Dietitians and nutritionists plan nutrition programs and supervise the preparation and serving of meals. Dieticians help prevent and treat illnesses by promoting healthy eating habits, scientifically evaluating clients' diets and suggesting diet modifications, such as less salt for those with high blood pressure or reduced fat and sugar intake for those who are overweight. Dietitians also run food service systems for institutions such as hospitals and schools, promote sound eating habits through education and conduct research.

Clinical dietitians provide nutritional services for patients in institutions such as hospitals and nursing homes. They assess patients' nutritional needs, develop and implement nutrition programs, and evaluate and report the results. They also confer with doctors and other health care professionals in order to coordinate medical and nutritional needs. Some clinical dietitians specialize in the management of overweight patients, care of the critically ill, or care of renal (kidney) and diabetic patients. In addition, clinical dietitians in nursing homes or small hospitals may also manage the food service department.

Community dietitians counsel individuals and groups on nutritional practices designed to prevent disease and promote good health. Working in such places as public health clinics, home health agencies, and health maintenance organizations, they evaluate individual needs, develop nutritional care plans, and instruct individuals and their families. Dietitians working in home health agencies may provide instruction on grocery shopping and food preparation to the elderly, or patients with AIDS, cancer, or diabetes. Popular interest in nutrition has led to opportunities in food manufacturing, advertising and marketing, in which dietitians analyze foods, prepare literature for distribution or report on issues such as the nutritional content of recipes, dietary fiber or vitamin supplements (see also food scientist under Agricultural Science).

Management dietitians oversee large-scale meal planning and preparation in such places as health care facilities, company cafeterias, prisons and schools. They hire, train and direct other dietitians, dietetic technicians and food service workers; budget for and purchase food, equipment and supplies; enforce sanitary and safety regulations; and prepare records and reports (see also food service manager under Culinary Arts/Food Service Technology).

Consultant dietitians work under contract with health care facilities or in their own private practice. They perform nutrition screening for their clients, and offer advice on diet-related concerns such as weight loss or cholesterol reduction. Some work for wellness programs, sports teams, supermarkets and other nutrition-related businesses. They may consult with food service managers, providing expertise in sanitation, safety procedures, budgeting and planning.

Dietetic technicians assist dieticians in planning and preparing food for special diets, usually in hospitals, nursing homes and other healthcare facilities (see also Culinary Arts/Food Service Technology).

 

Institutional dietitians, nutritionists and dietetic technicians spend much of their time in clean, well-lighted and well-ventilated areas. Most hospital and institutional kitchens have modern equipment, convenient work areas and air-conditioning; but in older institutions, the kitchens often are not as well equipped. Some dietitians and technicians spend time in hot, steamy kitchens. They may be on their feet for most of the workday. Job hazards include slips and falls, cuts and burns, but injuries are seldom serious.

Some dietitians work in comfortable offices. Self-employed dietitians may work from a home office. Some dietitians may travel between client locations throughout the day.

Most dietitians and technicians work a regular 40-hour week, although work hours in hospitals, nursing homes and other "around-the-clock" institutions includes early mornings, late evenings, holidays, and weekends, while hours in factory and school cafeterias may be more regular. Many dietitians and dietetic technicians work part-time.

 

Patient care professionals must be sympathetic, patient and caring. They need a calm temperament and emotional stability to cope with human suffering, emergencies and other stresses, as well as excellent interpersonal skills and a cheerful disposition. They must be responsible, alert, observant and able to work as part of a team.

Managers must be able to solve problems and concentrate on details. Self-discipline, initiative and leadership ability are essential. They need good communication skills to deal with medical staff and suppliers, as well as to motivate and direct their subordinates.

Dieticians who formulate recipes and prepare food should possess a keen sense of taste and smell. Creative culinary skills in addition to scientific aptitude are a plus. Food service management can be demanding, so good health and stamina are important. Meticulous personal hygiene and a fanatical regard for cleanliness and safety are a must for all kitchen and healthcare workers. Most States require health certificates indicating food-handling workers are free from communicable diseases.

 

The basic educational requirement for dietitians and nutritionists is a bachelor's degree with a major in dietetics, foods and nutrition, food service systems management or a related area. Students take courses in foods, nutrition, institution management, chemistry, biology, microbiology and physiology. Other suggested courses include business, mathematics, statistics, computer science, psychology, sociology and economics.

Of the 40 States having laws governing dietetics, 27 require licensure, 12 require certification, and 1 requires registration. The Commission on Dietetic Registration of the American Dietetic Association (ADA) awards the Registered Dietitian credential to those who pass a certification exam after completing their academic education and supervised experience.

As of 1997, there were 231 ADA-approved bachelor's degree programs. Supervised practice experience can be acquired in two ways. There are 49 ADA-accredited coordinated programs combining academic and supervised practice experience in a 4-year program. The second option requires completion of 900 hours of supervised practice experience, either in one of the 190 ADA-accredited internships or in one of the 64 ADA-approved preprofessional practice programs. Internships and preprofessional practice programs may be full-time programs lasting 9 to 12 months, or part-time programs lasting 2 years. Students interested in research, advanced clinical positions, or public health should get a graduate degree.

Dietetic technicians require at least a high school diploma or its equivalent. Recommended high school courses include biology, chemistry, mathematics, health and home economics. Many high schools offer Career and Technology programs that prepare students for entry-level jobs, and community colleges offer associate and certificate programs in dietetic technology. Most dietetic technicians also receive extensive on-the-job training.

Although curricula may vary, students usually spend most of their time learning to interview patients, and prepare and serve food through actual practice. Training programs often include courses in menu planning, determination of portion size, food cost control, purchasing food supplies in quantity, selection and storage of food, and use of leftover food to minimize waste. Students also learn sanitation and public health rules for handling food. Training in supervisory and management skills are sometimes emphasized in courses offered by private vocational schools and university programs.

 

Experienced dietitians may advance to assistant, associate or director of a dietetic department, or become self-employed. Some dietitians specialize in areas such as renal or pediatric dietetics. Others may leave the occupation to become sales representatives for equipment or food manufacturers.

Dietetic technicians usually advance with additional education. They may become dietitians, nurses, chefs or kitchen supervisors.

 

According to a Hay Group survey of acute care hospitals, the median annual base salary of full-time staff dietitians was $34,400 in January 1997. The middle 50 percent earned between $31,300 and $37,200.

According to the American Dietetic Association, median annual income for registered dietitians in 1995 varied by practice area as follows: clinical nutrition, $34,131; food and nutrition management, $42,964; community nutrition, $33,902; consultation and business, $43,374; and education and research, $42,784. Salaries also vary by years in practice, educational level, geographic region and size of community.

 

Dietitians and nutritionists held about 58,000 jobs in 1996. Over half were in hospitals, nursing homes, or offices and clinics of physicians.

State and local governments provided about 1 job in 6—mostly in health departments and other public health related areas. Other jobs were in restaurants, social service agencies, residential care facilities, diet workshops, physical fitness facilities, school systems, colleges and universities and the Federal Government—mostly in the Department of Veterans Affairs. Others were employed by firms that provide food services on contract to such facilities as colleges and universities, airlines and company cafeterias. Some dietitians were self-employed, working as consultants to facilities such as hospitals and nursing homes, and seeing individual clients.

Employment of dietitians is expected to grow about as fast as the average for all occupations through the year 2006 due to increased emphasis on the prevention of disease by improved health habits. A growing and aging population will increase demand for meals and nutritional counseling in nursing homes, schools, prisons, community health programs and home health care agencies. Public interest in nutrition and the emphasis on health education and prudent lifestyles will also spur demand. Besides employment growth, job openings will also result from the need to replace experienced workers who leave the occupation.

Employment of dietitians in hospitals is expected to decline because of anticipated slow growth in the number of inpatients, and as hospitals contract out food service operations. On the other hand, faster than average growth in employment is expected in nursing homes as the number of elderly people rises sharply, in contract providers of food services, in residential care facilities, in offices and clinics of physicians, and in other social services.

Employment growth for dietitians and nutritionists may be somewhat constrained by some employers substituting other workers such as nurses, health educators, food service managers and dietetic technicians. Growth would be faster but there are limitations on insurance reimbursement for dietetic services.