for the clarify and safety of those seeking nutrition advice. Let me know if you have any thoughts or dialogue to add to the conversation!