Letters to the Editor
Registered Dietitian Nutritionists Should Be Included in Patient Health Care Teams
Am Fam Physician. 2019 Feb 1;99(3):142-143.
Original Article: Diets for Health: Goals and Guidelines
Issue Date: June 1, 2018
See additional reader comments at: https://www.aafp.org/afp/2018/0601/p721.html
To the Editor: I was surprised and disappointed to see that, except in passing, the critical role of registered dietitian nutritionists (RDNs) as an integral part of a patient's health care team—and as a valuable partner for any family physician—was not explored in the article, and that the Academy of Nutrition and Dietetics was not listed as a patient resource in Table 6. It is well within the RDN's scope of practice to provide education and counseling for all of the barriers to a healthy diet noted in Table 5.
Medical nutrition therapy provided by a qualified professional such as an RDN is linked to improved clinical outcomes and reduced costs related to physician time, medication use, and hospital admissions for persons with obesity, diabetes mellitus, disorders of lipid metabolism, and other chronic diseases.1
Patients correctly view physicians as a trusted source of information and treatment; physicians should determine the nutrition and obesity prevention and treatment messages they have the time and skill to provide to their patients. However, there is an important difference between advising patients on the basics and the in-depth counseling provided by an RDN who has the knowledge and skills needed to help individuals make changes that can affect outcomes. Referring patients to RDNs “could be one of the most important ways that health care professionals help patients learn about, implement and sustain behavior changes.”2
The Academy of Nutrition and Dietetics maintains a national, searchable online referral service enabling consumers and clinicians to locate an RDN in their area (https://www.eatright.org/find-an-expert). It also offers a free continuing medical education–accredited webinar on how RDNs add value to physicians' practices (https://www.eatrightstore.org/product-type/webinars-and-presentations/primary-care-plus-how-a-registered-dietitian-nutritionist-adds-value-to-your-practice).
Author disclosure: No relevant financial affiliations.
1. Academy of Nutrition and Dietetics. Medical nutrition therapy (MNT) systematic review (2009). https://www.andeal.org/topic.cfm?cat=3949. Accessed July 9, 2018.
2. Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: training doctors for prevention-oriented care. June 23, 2014. https://bipartisanpolicy.org/library/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention [registration required]. Accessed July 9, 2018.
In Reply: Thank you for sharing your insight and this excellent resource. Educating physicians about the composition of a healthy diet is an important first step; however, the next and perhaps more important step is to help patients change behavior. Helping patients make lifestyle changes— and dietary change in particular—is a challenging task that does not fit well into a short office visit with competing demands. One of the best ways to do this is through a team-based care approach. Although not available in some practices, dietitians have a critical role. Many patients need much more than an overview of dietary recommendations. Dietitians are often the most highly qualified member of the team to help patients take the next step in making actual dietary change. A number of studies have shown the benefit of adding a dietitian team member.1,2
Physicians have an opportunity to advocate for expanded coverage of dietitian services for their patients. They also can consider creative ways to involve dietitian expertise in the office setting. Dietitians can provide medical nutrition therapy, assist in coaching patients, join in shared medical appointments, provide cooking demonstrations, and in some cases teach cooking classes to patients. If the U.S. health care system is successful in transitioning to a value-based system, services such as these will likely be highly sought after because they have the potential to make a substantial impact on disease prevention and treatment.
Although this short article was about the specifics of diet and not about treatment, implementation of diet change is an important topic. Physicians will be unable to dramatically change the lifestyles of our populations alone. We will need to work with many professions, including dietitians, to achieve this monumental task.
Author disclosure: No relevant financial affiliations.
1. Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5–13.
2. Wolf AM, Conaway MR, Crowther JQ, et al.; Improving Control with Activity and Nutrition (ICAN) Study. Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study. Diabetes Care. 2004;27(7):1570–1576.
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