Your Complete Guide To Nutritionists

Nutritionist Cheat Sheet

What is a ”nutritionist”?

The term “nutritionist” refers to someone who practices nutrition counseling, which can come in many forms: one-on-one (either in-person or virtual), group counseling, counseling through apps, and more. “Nutritionist” is a catch-all term for practitioners of nutrition, and the legal regulation on whether a nutritionist needs to be “licensed” to practice with clients is dependant on each state’s legislation. In the majority of the US, the term “nutritionist” has almost no regulation, and anyone can call themselves a nutritionist and act as one. It is not one in the same with Registered Dietitian (RD/RDN).

How is it different from an RD/RDN?

Nutritionist is not interchangeable with the term Registered Dietitian (RD). All Registered Dietitians are nutritionists, but not all nutritionists are registered dietitians. (Note: registered dietitian (RD) and registered dietitian nutritionist (RDN) mean the exact same thing. The “nutritionist” piece of RDN was added to the RD title in 2013.)


RD’s and RDN’s require a specific type of education that varies from the requirements of a Licensed Nutritionist. Becoming a Registered Dietitian requires at least a Bachelor’s degree in Nutrition, completion of a clinical internship and passing a Board examination, as well as continuing education to maintain the license. They have the widest scope of practice of all nutrition providers.

What’s the difference between holistic, integrative and functional nutrition?

These are three descriptors of nutritionists that represent different schools of thought and styles of practicing nutrition. Note that these terms also aren’t regulated so anyone can call themselves any of these categories.

By definition, both integrative and functional nutrition are holistic, but there are distinguishing factors.

Holistic Nutrition Integrative Nutrition Functional Nutrition
Looks at All Aspects of a person's life when it comes to their nutrition, including work, relationships, water intake, exercise, etc. X X X
Individualized approach X X X
Aims to optimize energy levels, emotional well-being and immune function X X X
Symptoms X X X
Preventative in nature X X X
Encourage incorporating whole foods X X X
Relies on Functional medicine lab testing (stool tests, genetic tests, in-depth tests on hormones, food allergies, nutrients etc) to identify deficiencies and optimize diet X
Encourages integrating western knowledge on nutrition (the chemistry, biology etc) with eastern views- incorporating nutrition practices sometimes from traditional chinese medicine, ayurveda,etc. X

What’s the scope of practice for nutritionists who aren’t RD’s?

Non-RD nutritionists cannot legally “prescribe” nutrition to “treat” disease. This means they can’t diagnose conditions, and they can’t claim that any diet recommendations they make are a treatment. They also usually can’t prescribe lab testing or read results of medical tests.

However, they can consult with clients and offer guidance about healthier eating and coach them. They can provide specific expertise and knowledge, share resources, and recommend diets and exercise routines in a general sense. A lot of nutritionists work cross-functionally with MDs or other providers, and can refer you to get lab testing done when appropriate.

Does insurance cover nutrition counseling?

Sometimes. Nutrition benefits may or may not be provided in your plan. Sometimes they’re only available for certain diseases that are medically diagnosed, including diabetes, obesity, hypertension and kidney failure. However, some insurances might cover nutrition services for preventative reasons. You need to ask your specific plan to see what services are covered. They're sometimes called nutrition counseling. You can call or check online for specific coverage questions.

Also, according to California law, any nutritionist with a Masters degree or higher in clinical nutrition from an accredited college or university, is eligible for reimbursement through insurance for nutrition counseling, but only when the client has a physician referral.

What can a nutritionist help with?

Nutrition practitioners can help with a huge array of different health conditions, especially when they’re holistic/functional nutritionists, as the gut is connected to the management and treatment of many different diseases, especially chronic and autoimmune ones. RD’s have official board certifications they can obtain in 9 different fields. Outside of that, nutritionists tend to gain deep expertise in certain specialties and disease groups based on the clients they work with most commonly.


Areas of expertise/specialties:

  • Adrenal fatigue

  • Autoimmune disorders

  • Cancer Support

  • Diabetes support/hypoglycemia

  • Digestive health/IBS/Crohns, “microbiome health”

  • Eating disorders

  • Food allergies, intolerances, sensitivities

  • Heart problems (high BP, high cholesterol, triglycerides, etc)

  • Kidney Disease

  • Mindful/ Intuitive Eating

  • Pediatric nutrition

  • Sports performance nutrition

  • Vitamins/Minerals/Herbs

  • Weight management- including weight loss, weight gain, weight management

  • Women's Health-- pregnancy, fertility, infertility, hormones, postpartum, PCOS, HA, PBCS, etc.

How do I find the right nutritionist?

Our goal here at Rupa Health is to make it seamless for you to find a trusted, credible nutritionist that specifically fits your needs. We thoroughly vet all our nutritionists with a vetting process developed by in conjunction with some of the top industry experts form institutions like Stanford, Johns Hopkins, etc.

We’ve found that it’s important to find someone with expertise in your specific condition, which is why we categorize & organize practitioners by specialty. We also note what insurance companies that our practitioners are in network with.

Basic Info

What does the term nutritionist mean?

  • The term “nutritionist” refers to nutrition counseling, which can come in many forms: one on one (either in person or virtual), group counseling, apps, and more.

  • The term “nutritionist” actually isn’t regulated at all- anyone on the internet can call themselves a nutritionist (in most states). It’s not interchangeable with the term Registered Dietitian (RD or RDN), which is one of the highest licenses for a practitioner of nutrition with the widest scope of practice

  • This is state-dependent. See your state laws here

  • The field of nutrition is growing, and there are more and more types of certifications and schools for it, each governed by a different body and having varying scopes of practice (see chart)

  • However, the type of degree doesn’t indicate the knowledgeability, style or nutritional value system that the individual has

Background

  • Close to 50% of the US population takes nutritional supplements daily

  • Chronic disease accounts for nearly 85% of our nation’s healthcare spending, and diet plays a huge role in all these conditions

    • The U.S. Centers for Disease Control and Prevention (CDC) estimates that estimates that eliminating three risk factors – poor diet, inactivity, and smoking – would prevent: 80% of heart disease and stroke; 80% of type 2 diabetes; and, 40% of cancer.

    • An estimated 50-80% of chronic diseases, including heart disease and cancer, are partly related to or affected by nutrition, according to Martin Kohlmeier, a research professor in nutrition at the University of North Carolina at Chapel Hill.

  • Registered dietitians can actually “prescribe” diets, while some nutrition practitioners that are more like health coaches cannot legally give medical advice, but they can give general nutrition suggestions and nudge patients to better health, as long as they aren’t tailored to individuals

  • It’s important to know who you’re going to see and whyyour


Licensed Nutritionist vs Nutritionist vs Registered Dietitian (RD)

According to the Academy’s definition, all RDNs are nutritionists, but not all nutritionists are RDNs.(17) This is because RD’s require a specific type of education that varies from the requirements of a Licensed Nutritionist.

“Nutritionist” is a catch all term for practitioners of nutrition, and the laws on whether a nutritionist needs to be “licensed’ depends on state.   The following states don’t legally require a license to practice nutrition.

  • Arizona

  • Arkansas

  • California

  • Colorado

  • Connecticut

  • Georgia

  • Hawaii

  • Idaho

  • Indiana

  • Iowa

  • Kansas

  • Louisiana

  • Michigan

  • Nevada

  • New Hampshire

  • New Jersey

  • Oklahoma

  • Oregon

  • South Carolina

  • Texas

  • Utah

  • Vermont

  • West Virginia

  • Wisconsin

  • Wyoming

What’s a Registered Dietician (RD or RDN)?

RD stands for Registered Dietitian, and RDN stands for registered dietitian nutritionist. These terms are interchangeable and have the exact same definition and legal trademark. As of 2013, RD’s were given the option to use the RDN credential instead. RDs/RDNs are the highest trained types of nutrition professionals with the largest scope of practice in the US, who have met the strict educational requirements and standards created by the CDR, Commission on Dietetic Registration, of the Academy of Nutrition and Dietetics (AND). ACEND is the accrediting agency for dietetics education programs of the Academy and is recognized by the US Department of Education as the accrediting agency for education programs that prepare RDNs.

What are the educational requirements for becoming a Registered Dietitian?

TLDR: At least a Bachelor’s degree in Nutrition + clinical internship + board exam + continuing education requirements to keep license

Approximately 50% of RDNs have earned advanced degrees at the master’s or doctorate levels.

Undergrad

The CDR requires completing an educational program in dietetics and/or nutrition at a university that is accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics (AND).  Educational programs may be a Bachelors degree or higher in one of the following 2 routes:

Option 1: A coordinated Program in Dietetics – this combines a bachelors degree with the required internship all in one program. They generally take 4 years to complete. The program must contain coursework in all of the following:

  • Physiology and anatomy

  • Chemistry

  • Biochemistry

  • Microbiology

  • Computer science

  • Sociology

  • Business

  • Economics

  • Food and nutrition sciences

  • Food service systems management

Option 2: Didactic Program plus Dietetic Internship --these programs separate the two components. So you complete the classroom coursework, and complete a separate internship of at least 1200 hours after completion of the coursework

      • Medical nutrition therapy

      • Clinical nutrition research

      • Pediatric nutrition

      • Community nutrition

      • Geriatric nutrition

After completing one of the options above, you have to pass the CDR’s Registration Examination for Dietitians to become an RD. Once the RD credential is earned, you also still have to complete the licensing/certification requirements of the state that you plan to practice in.

See here for detailed state laws about the licensure/certification processes for RD’s. This involves applying for and paying the fees required for licensure/certification, and the continuing education requirements needed to keep the licensure/certification (difference between licensure and certification? See below).

The CDR nationally requires RD credentials to be renewed on a five-year cycle


What’s a Licensed Nutritionist?

A Licensed Nutritionist has earned credentials from a nationally recognized nutrition licensing body, such as the Commission on Dietetic Registration (CDR) of the Academy of Nutrition and Dietetics (AND or the Certification Board for Nutrition Specialists (CBNS) or the Clinical Nutrition Certification Board (CNCB). Some states require licensure of nutritionists while others do not. A list of such state regulations is published by the CDR. Licensed Nutritionists are regulated by their certification board as well as by the state in which they practice.

What are all the different types of licensed and non-licensed nutritionists and different governing bodies? Their education, scope of practice, etc?

There are many types of “nutritionists” and training programs which have varying scopes of practice, which include CDR’s, CNC’s, etc.  

Whether a nutritionist went to a program that offers full licensing or not doesn’t necessarily dictate how knowledgeable they are, but can sometimes affect their scope of practice legally.

How can a nutrition practitioner help me?

What kind of guidance can licensed nutritional professionals offer?

  • Meal and menu planning

  • Education

  • Motivational psychology

  • Recommending diets or supplements

  • Diet and lifestyle evaluation

  • Shopping tours

  • Family meal planning

  • Suggestions for improving lifestyle

  • Suggestions for managing stress

  • Teach classes on wellness and holistic nutrition

  • Advise clients on basic wellness supplementation

The scope of practice is dependent on the license type for eah nutrition professional.

What are the specialties within nutrition and what conditions can it help with?

Nutritional providers have varying scopes of practice that depend on  their education, specialties and their client’s health goals. The most common reason for seeing a nutritionist is for weight management, or a nutrition-related disease (cardiac diseases, malnutrition, obesity, etc.)

Registered Dietitians (RDs and RDNs) can be board certified by the Commission on Dietetic Registration. These are the board certified specialities offered (CS) in the field of dietetics:

      • Gerontological Nutrition (CSG)

      • Oncology Nutrition (CSO)

      • Obesity and Weight Management (CSOWM)

      • Pediatric Nutrition (CSP)

      • Pediatric Critical Care Nutrition (CSPCC)

      • Renal Nutrition (CSR)

      • Sports Dietetics (CSSD)

      • Diabetes Educator (CDE)

There are other specialties that nutritionists & RDs specialize or have expertise in that aren’t necessarily board-certified. Most nutrition practitioners build deep expertise in one disease area or another through seeing clients with these disorders, doing research and completing their continuing education in that specific area.

The following are some specialties nutrition practitioners can provide support and guidance for:  

  • Adrenal fatigue

  • Autoimmune disorders

  • Cancer Support

  • Diabetes support/hypoglycemia

  • Digestive health/IBS/Crohns, “microbiome health”

  • Eating disorders

  • Food allergies, intolerances, sensitivities

  • Heart problems (high BP, high cholesterol, triglycerides, etc)

  • Kidney Disease

  • Mindful/ Intuitive Eating

  • Pediatric nutrition

  • Sports performance nutrition

  • Vitamins/Minerals/Herbs

  • Weight management- including weight loss, weight gain, weight management

  • Women's Health-- pregnancy, fertility, infertility, hormones, postpartum, PCOS, HA, PBCS, etc.

What’s the difference in how RD’s and nutritionists can treat me?

Unless you’re an RD or a Doctor, you can’t:

  • prescribe diets or supplements to treat medical and clinical conditions

  • prescribe diets to treat symptoms of medical and clinical conditions

  • diagnose medical conditions

But you can :

  • encourage clients to eat a healthier diet

  • educate clients about nutrition: for example the health benefits of eating healthy fats, protein, and other macronutrients

  • let clients know about evidence-based nutritional supplements that might augment their healthy lifestyle without prescribing anything

  • offer clients recipes or demonstrate food preparation skills

  • provide them with strategies to improve their eating habits and educate them about the pillars of good nutrition

  • help them choose the right foods to eat pre- and post-workouts

  • suggest that clients drink adequate amounts of water for hydration

  • share resources from recognized organizations,  such as The Academy of Nutrition and Dietetics, the American Heart Association, and Precision Nutrition

Other nutrition practitioners differ because they can’t “prescribe” nutrition to “treat” disease. Again, this is left to RDs and MDs. But nutritionists can consult with clients and offer guidance about healthier eating.

What about when it comes to the terms holistic, integrative or functional?

These terms currently aren’t regulated, but there are things to look for and certifications that show that someone has expertise in one of these areas or types of nutrition.

Holistic nutritionist

Holistic nutrition focuses on treating the individual as a whole and giving them customized and tailored nutritional advice. It looks at a person’s nutrition by incorporating all aspects of their life: stress, habits, water intake, lifestyle, personality type, relationships, etc.

Defining aspects of holistic nutrition:

  • Looks at all aspects of a person’s life

  • Individualized approach

    • For example, not giving a super structured diet to someone who doesn’t value structure

    • Working with that person’s specific needs

  • Incorporating whole foods

  • Avoiding using medicine whenever possible, focuses on natural approach

  • Preventative in nature: wants to optimize energy levels, emotional well-being and immune function


Different from other 2: less emphasis on working together with other Western or alternative providers

Doesn’t encourage supplements or vitamins as much

Certification

Since “holistic nutritionist” is relatively new and still an emerging profession, many states don’t regulate use of this title. However, many holistic nutritionists can obtain board certification by completing the following steps:

  • Complete an educational program in holistic nutrition that is approved by the National Association of Nutrition Professionals (NANP)

  • Acquire at least 500 hours of work experience in holistic nutrition counseling

  • Pass the Holistic Nutrition Credentialing Board exam to become board certified in holistic nutrition

Another certification agency for holistic nutritionists is the Holistic Nutrition Credentialing Board (HNCB). Individuals that successfully pass examination by the HNCB are granted the distinction of “Board Certified in Holistic Nutrition.”

Integrative nutritionist

Sometimes “integrative” and “functional” nutrition are either used interchangeably or together, but they are different.

Integrative, by definition, is also holistic because it looks at the person as a whole and considers all aspects of their life when looking at their health

  • It’s integrative more because it incorporates western knowledge on nutrition (the chemistry, biology etc) with eastern views- incorporating nutrition practices sometimes from traditional chinese medicine, ayurveda,etc.

  • This can literally mean: prescribing Chinese herbs, encouraging hot water with lemon first thing in the morning,etc., referring out to or working with acupuncturists, etc.

  • There’s some overlap with functional nutrition

Similar to holistic: whole-body approach, whole foods, preventative

Different from holistic: more co-work with other practitioners, pulls from alternative medicine

Certification

There isn’t a formal definition of integrative nutrition, either, because it encompasses many different modalities. Integrative medicine wants to heal the whole person through food, vitamins, minerals and both herbal and dietary supplements- to work in conjunction with Western medicine when necessary.

  • IIN- Institute for integrative nutrition- basically anyone

  • IFNA- Integrative & Functional Nutrition Academy- healthcare practitioners, but must have minimum BS in Nutrition


Functional nutritionist:

Functional nutrition is focused on building health by bringing the body back to its proper, natural physiological functioning (hence, functional). A functional nutritionist often has the same educational background as a conventional nutritionist or RD, and combines this knowledge either with a functional medicine certification.

Functional nutrition treats the patient systematically, meaning looking at all the symptoms as part of the same root cause, as opposed to singling and treating each individual symptom separately. Instead of suppressing symptoms through medicine or natural agents, this method wants to “read” these symptoms to understand how we can get the body back on track to being healthy again. It looks at the whole picture-- diet, symptoms, illness history, medications, lifestyle, toxic exposure, history of antibiotic use, stress, lab work, etc., we are able to put together an overall plan.

Functional nutrition applies a whole food approach and can recommend alternative healthcare methods like herbs, supplements, and refer out to acupuncturists or other alternative providers. What sets it apart from integrative and holistic is that it often relies on in-depth functional medicine testing to see what’s going on in the body at a cellular level.

Similar to holistic & integrative: whole-body approach, preventative

Similar to integrative but diff from holistic: can encourage supplements or herbs

Different from both: relies heavily on testing methods

Certification types that nutrition practitioners can get:

      • IFM- Institute of Functional Medicine- only if you are an RD

      • IFNA- Integrative & Functional Nutrition Academy- healthcare practitioners, but must have minimum BS in Nutrition

      • Functional Nutrition Lab- basically anyone

Logistics: going & paying

Does Insurance cover my Dietetic Professional services?  

California law explicitly states that a nutritionist with a Masters or higher in clinical nutrition from an accredited college or university, is eligible for reimbursement through insurance for nutrition counseling (when this option is available through your plan), when the client has a physician referral. see more about state-dependent laws here http://www.nutritionadvocacy.org/california-0

Nutrition benefits may or may not be provided in your plan.

Sometimes they’re only available for certain diseases that are medically diagnosed, including diabetes, obesity, hypertension and kidney failure. Some insurances might cover nutrition services for preventative reasons. You need to ask your specific plan to see what services are covered. They're sometimes called nutrition counseling. You can call or check online for specific coverage questions. Some helpful questions to get started are:

      • What is the coverage under my plan for nutritional counseling?

      • Is this benefit limited to having a specific medical diagnosis? If so, what is included? Is any medical diagnosis specifically excluded from my nutrition benefits?

      • How many visits are available each year? Is it unlimited?

      • Do I need a referral? If so, who does this referral need to be from?

      • Is there out-of-network coverage for a nutritionist?

      • Is there a co-pay to see a registered dietitian nutritionist?

      • What nutrition services are covered under the preventive services benefit of my plan (for example, does my plan cover obesity screening and counseling or healthy diet counseling)?

      • Given my deductible I've already met for the year, including my plan copays and coinsurance, what will I need to pay out of pocket to see a registered dietitian nutritionist?

How expensive is it?

  • Paying out of pocket, seeing a nutritionist is 70-80$ per session, according to Thumbtack in 2018

  • Many nutrition professionals do packages- so they’ll give you a discount for a set deal- for example, $600 for 8 sessions over 3 months, including perks like communicating with your practitioner in the meantime, food tracking software, etc.

  • Keep in mind that a nutritionist, especially a functional nutritionist, may recommend that you do certain lab testing which is sometimes not covered by insurance

  • Rolled into the price of seeing your nutritionist may be access to send them questions at anytime, or access to apps that help you track your nutrition information and share it with your practitioner

    • You can always ask to not use these

What does a typical first session with a dietetic practitioner entail?

  • Sometimes practitioners will offer a free 15-30 minute consultation before you go in for a visit, via phone or video to assess whether you are a food fit as a client & practitioner

  • Your first real visit can last from 45 to 90 minutes. You’ll usually go through your health goals, medical history, talk about the medicines & supplements you take (if any), and any other pertinent information

  • They’ll get to know you as a person, and develop a treatment plan together that fits your needs, which can include things like number of follow up sessions, diet plan, communication, lifestyle modifications to consider, etc.

How many session do I need? How often?

  • The frequency of sessions after the initial appointment vary and are based off the patients needs and health goals that are set by the practitioner and/or insurance coverage

  • Typically, practitioners see patients about 4 times in the first 6 months

  • Some nutritionists will want you to keep a food journal, take photos of your meals or track your eating in some ways, at least for a certain period of time ranging from a few days to two weeks

  • Sometimes they’ll want to use apps to communicate with you in-between sessions through phone calls, emails or through messaging apps (see below). Keep in mind you might want to check that it’s HIPAA compliant software if you want to maintain patient-provider confidentiality and protect your personal health information

  • Some practitioners can meet virtually, while other practitioners prefer seeing the patient in person for at least their initial appointment. This is dependant on the practitioner and should be discussed before setting up appointments

Virtual vs In-person?

There’s an increasing trend of virtual appointments with nutrition practitioners.

Benefits:

  • Access to a specialist without the monetary and time cost of travel

  • Convenience

  • Possibly more affordable

  • Enhanced patient compliance

If you find a provider that seems perfect for you, it might be worth it to ask if they offer a telemedicine option.

Key Points on the legality:

  • Your provider must be licensed in the state you live in, as well as the state the patient is in during the telemedicine visit. Some states include phone contact in this. It’s illegal to practice without a license.

  • You’re also subject to the telemedicine laws of both states (which vary widely- when it comes to things like prescribing over the internet, etc)

  • You must use HIPAA-certified communication platform (Skype is one of these)

  • California law, for example, prohibits providers from prescribing certain drugs through the internet without first conducting an appropriate medical examination of the patient.

  • In CA, “Reimbursement is allowed for live video, store and forward and remote patient monitoring.” (a law is in progress for requiring insurance coverage for phone visits)

  • the reimbursement rate by insurance is the same as for in-person visits

  • Informed patient consent is required

  • It’s illegal for your insurance company to require face-to-face visits if the virtual option is possible

  • Fine line-- “practicing medicine” under the law is diagnosing and treating, which means giving advice to an individual patient about what they can or should do

References

Embed Block
Add an embed URL or code. Learn more
NutritionRosa Hamalainen