Dietitian vs Health Coach?

Versus Nutritionist?

Yes readers, I am “going there”.  I’m taking the time to point out the DRAMATIC difference between a health coach, and a Registered Dietitian.  It seems like these days there is no shortage of nutrition advice coming out on full blast: Instagram, Facebook, Facebook pages, blogs, twitter, the news, and the list goes on from there.  It’s everything on the spectrum from selling shakes and supplements, to selling a lifestyle, and everything in between and sometimes meeting in the middle.

IN FULL DISCLOSURE: I am in fact a Registered Dietitian, I have been suckling from the Dietitian pot of sugar free kool aid for the better part of 9 years (undergrad, grad school, and work experience), so my objectivity may be called into question in a few of the points I make, I assure you it doesn’t make what I’m saying less true.


I think universally several things can be agreed upon:

  • Nutrition is a science, and it continues to evolve to this day like other forms of science.
  • Nutrition is a unique combination of several forms of science: physiology, anatomy, biology, even chemistry in addition to being a science of its own (if that makes sense?)
  • Nutrition has a direct impact on health, and well being

I’m sure there are some things that could be added to that last point, but my point is (one of them), when it comes to nutrition – there is NOT a lot of universal agreement.  So there is a lot to address in such a short blog post.

  • So what is the actual difference between a dietitian/health coach and nutritionist?
    • So first of all anyone can say they are a health coach or a nutritionist, to become a Dietitian, you have to have at least a Bachelors Degree in nutrition or an approved nutrition related field, complete your supervised practice experience (internship).  There are integrative programs for “Nutrition Specialists” and “Health Coaches”, but neither are real or even protected credentials.
  • Where does licensure come into play?  Why is it important?
    • Licensure is important for a gal like me, 46 states (unfortunately Michigan is not one of them) have Licensure as an added protection to RD’s.  The RD credential is overseen by the Commission on Dietetic Registration.  Licensure is overseen by each state and their licensure laws.  These licensure laws map out if just the term Registered Dietitian is protected by state law and licensure or if Nutritionist is also lumped it.
  • What about other certifications?
    • Personally I am also a CDE: Certified Diabetes Education – which is regulated by a different agency(the National Certification Board of Diabetea Educators), what this means is that I maintain my RD credential through one governing body, and my CDE through the other, both have their own set of requirements for continuing education.  There are various credentials RD’s can get to enhance their skill set in their area of practice – with each certification there will be governing bodies over those certifications in which RD’s need to track their continuing education credits (this shows they are staying up to date on current materials in the field each year).  These other credentialing bodies will also offer different resources and guidelines for you to implement in your specialty position.

Unfortunately if you google “health coach vs registered dietitian” the first hit is for an Integrative Nutrition Program – within that link there is a bit of biased info on how this Institute trains their Health Coaches to:

“Work with wellness goals, focus on disease prevention, reduce stress, and take a whole body approach.”  (I am paraphrasing, but this is what it says)  It goes on to say that Health Coaches can work independently or in a wellness setting or practice.

The description of a RD (direct quote): “Registered Dietitians are overseen by the Academy of Nutrition and Dietetics and therefore must follow a certain set of guidelines in terms of the recommendations they make to patients” it goes on to say that while this ensures a certain standard of practice (uhhh yes please- standards are good)in that it “limits” someone from doing what is personal preference in lieu of what is evidence based (I.e. You can’t to just say whatever the heck you want).  It doesn’t limit the degree a RD can individualize goals or plans for a client.  I will admit here that just like any profession there are some RD’s out there that take the guidelines as gospel, and do not use them for what they are-guidelines to use as a means to individualize.  Guess what there are people in every profession who do this to some degree.

Glad we’re getting some really awesome facts about Dietitians out there.  Guidelines to most RD’s are just that: guidelines, a good professional knows when it’s time to color outside the lines- but still utilizing evidence based practice.  Oh yes.  EVIDENCE BASED PRACTICE.

I fully understanding this is part of a marketing strategy to get students enrolled in their program.  Except there is definitely some bias on what was said about RD’s to differentiate them from Health Coaches.  And again, please let me point out: EVERYTHING A HEALTH COACH CAN DO, A DIETITIAN CAN DO, AND HAS A GOVERNING BODY TO ANSWER TO!!  (Too much?)

And aren’t accreditations and governing bodies good things?  Lawyers, Doctors, Nurses have accreditations in place so that people who are not trained to be these – cannot say they are.  In fact many states (if not all) require accreditations for electricians, plumbers and many other professions – professions that are important, and that we would not inexperienced people practicing on us/for us and accepting our money to do so.  Governing bodies are also a good way for accountability for practitioners.

Let me get back on point.

  • So at this point you might be asking- “Sarah, it sounds like Dietitians and Health Coaches all have similar goals of spreading information about health and nutrition, in an effort to make peoples lives better.”
    • That is true, and that is also a fair assessment of the situation I’ve presented as a whole thus far.  Please remember: professionals who have legitimate training and have experience can call themselves “Health Coaches” or Nutritionists (except in some states, see “licensure”). But so can people who sell Beachbody or other supplements, OR have had positive experience personally, or have a general interest in nutrition- they can also call themselves Health Coaches. But the second group-  they have no governing body, no set of guidelines, and no one to answer to when they take their own experience as gospel and try to make it fit to everyone.  That is a huge issue with the “n=1 training” (n meaning sample size)

But this may be where the path splits here on schools of thought. This is also where it gets very hard for me to be objective.  Because I am, what I am- a Registered Dietitian.  But I’ll remain as objective as possible.

  • Some argue that “nutrition” and the ability to educate about nutrition is more of a toolkit used by a variety of practitioners: Nurses, Dietitians, Doctors, chiropractors, health coaches, etc.
    • To some degree, there is a little fact here, in a clinical setting, but again, dietitians are the only professional group who have specific training in nutrition.
  • So Sarah, what’s really wrong with Health Coaches who lose weight, and promote shakes, and nutrition, and provide advice about nutrition to help people out
    • If you are looking for a one word answer: nothing.
    • But then I will ask you – aren’t qualifications important?  I am not here to take away from the HC’s who have had personal success  with making lifestyle changes for themselves.  THAT’S GREAT!  I got into this line of work to see people get healthier.  However, it is unrealistic to think that their (n=1 experience) will be able to reasonably translate to every single person.
      • My conservative n (sample size or experience) is equal to thousands.  This is me personally, and again being conservative, considering realistic days worked, average patient visits, accounting for follow up visits of the same patients, and my whole practice time.  There are dietitians out there whose sample size (n) is in the 10’s of thousands if not more.  
    • Sure quality versus quantity is an important point, but Dietitians are trained for motivational interviewing, they are taught to probe, and dig deeper, and adjust “plans” to be individualized to their patients.
    • To argue fairly – there are health coaching, and integrative nutrition programs out that that also teach these skills.  To continue this side of the argument I have worked with professionals who have advanced degrees (Ph.Ds) in nutrition, who opted to not go through with the internship and become an RD.  It would be silly to belittle their experience and contributions to the field of nutrition.
    • BUT.  Bottom line: Dietitians are the only professionals allowed to bill and conduct Medical Nutrition Therapy (MNT).  Pertaining to the nutritional and disease management – i.e. diabetes education, “heart healthy” diets, etc
    • Health coaches are not formally trained – especially if they are self taught -how to calculate protein and calories needs, and therefore are not- qualified to provide meal plans.
    • Dietitians receive training in medical nutrition therapy (how disease states – including obesity – can be impacted by nutrition), nutrition and medication interactions, digestion and absorption of different macro and micronutrients- to name a few…


This isn’t an argument about “selling supplements”, this isn’t even about belittling HC’s.  So if that was how it was perceived, my apologies.

But I hope at the very least I’ve highlighted some very important differences between the two titles, and quashed some myths.

Guiding clients to weight loss is a lot more than posting inspiring photos on social media, and reminding them to eat veggies. Many times you need to dig a lot deeper with people to address barriers. Again, I’m not here to belittle how people make a living, but again I’ve worked hard to get where I’m at in my career to see people who are self trained try to advise on the level I do, frankly- I find it upsetting actually (I am aware of the condescending undertones in that statements, but I’ve left it in this post for a reason).

I believe Dietitians and Health Coaches can work together to aid the public in making better choices, but I firmly believe that in such a scenario a trained Dietitian, or someone with advanced training in Nutrition (MS, PhD) would need to be overseeing Health Coaches and Nutritionists. Another thing I firmly believe is that evidence trumps everything- and while organizations and governing bodies may be late to change their positions- I’ve worked as an RD and with RDs who utilize new evidence to make recommendations to patients- but are confident in referencing that evidence and therefore do not make recommendations based on their personal beliefs- but rather evidence.

 

Again, I didn’t write this post to be a “B”.  I did it to bring up some important points regarding the differences in training, qualifications, and practice/practical experience.  I genuinely believe what I stated before that they can work together in certain settings, as both titles have the same goals.  But ultimately in terms of which group is more qualified to be advising on what, and how much to eat, and how to lose weight- well that responsibility should remain with and only with the Dietitian.

 

2 thoughts on “Dietitian vs Health Coach?

  1. Olivia Zarrelli says:

    Everything a dietitian is said to be able to do and “wants” to do will likely not happen because after internship they will 9/10 end up in acute care in clinical or stuck in a nursing home. Where they will do free fluid calculations and assign the cardiac diet to patients of horrid hospital food for life. Also there IS a certification and mind you, a MASTER’s degree for Health and Wellness Coaches. http://www.muih.edu/academics/masters-degrees/master-arts-health-wellness-coaching.

    • HalfRD_HalfHuman says:

      Hi Oliva,
      Please cite your source for “9/10 RD’s getting stuck in clinical or in a nursing home”. Also, I’m pretty sure I mentioned the fact there are individuals with advanced degrees in nutrition that are not RD’s and are still assets to the field of nutrition.
      Have a great day!
      -HRD_HH

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