the registered dietitian: perceptions, assumptions, and reality
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CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
THE REGISTERED DIETITIAN: PERCEPTIONS, ASSUMPTIONS, AND REALITY
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Family and Consumer Sciences
by
Arthur R. Kress
January 2007
1
The thesis of Arthur R. Kress is approved:
____________________________________ ___________________Scott Plunkett, Ph.D. Date
____________________________________ ___________________Claudia Fajardo, Ph.D. Date
____________________________________ ___________________Terri Lisagor, Ed.D., RD, Chair Date
California State University, Northridge
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DEDICATION
This thesis is dedicated to my mother, who during her lifetime was a constant
source of support and unconditional love. She cared about, loved, and lived for her
family, and was always there to support us. She was taken away much too soon, and I
miss her dearly.
I also dedicate this thesis to my father, who has been a significant source of love
and support in so many ways, and has been instrumental in shaping who I am today.
And finally, I dedicate this thesis to my brother Marc, sister Meryl, and friends
who have been an inspiration to me throughout the years.
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ACKNOWLEDGMENT
I would like to thank all those who supported my efforts in writing this thesis.
To my chair, Dr. Terri Lisagor, your energy and support kept me constantly focused on the goal, and your wisdom helped to assure the accuracy and importance of this research. I thank you for your continuing friendship and your constant support.
To Dr. Scott Plunkett, your assistance with the evaluation and interpretation of data was invaluable, as was your constant guidance in shaping the form of this thesis.
To Dr. Claudia Fajardo, your support, guidance, and friendship throughout this process was greatly appreciated.
To Laurel Graham, ADA Librarian, your effort and willingness to provide much of the data and reference material for this thesis was appreciated more than you could possibly know.
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TABLE OF CONTENTS
Signature Page iiDedication iiiAcknowledgment ivList of Tables viiAbstract viii
CHAPTER 1 – INTRODUCTION 1Statement of the Problem 2Purpose 3Definitions in Alphabetical Order 3Research Hypothesis 4Assumptions 5Limitations 5
CHAPTER II – REVIEW OF LITERATURE 6Definition of Dietitian 7Definition of Nutritionist 9Recognition and Salary 11Snowball Survey 11Summary 13
CHAPTER III – METHODOLOGY 15Participants 15Instruments 16Statistical Analysis 17
CHAPTER IV – RESULTS 18Focus Group 18Participants 21
CHAPTER V – DISCUSSION 28Discussion of Findings 28Implications 33Research Implications 37Conclusion 38
REFERENCES 40
APPENDICESA. American Dietetic Association Nutrition and You:
Trends 2000 – Background, Objectives, and Summary 43
B. American Dietetic Association Nutrition & You:
5
Trends 2002 - Final Report of Findings 49C. Feedback Form 95D. Survey Summary 96
6
LIST OF TABLES
Table 1 – Focus Group Results 19
Table 2 – Socio-Demographic Data on Participants 21
Table 3 – Most Valued Sources of Nutrition Information 23
Table 4 – Professions Best Equipped to Treat Nutritional Problems 24
Table 5 – Best Qualified to Deal With Nutrition Issues 26
Table 6 – Assessed Functions of Registered Dietitian or Nutritionist 27
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ABSTRACT
THE REGISTERED DIETITIAN: PERCEPTIONS, ASSUMPTIONS, AND REALITY
by
Arthur R. Kress
Master of Science in
Family and Consumer Sciences
The purpose of this study was to determine the public’s ability to differentiate and
understand the functions of both the Registered Dietitian (RD) and the Nutritionist. Input
was obtained from 418 persons, both male and female, ranging in age from 19 to 82,
utilizing an online snowball survey. A Chi2 analysis of the data was performed to
determine variation based on age, gender, occupation, state (location), level of education,
and household income, but very few statistical variations were observed. Study results
indicated a general confusion about the roles of both the RD and the Nutritionist. Even in
those areas where a greater percentage of respondents correctly identified the RD
function, there was a significant (>20%) “Not Sure” response that could have easily
altered the results. In conclusion, the public’s inability to clearly distinguish the
difference between the RD and the Nutritionist is an indication that Registered Dietitians
are not being well promoted. It indicts efforts by the American Dietetic Association to
effectively create public awareness of the RD function, and it may affect RD status,
remuneration, and the level of nutritional support provided to the general public.
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CHAPTER 1
INTRODUCTION
The formal organization of dietetic practitioners began in the late 1890’s, with a
series of annual conferences to discuss the training and duties required primarily of
hospital Dietitians. This fledgling organization led eventually to the creation of the
American Dietetic Association (ADA) in 1917, as a way of giving women in nutrition
and dietetics a way of sharing knowledge and discussing mutual problems and concerns.
Only 100 Dietitians attended that first meeting in Cleveland, but over the years the
organization grew rapidly to become a national, even international, voice for Dietitians,
both men and women, which now numbers close to 65,000 members. Throughout its
growth, the ADA has been conflicted about the definition of Dietitian, and has often used
the term synonymously with Nutritionist. At the Third White House Conference on Child
Health and Protection (possibly in 1930), a Dietitian was defined as “Any person who is
qualified for membership in the American Dietetic Association (and) is, by virtue of
uniform basic training and required experience, entitled to be designated as a Dietitian”
(Cassell, 1990, p. 71). So not only do we have a term used to define itself, but this
definition says nothing about function nor does it clarify the confusion between Dietitian
and Nutritionist. And in 1985, when the public, as well as physicians, Dietitians, and
media personnel were asked about the differences between Dietitian and Nutritionist, all
four groups expressed confusion (Cassell, 1990). In a nationwide public opinion survey
conducted by the ADA in 2000 (Appendix A), when the public was asked about their
sources of nutritional information (being allowed to make multiple selections), 90%
listed registered Dietitians (RD), and another 90% listed Nutritionists, not seeming to
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realize that there is a difference between the two. Unfortunately, this survey is no longer
accessible, and only press releases describing the results can be found on ADA’s website.
In a more recent survey (Appendix B), the term Nutritionist is eliminated as a choice,
possibly because the ADA hoped to avoid any negative conclusions. Today, anyone can
call him/herself a Nutritionist; no formal education or experience is required. A Dietitian,
on the other hand, must meet educational standards, complete an internship, and then pass
a qualifying national exam.
Statement of the Problem
It appears that the public does not recognize that RDs are the nutrition
professionals, and are capable of providing the highest level of nutritional care. This lack
of recognition likely translates into a poorer level of care for the public and a lower
professional status for Dietitians, and may certainly affect remuneration. In a recent
survey of 106 students at California State University, Northridge, while not definitive,
17% of respondents believed that RDs must have a college degree while only 6%
recognized that RDs must pass a certification exam. If these results are generalizable to
all demographic groups in the US, it is a terrible indictment of the ADA and its intended
purpose of representing all RDs. This research attempts to survey current opinion to
determine the public’s understanding of the Registered Dietitian. It’s hoped that if results
show that confusion still exists in the public mind, the ADA can take steps to better
promote the profession and do whatever is necessary to enhance the status of RDs and to
improve their economic potential.
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Purpose
The purpose of this study is to assess the public’s knowledge of the difference
between Registered Dietitians and Nutritionists; to encourage the follow-up necessary to
promote a positive professional image and to help assure optimal nutrition support for a
population concerned with nutrition-related issues.
Definitions in Alphabetical Order
1) Dietitian Plans and directs food service programs in hospitals, schools,
restaurants, and other public or private institutions. Plans menus
and diets providing required food and nutrients to feed individuals
and groups. Supervises workers engaged in preparation and
serving of meals. Purchases or requisitions food, equipment, and
supplies. Maintains and analyzes food cost control records to
determine improved methods for purchasing and utilization of
food, equipment, and supplies. Inspects work areas and storage
facilities to insure observance of sanitary standards. When
employed in schools, hospitals, or similar organizations instructs
individuals and groups in application of principles of nutrition to
selection of food. May prepare educational materials on nutritional
value of foods and methods of preparation (Dietitians and
Nutritionists defined, 1964).
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2) Nutritionist Organizes, plans, and conducts programs concerning nutrition to
assist in promotion of health and control of disease; instructs
auxiliary medical personnel and allied professional workers on
food values and utilization of foods by human body. Advises
health and other agencies on nutritional phases of their food
programs. Conducts in-service courses pertaining to nutrition in
clinics and similar institutions. Interprets and evaluates food and
nutrient information designed for public acceptance and use.
Studies and analyzes scientific discoveries in nutrition for
adaptation and application to various food problems. May be
employed by public health agency and may be designated as
NUTRITIONIST, PUBLIC HEALTH (Dietitians and Nutritionists
defined, 1964).
Research Hypotheses
This study is guided by the following research hypotheses:
1) The public’s perception of a Nutritionist as the professional nutrition practitioner is
significantly and positively greater than the perception of a registered Dietitian.
2) Knowledge of the differences between Dietitian and Nutritionist varies with
socioeconomic status and gender.
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Assumptions
This study was based on the following assumptions:
Information obtained from subject questionnaires is accurate.
Data entry and analysis was error free.
Subject numbers and diversity were sufficient to obtain desired data.
Limitations
This thesis will add to the understanding of how the public perceives the
Registered Dietitian. However, certain limitations to the study exist.
This is a self-reported study, so participants’ recall may affect the results, as may a
desire by participants to “say the right thing”.
This is a single snapshot in time and could be affected by personal and social issues
beyond the scope of this study.
Data collected using an online snowball survey may be biased and may not accurately
reflect the general population. Hence, generalizability is limited.
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CHAPTER II
REVIEW OF LITERATURE
Surveys of the public perception of Dietitians are rare, and they seem to be
limited to those sponsored by the American Dietetic Association (ADA). When asked for
copies of these surveys, the ADA claimed they no longer exist. However, the ADA did
provide two sets of survey results. In Nutrition & You: Trends 2002, Final Report of
Findings, October 2002 (Appendix B), the ADA concluded that television was the main
source of nutritional information, with magazines and newspapers a distant second. The
question did not list Dietitians or Nutritionists as an option, but did include doctors. The
ADA survey further questioned the respondents’ awareness of Registered Dietitians
(RDs). According to the report, around 90% of the respondents are aware of RDs. Of all
the respondents, 86% saw RDs as a “credible source of information on obesity.” And on
issues of dietary supplements, irradiation, and genetically modified foods, 68%, 55%, and
51% respectively, rated RDs as very credible sources of nutritional information.
Generally, females were more likely to look to the RD for nutritional information, as
were respondents with a lower level of education. An earlier ADA survey, Nutrition &
You: Trends 2000, Background and Objectives, January 2000 (Appendix A) showed that
television was the primary source for nutritional information. However, instead of asking
about the main source of that information, the ADA asked about the most valued source.
This makes a comparison between the two surveys difficult. The earlier survey also lists
doctors, registered Dietitians, Nutritionists, magazines, and nurses, among other
possibilities, and respondents were allowed multiple selections. Ninety-two percent of
those respondents selected doctors, while both registered Dietitians and Nutritionists
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came in second at 90%. It appears that respondents were not able to distinguish between
RDs and Nutritionists, and ascribed to both groups the same level of competency. In the
2002 survey, the ADA eliminated this question, and made no reference to Nutritionists.
A recent survey conducted among California State University Northridge students
(May, 2005) entitled Registered Dietitian vs. Nutritionist: Is There A Difference, showed
that a majority, both male and female, lacked knowledge of Nutritionist/RD
requirements, i.e. they were not aware that RDs must meet stringent criteria, while a
Nutritionist may practice without adhering to any specific requirements. Most incorrectly
believed that Nutritionists must meet RD qualifications, and significantly more males
than females understood that Nutritionists did not need either a college degree or any type
of certification.
Definition of Dietitian
Perhaps one major area of confusion is the definition of Dietitian. There has been
much confusion within the ADA over the years, not only about what constituted a
Dietitian, but how to differentiate a Dietitian from a Nutritionist. The ADA in 1930
defined a Dietitian as “Any person who is qualified for membership in the American
Dietetic Association (and) is, by virtue of uniform basic training and required experience,
entitled to be designated as a Dietitian” (Cassell, 1990 p. 187). Despite this earlier
definition, the term Dietitian was not officially adopted until 1934. Then in 1940, an
ADA committee developed the following definition: “A Nutritionist in a public health
agency was a ‘qualified, professionally trained person who directs or carries on a
program of activities dealing with the application of the scientific knowledge of nutrition
to the prevention of disease and the promotion of positive health’” (Cassell, p.188). So
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with a seeming shift in terminology, an overlap between Dietitian and Nutritionist now
existed and continued to exist for the next four years. Then, in 1944, Nell Clausen, the
then President of ADA, stated that “the term Dietitian should be legally defined…,”
(Cassell, p. 141) yet this wasn’t to happen for another 20 years. In 1955, a committee
established by the ADA, came up with another definition, stating that a Dietitian was a
person who was “a member of the profession of dietetics, which deals with the science,
the technical aspects and the art of feeding people” (Cassell, p. 188). But the ADA
continued to struggle with this issue. Then in 1965, the executive board of ADA accepted
the definition, which stated that a Dietitian is “a translator of the science of nutrition into
the skill of furnishing optimal nourishment of people” (Cassell, 1990, p. 291). But even
this was criticized, as foodservice administrators felt themselves excluded. So this lack of
a legal definition was to haunt the ADA for years, preventing an actual count of
practitioners, not knowing how many met ADA standards, and lacking an awareness of
what Dietitians did and where they practiced. Today, the ADA definition is largely
dependent on the key requirements. For example, the ADA’s website defines Registered
Dietitians as “…food and nutrition experts, who have met the following criteria to earn
an RD credential: Complete a minimum of a bachelor’s degree…complete a CADE-
accredited supervised practice program…pass a national examination… complete
continuing professional educational requirements to maintain registration” (Definition of
Registered Dietitian, 2006, ¶ 1). To further confuse the schizophrenic nature of this issue,
many different functions for Dietitian are listed in the revised Fourth Edition of the
Dictionary of Occupational Titles (DOT) (Functions of Dietitian, 1981): Administrative
Dietitian, Chief Dietitian, Clinical Dietitian, Consultant Dietitian, Research Dietitian, and
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Teaching Dietitian (Functions of Dietitian, 1971). Obviously, this was an attempt to be
inclusive, but it is ultimately incomplete, since categories such as Entrepreneur and Food
Science Dietitian, among others, are not included. A search for Nutritionist in the DOT,
brings up Home Economist, while a search for Public Health Nutritionist, brings up
Community Dietitian. And this additional overlap in terminology is definitely confusing.
No wonder the public has so much difficulty with these terms. Not only can the ADA not
define them well, but the government also has difficulty in doing so.
Definition of Nutritionist
As discussed above, the definition of Nutritionist has often been confused with
Dietitian. Most importantly, the ADA has wavered between the two terms when
describing nutrition practitioners. But it is not only the ADA that has a problem.
Confusion also reigns in dictionaries, government agencies, and professional
organizations. For example, the U.S. Department of Labor, Bureau of Labor Statistics,
lumps Nutritionist and Dietitian together in their Occupational Outlook Handbook, a
source of career information for hundreds of professions (United States Bureau of Labor
Statistics, 2006). The National Cancer Institute website, defines Nutritionist as “a health
professional with special training in nutrition who can help with dietary choices. Also
called a Dietitian" (Definition of Nutritionist recommended by the National Cancer
Institute, 2006, ¶ 1). So, to the National Cancer Institute the Nutritionist is synonymous
with Dietitian. The website MedicineNet.com, which is owned and operated by WebMD,
defines Nutritionist as:
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“(1) In a hospital or nursing home, a person who plans and/or formulates special
meals for patients. It can also simply be a euphemism for a cook who works
in a medical facility but who does not have extensive training in special
nutritional needs;
(2) In clinical practice, a specialist in nutrition. Nutritionists can help patients with
special needs, allergies, health problems, or a desire for increased energy or
weight change devise healthy diets. Some Nutritionists in private practice are
well trained, hold a degree and are licensed. Depending on state law, however,
a person using the title may not be trained or licensed at all.”
(MedicineNet.com, 2006, ¶ 1).
But even this definition is suspect since it is unlikely that a Nutritionist will be
found working in a hospital. It is possible, however, for Nutritionists to be certified. The
American Health Science University (AHSU) awards this title to candidates who have
completed six courses in nutrition and passed a six-hour comprehensive exam. This is a
private certification, however. Some states also certify Nutritionists. New York, for
example, requires a Bachelor’s degree in Nutrition with a minimum of six months
experience, or an Associate’s degree in Nutrition with at least eight years of experience.
And, all candidates must pass a state-approved licensing examination. There are also
Registered Nutritionists, but a quick check of the Internet seems to indicate that this title
is available primarily in the United Kingdom and Canada. Typically, however, a
Nutritionist is a person who decides to practice or advise on the subject of nutrition.
There are no requirements for a Nutritionist; no education, no internship, no national
exam. All one needs to be classified as a Nutritionist is a desire to work in the field.
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Recognition and Salary
There has been much concern among RDs that salaries in dietetics are not
commensurate with the education and experiential requirements necessary for
certification. In 2001, the house of delegates of the ADA indicated that salaries for
members “do not always meet expectations when compared with the required scientific
background for dietetics professionals” (Bonne, 2004, p. 26). And not much has changed
since then. In May 2005, the median wage for all Dietitians and Nutritionists in general
medical and surgical hospitals was $22.37 per hour, or $46,540 a year for full-time work
(United States Bureau of Labor Statistics, 2005). Certainly, there are many factors that
affect salary levels, such as education, years of experience, supervisory responsibilities,
nature of the job, type of employer, demand, and even location of the job, but the salary
for Dietitians still pales when viewed against other professions requiring a lesser or
similar background. For example, in May 2005, the median salary for Registered Nurses
working in general medical and surgical hospitals was $27.80 per hour or $57,820 a year,
or $11,280 more per year than for RDs (United States Bureau of Labor Statistics, 2005).
It is possible that including Nutritionists with Dietitians reduces the mean average wage,
yet since only hospital employment is being addressed here, that is not likely a
meaningful consideration.
Snowball Survey
Perhaps the easiest, quickest, and cheapest way of gathering information is via
convenience sampling, which is based on easy availability or accessibility to a survey
population (Definition of Convenience Sampling, 2006). The technique is not
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randomized, and the respondents may not be representative of a larger population, but the
information obtained can provide significant insight and is useful in obtaining data for
exploratory research.
The snowball survey is a form of convenience sampling that has the capability of
obtaining many respondents quickly, and with minimum cost and effort. More
importantly, it allows the data collected to be automatically transferred to a database for
evaluation (Braithwaite, Emery, deLusignan, & Suitton, 2003). The snowball survey has
typically been used to recruit participants from hidden populations, such as intravenous
drug users or HIV/AIDS patients (Thompson & Collins, 2002; Atkinson & Flint, 2001).
Functionally, the researcher selects one, or a small group of subjects, possibly friends
and/or relatives, often with specific criteria, to participate, and then recommend their
friends and relatives who also meet the criteria. These persons, in turn, recommend their
friends and relatives, and so on, such that the number of respondents expands rapidly,
much as a rolling snowball increases in size. J.S. Coleman introduced the technique in
1958 as a way of identifying the network structure within a population (Snijders, 1992).
However, problems with the technique became immediately apparent. It is definitely
biased toward persons with a pattern of interrelationships or friendships with many other
individuals (Snijders, 1992). Also, Internet users do not typically represent the general
population, and the differences may be significant. According to researchers L.J. Skitka
& EG Sargis, “web users are younger, wealthier, and higher in education than are
nonusers,” and these differences may affect generalizability (Skitka & Sargis, 2006, p.
546). However, the Internet is uniquely positioned for conducting a snowball survey,
since access to individuals is easily facilitated, is quick, can be anonymous, and is
20
inexpensive. Some studies have even shown that data obtained on the Internet, can be
similar to data obtained in more traditional ways (Eaton & Struthers, 2002). In addition, a
number of techniques have evolved to reduce the bias of snowball surveys. One
technique assures that the initial sample is randomly selected, thereby increasing the
possibility for statistical inference (Goodman, 1961); another refers to adaptive sampling
in which the selection of subjects “adapts to observations made during the survey
(Harrison, 1997, p. 298).” When values of interest are observed, “sampling intensity may
be adaptively increased for neighboring or linked units” (p. 298). But only the random
selection approach lends itself to Internet implementation.
Summary
Recent ADA surveys of public opinion are difficult to compare, at least with respect
to differences between Registered Dietitians and Nutritionists. Some survey questions
appear to be inconsistent, and even that inconsistency is difficult to verify because the
actual surveys are unavailable for review. With only summary documents for evaluation,
however, it does appear that respondents are aware of, and have some regard for,
registered Dietitians, but at the same time they appear to have a similar regard for
Nutritionists. Yet despite this, respondents to an ADA survey identified doctors, who
have little nutritional training, as their most valuable source of nutritional information.
Perhaps part of the public’s inability to separate RDs from Nutritionists, or even from
doctors for that matter, is related to the ADA’s inability to establish a meaningful
definition for Dietitians. But even then, it appears that some government agencies are
also confused about this. So, no wonder RDs don’t get the recognition they deserve, and
21
are not sufficiently remunerated for their efforts, at least when compared with professions
that have comparable requirements.
To survey current attitudes about the public’s ability to differentiate the functions of
RDs and Nutritionists, an online, snowball survey was used to gather information. This
approach is particularly valuable for obtaining many respondents quickly, with minimal
cost and effort. In particular, the results can be used to provide insight and additional data
for exploratory research.
Overall, this chapter provided a review of the recent surveys conducted to determine
the public’s ability to distinguish between a Registered Dietitian and a Nutritionist. It also
discussed the differing definitions of the two professions, and the survey technique used
to obtain the necessary data. The next chapter discusses the methodology used to conduct
a new survey, and one designed to determine if the public’s perception of the two
professions has changed in any way since the last ADA survey in 2002.
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CHAPTER III
METHODOLOGY
This study was designed to determine the public’s knowledge of differences
between a Nutritionist and a Registered Dietitian. In addition, it was desired to determine
if those differences were affected by location, age, gender, education, and socioeconomic
status. More specifically, study objectives were to:
1) Assess the public’s ability to identify tasks that are common to both RDs and
Nutritionists and separate out those tasks that can be performed more
efficiently (or only legally) by RDs.
2) Determine how understanding the differences are affected by location, age,
gender, education, and socioeconomic status.
3) Utilize the survey results to help the American Dietetic Association better
promote RDs and assure that the general public obtains the best
nutritional care.
Participants
The target population for this study was anyone over 18 years of age, considered
“adult” by our society and capable of making decisions about whether or not to seek
professional support from a Registered Dietitian. This was a convenience, snowball
survey, designed for easy accessibility and was not randomized, so generalization
becomes difficult.
SurveyMonkey.com was the website used to develop and conduct the survey,
which was initiated on January 10, 2006 (Appendix D). Initially, California State
23
University Northridge (CSUN) professors, personal friends, and relatives were asked to
contact their friends and refer them to the survey site. In turn, the initial respondents were
asked to refer their friends and so on, such that the total number of respondents could
ultimately represent multiple states, various education levels, and a range of
socioeconomic status. The survey was anonymous and the demographics of respondents
were totally coincidental and dependent on referrals made to others and the desire of
those contacted to participate. The survey was terminated on February 15, 2006 with a
total of 417 respondents.
Instruments
Focus Group
Prior to initiating the study, a focus group was conducted at the Greater Los
Angeles Veterans Administration (VA) Healthcare System. Seven Registered Dietitians
(RDs) participated in this group for the purpose of validating the study questionnaire and
obtaining opinions on the merit of this research. Each RD was asked to complete a
feedback questionnaire (Appendix C) that focused on the validity and wording of the
survey questions, and asked whether additional issues needed to be addressed. Also, RDs
were asked if they felt that the survey might lead to changes in how the profession was
promoted by the American Dietetic Association and viewed by the general public.
Participation was voluntary. All suggested changes were evaluated and either
incorporated in the final questionnaire or rejected if redundant or if they altered the nature
of the study.
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Questionnaire
The survey consisted of seventeen questions, the first eight relating to socio-
demographics and a history of hospitalization (Appendix D). A question about the
sources of nutrition information was taken, by permission, from an earlier ADA
questionnaire.
Respondents were asked to look at a variety of issues such as dietary supplements,
obesity, food irradiation, genetically modified foods, diabetes, hypertension, heart
disease, and cancer and indicate whether a Nutritionist or an RD was the most qualified
to deal with each of these issues. Likewise, respondents were asked to address such issues
as creating diets and menus, teaching nutrition, assessing hospitalized patients, providing
nutrition counseling, preparing and serving food, offering psychological advice, and the
requirement to have a college degree, complete an internship, and pass a certification
exam. Two questions included in the survey were added to determine bias for pre-
existing knowledge of the RD function: “Have you ever been hospitalized?” and “Have
you ever been seen by a Registered Dietitian?”
Statistical Analysis
A Chi Square analysis was performed on the demographic data to determine
whether differences between a Registered Dietitian and a Nutritionist varied according to
ages, genders, educational levels, and socioeconomic status. The Statistical Package for
the Social Sciences (SPSS) V13.0 for Windows was used to analyze the data, with level
of significance set at P < 0.05.
25
CHAPTER IV
RESULTS
Focus Group
Seven Registered Dietitians (RDs) participated in the focus group at the Veterans
Administration (VA) Greater Los Angeles Healthcare System. Only a limited time was
allowed for questions, however, since the focus group was conducted at the end of a
monthly status meeting of RDs and Diet Technicians. The time limitation prevented
much verbal discussion with the group, so issues covered were specifically related to
those questions on the feedback form. The results are summarized in Table 1. All agreed
that the survey was worth pursuing. Most RDs (4 of 7) thought that the survey could
affect how Dietitians are viewed by the general public and could influence how the ADA
promotes the profession. One RD suggested that the question, “A doctor is more qualified
than a Nutritionist or a Registered Dietitian to discuss food related issues,” could be
confusing. The respondent thought that it would be impossible to separately relate a
medical doctor to either a Nutritionist or a Registered Dietitian. This comment clearly
delineated a real problem, and the question was revised accordingly. To the question
“Have you ever been hospitalized?” one RD suggested changing the words “been
hospitalized” to “worked in the healthcare field.” This was rejected since (1) the
questionnaire was aimed at the general public and would not likely be answered by
healthcare workers and (2) the question was used primarily to determine if respondents
had a bias or some pre-existing knowledge of RD functions, since they would likely be
seen by an RD during hospitalization. In considering the question “Indicate whether each
of the following items applies to a Registered Dietitian (RD), a Nutritionist, or both,” one
26
RD suggested that the response “prepares and serves food” should be removed. This was
also rejected since it was hypothesized that much of the public would see this as a
primary RD function, and it was desirable to verify if that hypothesis was correct.
Another RD felt that asking “Have you ever been seen by a Registered Dietitian?” was
biased, since a similar question was not asked about a Nutritionist. This was also rejected
since the purpose of this question was to determine respondent bias, and ascertain what
they might know about RDs prior to completing the survey. To the question “Would a
Nutritionist or a Registered Dietitian be most qualified to deal with the following issues:
(check ONE answer for each issue),” one RD suggested adding an “Equal” column to the
table, to show that both the Nutritionist and Registered Dietitian would be equally
qualified. This was rejected since, in all cases, the Registered Dietitian was most
qualified, and a “Not Sure” column would allow sufficiently for any confusion that might
exist. Lastly, one RD suggested adding the question “Should the ADA rename the
profession?” and this was also rejected since the questionnaire was not being
administered to RDs. In general, the group liked the survey, and believed it to be an
important medium for advancing the profession.
Table 1: Focus Group Results
Question Response Comments1. Is the survey question worth pursuing? 7 Yes2. Do you think the survey will elicit responses that can affect how RDs are viewed in this country?
4 Yes2 Not Sure
3. Do you think the survey can have an effect on how the ADA promotes RDs?
4 Yes3 Not Sure
4. Do you feel that an important issue has been overlooked in this survey?
1 Yes5 No1 Not Sure
“Maybe renaming our title to Registered Nutritionist-Dietitian”
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Question Response Comments5. Are questions worded in a way that is clear and unambiguous?
5 Yes1 Not Sure
“#3 – make 2 separate questions, i.e., an MD is more qualified than an RD; an MD is more qualified than a Nutritionist”
“Maybe ask ‘have you ever worked in the healthcare field?’ vs. ‘occupation’ in case someone was once an RD, pharmacist, MD, etc.”
6. Should any question be eliminated from this survey?
1 Yes3 No1 Not Sure
“Have you ever been hospitalized?”
“#6 – recommend removing ‘prepares and serves food’ since most RDs do not do this”
7. Should any question be added to this survey?
3 Yes3 No1 Not Sure
“Should the ADA rename the profession?”
“Have you ever seen a Nutritionist? – it seems biased by my asking about RD visit”
“Maybe ask if there is a difference between Nutritionist and RD”
8. Comments “I really like the idea of changing our name from Registered Dietitian to Registered Nutritionist”
“Question #5 – I think you should add a column to represent equal qualification”
“Be consistent with capitalizing title of RD and Nutritionist”
28
Participants
A total of 418 persons accessed the site during the survey period, and of these,
only 365 completed more than the socio-demographic data. The results are summarized
in Table 2. Of the 365 respondents that completed the survey, 76 were male and 289 were
female, with ages ranging from 19 to 82. The mean age was 39.8. Respondents came
from 29 different states, yet the majority of them came from only six states: California
(211), Oklahoma (45), Pennsylvania (21), Massachusetts (18), Florida (16), and New
York (8). Of the respondents, 174 (47.7%) had an income of $75,000 or above and 48
(13.2%) had an income between $30,000 and $44,999. Looking at the respondents
educational level, 118 (32.3%) completed some college, 90 (24.7%) held a bachelor’s
degree, and 95 (26%) received a post-graduate degree. Prior to taking the survey, all
respondents were provided with contact information, or ways to address concerns or
simply comment on the survey. No such responses were received.
Table 2. Socio-Demographic Data on Participants
Variables N %Gender Male Female
76289
20.879.2
Age Less than 21 21-30 31-40 41-50 51-60 61-70 Greater than 70
2975395561216
10.226.213.619.221.37.42.1
29
Variables N %State (location) Oklahoma California North Carolina Florida Pennsylvania Nevada Massachusetts New York Kansas Washington Connecticut Montana Ohio Texas Thailand Missouri Maryland New Jersey Arizona Illinois Indiana Louisiana Washington D.C. Utah Iowa Georgia Delaware Germany Rhode Island
45211116211188443124141522111111111
12.357.8.34.45.8.34.92.21.11.10.8.3.51.1.31.1.31.4.5.5.3.3.3.3.3.3.3.3.3
Education Some high school High school graduate Some College Bachelor’s degree Post graduate student Post graduate degree
518118903995
1.44.932.324.710.726.0
Household Income Less than $15,000 $15,000-$29,999 $30,000-$44,999 $45,000-$59,999 $60,000-$74,999 $75,000 or above
3235483540174
8.89.613.29.611.047.7
30
When asked about their most valued source of nutrition information, half of the
respondents indicated magazines (50.7%). Doctors followed (48.2%), with Internet
(44.7%), and family and friends (42.7%) as the third and fourth choices respectively.
Registered Dietitian tailed behind as the seventh choice (23%), closely followed by
Nutritionist (21.6%). Significantly more women than men relied on magazines
(Chi2=8.824, p=.003) and significantly fewer men looked to doctors as a source of
nutritional information (Chi2=3.892, p=.049). The results are summarized in Table 3.
Table 3. Most Valued Sources of Nutrition Information________________________________________________________________________
Variables N %
Magazines 185 50.7Doctor 176 48.2Nurse 37 10.1Newspapers 97 26.6Nutritionist 79 21.6TV News 104 28.5Family and friends 156 42.7Registered Dietitian (RD) 84 23Radio news 43 11.8Other non-news TV 25 6.8Internet 163 44.7Other 69 18.9
When asked if a Nutritionist is more qualified than a Registered Dietitian to deal
with food-related issues, 78 respondents (21.4%) said yes, 114 (31.2%) said no, and
almost half, or 173 (47.4%) said they were not sure who was most qualified. A majority
of respondents thought that both the Nutritionist and Registered Dietitian were more
qualified than a doctor to discuss food related health issues, but a higher percentage
believed the Nutritionist, of the two, was more qualified (61.6% vs. 59.7%). Significantly
31
more women than men were not sure whether an MD or an RD was more qualified to
deal with food-related issues (28.7% vs. 15.8%), and more men than women believed that
an MD had a greater qualification in this area (Chi2=12.914, p=.007). Significantly fewer
respondents in the lower age range (less than 26) believed that an RD was more qualified
than an MD, yet as age increased beyond 26, increasingly fewer respondents were likely
to believe that an MD was the most qualified (Chi2=12.914, p=.044). When asked who is
best equipped to treat nutritional (or food-related) problems, the largest percentage of
respondents (40.5%) selected Registered Dietitian with Nutritionist a close second
(32.9%). However, a large percentage of respondents (16.4%) were not sure who was
best equipped to deal with these issues. Significantly more women selected an RD as the
person best equipped to treat nutritional problems, while a larger percentage of men
chose the doctor (Chi2=16.325, p=.006). Responses were also differentiated by age with
significantly more respondents in the lower age ranges (less than 52) believing an RD is
the most qualified. In the higher age ranges (greater than 39) more respondents tended to
select Nutritionist as the nutrition expert (Chi2=26.528, p=.033). These results are
summarized in Table 4.
Table 4. Professions Best Equipped to Treat Nutritional Problems________________________________________________________________________ Variables N %
Nurse 0 0Doctor 30 8.2Registered Dietitian 148 40.5Social Worker 0 0Nutritionist 120 32.9Teacher 0 0Diet Technician 4 1.1Other 3 .8Not Sure 60 16.4
When asked if a Nutritionist or a Registered Dietitian would be most qualified to
deal with a variety of nutritional or disease related conditions, respondents selected
32
Registered Dietitian for 6 of the 8 issues (i.e. use of dietary supplements,
obesity/overweight, diabetes, hypertension, heart disease, and cancer). The Nutritionist
was only selected as most qualified to deal with genetically modified foods. Most
respondents were not sure who was most qualified to deal with food irradiation. Each
condition had a large “Not Sure” vote, ranging from 23% to 39%. With increasing age,
significantly fewer respondents believed that the RD was most qualified to deal with
dietary supplements, while greater numbers of respondents aged 39 and above believed
that a Nutritionist was best qualified here (Chi2=24.249, p=0.000). Significantly more
respondents aged 26 and younger were likely to see a Nutritionist as most qualified to
deal with dietary supplements, yet when the age range is extended to 39, more
respondents chose the RD (Chi2=24.249, p=.000). Significantly, the “Not Sure” vote also
increased with increasing age (Chi2=12.686, p=.048). With a higher education (Bachelors
degree or more), significantly more respondents saw the RD as most qualified to deal
with genetically modified foods, while a larger percentage (45.4%) of those with some
college or less believed the Nutritionist was most qualified to deal with this issue
(Chi2=8.674, p=.013). These results are summarized in Table 5.
33
Table 5. Best Qualified to Deal With Nutrition Issues
Variables N Nutritionist %/ RD %/ Not Sure %/ (Respondents) (Respondents) (Respondents)
Use of dietary supplements 365 32 (116) 44 (162) 24 (87)Obesity/overweight condition 365 23 (83) 55 (199) 23 (83)Irradiation of foods 365 30 (110) 32 (117) 38 (138)Genetically modified foods 365 36 (132) 31 (114) 33 (119)Diabetes 365 19 (71) 54 (196) 27 (98)Hypertension 365 21 (78) 47 (171) 32 (116)Heart disease 365 23 (85) 48 (177) 28 (103)Cancer 365 21 (76) 41 (148) 39 (141)
When respondents were asked to state whether a specific task applied to a
Registered Dietitian or a Nutritionist, the largest percentage indicated that both
professions would create diets and menus (65%), teach nutrition-related subjects (59%),
and provide nutrition counseling (52%). By selecting “Don’t Know,” respondents were
not sure if RDs or Nutritionists prepare and serve food (38%) or even if they offer
psychological advice (44%). The largest percentage of respondents believed that the RD
would assess nutrition of hospitalized patients (49%), have a college degree (33%),
complete an internship (38%), and pass a certification exam (40%). Significantly more
women than men believed that both the RD and Nutritionist create diets and menus
(Chi2=13.806, p=.003), that both the RD and Nutritionist teach nutrition related subjects
(Chi2=9.931, p=.019), that the Nutritionist provides nutrition counseling (Chi2=8.461,
p=.037), that the RD prepares and serves food (Chi2=8.906, p=.031), and that the RD
offers psychological advice (Chi2=8.906, p=.031). However, significantly more males
than females did not know who would create diets or menus (Chi2=13.806, p=.003), who
would teach nutrition related subjects (Chi2=9.931, p=.019), who would most likely
34
provide nutritional counseling (Chi2=8.461, p=.037), who would prepare and serve food
(Chi2=8.906, p=.031), or who might offer psychological advice (Chi2=8.906, p=.031).
With increasing age, fewer respondents knew whether an RD or a Nutritionist would
provide psychological counseling (Chi2=24.894, p=.003). Younger respondents tended to
believe that either an RD or both the RD and Nutritionist provided this service. The
results are summarized in Table 6.
Table 6. Assessed Functions of Registered Dietitian or Nutritionist
Variables N RD %/ Nutr %/ Both %/ Don’t Know % (Resp*) (Resp) (Resp) (Resp)
Creates diets and menus 365 19 (68) 5 (19) 65 (237) 11 (41)Teaches nutrition 365 8 (30) 21 (76) 59 (217) 12 (42)Assesses hospitalized patients 365 49 (178) 12 (43) 24 (86) 16 (58)Provides nutrition counseling 365 9 (33) 28 (102) 52 (190) 11 (40)Prepares and serves food 365 25 (91) 12 (45) 25 (90) 38 (139)Offers psychological advice 365 19 (70) 13 (47) 24 (88) 44 (160)Must have a college degree 365 33 (122) 13 (49) 31 (113) 22 (81)Must complete an internship 365 38 (139) 9 (33) 24 (88) 29 (105)Must pass a certification exam 365 40 (145) 7 (26) 32 (117) 21 (77)
* Resp = Number of respondents
When asked if they were ever seen by a Registered Dietitian, 292 respondents (80%) said no and 19 (5.2%) were unsure.
35
CHAPTER V
DISCUSSION
The purpose of this study was to determine the public’s ability to differentiate
between a Registered Dietitian (RD) and a Nutritionist, and understand the functions of
each. As might be imagined, there are few studies on this subject, since the interest is
narrowly defined and limited to RDs and the organization that represents them. Two
recent studies were conducted by the American Dietetic Association (ADA) in 2000 and
2002. The focus of these studies was somewhat different from this current research, since
the earlier studies also questioned the public’s attitudes, behavior, and perceptions about
foods and nutrients such as vitamins and herbal supplements. Both the ADA surveys, and
the current research, however, asked about the public’s most valued sources of nutrition
information, the same question included (by permission) in this study. Neither of the
earlier studies, however, attempted to differentiate between a Nutritionist and an RD. So
this approach is somewhat unique. Overall, the current research indicates that the public
has some knowledge of the RD function, but is definitely confused when trying to
distinguish between the two professions.
Discussion of Findings
The original survey was not available. However, according to the ADA’s
Nutrition & You: Trends 2000, Background and Objectives, January 2000 (Appendix A),
results indicated that when consumers were allowed more than one answer, they rated
doctors, registered Dietitians, and Nutritionists as the most valued sources of nutritional
information, followed by magazines, nurses, and newspapers. Then inexplicably, ADA’s
36
Nutrition & You: Trends 2002 survey Final Report of Findings, October 2002 (Appendix
B), eliminated both RD and Nutritionist as valued sources, and now respondents rated
television and magazines as most valued, with doctors falling to 8th position. There was
no explanation given for why RDs and Nutritionists were eliminated as options, but the
summary did comment on the doctors’ poor showing by simply stating “significantly
fewer respondents currently cite doctors as a source of information…” (p. 10). Perhaps
ADA sensed there would be a precipitous drop in the reliance on RDs and that is why the
option was eliminated. Regardless, the oversight was corrected in this research, and the
results were surprising, but not unexpected. Magazines, doctors, and Internet were the
first three choices among respondents (50.7%, 48.2%, and 44.7% respectively), with
Registered Dietitians and Nutritionists falling to 7th and 8th -position in the “most valued”
category (at 23% and 21.6% respectively). These results were very different from the
2000 ADA survey, which showed that doctors, RDs, and Nutritionists were the most
valued sources of nutritional information. So if these results are accurate, much work has
to be done to reestablish the reputation of RDs. However, it is also possible that the
current results are incorrect or the earlier study failed to accurately reflect consumer
preferences. Perhaps only future, randomized studies will be able to resolve this issue
completely. The 2002 ADA survey also found that reliance on magazines and
newspapers was directly related to income. The current research did not confirm this.
However, it did show that more women than men tend to rely on magazines as a source
of nutritional information. And this may prove to be a valuable insight into how to best
communicate with women about nutritional issues. Yet the reliance on magazines as the
most valued source of nutritional information is somewhat nebulous, since the authors of
37
those articles may have been RDs, Nutritionists, doctors, or even freelance journalists.
There’s no way to know from this survey. And again, a similar logic applies to the
selection of doctors as the #2 choice. It is highly unlikely that the doctors selected would
be either RDs or Nutritionists, and they would therefore have little background in
nutrition. A 2001 paper entitled “Survey of Nutrition Education in U.S. Medical Schools
– An Instructor-Based Analysis” showed that on average, medical students are required
to have 18 +/- 12 hours of nutrition education (Torti, Adams, Edwards, Lindell, & Zeisel,
2001), hardly enough to provide sufficient expertise in this area. So it can be inferred that
to the extent patients rely on doctors, they may not be getting the latest and most
appropriate nutritional advice.
It is most obvious that the public is unaware of the difference between a
Nutritionist and a Registered Dietitian when they are asked who is most qualified to deal
with food related issues. Even though the greatest number of respondents (31.2%)
believes that an RD is most qualified here, when the incorrect answers “Yes” and “Not
Sure” are combined, they total 68.8%. That is more than two-thirds of all respondents
who don’t recognize the expertise and capability of an RD! But respondents also seem to
be somewhat mixed in their responses. For example, they believe that both the RD and
Nutritionist are more qualified than a doctor to discuss food-related issues, yet
respondents also indicate that doctors are their second most valued source of nutritional
information, following magazines. RDs and Nutritionists aren’t even close. A similar
situation exists with the following two questions. When respondents were asked, “Who is
best equipped to treat nutritional problems,” the largest percentage chose RD (40.5%)
with Nutritionist following at 32.9%. Doctors received only 8.2% of the vote. If all other
38
options (nurse, doctor, social worker, Nutritionist, teacher, diet technician, other, or not
sure) are added together, 59.5% of the respondents were incorrect in their response. That
is, they didn’t select “RD.” When asked whether a Nutritionist or an RD was most
qualified to deal with issues such as dietary supplements, obesity/overweight, irradiation
of foods, genetically modified foods, diabetes, hypertension, heart disease, and cancer,
only two options were correctly selected, and attributed to the RD: obesity/overweight
and diabetes. Four of the remaining 6 options (use of dietary supplements, hypertension,
heart disease, and cancer) also correctly selected the RD, but the non-RD vote again
indicated significant confusion among the respondents.
The last question asked respondents to indicate if certain issues applied to either
an RD, a Nutritionist, or both. These were: creates diets and menus, teaches nutrition
related subjects, assesses nutrition of hospitalized patients, provides nutrition counseling,
prepares and serves food, offers psychological advice, must have a college degree, must
complete an internship, and must pass a certification exam. Sixty-five percent of
respondents thought both the RD and Nutritionist created diets and menus, but
individually, RD (19%) had a greater percentage than Nutritionist (5%). So here, a large
percentage of respondents accurately identified the creation of diets and menus as a
significant function of both professions. Only a small percentage of respondents realized
that the RD must have a college degree (33%), complete an internship (38%), or pass a
certification exam (40%); and this may contribute to a lower status for RDs and could
also be a major factor in confusing an RD with a Nutritionist, who is not required to have
these qualifications. Twenty-five percent of respondents believed that RDs prepare and
39
serve food, a percentage that’s twice as high as that for Nutritionist. So, if this truly
reflects public opinion, one-quarter of the population, inaccurately believe that RDs
perform this menial task, which in reality, is generally relegated to food service workers
who have no special training. And only 49% recognized that RDs, and not Nutritionists,
are allowed to assess the nutrition of hospitalized patients, which is a major and unique
function of the clinical Dietitian. Twenty-four percent thought that both RDs and
Nutritionists offer psychological advice, which neither profession is qualified to provide,
further illustrating the confusion in the public’s mind about the functions of RDs and
Nutritionists.
Two questions were included in the survey to gauge bias, or a pre-existing
knowledge of Registered Dietitians. When asked if respondents had ever been
hospitalized, 65% said yes. But when asked if a Registered Dietitian had ever seen them
under any circumstances, 80% said no. Strangely, more had never been seen by an RD
than had been hospitalized. But perhaps that is understandable since an RD does not see
all hospitalized patients, unless the severity of their illness warrants it. And even if the
respondent did see an RD, he or she may not have been aware of it, or that experience
may not have created a greater awareness of RD functions. So since these questions were
intended to eliminate respondents who, by virtue of their interfaces with RDs, would
have a greater knowledge of the RD function, the ambiguity of these questions made it
necessary to eliminate them for this purpose.
40
Implications
The results of this study show that the public cannot easily distinguish between
the Nutritionist and the RD. Ultimately, this may mean that RDs are not seen as the
nutrition professionals, and they may not receive the status or income commensurate with
their education, training, and experience. For example, the mean average wage for
Dietitians in a General Medical and Surgical Hospital as of May 2005, was $46,540
(United States Bureau of Labor Statistics, 2005); for Nutritionists at the same time, the
mean annual wage was $57,820 (United States Bureau of Labor Statistics, 2005), a
difference of $11,280! Not seeing RDs as the nutrition professionals also means that the
general public is not well served when they seek nutritional advice. Most people
understand the function of a medical doctor or a nurse, and believe that their advice can
lead to an improved state of health. These professions are respected partly because of
this, and they are typically held in high esteem. Perhaps if the general public better
understood the importance of RDs, the profession might also be elevated to a higher level
of esteem. Since the Nutritionist is not required to have any specific training or
experience, then the public, which may not understand the different competencies
required, may wind up relying on advice that is not evidence-based, and which may
actually harm them. This could ultimately increase the cost of healthcare and adversely
affect everyone’s insurance premium. So what can be done to improve this? A number of
options present themselves:
First, RDs, to some extent, have to rely on the ADA as the organization chartered
to represent them. But ADA’s track record in this arena has not been good, despite their
attempts to make a difference. For example, an article appearing in the magazine Today’s
41
Dietitian (Grieger, 2005), mentioned that in 1998-99, the ADA conducted a $1.5 million
national campaign to increase the “public awareness or credibility of RDs.” But
according to the article, it failed miserably. Why? The article didn’t say, and the ADA
never responded to my queries about the campaign. But rather than modify their
campaign, it seems that ADA took a different approach. They attempted, and still are
attempting, to require RDs to have a Master’s Degree. But is that the answer? The real
problem appears to be more basic than that. After all, how many hospitalized patients
know, or care today, if their nurse has a Master’s Degree? Patients simply trust the nurse,
believe in his/her expertise, and expect them to provide the necessary care. It is much
more important that the ADA focus its efforts in developing similar expectations for RDs,
possibly by helping to clarify the differences between RD and Nutritionist. And it is most
important to assure that the general public, and even some doctors and nurses, understand
the importance of RDs to the field of nutritional and physical health. The ADA also needs
to target government documents that confuse RD and Nutritionist, as well as the web
pages that confuse these terms.
Next, it is important that the ADA spearheads the research that might help to
highlight the contribution of Dietitians to the field of nutrition. Why is it that the Journal
of the American Medical Association (JAMA) seems to publish studies that have a
greater chance of getting national attention than those published in the Journal of the
American Dietetic Association (JADA)? Perhaps because JAMA publishes articles such
as “Comparison of the Atkins, Ornish, Weight Watchers and Zone Diets for Weight Loss
and Heart Disease Risk Reduction: A Randomized Trial,” or “Consumption of
Vegetables and Fruits and Risk of Breast Cancer,” while JADA publishes articles like
42
“Competitive Foods Available in Public High Schools,” “Association of Ghrelin and
Leptin Hormones with BMI and Waist Circumference,” or “Health Coaching as a
Career.” To be sure, these articles are important to the profession, but they are incapable
of achieving the visibility to ultimately elevate the status of RDs. Why? It is these special
studies that seem to get promoted by the national media, and help to promote the
profession of medicine. And Dietitians should expect no less. If these special studies
require increased expense and expertise to implement, then perhaps the ADA should
allocate their funds more wisely to sponsor such efforts.
Third, since many in the public seem to perceive “Nutritionist” as the nutrition
professional, why not investigate the possibility of changing the official designation.
After all, this classification is not a fete accomplis, since the ADA throughout its history
has been conflicted about the identity of its practitioners. And if the public is any judge of
the ADA decision, perhaps ADA made the wrong choice. It seems that many in the
public domain see Dietitians as people who prepare menus, cook food, and are confined
to the kitchen. And even a requirement for a PhD will not overcome that obstacle. As two
focus group participants suggested, either change the name to “Registered Nutritionist” or
“Registered Nutritionist-Dietitian.” This may or may not be possible, depending on the
politics involved, but it should be investigated and careful consideration given to its
implementation.
Fourth, this study showed that even though 65% of respondents were hospitalized,
80% of those respondents had never seen (or did not think they saw) an RD. There seems
to be a definite disconnect here that needs to be corrected. Perhaps the ADA could
43
educate all inpatient Dietitians to actively inform patients of their status, and to reiterate
that message constantly.
Fifth, in addition to promoting good eating habits, why not use National Nutrition
Month as a medium for promoting the RD. It is a great opportunity to use this annual
event, which already has some national visibility, to help publicize RD contributions,
expertise, and accomplishments.
Sixth, selecting a “Registered Dietitian of the Year” could be a significant
promotional event. ADA could send out national news releases showing what that person
has accomplished, and highlighting how those accomplishments has led to improved
health for the general public.
Seventh, various national magazines could be approached about accepting articles
relating to Registered Dietitians and their significant achievements.
Eighth, RDs can be promoted much more effectively in elementary schools as
well. It is important that young people grow up with an understanding that RDs can add
value to their lives. Perhaps a comic book can be created for this age group describing the
various roles held by RDs. In addition, various promotional materials can be produced for
children, and RDs can make a special effort to frequently visit with this population.
Ninth, ADA could sponsor a weekly, or monthly, radio, television, or web
broadcast, with RDs as host. This could be dedicated both to providing the latest
nutritional information and helping to promote the profession.
Tenth, the ADA has never had a male president, and this may possibly relate to
how poorly the profession has been promoted. It does appear that research on
male/female differences has been inconsistent in this area. But there is some agreement
44
that women, in general, tend not to be competitive (Niederle & Vesterlund, 2006;
Gneezy, Niederle, & Rustichini, 2003), are more agreeable and take fewer risks than men
do (Lauriola & Levin, 2000), are less assertive (Costa, Terracciano, & McCrae, 2001),
and are more focused on feelings than ideas (Costa et al.,2001). Perhaps these are not the
qualities necessary to best promote the profession. Perhaps these are qualities that also
make it difficult for many RDs, most of whom are women, to promote themselves.
Perhaps if ADA researched this issue, they would uncover a value in developing
assertiveness training programs, or they might consider actively recruiting a male
president, and then analyze the results.
But these are just some of the possibilities. This is not intended to be an
exhaustive list, but to provide approaches that ADA and individual RDs can implement
immediately to heighten an awareness of the RD function. However, it does appear to this
researcher that if something significant is not done, and soon, this profession could blend
in with many other nondescript professions and get lost in the flow of history.
Research Implications
Since a greater percentage of survey respondents were female (79.2% vs. 20.8%
male), the results could be considered biased. However, given that the Chi2 analysis
indicated relatively few significant gender differences, the impact of a larger percentage
of females seems minimal. Even so, future research may want to focus on increasing the
percentage of male respondents.
It is possible that the survey’s focus on diet and nutrition and asking if the
respondents had ever seen an RD, may have biased the response; participants may guess
45
that an RD is the primary focus. Hence, future studies may want to keep the subjects
blind to the focus by including questions about doctor related tasks.
It is also possible that some of the results could be due to the use of the term
“Registered Dietitian”. It might be a good idea for future research to have some surveys
use the term “Registered Dietitian” when comparing to a Nutritionist and some to simply
use the term “Dietitian” to see if any differences are observed.
Given that this survey targeted people with internet access, the study may have an
under-representation of lower-income respondents. Hence, future studies may want to
target lower-income people as well.
Conclusion
The research hypotheses stated that (1) The public’s perception of a Nutritionist
as the professional nutrition practitioner is significantly and positively greater than the
perception of a registered Dietitian, and (2) knowledge of the differences between
Dietitian and Nutritionist varies with socioeconomic status and gender. This study did not
support these hypotheses, but it did illustrate the confusion that exists in the public mind
when it comes to differentiating between an RD and a Nutritionist. And perhaps this is
the greater issue and the one in most need of immediate attention.
That Registered Dietitians are not given the respect they deserve is a common
complaint from RDs, and one that is confirmed by public perception as described in this
study. But the situation is not irreversible. By better promoting the RD, by sponsoring
ground- breaking studies, and more closely working with media, the ADA and individual
46
RDs have the power to make a difference. Research on topics of national interest would
be invaluable and add to the ammunition and impetus for change.
A limitation to this study is the selection bias, inherent in the use of an online
snowball survey. First, persons responding to this survey had to be computer literate, so
those not owning or capable of operating a computer were automatically eliminated.
Second, research shows that computer users tend to be younger, wealthier, and better
educated than nonusers (Skitka et al., 2006), so this may have eliminated a whole subset
of possible respondents; and third, not all who received the invitation to participate,
agreed to do so. Perhaps a larger, more randomized study would help to confirm these
results. But until then, it is time for the ADA and individual RDs to grasp their own
destiny and initiate those changes that will not only help the profession, but will also
serve to benefit a population hungry for the best nutritional support.
47
REFERENCES
Atkinson, R., & Flint, J. (2001). Accessing hidden and hard-to-reach populations: snowball research strategies. Retrieved September 20, 2006 from http://www.soc.surrey.ac.uk/sru/SRU33.html
Bonne, M. (2004, January). Dietetics salaries. Today’s Dietitian, 26-29.
Braithwaite, D., Emery, J., deLusignan, S., & Suitton, S. (2003). Using the internet to conduct surveys of health professionals: a valid alternative? Family Practice, 20, 545-551.
Cassell, J. (1990). Carry the flame: the history of the American Dietetic Association. Chicago, IL: American Dietetic Association.
Costa, P.T., Terracciano, A., & McCrae, R.R. (2001). Gender differences in Personality traits across cultures: Robust and surprising findings. Journal of Personality and Social Psychology, 81, 322-331.
Definition of convenience sampling, recommended by Ryerson University (n.d.). Retrieved on September 04, 2006 from http://www.ryerson.ca/~mjoppe/ResearchProcess/ConvenienceSample.htm
Definition of Nutritionist recommended by MedicineNet.com (2006). Retrieved on August 29, 2006 at http://www.medterms.com/script/main/art.asp?articlekey=4603
Definition of Nutritionist recommended by the National Cancer Institute (2006). Retrieved on August 29,2006 from http://www.nci.nih.gov/Templates/db_alpha.aspx?CdrID=44662
Definition of Registered Dietitian recommended by the American Dietetic Association (2005). Retrieved on August 27, 2006 from
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/CADE_748_ENU_HTML.htm
Dietitians and Nutritionists defined (1964). Unpublished manuscript. The American Dietetic Association, Chicago.
Functions of Dietitian as recommended by the Dictionary of Occupational Titles (n.d.). Retrieved on August 27, 2006 from http://www.occupationalinfo.org/dot_d3.html
Eaton, J., & Struthers, C.W. (2002). Using the internet for organizational research: a study of cynicism in the workplace. CyberPsychology & Behavior, 5, 305-313.
48
Gneezy, U., Niederle, M., & Rustichini, A. (2003, August). Performance in competitive environments: Gender differences. Quarterly Journal of Economics, 118, 1049-1074.
Goodman, L. (1961). Snowball sampling. The Annals of Mathematical Statistics, 32, 148-170.
Grieger, L. (2005, July). To degree or not to degree. Today’s Dietitian, 31-35.
Harrison, L., & Hughes, A. (1997). The validity of self-reported drug use: improving the accuracy of survey estimates. (National Institute on Drug Abuse Research Monograph No. 167). Rockville, MD: Division of Epidemiology and Prevention Research.
Lauriola, M., & Levin, I.P. (2001). Personality traits and risky decision-making in a controlled experimental task: an exploratory study. Personality and Individual Differences, 31, 215-226.
Niederle, M., & Vesterlund, L. (2006) Do women shy away from competition? Do men compete too much? Unpublished manuscript. Stanford University and NBER, University of Pittsburgh.
Skitka, L.J., & Sargis, E.G. (2006). The internet as psychological laboratory. Annual Review of Psychology, 57, 529-55.
Snijders, T.A.B. (1992). Estimation on the basis of snowball samples: how to weight? Bulletin de Methodologie Sociologique, 36, 59-70.
Thompson, S.K., & Collins, L.M. (2002). Adaptive sampling in research on risk- related behaviors. Drug and Alcohol Dependance, 68, S57-S67.
Torti, F.M., Adams, K.M., Edwards, L.J., Lindell, K.C., Zeisel, S.H. (2001). Surveyof nutrition education in U.S. medical schools – an instructor-based analysis (2001). Retrieved on September 2, 2006 from http://cogprints.org/2383/01/res00023.pdf
United States Bureau of Labor Statistics (2005, May). Mean annual wage for registered nurses in general medical and surgical hospitals. Retrieved on 25 August, 2006 from www.bls.gov/oes/current/oes291111.htm
United States Bureau of Labor Statistics (2005, May). Mean average wage for dietitians and nutritionists in general medical and surgical hospitals. Retrieved on 25 August, 2006 from www.bls.gov/oes/current/oes291031.htm
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United States Bureau of Labor Statistics (2006). Operational outlook handbook. Retrieved on 29 August, 2006 from www.bls.gov/oco/ocos077.htm
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