One Size Doesn't Fit All In Nutrition
By Jeffrey Bland, Ph.D Huffpost Healthy Living
America has the highest obesity rate in the world and is experiencing a massive crisis of obesity and chronic disease that is crippling our health and economy. We spend more per capita on medical care than any other nation. Sadly, in spite of our vast expenditures, we rank very low in health outcomes.
This shameful problem can only be solved by bringing together the best minds from all walks of health care, media, technology, and science to deliver lifestyle medicine that is customized to the individual. It's the impetus behind my new endeavor: the Personalized Lifestyle Medicine Institute.
I've devoted my life and career to the idea that health-care providers need the tools to understand the complexity and individuality of their patients and the ability to convey targeted information to them. An indispensable tool in providers' toolsets is nutrition counseling. "Personalized" medicine and nutrition care demand that individuals be able to choose from among the best nutrition practitioners for their needs.
More and more, health professionals from varied fields -- naturopaths, acupuncturists, physicians, clinical nutritionists, and more -- put their energies, time and money toward gaining the knowledge and experience necessary to effectively embrace the power of nutrition.
But astonishingly, health professionals with nutrition tools to reverse chronic health conditions are gagged in many states. In those states, nutrition counseling is essentially permitted only by credentials of a private trade association big and well-funded enough to impose its requirements as the de facto licensure requirements. This trade association -- formerly the American Dietetic Association (ADA) but recently renamed the Academy of Nutrition and Dietetics (AND) -- grants a private credential called "registered dietitian" (RD).
You heard correctly: A nutrition-driven chronic disease epidemic is raging, but the leadership of one private trade association wants to prevent nearly anyone but its members from providing meaningful nutrition advice!
Does an AND monopoly on nutrition advice in a state benefit its citizens' health? No. It turns out that states with monopolies for AND typically have much higher obesity rates than those that are open to competition. Of the 10 states with the highest obesity rates, seven are de facto AND monopolies. But of the 11 states with the lowest obesity rates, only two are de facto AND monopolies.
The leadership of the AND has spent its dollars and energies attempting to monopolize the field of nutrition by pushing through laws and federal regulations that serve only registered dietitians. If you think this cannot happen in America, think again.
Regulatory capture of health professions is nothing new. But this effort is particularly egregious:
First, the stakes for our society's health could not be higher, but the AND leadership is promoting the AND's own narrow interests.
Second, the "scope" of nutrition practice is not a set of competencies unique to a particular health-care provider, but is a tool skillfully used by many different types of providers.
Third, this does not involve substances that the law otherwise forbids the public to use (such as the prescribing of pharmaceuticals permitted only by licensed physicians). This is the purveying of advice with regard to a substance legally available to all and consumed every day: food.
The AND leadership seeks not just to prevent laypeople from providing dietary advice, but non-RD health professionals as well. AND's "model licensing bill" makes it a crime for those who give nutrition advice without a license. Where enacted, these laws prevent the vast majority of non-RDs from providing nutrition advice and artificially constrain the number of nutrition advisers and practitioners. In nearly half of US states these monopolistic licensure laws have passed, and entire segments of extremely well-qualified nutrition practitioners -- such as naturopaths, nutritionists, herbalists and many others -- are often barred from providing advice.
The sole beneficiaries of the AND's drive for monopoly are its registered dietitians and thus the AND itself. Make no mistake: There are many RDs who do wonderful work and many who go on to obtain advanced training outside the AND model. But the entry-level RD credential is far from the highest qualification. The RD credential requires a bachelor's degree, while several other nutrition credentials require masters- or doctoral-level training and far more rigorous and relevant examinations, such as the "certified nutrition specialist" credential, which I hold. What the AND does have is far greater funding, the incongruent sources of which have been well documented.
Previously, AND leadership was able to pass monopolistic licensing laws because it was well-funded while the nutrition field was fragmented. Legislators were unaware of the difference between dietitians and nutrition professionals, and the AND was able to pass one-sided laws because opposition was dispersed and poorly organized. In effect, the AND was acting as legislator, executive, judge, and jury regarding who could practice nutrition -- until now.
I serve as a board member and vice president of the Certification Board for Nutrition Specialists. The credential granted by our board, the Certified Nutrition Specialist (CNS), is an advanced-degree professional nutrition credential named in many state regulatory regimes across the nation. We seek fair licensing laws that allow each practitioner to practice to the level of his/her training.
To ensure our society has access to nutrition advice from diverse sources, we have gathered the professional nutrition field to advocate for nutrition practice laws in America that serve the interests of American citizens, not one private trade association. These efforts have now crystallized in the creation of the Center for Nutrition Advocacy, whose mission is to advance nutrition care providers' pivotal role in health care through effective public and private policy.
Recently, we have played a pivotal role in defeating or derailing monopolistic bills in 13 states, and rolling back existing monopolies in others. Stay tuned -- there is much more to this story, and it affects every one of us.