My RD-iversary!

anniversary

One year ago on March 2nd, I passed my RD exam and became a registered dietitian. It’s amazing to think of how much has changed since then in my professional life. I’m still working at the Large County Health Department, but in a different position. Now, instead of counseling clients one-on-one, I’m more involved in public health and policy approaches to population-wide problems. I feel very lucky to have this job. For one, I’m employed at a health department where the Director believes wholeheartedly in the utility of broad approaches as the best way to create a healthier populace. I have wonderful, creative coworkers who support me in the work that I love doing. I have a boss who believes in me, who is flexible, and who appreciates my work. And – I started a blog! If this is year one of my RD career, I’m definitely looking forward to what year 2 has to offer!

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Why I’m not a Member of the Academy

Well, I guess there’s no better way to kick off this baby blog than with an extremely controversial post. I want to write a little bit about why I am not a member of the Academy of Nutrition and Dietetics (also known as the Academy or the AND). I know that I may not make very many friends with this post, but it is something that is important to me. I am passionate about what I do and I want the best for members of my profession and for our clients.

Ostensibly, the Academy represents and advocates for credentialed nutrition professionals – Registered Dietitians (RDs) / Registered Dietitian Nutritionists (RDNs)* and Dietetic Technicians, Registered (DTRs). As their website states, they are “committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.” They offer nutrition information to the public on a variety of topics from men’s health to food safety. To their members, they offer several perks – free or discounted access to publications, competitive pricing to attend the Food and Nutrition Conference Expo or FNCE (a yearly gathering of nutrition professionals and representatives from the food industry), free or discounted continuing education units – required for recertification as an RD/RDN – and more. They also list your name on their website under the “Find A Registered Dietitian” tab, thus making you more visible to potential clients. All of these benefits seem great, right?
*The RD and RDN credentials mean the same thing. At about the same time that the Academy became “The Academy,” rather than its former moniker of the American Dietetic Association, they also started transitioning the phrasing of the RD credential to reflect the more standard title of “nutritionist” rather than just “dietitian.”

The problem, for me, is that the Academy has WAY too many ties to Big Food. These are the companies that we in the nutrition world see as dominating the U.S. junk food market – and, in many cases, the global market as well. Michele Simon has published an in-depth report on the issue.

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Simon is a public health attorney who has long been raising concerns about the food industry’s influence on nutrition. Her report highlights the (very) cozy relationship between the Academy and food companies. Here are just a few examples:

  • The Academy of Nutrition and Dietetics accepts funding from many of the companies whose products it should, in any sane world, recommend against. Here’s a list of some of their current sponsors. These sponsors also have “[the] right to co-create, co-brand an Academy-themed informational consumer campaign,” meaning that they can create marketing material for consumers that promotes their product and put the AND stamp on it.
  • Many of the approved providers of continuing education to RDs are food companies. Here’s the current list. Note a few of my favorites: the Coca-Cola Company, PepsiCo Nutrition, General Mills, Kraft Foods, National Pasteurized Eggs, Inc., and so on. According to Simon’s report, AND states that some of the benefits of becoming an accredited CEU provider are: exposure to Academy members, promotion of their continuing education activities, and having their name listed on the AND website.
  • AND’s political action committee (PAC) does not take on issues that would offend its sponsors, even if they have huge implications for public health. For example, AND actively opposed New York City Mayor Michael Bloomberg’s efforts to put a cap on the size of sugar-sweetened beverages that could be sold to consumers. (Sponsors: Coca-Cola, Pepsi-Co.) They also opposed California’s Proposition 37, which would have required the labeling of GMO products. (Sponsors: Monsanto, ConAgra Foods.)

How can such an organization claim to represent the best interest of nutrition professionals? Furthermore, how can they claim to make unbiased recommendations to the public about health and nutrition?

While I understand that the scientific community is rife with this kind of thing, I just can’t accept it. What makes it even harder to swallow is that the AND actually goes against their own code of ethics in allowing these partnerships. Under “Responsibilities to the Profession,” the code of ethics states that “The dietetics practitioner is alert to the occurrence of a real or potential conflict of interest and takes appropriate action whenever a conflict arises.” What constitutes appropriate action? There are two options set forth by the academy.

  1. “The dietetics practitioner makes full disclosure of any real or perceived conflict of interest;” or,
  2. “When a conflict of interest cannot be resolved by disclosure, the dietetics practitioner takes such other action as may be necessary to eliminate the conflict, including recusal from an office, position, or practice situation.”

Call me crazy, but I don’t think that the Academy’s disclosure of its “conflicts of interest” with almost every leading junk-food company in America constitutes a resolution of the problem.

Really?

Really?

Thankfully, as of right now, nutrition professionals are not required to be members of the AND in order to be credentialed. I hope against hope that this doesn’t change, and I also cross my fingers that I won’t have to pass up any professional opportunities due to my lack of membership. We’ll see.

In 2011, I was lucky enough to have a group dinner with the esteemed food journalist, gardener, and cook Michael Pollan (Thanks, Dad!). I asked him how we were supposed to fix all of the food problems in this country when the very organization that accredits dietetic education programs is in bed with its own worst enemies. He said something along the lines of, “I think the dietitians are going to rise up. I think that this new wave of nutritionists is going to demand that the [Academy of Nutrition and Dietetics] change its policies and practices. It’s going to be the students – it’s going to be people like you.” I’m happy to report that it has begun. Here’s a start.

The Silver Lining

Could public health budget cuts be a good thing?

At the Large Public Health Department where I work, we’ve been going through a long period of belt-tightening. This year, for the first time in 5 years, employees got a “retention” raise. Our programs are having to cut corners and, in some cases, entire programs are disappearing. It has been a rough go for everybody.

The upside of all of this is that, as funding decreases, policy becomes the focus. Before, direct client services were often the goal of most of our programming. Now our efforts are shifting. Here’s an example: we had a tobacco cessation program that was wildly successful (94%, to be exact). Numbers like that are hard to come by, and no one wanted to mess with the program because of that. But let’s put those numbers in perspective. The program was client-focused, so maybe in a session, the worker would see 3-4 people. In the course of a month, maybe 30 or 40. Of those 30 or 40, 94% would quit smoking – so, we’ve successfully reached a total of 28-37 people. As with tobacco cessation programs across the country, ours has been forced by grant funding to shift their focus to policy efforts. Now, although they have a lower success rate, they are reaching thousands of people per month with the same amount of money. Doesn’t this make more sense?

Think about all of the greatest public health advancements. Clean water – and toilets! Vehicle safety. Hand-washing. Immunization. What all of these have in common is that they reach a large number of people and are fairly passive to adopt as practices. This is how public health works best, in my opinion. I’m excited to see policy get more recognition in the coming years.