Dietitian or nutritionist?

​Just what IS the difference between a dietitian and a nutritionist? This is a very common question that I and other nutrition professionals get asked on a near-daily basis.
 
Every square is a rectangle, but not all rectangles are squares. Similarly, every dietitian is also a nutritionist, but not all nutritionists are dietitians.

​But what is the difference between the two, and is one really better than the other?

Let's explore 5 big areas where I think there is a difference between the two, and where it actually matters.

​1. Rebates
Officially, the main difference is that, “only a dietitian (with an accreditation from the Dietitians Association of Australia) is qualified to provide medical nutrition therapy or clinical nutrition consultations in either an individual or group setting (1).” Medical nutrition therapy is defined as “prescribing nutrition care in a hospital or private practice.”
 
In practical terms, this basically means that you can be rebated for consultations with an accredited practising dietitian (APD, which is the equivalent to a registered dietitian or RD in the USA). 

Dietitians (APDs) are recognised by Medicare. This means people who have seen a dietitian may be eligible for a Medicare, Department of Veterans’ Affairs, Workcover or private health fund rebate on services. Individuals may also be eligible for a Enhanced Primary Care Plan (EPC) with rebates for up to 5 sessions a year with a Dietitian (or 20 sessions a year on an Eating Disorder Management Plan, or EDMP). Both of these types of care plan are coordinated by your GP.

Nutritionists (unless they are APDs - queue the square and rectangle thing) are not able to register with Medicare and are therefore not eligible for any of the related rebates. Rebates may be available through private health insurance funds.
 
Private health insurance funds will often rebate sessions with an APD (depending on your level of cover), but not always sessions with a nutritionist – unless they are a naturopath, which some private health funds will cover. Check with your health fund for specifications.
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2. Qualifications
So why aren’t all nutritionists covered by Medicare and private health funds, when dietitians are covered? The reason for this might be that nutritionists as a profession are not regulated in Australia. This means that theoretically anyone can call them selves a nutritionist, even if the only training they’ve done is a 2-day online health coach course (or no training at all). I feel this is unfortunate for the many excellent nutritionists who do have tertiary qualifications and practice evidence-based medicine.
 
During my masters degree (aka. dietitian school) I was told that nutritionists can give advice on general healthy eating and disease prevention, but they can’t treat people who already have disease. That dietitians counsel on both preventative health and also use food to treat people for conditions such as diabetes, food allergies, cancers, and gastro-intestinal diseases.

This sends some nutritionists crazy!
 
It's just not as black and white as "dietitians can advise on healthy eating to prevent disease AND treat disease with food, but nutritionists can only advise on healthy eating for disease prevention."

​Many nutritionists have received a high level of tertiary training, usually a three-year bachelors degree. Iin my opinion many of these tertiary qualified nutritionists are indeed equipped to deliver evidence-based care, which may include management of chronic disease, especially if they've had significant clinical experience in a specialty area since completing their studies. But not all of them have received this level of education, whereas all dietitians have done at least four years of university (and in some cases, many more).
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3. Disordered eating
One area where I think dietitians do have an advantage over nutritionists is in the field of eating disorder (ED) treatment. As a student dietitian I had more exposure to patients with clinical eating disorders in the hospital system than your average nutritionist student who is confined to the community clinic of a natural medicine college (where many nutritionists complete their studies). I also think special training for eating disorder treatment is more generally accessible for accredited dietitians than it is for nutritionists once we graduate.

I believe the realms of natural medicine and functional nutrition have a bit of a blind spot when it comes to certain disordered eating patterns, like orthorexia which is often reaffirmed and applauded as simply "healthy eating" by some natural health practitioners who haven't been trained to identify this destructive form of disordered eating (or who are even experiencing it themselves). Obviously, this can muddy the waters of ED treatment.

Of course this can happen with dietitians too, but as a naturopath in-training I see it is a real problem amongst natural health practitioners who receive very little education on how to identify and manage patients with disordered eating, which is so very common.
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4. Philosophy
There is a consensus that the two professions draw on drastically different philosophies. Dietitians are usually seen as being conventional practitioners who administer food pyramid-based diet plans and hand out Sustagen in hospitals like its going out of fashion. Nutritionists may be perceived as drawing on a more holistic approach that takes into account the whole person – mind, body and spirit.

Again, it’s not as clear-cut as that!

There are an increasing number of dietitians practising integrative and functional medicine. Their core philosophy centres around a holistic, personalised approach to health and healing. These practitioners are also known as Holistic Dietitians, Integrative Dietitians, Functional Dietitians, or Real Food Dietitians. Some of them use the word 'nutritionist' in place of dietitian even if they are APDs.

Integrative dietitians draw on a variety of evidence-based nutrition therapies including whole foods, tailored supplements, and mind body modalities in clinical practice. Nutritionists (or nutritional medicine practitioners) who have completed a three-year bachelors degree also integrate these modalities and are thus often seen as “more holistic” than dietitians.

 
5. Clinical experience
The type and volume of clinical experience is an area where dietitians and tertiary-educated nutritionists may differ drastically (even when leaving out the 2-day online course qualified "nutritionists").

Since many dietitians end up being positioned in public health fields, that’s where they spend a lot of practicum time during their degrees. As a student dietitian I was required to fulfil 20 full time weeks of unpaid work, or 800 hours or 5 months of free work. Some dietetic internships require even more - its 1200 hours for RDs (dietitians in the USA).

Not only did we have to fulfil all those hours of practicum, we were also required to work in a variety of settings. I spent time working with newly arrived Burmese and Sudanese migrants, teaching them in a community garden and running cooking classes for them (an awesome rotation that I loved, although I expect they learnt far less from me than I did from them.)

​I completed busy rotations at three public hospitals where I was exposed to patients with a huge range of challenging conditions in areas like paediatrics, mental illness, cancer, eating disorders, and palliative care. I worked with people from a wide range of socioeconomic backgrounds, cultures, and ages.

Even though my hospital rotations cemented my desire to not work in the public health system, they gave me a huge amount of insight into how the system works (or doesn’t work), its strengths and weaknesses, and some much needed perspective on what it’s like to work with people suffering from some pretty serious health conditions. Most eye-opening for me was realising the huge social challenges faced by people coming from marginalised populations such as Indigenous Australians and newly arrived migrants.

Working with these populations taught me a great deal about real life issues for a majority of people. I learnt counselling skills for people in delusional states and for migrants who just days before had said goodbye to their families knowing they would never see them again. I worked with everyone from high-flying CEOs going in for emergency heart surgery, to homeless people who would never be able to access a private practitioner in a million years.

Nutritionists on the other hand don’t fulfil the same scope of clinical practicum. I’m currently completing nutritional medicine studies as part of my naturopathy degree and as fantastic and evidence-based as the course content is, the only practical experience we get is in the college’s student clinic. Here, exposure to a range of patients and conditions is sporadic and incomparable to that in my dietitian degree.

The total number of hours of clinical experience acquired by a nutritionist prior to graduation (at the college I'm attending for naturopathy studies) is about a quarter of that required of student dietitians in the masters degree I completed in 2011. Also, since nutritionists tend to work in holistic health centres or private practice, their exposure to patients is less likely to include those from under-privileged backgrounds, or those in acute care for say eating disorders or cancer.

I’m eternally grateful for my time working in population health, in community gardens, hospitals and nursing homes. I feel it made me a more well-rounded practitioner, and that has carried over into my current work as a private practice dietitian.

 
So which is better – dietitian or nutritionist?
Personally I think it all comes down to choosing someone you resonate with who knows what they’re talking about. Do your homework on their qualifications, level of experience, and areas of expertise.

If you meet a nutritionist who you vibe with, has tertiary level training in nutrition, practises evidence-based medicine, and specialises in the area of health relevant to you, then they may be a fantastic match for you. The only drawback is that you cannot receive Medicare rebates for sessions with a nutritionist.

If on the other hand you want a guaranteed rebate either through Medicare, DVA or your health fund,  then seeing a dietitian (specifically an APD) may be for you. Ditto if you are struggling with disordered eating and wish to go on an Eating Disorder Management Plan and/or see someone who specialises in that field.

It still pays to do your homework to ensure you'll vibe with the practitioner and also that they have the knowledge and tools to help you. For example, if you want a holistic dietitian who practises evidence-based medicine, be sure you specifically seek this out.


About our practitioners 
Here at Funky Forest Health & Wellbeing we have both types of nutrition practitioner! So you get to choose the right person according to your needs.

Casey Conroy is an Accredited Practising Dietitian specialising in disordered eating, and a holistic nutritionist. She is currently completing a naturopathy degree, which incorporates holistic, evidence-based nutritional medicine.

Andreas Kuhn is a naturopath, nutritionist and herbalist with training in evidence-based nutritional medicine. He is also qualified to prescribe individualised herbal medicines.

1. Nutrition Australia - http://www.nutritionaustralia.org/national/nutritionist-or-dietitian-which-me