Valuable Nutrition Education - Getting Tarnished?

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NutritionVista Global Dietetics Forum feels there is an urgent need to address this issue for developing countries such as India.

How can the industry curb this emerging problem?
Do we have a panel or body similar to the medical fraternity to monitor the quality of services being offered and take legal recourse against the offenders?
Should this be addressed in consumer forums since patient/clients health is of utmost importance?
Does IDA/ADA have the power vested in them to take action or should we get yet another body which can take action
Should there be legislation that mandates - that at a minimum only an RD can practice counseling?

References:
Beauman C, Cannon G et al. The principles, definition and dimensions of the nutrition science. Pub Health Nutrition, 8(6A), 695-698.

**“My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”

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05 October, 2012 | Ruchi Meena | Reply

i agree all of you, this system is used to be seen in only india, all private , govt. institutions, and even IHM's institutions are conducting certificate courses, the education system regarding dietetics is so flexible, In my point of view, The bachlor's degree and master's degree should be conduct in a IDA recognised institution /college likely as RD internship conduct in a IDA recognized hospital.....

31 May, 2012 | Seikh | Reply

Contrary to popular beelif, following certain diets can be harmful to your health. Doesn't everyone owe it to themselves to find a credible health professional, one that understands the body, can communicate with your doctor, understands the importance of test results, and can interpret what this all means for YOU as an individual? This is a great reminder to everyone about the importance of an "RD". Great blog post!

31 May, 2012 | Fabio | Reply

RZ,I think your standpoint is siaunlgr just as you think Tracie's is. You are basing yours on an organization you believe in, when she does not. From my relationship with Tracie, I think she would rather stand up for what she believes in than be licensed under and organzation that accepts sponsorships from those it should be fighting against. Should AA accept money from Budweiser?From a pure political standpoint, although you, or your future colleagues do not obviously advise people to drink Coca-Cola or eat Mars candy bars, it is a you scratch our back we scratch yours relationship. You can't be naive enough to think that these companies aren't benefiting from the relationship. They give the organization, that will license you in the future, money and in turn get a logo on eatright.org. Is this not a contradiction of beliefs? It should at least be a violation of your code of ethics. Tracie hit it on the head that is not about money but a freedom of choice. Look at all of the testimonials she has and all of the people she has helped. We should be able to seek nutrition advice from who we choose, not just those that are licensed by a national organization that does not have its priorities straight.

10 February, 2012 | Champagne | Reply

Karthik Dupakuntla January 12, 2010 This is a great place for SFDC cetiiftcarion information. Thanks for the links!I took the ADM 201 cetiiftcarion past week, have cleared it successfully.

11 October, 2011 | Sandy Pinkerton | Reply

I completely agree. If there was more education then less children would be battling Type 2 diabetes. It's important for parents and kids to stay updated when it comes to nutrition and exercise.

11 October, 2011 | Vijayalakshmi Iyengar | Reply

Dear Ms Pinkerton, yes we also do believe that quality education is required for dietitians to operate effectively, However in respect to increasing incidences of type 2 Diabetes in children, there is sufficient information out there for people to work towards preventing being overweight or Diabetes Type 2. Even familial diabetes or obesity can be delayed if a person (or the parents in the case of minor kids) takes care to eat and exercise right. The challenge is to resist fast, fried and processed foods as also eating larger portions and too much food, along with being sedentary in activity. A good life style and diet can positively help prevent or delay health problems.

09 October, 2010 | rao | Reply

I am M.Com PG. Want to do dietitian/ courses through Distance Edn. I have no mathes background after 10th. Am I eligible to do the same or any preeligibility couses are there to do this course. Please advise.

23 September, 2010 | Umayalamanchili | Reply

I agree all my friends statements. When unauthorised instutition giveing PGD, and all hospital will take all these type of dietitian and we have struggle a lot to train them as they would have entred the course with diffirent field even engreeing students are going into it, microbiology background or any background imagine how the quality of education will be.

19 September, 2010 | Padma.V | Reply

i do go with geetanjali point of giving different excahnge list. y dont we come up with STANDARDISATION OF DIET COUNSElLING.The senior dietitians can do some work on this and can come up with set procedures. This at the outset wil help patients rely on dietitians word and we and our profession gains more respect and recognition. To start with we can take diabetes as a conditon and come up with standard counselling points.

18 September, 2010 | Kanika Jain | Reply

There is report in Times of India Delhi edition (18\9\10) that says that health ministry of India is planning to introduce a common exit test for all MBBS students which they have to clear before they start practicing.Why can’t we have similar exit test for dietetic PG students too?
Also, revising syllabus and bringing uniformity in courses across universities might be a time consuming task which may take 3-4 years or more. But introducing an exit test is relatively easy task.

17 September, 2010 | Mrinal Jhangiani | Reply

So, my question for the day is - Is any group or body of dietitians doing anything about this problem.

Wishing the system changes will not make it happen.

Any concrete steps that might be a precursor to addressing the issue at hand.

13 September, 2010 | Mrinal | Reply

The two things that seem to stand out to me personally are -
1. Need for formal curriculum that is uniform, comprehensive, on par with international norms and demanding, culminating in a rigorous examination.

2.A six month mandatory internship at an accredited hospital facility - after which an RD exam may be taken. CME's are required on a regular basis to ensure QC and updated academic knowledge.

13 September, 2010 | Neelam Singh | Reply

Just like we have medical council of India (MCI) which undertakes various tasks including inspection\visitation with a view to maintain proper standard of medical education in India, giving permission to start new medical colleges and new courses including P.G. or higher courses, recognition and de-recognition, we should have dietetic council too which performs similar tasks for the field of nutrition. Else, it may be put under purview of MCI.

11 September, 2010 | Rahul Sharma | Reply

Disciplines like nutrition, physiotherapy, nursing should be treated at par with pure medical courses like MBBS and BDS (in terms of importance) by government bodies. Ultimately all of these professionals deal with a person’s life in one way or the other.

11 September, 2010 | Aanchal Sachdev | Reply

On one hand we have colleges and hospitals which conduct entrance examinations for PG courses in nutrition and dietetic internship respectively to maintain standards, on the other, there are private (unrecognized) institutes giving diplomas to make easy money. I think health education body should seriously look into this matter.

10 September, 2010 | Anastacia | Reply

I agree with the comments posted above.In Kenya there is no University (public/private) offering full Clinical Nutrition.The training is more community oriented and that has been a big problem when you have to work and give clinical expertise.
For the Universities i lecture on Clinical Nutrition,i am met with a lot of surprises and the students ask me where i trained Medicine.This brings us to the Question of"Are the dietitians capable of managing patients with multiple medical conditions if they do not understand how the body works"
Looking at the researches being done in Kenya they are based on anthropometry and KAPs yet as dietitians we should focus on in-Vitro topics too.When i researched on hypoglycaemia among renal patients and collected and analysed the blood glucose levels single handedly everyone was shocked"When i presented my PhD topic on "maternal hyperhomocysteinaemia"among university dons,everyone looked at me in shock!so where are we going in the 21st century? Who is to blame?
We should move from objective oriented researches to subjective.
As i train the online Renal Course at www.Anastacia College.Com,i get the same feeling.I use medical terminology but i am sorry most of registered students are practising but cannot relate well with the diagnosis/prognosis and this is quite serious.I tend to feel that most Dietitians are working hard to please doctors and not patients outcomes and in that we cannot get the recognition we deserve if you don't care about the outcome.So i urge my collegues who want recognition to enrol in clinical courses and get involved in workshops/conferences.Present papers,case studies and manage the patients confidently..
I don't see why we should not reverse the nephropathies, neuropathies,diabetes,hypertension,and many other conditions of todays world
We must stand up to the occassion and win the hearts of our communities because we tell them the truth that diseases are preventable and we give them the formulas.
he other day i was invited in a deep rural women's conference to talk about Nutrition together with an endocrinologist and an oncologist and because we have worked with them and they know my work they kept telling the participants to LISTEN CAREFUL TO THE NUTRITIONIST because she is the one holding the answers if we are to prevent and manage Diabetes,Cancers etc
So i urge each of you to firstly understand the profession/subject and get confidence and you will sail through.

13 September, 2010 | Geetanjali Kelkar | Reply

Hi Anastacia,

I agree with you. As far as nutrition research is concerned most of the hard core work is done by physiologists, biochemists, endocrinologists. Most of the dietitians restrict their work to KAP, anthropometry, or use of certain tools to assess nutritional adequacy. This may be either due to cost, lack of time or appropriate guidance in varied areas of nutrition. Some well known institutes of Nutrition offer extensive refresher courses only to MBBS or medical doctors. Certainly, dietitians may be restricted to only diet planning and counseling to patients. If we want to be in par with the doctors, the courses in physiology, biochemistry, endocrinology, research methodology and statistics must be advanced with recent research updates.

08 September, 2010 | Renuka | Reply

Syllabus of nutrition courses should be made uniform across all universities. It is quite evident from the discussion that courses are varying not only syllabus but internship component too. Also, it should be linked to industry needs

08 September, 2010 | Geetanjali Kelkar | Reply

Nutrition is an ever changing field. Standard safety precautions must be followed but new research and clinical experience broaden our knowledge, an alteration in treatment in accordance to drug therapy is most essential or appropriate.

11 September, 2010 | Sangeetha Narayana Swamy | Reply

I agree with you Geetanjali, there should be continuous updates given to practising dietitians through CME's either by senior dietitians or other memebers of the healthcare team. This will ensure the quality of the counseling given to the patient.

08 September, 2010 | Geetanjali Kelkar | Reply

In my opinion there is a need to develop uniform curriculum across the country. There is always a gap between what is taught in educational institutions and what is followed in Hospitals/ Health centers. It’s important to devise uniform exchange lists (each hospital has a different one some follow the 100Kcals/80 Kcals) develop guidelines, recommendations.

I agree with Smrithi that there are very few dietetics departments in hospitals that have RD and can guide student interns to prepare for the exams. Refreshers courses for dietitians should be conduced every two years to bridge the gap.

07 September, 2010 | Vijayalakshmi | Reply

Harsha I agree with you but we as dietitians should raise the bar.We need to read more, research more and work cohesively on projects... show doctors we are a force to reckon with. Respect has to be earned, not asked and not by one or two individuals but everybody ...as a professional whole. We have to show the doctors who we work with, that we are capable.That is why we should encourage more and more CDE programs(continual dietetic education programs) and participate in more conferences etc.

07 September, 2010 | Smrithi Kashyap | Reply

I think the norms for doing an RD exam should also change...The parameters for doing the exam is so stringent that many good dietitians who are capable cannot write the exams. The criteria has to be more flexible, not be so rigid. Especially as the facilities to work under an RD in a multi-speciality 150 bedded hospital is not easy for every body. So what is the next option they have?

18 September, 2010 | Mrinal Jhangiani | Reply

Smrithi,
When it comes to providing healthcare and dietary counseling that could seriously impact a patients health outcome, there needs to be very simple yet clear cut guidelines on what protocol to follow, and whether a dietitian is educated enough to provide the best care based on set protocol.

Would you go for medical treatment to a person who 'says' he has studied medicine but hasn't appeared for his MBBS exam. You don't have to answer this question, as its a no brainer.

We are not talking about riding a bicycle or writing a paper here. The reason an RD exam is stringent and demanding is that it provides an assurance to a patient that this dietitian knows what best protocol to follow, what advice to give and follow up with.

Lets think for a moment on how else one would evaluate your abilities other then your claiming you are good at your work. People make claims all the time.

What perhaps needs to change are the following - The prerequisites to sit for the exam, or the requirements to even file an application to sit for the exam, more frequent RD exams, simpler application process, etc.

Having talked to a lot of applicants who I have interviewed or worked with - the issue that bothers a lot of them is the arbitrary way applications for doing the RD exam are managed and processed by the IDA. The system seems to be very politicized and this must change.

Dietetic students must be encouraged and nurtured and guided along to successfully complete the RD exam.

Having said this, students have the duty to prepare and meet prerequisites and PASS the exam before practicing dietary consultations. They must respect the system, the exam and the IDA.

I will talk about both sides of the issue further. The system needs to be simple yet fair to all involved - the patient - the dietetic student - the IDA leadership and the profession.

After all the reputation of the entire industry is at stake.

23 September, 2010 | Divya R. Sanglikar | Reply

Mam, I am totally agree with you. Why they can not make RD exam as a part of your curriculum. They must give us registration no as MBBS doctor get. What is the need for giving exam separately.

23 September, 2010 | Mrinal | Reply

Divya,
Just as with any graduate academic program - there is a need to add in a fairly extended training and work experience break which is very important for the student to partake. What you learn at the undergraduate level can then be applied, learned and assimilated so that all that has been learned is reinforced in real practice.
After an adequate period of training, the student can then move on to a graduate program which is then capped off by the RD exam.

I dont agree with the philosophy that the RD exam must be taken as the graduate program is ending as a key component of the RD exam is practical experience.
Students must complete the MSc program from an accredited University spend at least 6 months to a year in formal internship at a hospital setting and then file a simple application - sit for the exam and be given results that are fair and effortless.
The exam must be uniformly given in different regions of the country and accessible for all.
This is my objective take - as I am looking at things from a non dietitians perspective - yet understanding that the health circumstances across the world call for large numbers of trained dietitians to deal with the issues of obesity, CVD and diabetes.

18 September, 2010 | Shilpa | Reply

Dear Smrithi,

I agree with you, coz am a dietitian with 2 years experience working in a multi speciality hospital. As I am the only dietitian handling the hospital, am not eligible to write the exam.

I feel the norms should be relaxed for working dietitians who want to take up the RD exam. A post graduate with more than 2-3 years of experience working in any hospital either in the team or independently should be allowed to take the exam.

07 September, 2010 | Mrinal Jhangiani | Reply

Hi Smrithi,
The minute you compromise on the caliber and type of questions asked - you compromise on the level of expertise and knowledge required to make an effective dietitian.
I strongly believe - we should look at the criteria that has been set by the American Dietetic Association, the types of questions on the UK, Europe, US RD exam papers - also perhaps Anastacia Wanjiku Kariuki of Kenya can help advise what exams they follow in her region and then assess where the Indian exams are falling short or are overly tough.

Perhaps you can elaborate by giving examples of why you believe the exams are too stringent.

07 September, 2010 | Smrithi Kashyap | Reply

Hi Mrinal
I was not referring to the exam being tough, in fact I agree it should be stringent to ensure only dietitians of high calibre can qualify.I am referring to stringent criteria for even sitting for the exam. As I mentioned earlier they insist on Two years of experience as a full time dietitian in a multi-specialty hospital of minimum 150 beds or Six months internship (after completion of qualifying examination) in a multi-specialty hospital recognized by IDA for internship & supervised by a Registered Dietitian (RD) or a senior dietitian with at least 10 years experience. Now availability of such jobs itself is few and far between and many do not take freshers. That`s why many hospitals do not have RD`S .

07 September, 2010 | Mrinal Jhangiani | Reply

Thanks Smriti,
As I am not a dietitian I appreciate your clarifying some of these points.

Looking at the mandated requirements objectively, perhaps there is room for review and suggestions to the deciding bodies involved.

I am sure there are many within the IDA who would like things to get refreshed and updated - after all India is progressing and we are in the 21st century.

May I ask you and other dietitians from our team what in your opinion would be the most sensible requirements for young women to sit for this qualifying exam.

It is only with dialogue that perhaps what the industry wants and needs to address will get debated. This is the first step.
Thanks,

07 September, 2010 | Harsha | Reply

Nutritionists need to be treated not as supporting hand of doctors but a team member. Only then things would improve.

07 September, 2010 | Rajul | Reply

There is a need to change mindset of health care authorities and professionals as well as people too. Until and unless they take nutrition as a discipline seriously these things are bound to happen. Do we ever see MBBS or BDS being offered through correspondence? Never

11 September, 2010 | Sangeetha Narayana Swamy | Reply

This is exactly what we are trying to put across. We should always ensure the quality of the knowledge acquired by the dietitian. This is utmost important because she is directly involved in handling the health of an individual.

06 September, 2010 | Yamini | Reply

Hi Deepti,
I agree with you. In fact, one of the popular distance education learning university in India is offering a post graduate course in nutrition. It has minimum eligibility criteria of B.Sc (home science) but those who have not done graduation in this stream can do diploma course from same university and then get enrolled for PG programme for nutrition. Though people do get to do M.Sc this way but they lack understanding of basic concepts that were being taught during B.Sc home science.So ultimately, they do face problem later while doing PG.So Its better to keep eligibility criteria keeping in mind what basic understanding is required for pursuing course.

06 September, 2010 | Deepti | Reply

What about raising \changing minimum eligibility requirement for enrolling in nutrition courses offered by private institutes? If the concerned authorities are not able to put a curb on growing number of institutes at least they can monitor what is the eligibility requirement and can have a say in it.

06 September, 2010 | Lovina | Reply

Internship should be made compulsory even for the people who are doing nutrition courses thorough correspondence.

07 September, 2010 | Rita | Reply

I don't think correspondence courses can do justice to the subject.

23 September, 2010 | Mrinal | Reply

The issue I have with correspondence courses is the following:
They are top to bottom a for profit enterprise - with the sole intent of enrolling maximum number of students that pay hefty tuitions.

The question one needs to ask is which curriculum are these long distance courses following, is it an authorized curriculum - one that is accredited by any respected nutrition body - IDA, NIN, NSI, etc or a leading university?

How can a student that graduates from these courses claim that she is for eg. equally qualified to manage a diabetic patient as is a dietitian with an MSc and years of experience. This is not a joke, patients lives are at stake here!

Anyone, including some well known non dietetic personalities lay claim to being the authority on nutrition and diet when they aren't qualified - But the media fawns over them as though each word is gospel.

This kind of self appointment must stop.
Anyone who is not educated in the field of dietetics and nutrition - cannot claim to be an authority just because they are famous and want to call themselves one.

For decades very hard working dietitians have studied and dedicated their lives to the cause of nutrition and ensuring patients get the best advise possible.

The last few years has seen the entry of lots of individuals and companies who do not care for the future and respect of this industry but are purely in it for profiteering.

Something has to give.

07 September, 2010 | Sangeetha Narayana Swamy | Reply

Correspondence courses should mainly concentrate on supplementing the already acquired knowledge. If they have courses that teach a subject from scratch then they should provide practical training and internships that will enhance the working knowledge and eligibility of the pupil. These practical training and knowledge should not be a 2-3 week program, they should be at least be a 6-8 month program. The point is what a person learns for five years can't be stuffed into another person's brain in just 10 days contact program.

26 September, 2010 | Mini Shankar | Reply

Rightly said Minal. I hate it when I see these `cosmetic' Nutritionists come in the news and act like experts on nutrition. All they know is how to handle weight loss, that too incorrectly.

If I were to throw a question to them like-whats the diet for a burn patient with 30% burns or for a person with 50% kidney failure or for someone with HIV infection they will see stars.

I view them as quacks and its sad that the media encourages them. Many noted quacks in this field hail from Mumbai including the lady who claims to be responsible for a certain dress size.

27 September, 2010 | Mini Shankar | Reply

Would request Minal to make use of Dr Mrs Kamala, who is on NutritionVista panel. Such an eminent nutritionist who is well connected in the right circles may be able to help. I cant for the life of me understand why the IDA doesnt undergo a revamp. Just check their guidelines for becoming a member, there is no guideline. Just pay the fee and become a member.

11 October, 2010 | Mrinal | Reply

We were waiting for Dr Krishnaswamy's response and acceptance of our invitation.

She has graciously accepted and we are honored to have her share her opinion on these important issues.

06 September, 2010 | Rashmi | Reply

There is gap between what many universities are offering and what the industry need is. Just like other medical courses syllabus for nutrition should be updated from time to time and there should be a bigger component for practical implementation apart from theory part.

06 September, 2010 | Vijayalakshmi | Reply

The Board of Studies of departments in colleges decide on the syllabi. Is there a disconnect between the University norms and industry need? If HOD`s of Department of Nutrition & Dietetics of different college convene to take an united stand on the need for intern ships and from then on the University Senate takes the lead and negotiates with the Medical council and Convener of Hospital Management services,it can definitely lead to a synergy.

06 September, 2010 | Savita | Reply

Internship should be made compulsory for all the Nutrition students at least at post graduate level. One can see discrepancies even in the duration of internship that students have to undergo as part of their master’s programme in various universities.

06 September, 2010 | Poonam | Reply

1)The IDA should have a list of recognised universities and courses. Only students from these courses should be eligible for practising and counselling.
2)The list of recognised hospitals for internship needs to be increased. There are so many cities, even large cities which are missing from the list.If more cities have hospitals for internship greater number of students are likely to take the RD exam, which will automatically improve the quality of services.

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