Nutrition is the science of food and its effect on the body. It is concerned with the nutrients in food, their use in body chemistry, and--in the final analysis--the relationship between diet and health. Nutritionists counsel individuals and groups; set up and supervise food service systems for institutions such as hospitals, hotels, prisons, and schools; and promote sound eating habits through education and research. The term "nutritionist' applies to a number of different professionals involved with food science and human nutrition. Among these are dietitians, food technologists, and home economists.
Among dietitians, major areas of specialization include administration, education, research, and clinical and community dietetics.
Administrative dietitians apply the principles of nutrition and sound management to large-scale meal planning and preparation, such as that done in company cafeterias, schools, and other institutions. They supervise the planning, preparation, and service of meals; select, train, and direct food service supervisors and workers; budget for and purchase food, equipment, and supplies; enforce sanitary and safety regulations; and prepare records and reports. Increasingly, dieticians utilize computer programs to plan meals that satisfy nutritional requirements and are economical at the same time. Dietitians who are directors of dietetic departments also decide on departmental policy; coordinate dietetic services with the activities of other departments; and are responsible for the dietetic department budget, which in large organizations may amount to millions of dollars annually.
Clinical dietitians, sometimes called therapeutic dietitians, generally work in hospitals, nursing homes, or clinics. They assess patients' nutritional needs, develop and implement nutrition care plans, and evaluate and report the results. Clinical dietitians confer with doctors and other members of the health care team about patients' nutritional care, instruct patients and their families on the requirements and importance of their diets, and suggest ways to maintain these diets at home. Computer programs enable dietitians to provide patients and their physicians with a complete nutritional analysis of food intake.
Technological advances in nutritional support for the critically ill have enhanced the clinical dietitian's role. In the hospital, dietitians oversee the preparation of custom- mixed high-nutrition formulas for patients who are critically or terminally ill. In the home health field, they help develop and oversee sophisticated nutritional therapies for homebound patients who, because of surgery or illness, are unable to eat regular foods.
Community dietitians or nutritionists may counsel individuals and groups on sound nutrition practices to prevent disease, maintain health, and rehabilitate persons recovering from illness. They may engage in teaching and research with a community health focus. This work covers areas such as special diets, meal planning and preparation, and food budgeting and purchasing. Dietitians or nutritionists in this field usually are associated with community health programs; they may be responsible for planning, developing, coordinating, and administering a nutrition program or a nutrition component within the community health program. They work mainly for public and private health and social service agencies, including "meals-on-wheels" programs, congregate meals for older Americans, and nutritional programs for women with infants and young children.
Research dietitians seek ways to improve the nutrition of both healthy and sick people. They may study nutrition science and education, food management, food service systems and equipment, or how the body uses food. Other research projects may investigate the nutritional needs of the aging, persons who have chronic diseases, or space travelers. Research dietitians need advanced training in this field and usually are employed in medical centers or educational facilities, or they may work in community health programs.
Although most work 40 hours a week, dietitians and nutritionists in hospitals may sometimes work on weekends, and those in commercial food services have somewhat irregular hours. Dietitians and nutritionists spend much of their time in clean, well- lighted, and well-ventilated areas, such as research laboratories, classrooms, or offices near food preparation areas. However, they do spend time in kitchens and serving areas that often are hot and steamy. Dietitians and nutritionists in clinical settings may be on their feet a lot; those involved in consulting spend a significant amount of time traveling.
Dietitians and nutritionists held about 42,000 jobs in 1990. Hospitals and nursing homes are a major source of employment in this field, accounting for just over half of all jobs in 1990. Firms that provide food services for hospital patients on a contract basis employ a small but growing number of dietitians and nutritionists.
State and local health departments, schools, and colleges, provide over 20 percent of dietitian jobs. Other jobs are found in a variety of settings, including prison systems, hotel and restaurant chains, and career firms that provide food service for their employees.
Many dietitians work as consultants, either full time or part time. In addition to serving on the staff of a hospital, for example, a dietitian may be a consultant for another health care facility. Nursing homes use consultants to provide much of their dietetic supervision.
Training, Other Qualifications, and Advancement
A bachelor's degree with a major in foods and nutrition or institution management is the basic educational requirement for this field. This degree can be earned in about 270 colleges and universities, usually in departments of home economics and food and nutrition sciences. Required college courses include food and nutrition, institution management, chemistry, bacteriology, and physiology. Other important courses are mathematics, statistics, computer science, psychology, sociology, and economics. It is also possible to prepare for this profession by receiving an advanced degree in nutrition, food service management, or related sciences and providing evidence of qualifying work experience.
To qualify for professional credentials as a Registered Dietitian (R.D.), the American Dietetic Association (ADA) recommends completion of a coordinated undergraduate program which includes an internship; completion of a bachelor's degree, plus an approved dietetic internship or 3 years of approved qualified experience; or 6 months of approved qualified experience plus an advanced degree. The internship lasts 6 to 12 months and combines clinical experience under a qualified dietitian with some classroom work. In 1984, 104 internship programs were accredited by the ADA. Coordinated undergraduate programs enable students to complete their clinical experience requirement while obtaining their bachelor's degree. In 1984, 67 such programs were offered by medical schools and by departments of allied health and home economics in colleges and universities. These programs are accredited by the ADA.
Experienced dietitians may advance to assistant or associate directors or director of a dietetic department. Advancement to higher level positions in teaching and research requires graduate education; public health nutritionists usually must earn a graduate degree. Graduate study in institutional or career administration is valuable to those interested in administrative dietetics.
Clinical specialization offers another path to career advancement. As a result of scientific advances that have increased our understanding of the role of nutrition in treating disease, clinical specialization is on the rise. Specialty areas for clinical dietitians include cancer, heart disease, and diabetes.
Persons who plan to become dietitians or nutritionists should have organizational and administrative ability as well as scientific aptitude, and should be able to work well with people. Among the courses recommended for high school students interested in careers as dietitians are home economics, career administration, biology, health, mathematics, and chemistry.
Employment of dietitians is expected to grow faster than the average for all occupations through the year 2000 to meet the expanding needs for individual and group meals in nursing homes, hospitals, retirement and life care communities, and social service programs of various kinds. Most job openings, however, will result from the need to replace experienced workers who stop working or transfer to other occupations. A number of experienced dietitians and nutritionists are moving into management positions in private industry, for example.
The factors that underlie future growth in demand for health services--population growth and aging, emphasis on health education and promotion of prudent lifestyles, and widespread ability to pay for care through public and private health insurance--will spur demand for dietitians and nutritionists. Demand is also expected to grow in commercial settings, including catering firms, restaurant chains, and medical supply firms. In addition, dietitians and nutritionists will be needed to staff community health programs, to provide nutritional counseling for employer-sponsored wellness and fitness programs, and to conduct research in food and nutrition.
Opportunities for part-time employment should remain favorable. This will be especially true in nursing homes and home health care, where dietetic services are frequently provided for only a few hours each week. Hospitals, too, use a substantial number of part-time dietitians in order to maintain staffing flexibility, raising or lowering the number of hours worked with fluctuations in the number of patients.
Entry level salaries of hospital dietitians averaged about $23,100 a year in 1990, according to a national survey conducted by the University of Texas Medical Branch. Many experienced hospital dietitians earned more than $31,275 a year. Salaries may vary by region.
Dietitians employed by others usually receive benefits such as paid vacations, sick leave, holidays, health insurance, and retirement benefits. Self-employed dietitians must provide their own benefits.
Dietitians and nutritionists apply the principles of nutrition in a variety of situations. Other workers with similar duties include food and home economists, executive chefs, and food service managers.
Sources of Additional Information
For information on accredited dietetic internships and coordinated undergraduate programs, scholarships, registration, and a list of colleges providing training for a professional career in dietetics, contact:
The American Dietetic Association, 430 North Michigan Ave., Chicago, Ill. 60611.
The U.S. Office of Personnel Management, Washington, D.C. 20415, has information on hiring requirements for dietitians in Federal hospitals and for public health nutritionists and dietitians in the U.S. Public Health Service. The Veterans Administration employs dietitians and maintains a list of eligible applicants. Graduates interested in VA positions may obtain application forms by calling, toll free, 800-368-6008. Residents of Virginia should call 800-552-3045. Those interested in a VA career as a dietitian are encouraged to visit the personnel office of any VA medical center.