THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, February 8, 1996 TAG: 9602070039
SECTION: FLAVOR PAGE: F1 EDITION: FINAL
SOURCE: BY MARY FLACHSENHAAR, SPECIAL TO FLAVOR
LENGTH: Long : 212 lines
THIRTY-YEAR-OLD Tammy Thomas tried for years to lose 70 pounds. She attempted everything, including membership in a weight-loss club.
Nothing worked.
Until six months ago, when she began visits to a registered dietitian. Thomas' weight and blood pressure, also high, began to drop. Today she is 48 pounds lighter, and confident she will shed the 22 additional pounds needed to reach her goal.
``What I like about this approach is the individual attention,'' said Thomas, who lives in Virginia Beach. ``The dietitian didn't just hand me a 1,200-calorie diet. She spent time learning about me and my eating habits.
``I also like the accountability. When I was part of a group it was easy for me to skip meetings. It's harder to break an appointment when it's one-on-one.''
As recently as 10 years ago the word ``dietitian'' had, at best, two meanings for most Americans: It could trip up even the star of a spelling bee; and it conjured up images of little-old ladies in hair nets, arranging bland food on a hospital tray.
The word has been used so much lately, we're probably getting better at spelling it. And the dietitian of the '90s is in such demand in so many places, she'd be wise to add a pair of roller skates to her uniform.
Today, dietitians are in the supermarket, giving tours. In the workplace, conducting wellness seminars. At health clubs, serving up nutritional guidance to fitness buffs. In restaurants, developing healthful menus. In the doctor's office, counseling patients with medical conditions, and healthy patients who want to stay that way.
Turn on the television news, and you may see a dietitian putting the latest food scare in perspective.
Some days Linda Barnes, registered dietitian (R.D.), could use that pair of roller skates.
The president of the 137-member Tidewater Dietetic Association is a nutritionist with the Virginia Beach health department by day. In the evenings and on weekends she sees patients in her private Virginia Beach practice, Integrated Nutrition Concepts. She also spends several hours one Saturday each month at Virginia Garden, a whole-foods store at the Farmer's Market in Virginia Beach, answering customers' nutrition questions.
Barnes teaches nutrition at Tidewater Community College and hopes to teach classes at local food stores soon. Recently, she talked to a vegetarian group about phytochemicals.
``Yes, dietitians have their fingers in a lot of different pies these days,'' said Barnes.
Twenty years ago when Doris Derelian entered the field, more than 80 percent of dietitians were in hospital or other clinical settings.
``The term dietitian connoted illness to the public,'' said Derelian, president of the American Dietetic Association. ``Now only half are in those settings.'' Many work in wellness, she said.
In 20 years, membership in the American Dietetic Association, the largest group of food and nutrition professionals in the nation, has grown from 22,000 to 67,000, said Derelian, who has a private practice in dietetics in San Diego. Four percent of the group's members are men, a result of the dietitian's foray into sports nutrition, she said.
``The Bureau of Labor Statistics believes dietetics as a career will see a 35 to 40 percent increase over the next 10 years,'' Derelian added.
One reason for the boom is research showing a strong link between nutrition and disease, dietitians say. Poor diet has been associated with cancer, heart disease, and other serious medical conditions while a good diet may increase the chances of a long, disease-free life. Consumers are hungry for reliable nutritional sources at a time when contradictory and confusing advice is served up daily.
Knowledgeable source
A registered dietitian is a source with credentials. She must earn a four-year bachelor's degree in one of the nutritional sciences at a college accredited by the dietetic association, intern for nine months to one year, pass an exam and take 75 hours of continuing education every five years.
Almost half of the association's members also have master's degrees, Derelian said. Registered dietitians sit on the committees that decide public policy on nutrition, such as the USDA's Dietary Guidelines.
The cornerstone of the dietitian's advice to consumers is a diet of variety and moderation, rich in whole foods and low in and fat, sugar and salt. If the headline is sensational - such as ``Licorice Cures Cancer'' - the source likely is not a registered dietitian.
Although dietitians do not practice medicine, their medical knowledge sets them apart in nutrition. Some have private practices in doctors' offices and get many of their patients through doctor referrals.
``Doctors don't have the time and they often don't have the nutritional expertise to micro-manage special diets,'' said Kristine Rand, a dietitian with The Group for Women, a medical practice with four offices in South Hampton Roads. Rand, who receives referrals from many doctors in and outside the group, works with pregnant women, heart patients, vegetarians, candidates for weight loss and gain, sufferers of eating disorders and more. Most of her patients have had a complete physical from a doctor before their first appointment with her.
``In many cases, the solution may be simple but the nutrition professional has to have medical knowledge,'' Rand said. ``For instance, if I have a patient who wants to lose weight but has a very low `good-cholesterol' reading, I know that a blanket low-fat diet will reduce that cholesterol even further, and maybe present a risk of heart attack.
``Another example is the patient who's compliant with a diet but whose weight hasn't budged. I might suggest going back to the doctor for a thyroid check.''
Rand schedules a first visit of 30 minutes to an hour during which she takes medical and diet histories, records the patient's weight and measurements and explains how to keep a food diary. She likes a minimum of two follow-up visits but may see a patient for a year or longer if the condition warrants. (Among Hampton Roads dietitians an initial visit usually costs between $40 and $70. Follow-ups average $10 to $20.)
Like other dietitians in private practice, Rand gives advice that matches the food tastes, body type and lifestyle of the client.
``In the case of weight loss, I ask what is a good, healthy weight for this patient,'' she explained. This may be within 20 percent of the number touted as the ideal body weight on the charts, she said.
And she doesn't ask for miracles. ``If the patient can make two small dietary changes that will stick for life, I'm much happier than I am with 20 short-term changes,'' she said.
The modern dietitian
The profession keeps pace with the times in many ways. Dietitian Lynn Earle-Cookson counsels athletes at the YMCA in Norfolk and patients and residents at a Norfolk medical practice. She teaches at Tidewater Community College and works for a home-health company. Aware that many of her private patients are even busier than she is, she makes house, and office, calls.
``I go to the office of a man who had a heart attack several years back who's struggling hard to eat right,'' said Earle-Cookson, who lives in Norfolk. ``I did a home visit for a high-school athlete who's hypoglycemic and needed advice on how to eat well to keep up with her busy schedule.''
Dietitian Christine Warren recalls the day not long ago when those in the profession were not nearly as busy. When she opened her business, Consultants in Nutritional Services, in 1981, the public ``didn't know who dietitians were and what we did,'' she said. ``And we weren't getting any doctor referrals. It wasn't until '85 or '86 that things started to turn around.''
Today her group, at the Koger Executive Center in Norfolk, counsels a range of clients, from those who are healthy and want to fine-tune their eating habits, to those who need special diets for serious conditions such as cancer, to those suffering from eating disorders.
``Dietitians are a little slow to be assertive,'' said Warren, ``although we've made great strides.''
Glad that a title protection bill for dietitians and nutritionists passed the Virginia General Assembly last year, Warren looks forward to the day when the stronger licensure bill, already in place in 24 states, might be enacted in Virginia (see box on Page F1).
Rand, of The Group for Women, found a different measure for the profession's evolving status.
``A while back I was watching an episode of the TV show `St. Elsewhere,' '' she said, ``and I got real excited when I saw that a dietitian was in the script.''
Then she knew the dietitian had arrived. MEMO: Mary Flachsenhaar is a free-lance writer living in Norfolk.
ILLUSTRATION: JANET SHAUGHNESSY
The Virginian-Pilot
DIETITIAN OR NUTRITIONIST: WHAT'S THE DIFFERENCE?
When someone with the title ``dietitian'' or ``nutritionist''
gives advice, we generally assume the guidance comes from a
professional with proper education and credentials. But in some
states, the terms are not regulated, and almost anyone may be free
to dole out information.
This has made it easy for for ``armchair nutritionists'' to
pedal advice, says Doris Derelian, president of the American
Dietetic Association.
Recently, Virginia passed a bill requiring anyone who uses the
title ``dietitian'' or ``nutritionist'' to be credentialed in at
least one of six specified ways.
Thirty eight states regulate the titles in some way. Virginia's
``title protection bill'' will be implemented this spring.
However, some dietitians and nutritionists in Virginia would
prefer the commonwealth have a ``licensure bill,'' which would more
precisely define the scope of practice for dietitians and
nutritionists. Twenty-four states have such laws..
The American Dietitic Association already clearly defines the
title ``registered dietitian,'' or ``R.D.'' Such a person must
earn an undergraduate degree at a college accredited by the ADA,
intern for nine months to a year, pass an exam and take 75 hours of
continuing education every five years.
A qualified person with the title ``nutritionist'' usually has a
more advanced academic degree than an R.D., such as a master's in
the nutritional sciences, but is not required to intern, says Dr.
Stanley Wallach, president of the Certification Board for Nutrition
Specialists.
When Virginia's regulations go into effect, certification by
this board or the American Board of Nutrition will be required to
earn the ``nutritionist'' title.
But the consumer should beware: A person may still dispense
nutritional advice under an unregulated title, such as ``nutrition
expert'' or ``fitness expert.''
CONSUMER BEWARE
When seeking nutritional guidance, watch for these red flags, say
dietitians. They indicate that the source may not be reliable:
Are there products for sale? If so, the motivation may be making
money;
Are results guaranteed? No one can guarantee results;
Is the eating plan extremely regimented? Dietitians endorse
realistic changes that can work for a lifetime because they are
based on an individual's style of eating;
Is one food emphasized above all others? Beware -- there are no
magic foods.
NUTRITIONAL HELP
How to find a registered dietitian in Hampton Roads:
Ask your doctor;
Call the American Dietetic Association's toll-free hot line
(800-366-1655) for referrals in your area.
Call Linda Barnes, president of the Tidewater Dietetic
Association (463-3008), for referrals.
by CNB