Common Misconceptions about Dietitians

By: Alyce Reichenbacher

I love being a part of the dietetics profession and I cannot wait to one day have MS, RD at the end of my name. However, sometimes others make assumptions about my nutritional choices due to my association with dietetics. For example, I will be in line at a buffet and the person in front of me says “don’t judge me, I know it’s bad” as they reach for the chocolate chip cookie at the end of the table. Or I walk into a patient’s room and they refer to me as the “food police.” Or I order boneless buffalo wings with ranch instead of the house salad when I’m out to dinner with friends and get a look from them like wait you eat THAT, I thought you were in dietetics. I’ve started to feel like the average person perceives dietitians as judgemental fitness freaks that force you to eat kale and quinoa for each meal.

No fear, I am here to squash those misconceptions of Registered Dietitians (RDs) and bring some truth to the profession. Here is a list of five commonly faulty thoughts about dietitians.

1. Dietitians eat healthy 100% of the time and think you should too
1. Not everyone is perfect! We all deserve to treat ourselves once in a while and I am a firm believer that we need to feed our body and our soul. Depriving ourselves of things we love is not only torture, but it will most likely force us to binge later on. As dietitians, it is our job to help our clients and patients still eat the foods they love while keeping their body healthy. That advice goes for us, health professionals, as well. I most certainly do not eat healthy for every single meal. What is life without chocolate peanut butter ice cream or a barbeque chicken pizza every once in a while? The most important advice we can give you is to enjoy everything in moderation. When it comes time to have that special treat, appreciate it! Take pleasure in treating yourself to a favorite food on occasion.
2. We know everything when it comes to food
1. As much as I would like to say that statement is true... it is not. Especially as a Dietetic Intern, I feel like I have only scratched the surface on food and nutrition. It is such a vast subject and I have so much more to learn. That being said, eventually we all find our niche. It is common for RDs to specialize in a certain area which can cause them to not stay as up-to-date on information in other areas. For example, a RD who works in an eating disorder facility is not always up to speed on the most recent recommendations in sports nutrition. Because it is such a dense field, we may not be able to answer a specific question right off the bat if it is in an area we are not as familiar with. However, we often know where to find science-based answers or can direct you to someone who can!
3. Our field is “black and white”
1. Is red meat bad for me? Will intermittent fasting help me lose weight? Should I take a multivitamin? Sometimes I struggle when people ask me questions and the answer is often “it depends.” There are so many aspects of a person’s health that you have to consider when talking about nutrition. Every client has different dietary needs, goals, lifestyles, and food preferences. What works for one person most likely will not work for the next. In addition, each RD has their own beliefs and backgrounds. Luckily, we are trained on how to tailor unique advice for every individual using evidence-based research.
4. Dietitians are the same as Nutritionists
1. Registered Dietitian, Nutritionist, Registered Dietitian Nutritionist? It’s confusing to know which term is correct. If someone claims to be a Nutritionist, he/she could be a qualified professional but they could also be someone who took a class or two on health and wellness. There really is no accreditation for being a nutritionist and there is no regulation on who can call themselves nutritionists. Registered Dietitian, Registered Dietitian Nutritionist, RD, RDN, and Dietitian are all ways of saying the same thing. An RDN is someone who has completed a minimum of a bachelor’s degree in nutrition and dietetics, completed an ACEND-accredited supervised practice program (fancy way of saying internship) where we accomplished at least 1,200 hours of supervised practice, and passed a national examination often referred to as the RD exam or CDR. 
5. All we do is meal plan and get people to lose weight
1. That is the same as saying all photographers do is point and shoot; when really, there are countless things that need to happen. The photographer has to find the correct lighting, backgrounds, and position characters the way that best suits how the shot needs to be captured etc. In fact, most dietitians do not create meal plans for their clients. This is because meal plans can be a temporary and unrealistic way of fitting a person’s lifestyle long-term. Our goal is to make life changing and sustaining tweaks to your diet and/or lifestyle in a way that is healthy, maintainable, and individualized to you. Not to mention, RDs work in a vast array of settings. Weight loss is only one area in which they specialize in. Other careers in dietetics can include working in a cancer center helping patients maintain good nutrition to keep fighting, in a children’s hospital calculating tube feedings for kiddos who are too ill to eat, in a private practice setting delivering corporate wellness speeches to big companies, in a food service operation as a chef or menu designer, in a diabetes clinic teaching those newly diagnosed how to work their pumps and count carbohydrates, in a nursing home working to keep the geriatric population happy and healthy, in a OBGYN office providing women with prenatal nutrition, and the list goes on and on. We often wear many hats and our days consist of so much more than typing up meal plans and telling people calories in equals calories out.

I hope these few points help to clear your mind about dietitians and can also allow you see how expansive this profession really is! We are non-judgemental, pro-quality of life individuals just trying to make the world a healthier place, one whole food at a time!

Off the Beaten Path

By Loni Pereszlenyi

The “Controversial” Story of How I Got Here

Caution: Extreme honesty ahead! (As if anyone who knows me expected anything less!)

        Everybody has a reason for choosing his or her life’s work. Think about the multitude of disciplines and the plethora of job titles that can be found under those disciplines. Now, if you are reading this, go ahead and think about why you chose your career. Chances are that for many of you, you realized you had a specific skill set or excelled in one area in one way or another. For those of us in the health professions, chances are we thought a little bit more with our hearts than with our heads. I know for myself in particular, the reason why I wanted to become a registered dietitian was something that is not only personal, but it can be considered controversial, as well - and this is because I am an eating disorder survivor. My mission in life is to help those with eating disorders/disordered eating get to a place of recovery and resiliency, because I was once lost in the depths of this debilitating disease and I’m not only surviving - I’m absolutely thriving. 

So, for those of you who don’t know, I am sure you’re curious as to why my pursuing a career as a registered dietitian would be a topic of controversy. Before I get to that, I’d like to tell you the story of how I got to this point, so that you can have all of the facts before taking a side on the topic.

I was 15 years old and at the end of my sophomore year of high school when I began to starve myself. Many things happened to me as a teenager. Possibly my favorite person ever to exist, my Bubby (for those of you who don’t know what a Bubby is, it’s grandmother in Yiddish - an old time Jewish language of sorts), passed away. I really didn’t know how to deal with that. It was the first loss of that magnitude I had ever experienced. At the same time, I was developing this body that I absolutely hated. I was getting curvier, and my body was changing at an incredible rate. Some people literally used to call me “boobs,” back in high school. It’s all people looked at when they looked at me. I didn’t even know how to dress myself. All of my friends had these tiny bodies, and all I wanted to do was hide away because I was so uncomfortable with myself. I was sad over my Bubby passing, I hated the way I looked, and the only way I knew how to control it was to punish myself for the changes all I was going through. It’s funny to look back on it now, because I was 120 pounds, and I looked good! However, by the start of my junior year, I weighed 90 pounds. I hadn’t had a period for months. My hair was falling out. I was gaunt and had no energy to get through my days at school. I would overhear people at school whispering about how skinny I’d become, and I thrived on it. At the lowest point of my eating disorder, my diet consisted of an apple and a salad to get me through my days. Nobody knew how to approach me about what I was going through. So, my mom took me to my doctor and a dietitian. I was told I’d wind up in the hospital with tubes and needles sticking out of my arms and that I’d die. That scared me enough into eating again. However, my body and metabolism had become so screwed up that I ended up gaining almost 50 pounds back. Even though I gained the “required” weight, my eating disorder was never addressed, leaving it unresolved. I never learned how starving myself affected me physiologically. I never learned how to eat mindfully. I never learned that I was using starvation as a way to not have to deal with any of the changes in my life. Since none of this was addressed, I did not have the proper mechanisms to process the life changes that would inevitably come my way in the future.

Fast forward five years - I was a junior in college majoring in liberal studies. What is liberal studies you ask? It means you have zero clue what you want to pursue as a career. It means that you have to apply to grad school to have more years (and more loans) to figure it all out. It means that you take whatever classes sound good to you. As it was, I was lost. But my friend the eating disorder was sitting on my shoulder like the devil. For almost three years, I dipped into another period of restriction - and this time, excessive exercise - to cope with this new life change. I couldn’t fathom how someone with a college degree just simply could not find her passion. So, I kept my focus on how I was winning this game of restricting food while exercising during all of my free time throughout the day. One day - and I remember this day vividly - I was too tired to work out. I punished myself. I didn’t eat anything but a protein bar that entire day. The next day, I remember turning to my mom and telling her that I was worried because my hair was falling out in clumps. I was anxious because I didn’t want to gain weight, but I knew I was entirely too underweight. I was tired. I was tired of being tired. I knew I had to get help, but I didn’t know if I had the ability or the strength to see it all through. Then came the moment that changed the course of my life; I’m not being dramatic, either - this one moment really changed my life!

I knew dietitians as professionals in working with food. I knew what I was doing by using food restriction as a coping mechanism for life’s changes. I remember finding a particular outpatient dietitian’s website online. I said to my mom - the only person I trusted at the time to know what I was going through - I think I need to call this person for help. Hands down it was the best decision I have ever made. This particular dietitian - we will call her “L” - never gave up on me. Each time we met, L guided me through each appointment in a way that allowed me to talk about what I felt contributed to the patterns I had held onto for years. I never once felt uncomfortable or ashamed in L’s presence, because each session felt like a natural conversation. I felt like for once I was talking to somebody that really understood me. And my eating disorders started to feel like an evil burden on my body.

Now I know what you’re thinking; eating disorder recovery seems so easy. Not so fast. Part of what made L so amazing is that whenever I left each session, I felt encouraged to take the goals we set and work on them. It took me some time to trust in our connection as practitioner and patient, but as I said before, L never gave up on me. If I came back to session and did not complete an assignment or achieve a goal, L held me accountable. In time, by trusting L, I learned to trust myself and the ability I had to make a full recovery. Throughout the recovery process, I reiterated to L that I wanted to take what I’ve learned and help others just like me. I realized that as our sessions became fewer and far between, I was recovering, but the need to help others in my position was not wavering. I realized that I wanted to become an eating disorders dietitian just like L. 

I waited until I felt like I was at a place in my recovery in which I would be able to fully immerse myself into my schoolwork and field experiences, and I made the decision to return to school to pursue a career as a registered dietitian. I worked incredibly hard and received my bachelor’s degree in nutrition and dietetics in 2016, and began my dietetic internship/masters degree at SLU in 2017, focusing on pediatric nutrition. Although it has been an arduous and long journey, I have never lost sight of my goal of becoming an eating disorders dietitian. If I can replicate in the future - even just one time - what L did for me and save even one life .. well, I’d say I’m going to be a damn good eating disorders dietitian.  

So let’s get back to the controversial topic of being an eating disorder survivor and becoming a registered dietitian. It’s very easy to assume that someone who has battled eating disorders will judge their patients. It’s very easy to assume that someone who has once battled eating disorders will relapse again and encourage his or her patients to continue on with their disordered behavior. It’s very easy to assume that counseling and educating eating disorder patients will result in the registered dietitian relapsing into prior behaviors. It’s simply very easy to assume that someone who has battled eating disorders will never fully experience recovery. 

These assumptions are not proven facts. While dietitians who are eating disorder survivors may be at an increased risk of relapsing, this does not mean that they cannot effectively counsel eating disorder patients. I personally know many former alcohol and drug abusers who have made careers out of counseling current alcohol and drug abusers. Therefore, I cannot change your opinion if you’ve already formed one about this topic, but let me be a vocal exception to all of those assumptions. I am an eating disorder survivor and thriver, and I am here to tell you that my MISSION in life is to help my future patients overcome their eating disorders/disordered eating and live, love, and value their lives. I’ve often abided by the poem “The Road Not Taken” by Robert Frost. “Two roads diverged in a wood, and I - I took the one less traveled by, and that has made all the difference.” My “roads” were not about one path vs. another path. I did not choose my eating disorders. However, I wanted to make something out of the path that I took, and hopefully I will make a difference in the paths of those that come after me.

Photo Credit:

https://www.amazon.in/Alter-Ego-Robert-Famous-Inspirational/dp/B01D5WK4FU

One of the 4%

A Male Perspective on Diversity in the Field of Dietetics

By Joseph Nilges

I started out as a culinary student, working my way from job to job on a yearly basis. After competing in a cooking competition and winning a bronze medal, I knew that I had reached new heights in my career, but I didn’t feel like this accomplishment was enough. I soon found the number for the Saint Louis University Nutrition & Dietetics office and transferred into their program the following semester. Now, after 4 consecutive years attending Saint Louis University, I have discovered how little diversity there is within the field of dietetics. 

Coming into dietetics with a culinary background I was always part of the majority, now I am of the smallest minority and adapting to the change was challenging.

One of the 4% reflects how little diversity there really is within the dietetics field. As of February 19, 2018 the Academy of Nutrition & Dietetics reported 3,690 (3.8%) male registered dietitians floating among 88,883 (90.6%) female registered dietitians (RD), leaving 5.6% unreported. Of the total 98,000 registered dietitians white ethnicity represented the majority at 77.8% with unreported coming in 2nd at 7%. Over the next few paragraphs we will discuss why there are not more males in dietetics, barriers that can be challenging for males within the field, and what the future might hold for bringing more males into the profession.

Where Are All The...

The gender discrepancy can be traced back to the 1920’s where therapeutic diet treatments were entrusted to senior hospital nurses who had developed certain skills. Nursing had risen to become a female profession until recently, so it is not surprising that males do not make a majority. There are many different reasons why we do not see more male dietitians in the field, one of them being that the educational pipeline that helps drive interest in the field of dietetics does not start early enough within the school system. The educational pipeline refers to the integrated system of institutions from primary school to university that seeks to attract students to colleges with a goal of attaining the skilled individuals in the workforce. 

The Academy of Nutrition & Dietetics noted that active, committed participation with academia is crucial for addressing the low percentage of diversity in dietetics. This participation is negatively influenced by parental and peer group perceptions of college attendance often based on financial measures, substandard academic preparation, lack of support among teachers and guidance counselors who have lower academic expectations, inadequate guidance through college planning and financial aid process, perceptions of dietetics being a “woman” field, lower salary received for amount of education involved, and difficulty among some groups of academic requirements to name a few.  

“People still see dietitians as hairnet-wearing women who act as food police. There are also things that prevent men from entering dietetics such as low pay for dietitians” – Rick Hall, MS, RD Arizona State University

Overcoming Difficulty

Men that are thinking about entering the field of dietetics I have some personal advice for you. First off, be prepared to have feeling of being different and finding personal identity. Second, be prepared to adapt to the profession through different means of communication with the female majority. Third, be prepared to stand out among the profession. 

1.              Be prepared to have feelings of being different and finding personal identity.

Being a male in dietetics can have its difficulties. I have personally felt the feeling of

being different and finding my place within the profession during my undergraduate and graduate degrees at Saint Louis University. I commonly have felt disconnection with my class mates and coworkers based on the fact that I am male and women interact differently with one another. Often I have found myself conforming to the norms of the dietetics profession, such as personally feeling more pressure from preceptors to perform at a specific level. 

2.          Be prepared to adapt to the current norms.

Often I have found myself feeling like I was alone and conforming myself to fit the norms of the female dominated dietetics profession. I found that a strong sense of self -identity, self-awareness, and open communication with peers were the best ways for myself to overcome this barrier. Surrounding myself with a strong support system of friends and family was also beneficial for me to confront my disconnect  with feeling of being an outsider.

3.        Be prepared to stand out among the profession and bring a voice.

Being able to stand out for males seems to be easier and can have advantages although performance standards seem to be heightened for male students. The opportunities for males within dietetics are continually growing, so employers want to assure that if they hire a male dietitian they will bring new ideas to the table, which could put more pressure on male dietitians. There is also a need for males to project their voice to help to bring more males into the dietetics profession. Bringing a voice and advocating for more males in the profession is an important part of being a minority in any profession to help increase diversity in the field. 

Passion seems to be one of the drivers of success for males in the dietetics. 

Future of male involvement in dietetics

The most important influence for diversity in dietetics is to involve more stakeholders into the equation including: parents, students, teachers, counselors, teaching programs, and advising boards and governmental officials alike that can influence policy change to introduce greater involvement of nutrition education and knowledge of dietetics. It is important that male dietitians project a voice to appeal for more men recruitment, but it is not only the responsibility of the minority groups to do so. Everyone along the institutional learning process must get involved and work together to change the future generation of practitioners. 

References:

Eat right ™. Commission on Dietetic Registration the credentia ling agency for the Academy of Nutrition and Dietetics. (2018, February 19). Retrieved February 26, 2018, from https://www.cdrnet.org/registry-statistics?id=2579&actionxm=ByDemographics

Flowers in the urinal: Is the lack of men in dietetics really an issue? (2015, October 15). Retrieved February 26, 2018, from https://www.dietitians.ca/Learn/Practice-Blog/October-2015/Flowers-in-the-urinal-Is-the-lack-of-men-in-diete.aspx

Lordly, D., Gheller, B., & Joy, P. (2017). Becoming and being a male dietitian in a female dominated dietetics profession. Retrieved February 24, 2018, from http://eds.b.ebscohost.com/abstract?site=eds&scope=site&jrnl=14863847&AN=124595822&h=r%2faMJj0l1muk%2faCdmmiA0kBioVQ8bSKyFJwV%2fywGf0Q8lwV43PckvpDVyLu6ZJDGeMxELgRkAjpYJCRSK9BNjA%3d%3d&crl=c&resultLocal=ErrCrlNoResults&resultNs=Ehost&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d14863847%26AN%3d124595822

Stein, K. (2018). The Educational Pipeline and Diversity in Dietetics. [online] jandonline.org. Available at: http://jandonline.org/article/S2212-2672(12)00481-9/fulltext [Accessed 26 Feb. 2018].

Images are credited to google images and personal photos. 

Let’s Get Clinical

By Alix Opfer 

Terrified is an understatement. This is how I felt when walking into my first clinical rotation. The word “clinical” was never something I related with. The thought of being in a hospital was not attractive to me and I had no intention of loving my clinical rotations while in my dietetic internship. I started at Missouri Baptist Hospital, my first day of clinical rotations with ten other interns and our graduate assistant. We guessed our way through the charting system and took turns going in pairs to visit patients. Our graduate assistant would ask “who wants to go next?”. I would hide behind my laptop or use the restroom at this time to avoid the experience. When I did have to see patients, I basically wrote a script of what I wanted to say so I wouldn’t forget from the nerves hitting me. I knew that I was going to have to get used to speaking with patients eventually, I just tried to defer that day as long as I could. These days were in late August of 2017.  

 

Fast forward to February of 2018, I have completed a number of weeks at various clinical rotations including gastrointestinal, cardiovascular, diabetes, pediatrics and oncology. As the weeks went by, I felt myself becoming more confident in talking with patients and providing educations. The fear went away pretty quickly as I was forced out of my comfort zone. Now 7 months later, I feel that I have little to no anxiety when entering patient’s rooms. I feel that I have made large steps in confidence in myself when working in a clinical setting. I still have TONS to work on, but I am happy to report that I would no longer hide behind my laptop or run to the restroom when asked to see patients J

I’m not writing this just to tell you that I’ve grown in this internship. I’m writing this for future dietetic interns who are fearful of the word “clinical” and believes they may have some anxiety as well when visiting patients for the first time. I can relate and I can also tell you that with practice and experience, it becomes much easier and you truly learn the value of the knowledge gained when working in a clinical setting. I’m still unsure that a clinical setting is particularly my forte, but I know that I have learned more than I ever thought possible in my clinical rotations. Clinical dietetics is truly the foundation that we need to be great dietitians. For those potential dietetic interns that have never worked in a clinical setting and are worried about this large aspect of the internship, I have a few tips for you that have helped me:

1. Think of an introduction: Practice how you want to introduce yourself to patients

2. Look at the chart carefully: a patient’s previous notes are what guide you, look carefully and thoroughly (labs, meds, old RD notes, etc.)

3. Learn your medications: I struggle with medications, a fellow intern made a large compilation of medications to help learn what each medication does. I wish I would have done this at the start of the internship

4. Comfy yet professional: wear comfortable clothing, especially shoes

5. Be confident in what you know

6. Handouts….and more handouts: use handouts to help emphasize your topic

7. Ask Questions: you will have tons of questions, don’t be scared to ask them

8. Enjoy! Even if a rotation is not your favorite, learn what you can 

I’m sure that the other interns have many other tips that they could add, but these are just a few things to keep in mind when starting into your clinical rotations. My main point is that for those that have never worked in a hospital, talked with patients in a clinical setting, or are just nervous in general; I can relate.