Why Dietitians Are Hospital Food Service Managers

 Written By: Peter Baartman; SLU Dietetic Intern

        Have you heard of a Dietitian? Chances are, if you see someone with the letters “RDN, LD” behind their name, you may wonder what sport they play, or what Greek life they took part in. Registered Dietitian Nutritionists, RDs, are vital healthcare professionals, but the role of an RD expands beyond the hospital. RDs work in private practices and public health roles, but they also have a heavy influence on food service operations. Even within the Dietetic profession, however, foodservice is commonly the least popular avenue to take. Clinical, corporate, and any other avenue of nutrition services almost always takes precedence in people's job searches. 

        Isn't food service for Head Chefs and general managers with MBAs to handle though? Despite the commonality of this thought, there are very good reasons Dietitians are involved in foodservice, specifically in the hospital. Dietitians provide valuable insight, training, and leadership for hospital foodservice staff, from the smallest rural operation to a 1500 bed hospital. Dietitians are needed in foodservice in order to effectively serve nutritious and engaging meals to hospital patients, while also taking into account the individuality and needs of every patient. RDs offer effective leadership and training for the foodservice staff, and a more informed understanding of patients' needs and desires.

        First off, it is important to know what a food service manager actually does. This role extends through a lot of different careers, from fast food managing, catering businesses, and the big one, hospital foodservice. The food service manager is the person in charge of the entire operation as a whole. They oversee employees, develop the menu, and direct the process of ordering and receiving deliveries of food and equipment. They organize the schedule, do inspections to make sure the kitchen is working smoothly, conduct customer satisfaction surveys and education initiatives in the hospital; the list goes on and on. This sounds like the kind of job for someone with a management or human resources degree, so again, what does being a Dietitian have to do with all of this? 

        The first and most important reason is that Dietitians are trained to do this job! The Academy of Nutrition and Dietetics puts it this way: “Often RDNs… who work in the area of food service must juggle management roles with food planning, safety and recipe analysis, which requires a broad skillset”(Academy of Nutrition and Dietetics(AND), 2024). Most undergraduate Nutrition degrees include multiple classes and 15 or more credit hours of specific foodservice management courses. Students learn budgeting, employee management, menu development, and more. By the time students come to their Dietetic Internship, the accredited internship hours dietetic students undertake to qualify for their license, they have 9 weeks or more of food service experience, depending on their specific program. A significant portion of the accreditation exam for RDs is foodservice based and The Academy of Nutrition and Dietetics includes management of any retail food operation or hospital foodservice system in its official position paper(AND, 2024). RDs also, in the course of their education, take culinary specific classes, learning basic cooking techniques, presentation skills, and become certified foodservice managers. Because of this, RDs already understand the minutiae of what their foodservice employees do, which facilitates a better employer/employee relationship. It also makes RDs qualified to train employees on food safety, knife skills, or menu planning, because they understand food safety and kitchen operations through firsthand experience. That firsthand experience opens up avenues of management that would otherwise be overlooked or unknown to traditional managers. All of this comes together to shape professional Dietitians who are capable of managing foodservice operations. 

        RDs are not solely capable because of their foodservice training. An important aspect of hospital foodservice is the ability to understand and adapt to specific patients' needs. When in the hospital, every single patient could be on a completely different diet than the patient in the same room as them! They could have allergies, conditions that require specifications for preparation of their food, or simply are looking for an appetizing meal that fits into their hospital chosen diet order. This is where RDs have an advantage over traditional managers. RDs are experts in nutrition, and go through extensive clinical training in order to prepare for patient feeding scenarios. Thus, when it comes time to update or change the menu at the hospital, Dietitians can create meal options that not only fit into the diet orders specifications, but are foods patients actually want to eat. RDs understand the needs of specific patients, and can order and plan menu items that tailor to a patient who has an allergy, or is a newly diagnosed celiac patient or Type 2 Diabetic. When RDs make the menu, the nutrition information is accurate, the operation makes quality food that fits specific dietary needs, and the food is varied and interesting (not just the same old dishes over and over again). RDs are also trained in sustainability in foodservice operations, and can implement initiatives to make their kitchens more sustainable. 

        Lastly, RDs are able and effective educators, using the kitchen for more than just serving food. RDs as managers can create education programs about nutrition, showcase interesting and delicious dishes using specific inpatient diets, and more. As experts in nutrition, dieticians manage kitchens that are more sustainable, provide quality food to varied patients, and can educate employees and patients alike about healthy eating. The British Dietetic Association summarizes the role of an RD in foodservice, saying “Food service dietitians drive improvement through food and drink services that are good quality, safe, nutritionally adequate, patient-focused and represent good value for money”(British Dietetic Association, 2024). If the goal of hospital foodservice is patient satisfaction, quality food, and well-run operations, Dietitians as foodservice managers are the answer. There is no one better to manage a hospital kitchen, or any kitchen, than your friendly neighborhood nutrition expert, the RD.

Back to Basics: Navigating Nutrition's Ever-Changing Landscape

 Written by: Katherine Walcott; SLU Dietetic Intern

If you’re at all interested in nutrition (or frankly, if you’re at all on the Internet), you’ve seen your fair share of nutrition articles that seem, well, too good to be true… to put it nicely. As someone studying nutrition, I am constantly being sent these types of articles, such as “Study on Strawberries and Brain Health Bears Fruit”1 or “Sweet Discovery: Eating Chocolate Can Add Years to Your Life.”2 I am also constantly being asked my opinion on new shows or documentaries, such as Netflix’s “You Are What You Eat: A Twin Experiment”3 or “Live to 100: Secrets of the Blue Zones.”4 And while I hesitate to speak for anybody, I am fairly confident that I speak for most nutrition professionals when I say the answer is almost always, well, complicated. 

 

Which is frustrating, right?! Trust me, I get it. If I could give patients (and well-meaning family members who fill my inbox with these articles–if you’re reading this grandad I promise I read them) straightforward and simple answers, I would. But as a future dietitian, I know I’d be lying. So let’s dig in deeper, shall we? 

 

Let’s start with Netflix’s “You Are What You Eat: A Twin Experiment.”3 Let me start by saying that, overall, I really enjoyed the show. I agreed with many of its general premises, but it also left me with a lot of thoughts, which I will do my best to succinctly sum up for you. 

Cover art for Netflix’s “You Are What You Eat: A Twin Experiment” featuring 4 pairs of identical twins who enrolled in an 8-week study evaluating the effect of a vegan vs. omnivore diet on cholesterol, weight, and other nutrition-related measures.3 

 

When I first heard about the show and watched the trailer, I thought I was going to be watching a quick 4 episodes about an interesting nutrition research study. However, I quickly realized the show was about much more. While its central theme was the study, it expanded outside of the study to talk about issues of inequity in our food system, antibiotic use in farm animals, food safety measures in the meat industry, the food industry's role in marketing, emerging plant-based products on the market, and even how diet affects the sexual response. (I don’t think I’m alone when I say I was not expecting episode 2 to start off with the twins watching pornography in a research lab.)3 

 

After watching the series, I wanted to read the original study to see how it compared to the show. The study’s title is “Cardiometabolic effects of omnivorous vs vegan diets in identical twins a randomized clinical trial.”5 Like the show, let me start off by saying I enjoyed the read (nerdy, I know) and agreed with many of the points made in the introduction and discussion. However, I was shocked to find no mention of the word “exercise” or “physical activity” anywhere in the paper5 despite exercise playing a major role in the Netflix show.3 Since exercise is one factor that can affect cholesterol levels6 (the primary outcome of the study5), this surprised me.

Visual abstract for “Cardiometabolic effects of omnivorous vs vegan diets in identical twins a randomized clinical trial,” the study behind Netflix’s “You Are What You Eat: A Twin Experiment.”5 

 

I was also surprised to find that, in contrast to the documentary portraying the first 4 weeks as being strictly controlled through delivered meals,3 in the study participants were allowed to supplement these meals with snacks they purchased (though they did have to follow guidance from health educators).5 Another thing that seemed different to me from the show was that those on the vegan diet consumed 13-14% of their calories from protein while those on the omnivore diet consumed 20% of their calories from protein.5 To me, the show seemed to portray these diets as being equal in all but animal foods. (The show also hammered home that those on the vegan diet lost more muscle than those on the omnivore diet... I wonder why.3) 

 

What surprised me the most however, was the demographics of the twins, which I felt seemed very different from what was portrayed in the documentary. Of the 44 twins who participated in the study, 77.3% were female, the average age was 39.6 years, 95.5% had achieved at least a college level of education, 72.7% were white, and average BMI was 25.9 (considered to be on the borderline of healthy and overweight7–though I think we can all agree BMI is a flawed way to look at health). Additionally, the researchers excluded people with a number of characteristics from participating, including those with high cholesterol (specifically LDL-C ≥190 mg/dL for my nutrition nerds out there5,7); those with high blood pressure (systolic blood pressure ≥160 mmHg or diastolic ≥90 mmHg for my nerds3,8), those with diabetes, and those taking medications for diabetes, unhealthy lipid levels, high blood pressure, and even psychiatric disorders.5 

Now, before anyone says I’m poo-poo’ing the study, I’m not. Researchers can’t control everything participants do during studies, sometimes the participants they can get just don’t end up being that diverse, and often they have to exclude people with certain characteristics. I agree with their exclusions, but I do think it draws an interesting contrast to a documentary that to me seemed aimed at Americans with (or at risk of developing) diabetes, hypertension, and other diet-related diseases. 

 

As a scientific research article, the study itself was a great read, and as a Netflix nutrition documentary, the show was a great watch. However, every study and every show has its flaws, no matter how small they are. If we're not careful, we can forget that there is always nuance in nutrition because there are always differences among people. (Hence the irritating, seemingly never straightforward but nonetheless well-intentioned answers to your nutrition questions.) 

 

Speaking of studies and their flaws, remember the strawberry one I mentioned at the top? Let’s look at that one, shall we? I’m sure we will find no flaws or nuance whatsoever… right? 

 

Completely reliable, entirely unquestionable 8-word summary of a completely reliable, entirely unquestionable research study that is definitely not funded by the California Strawberry Commission.1,9 

 

The original article I was sent (shoutout to my grandfather who gave me fodder for this post) is titled “Study on Strawberries and Brain Health Bears Fruit.” After reading the article, you’d think that eating strawberries improves memory, reduces depression, and may reduce the risk of dementia.1 However, after reading the study, you’d think something else. (To be clear, I think regularly eating fruit–as well as vegetables, whole grains, nuts, seeds, fish, etc.–is beneficial for one’s health and will reduce one’s lifetime disease risk. What I take issue with is the implied promise that eating strawberries could prevent dementia.)  

 

Looking at the actual study itself, it enrolled 34 people with "complaints of mild cognitive decline" (very broad and subjective if I do say so myself) aged 50-65 with overweight BMIs and put them through a round of cognitive and mood tests. It then fed half of them 13 grams of strawberry powder a day for 12 weeks (what it claims is equal to 1 cup of fresh strawberries) and half of them a placebo powder before putting them through these same tests again. Interestingly, when we look at who was excluded from the study, anyone with an actual diagnosis of cognitive impairment or a psychiatric condition was excluded. (So too was anyone with diabetes, kidney disease, liver disease, or regular use of certain medications or dietary supplements.) Also interesting is that, at the end of the study (by which point most people have gotten bored and stopped reading–trust me, I get it), it says “This research was supported with funding and donation of strawberry and placebo powders by the California Strawberry Commission, Watsonville, California 95076, USA.” But under Conflicts of Interest it says “The authors report no conflict of interest.” … Are we sure about that? 

 

Anyways, now that I’ve given you my opinions on the Netflix documentary and dissected that study, what is my point? Well, I wanted to show how nutrition research and recommendations can often feel complicated, super specific, and all-or-nothing. As for why things are this way, well, documentaries have to be interesting to make money, and strawberries have to be marketed to get sold. This doesn’t make documentaries or strawberries bad, but it does create a world where you, the consumer of information, have to ask a few questions. Questions like, who is behind this recommendation, what are they saying, what are they not saying, do they have any motivation for saying this, and so on. It can be tiring, but it gets easier (and forming your own opinions is more fun anyways.) It does make you wonder though, why are nutrition recommendations always changing, and why do they always have to be so complicated? 

 

Well, they aren’t, and they don’t. 

 

Sure we’re still learning a lot about specific compounds in foods and specific diets, but overall nutrition recommendations have stayed pretty constant for decades.10 In the 1940s, Americans were encouraged to eat 7 categories of food, 3 of which were fruits and vegetables. In the 1950s to 1970s, this was simplified to 4-5 groups, one of which was fruits and vegetables. This stayed consistent through the 1980s, though the graphics improved (though they still leave much to be desired by today’s standards). In the 1990s, recommendations were made into a food pyramid, with 5-9 servings of fruits and vegetables being recommended daily, and in the 2000s the pyramid got a new look. (This one is personally my least favorite… if you were curious. I think it's too confusing, and not in the fun now-I-get-to-ask-more-questions way, but in the what-do-those-weird-colored-vertical-lines-mean way.) Finally in the 2010s we got MyPlate, the graphic used to educate people on what to eat today. While this graphic doesn't give specific servings11,12 (as servings differ for everyone13), it leaves no doubt that half of one's plate should be fruits and vegetables (and even more than half should come from plants).11,12 

USDA food guideline graphics over the years. Pictured from left to right: 1940s’ "A Guide to Good Eating," 1950s-1970s' "Food for Fitness, A Daily Food Guide," 1970s' "Hassle-Free Daily Food Guide," 1980s' "Food Wheel: A Pattern for Daily Food Choices," 1990s' "Food Guide Pyramid," 2000s' "MyPyramid," and 2010s' "MyPlate."11,12 

So why did I just give you that super fun, super interesting (don’t lie, you know you loved it) history lesson? Well, just to show that, despite the documentaries guilt-tripping us into believing there is no place for animal products in our diet or the industry-funded studies brainwashing us into believing their food is the best food for our brains, overall nutrition guidance has not changed much over the years. So if you’re lost amid the sea of seemingly never-ending, always-changing nutrition “research,” relax. The one thing the Netflix documentary, strawberry study, and 100 years of USDA guidelines have in common? They tell you to eat plants. 

 

… And if you’re still not satisfied with that answer, that’s what dietitians are for. Come talk to us. We’d love to have you. :)