The role of nutrition in our lives is universal and vital. Popular culture tends to focus on the vain effects of food like being over or under weight, maintaining a youthful appearance, or even trendy food imagery. Fad diets like the paleo diet, for example, hold no scientific merit at all but are touted by marketing companies as a cure to many ailments (Warinner, 2013). With 29.1 million people diagnosed with diabetes in 2014, and another estimated 8.1 million people with undiagnosed diabetes, we are nation at odds with our nutrition illiteracy (CDC, 2014). Our survival is dependent on the successful management of the food we eat. Calories, nutrients, vitamins, hydration affect our bodies directly. Proteins build codes for DNA and build tissues, fats process vitamins and hormones, hydration assists with digestion and respiration, while electrolytes ensure proper cardiac and neural function. (Torora) Those in positions of authority and expertise influence our choices and our ways of thinking about food and nutrition; indeed, they define the word for us. The Journal of the Academy of Nutrition and Dietetics references the Merriam-Webster definition as “nutrition: (n) the sum of the processes by which an animal or plant takes in and utilizes food substances.” We should trust our understanding of nutrition to the most qualified and properly educated among us.

Registered Dietician Nutritionists (RDN) are in a unique position to have a positive effect in public health by increasing their presence in social media, working with policy makers, and being an active member of a patient’s health care team. Because RDN’s have extensive, focused education, training, and clinical experience on the topic, they are the logical source for accurate and dependable nutrition information. 

The extensive formal education requirements are varied and undergraduate degrees can be any hard science to best suit the graduate-level course work to follow. Chemistry, kinesiology, and molecular biology are popular choices for those moving on to study dietetics in graduate school. Graduate education will result in nutrition-specific or nutrition/physiology master’s degrees which include hundreds of hours spent in the clinical and research settings.  Because of this comprehensive science foundation, RDN’s are well-equipped to study and interpret the latest trends and research topics. 

To work in most any state in the Union, a Registered Dietician Nutritionist must obtain and maintain a state license. This is similar to the requirement for nurses, teachers, and other professionals who encounter the public. While the specific requirements vary from state to state, they do mandate a minimum number of on-going and continuing education hours and some even require annual exams. South Carolina, for example, requires a total of seventy-five hours of completed course work every five years (Academy of Nutrtition and Dietetics). Continuing education hours are tracked by the state and can be obtained through various professional courses, conferences, research projects, and clinical service hours. This mandatory, hands-on, and on-going education produces a professional RDN who is up to date on the latest findings and practices in nutrition and dietetic practices. Because of these strict requirements, a state-licensed RDN is qualified to incorporate sound nutritional advice with a client’s on-going medical and lifestyle concerns in a way that best suits their learning capabilities.

One popular method of sharing scientific knowledge is the use of social media. Twitter, Facebook, and Instagram have been used with great success by scientists and scientific agencies to spread awareness of topics they feel are important. NASA tweets and posts on Instagram regularly with photos of recent satellite and telescope images. Popular scientist Neil DeGrasse Tyson tweets facts and perspectives several times a day in addition to hosting podcasts. Dr. Tyson has 6.98 million followers @neiltyson. Food scientist, author, and television personality Alton Brown uses social media not only to advertise his latest projects, but to educate the public on nutritional information in his recipes and upcoming nutritional legislation that could impact the public. These are two examples of scientists who share evidence-based knowledge through social media; a Registered Dietician Nutritionist could do something similar.

Two studies have explored the use of technology and social media as they affect nutrition literacy. The first study, conducted by Rosa Hand and her associates, examined the use of social media as a tool to share science-based health information. Published in 2016, the study reviewed the sharing of evidence-based information using specific key words like “awareness”, “charity”, and “support” in conjunction with hashtag “#heartfailure”. The researchers concluded that a significant number of posts about these topics were retweeted and that those who retweeted were both concerned about health and interested in finding out more. Researchers also concluded that there is a significant opportunity for nutrition information to be shared in the same way. (Rosa Hand)

The second study, “Using a Smartphone Application to Promote Healthy Dietary Behaviors and Local Food Consumption”, found that the use of handheld technologies increased user’s wise food choices, lowered blood pressure through the healthier diets, and assisted the users in finding local, fresh foods. (J. Gilliland) Because these successful models are in place, a Registered Dietician Nutritionist could use social media to share pertinent, reliable knowledge in effective, sound-bite format. If an RDN with a winning, relatable personality were to gain a substantial social media following, the impact on the public’s nutritional literacy would be profound. The millions of people who follow scientists and research facilities of all disciplines on social media demonstrate the public’s desire for scientific fact, as well as their receptivity to ongoing research information. Thanks to Tyson and Brown, science is once again in the forefront of popular culture. There’s no reason an RDN shouldn’t join these ranks and make gains in educating the public on the factual, peer-reviewed science on the food we eat. 

Government policies have a significant impact on all aspects of nutrition for the United States and those in policy making roles should have the most reliable, recent science within reach. Regulatory agencies determine the types of crops that will be planted and harvested with public funds, which foods will be served in public settings (schools, prisons), and the required nutritional content of those foods (United States Food and Drug Administration). Leaders of regulatory agencies are nominated and appointed by elected politicians; neither the politicians nor the nominated individual are required to have a specific level of education or specialty. Were RDNs to have a greater role in the political process, they would have the opportunity to offer sound, evidence-based options and explanations. The result would be a leadership with increased nutritional literacy and would result in a more effective public nutrition policy. 

In June, 2011 the USDA revealed MyPlate.gov, a replacement to the long-suffering food pyramid and the short-lived MyPyramid program. The new nutritional campaign was said to be easier to for the public to understand because of the inherent visual comprehension of the plate and serving portions. What the MyPlate infographic fails to convey are quantities of foods, their nutritional qualifications, and no mention is made of fats or sugars (USDA, 2011). Chairman of the department of nutrition at Harvard University, Walter Willett, expressed his concern over the new initiative’s lack of detail and nuance. He is quoted in the Daily Mail, “To make informed choices, people need additional information. It really makes a difference whether the grains you eat are whole grains or refined grains.” Mr. Willett goes on to mention that the protein section of the plate does not mention variety (such as nuts, fish, or chicken) and the diary allotment is shown as a glass of milk. He says, “It implies there should be a glass of milk or some dairy at every meal and there’s no evidence to show that’s beneficial.” (Daily Mail, 2011) This is an example of well-meaning public nutrition policy that is incomplete or misleading. An RDN as spokesperson and educator would be well-qualified to educate the public about the USDA’s nutritional guidelines and how best to implement those guidelines. 

Nutrition scientists Jamie Zoellner and Deborah Carr published a study in 2009 which investigated the nutrition literacy of public school nutrition managers. They report that only 32% of participants qualified as having “adequate nutrition knowledge”. In this case, the researchers defined nutrition knowledge as being able to correctly read and interpret packaged food’s nutrition labels (Zoellner and Carr, 2009). This is yet another area in which the influence of an RDN could benefit overall public health. If the public school system were to implement a nutrition literacy program for the cafeteria and food purchasing managers, cafeteria offerings nationwide could improve. Instead of 85% of school food being tossed out (Cohen, 2013), an RDN-led initiative could provide more healthful, enjoyable food options while also saving money. It makes no sense for our public funds to continue to fund the current school cafeteria failures when we have access to food scientists capable of fixing the problem.

Other concrete evidence of RDN’s contributions include the positive impacts on the lives of their patients as a part of a comprehensive health care team. A study published in the Journal of the Academy of Nutrition and Dietetics explored the outcomes of a control group and an experimental group of recently-discharged hospital patients. The Danish Health and Mental Health Services facilitates a discharge liaison team to follow geriatric patients upon discharge from the hospital; the team includes a medical doctor, a nurse, a home health technician, and can include a dietician. Teams follow patients for up to six months or as long as the team finds benefit in visiting the patient. The experimental group of patients had a panel of caregivers which included a dietician, while the control group did not. The control group patients exhibited better compliance with nutritional guidelines as well as medication scheduling. Glucose levels, healthy weight maintenance, cholesterol counts, and even cognitive and daily living functions improved because of the improved nutritional intake as guided by the RDN (Parker, 2014). 

While medical doctors are often viewed as the ultimate authority in all things health related, there are significant shortcomings to the nutrition education of many physicians. A 2015 study published in the Journal of Biomedical Education found that “up to 71% of medical schools in the United States failed to offer the recommended twenty-five hours of nutrition instruction” and that most medical students received an average of nineteen hours of nutrition instruction and clinical experience (Adams, 2015). Once they begin their practice, physicians spend an average of thirteen to sixteen minutes with each patient per visit (Brodwin, 2016), which may not be long enough for patients to have their medical and nutrition concerns addressed. Physicians are also likely to include their own personal opinions and preferences when offering nutrition advice to their patients and are not required to study the latest nutrition science or research. They may not have the most up-to-date findings simply because they are focused on solving acute illnesses or other chronic conditions. Compare this to the extensive and ongoing nutrition education of RDNs as well as average of forty-five minutes allotted per client. (Sanders, 2014) RDNs are trained in lengthy clinical internships, training in consideration of prescribed medications and ongoing medical conditions. Working with the primary care physician, the RDN can create a healthy, helpful way of eating for the patient.

The Center for Disease Control data reports offer a window into the unhealthy relationship Americans have with food. Obesity cost Americans $147 billion in 2008. In 2014 17% of our children were obese and 36% of adults were obese.  One in every four adult deaths is due to heart disease. Chronic kidney disease affects 10% of all American adults. Diabetes caused 76,488 deaths that same year (CDC). There is a disconnect between the evidence-based knowledge of what food does for our bodies and what we are allowing to happen to us as a society. 

People seem to recognize the problem and are searching for ways to help themselves, though. An estimated $40 billion dollars is spent on the fitness industry every year. The average household spends about $8000 per year on fruits and vegetables while healthy lifestyle blogs pop-up continually. We are, in fact, trying to help ourselves; we just need the right guidance. Registered Dietician Nutritionists are educated, unbiased scientists and patient advocates possessing the skill set and desire required to educate the public. RDNs can serve as voices of reason and science; if we listen to their advice, we just might save ourselves. 
