The blurry line
Nutrition and exercise: They go hand–in-hand for many fitness goals, such as weight loss, athletic performance, disease risk reduction, strength training, sports, and so on. Pursue one without the other and success is rare. Although they are clearly tied together, both involve extensive professional training and expertise to master. When building a house, you need a plumber and an electrician; when building your body, you need experts in fitness and nutrition. But the line between the two professions can get blurry: Some trainers feel confident in their knowledge of nutrition, and some dietitians feel good about giving exercise tips. Despite the blurriness, there is a line — one that is supported by scope-of-practice guidelines, licensure, and laws that differentiate between the fitness professional and dietitian. These guidelines mandate that the two professions are distinct, and their rules should be abided by, acknowledged, and respected.
Who’s who?
Figuring out who’s who is the first step to help your client reach his or her nutrition and exercise goals. The players include the fitness professional and the registered dietitian.
The fitness professional
There are several types of fitness professionals out there, and this may be confusing to some clients. Because there isn’t a national governing body for the profession as a whole that offers a national registration or state-by-state licensure, there are organizations that provide certifications. The most popular include, but are not limited to:
- The American College of Sports Medicine (ACSM)
- ACSM Registered Clinical Exercise PhysiologistSM
- ACSM Health/Fitness Instructor®
- ACSM Exercise Specialist®
- ACSM Certified Personal TrainerSM
- American Council on Exercise (ACE) Personal Trainer Certification
- Exercise Physiologists Certified, American Society for Exercise Physiologists (ASEP)
- National Strength and Conditioning Association (NSCA)
Regardless of the certification that you choose, all focus the area of expertise on fitness assessment, prescription, and implementation — not nutrition. IDEA Health and Fitness Association fitness professionals also are not to prescribe diets or supplements to their clients. And why would you want to? It’s likely that given your extensive training as an exercise and fitness expert, you’d rather not spend your valuable hour discussing issues that do not fall under your area of expertise. Not only that, but the consequences can be serious. Because of licensure and regulation surrounding the dissemination of nutrition therapy, violating these rules, even with the best intentions, can lead to unintended legal consequences.
The registered dietitian (RD)
There are several different types of nutrition experts: the nutritionist, the registered dietitian (RD), and the licensed dietitian (LD). Regardless of the similarities between the titles, there are significant differences between them. The title ”dietitian” is indicative of an individual that has received a bachelor’s degree in Food and Nutrition, and has met national standards. This designation assures a client that the information he or she receives from the expert is credible and solid. Nutritionists, unlike dietitians, do not have to meet specific national standards, and are therefore not subject to the same legal protection as dietitians. In theory, one could call oneself a nutritionist without having any credentials to support such a title.
The requirements for an RD are as follows:
- Completion of a bachelor’s degree approved by the Commission on Accreditation for Dietetics Education (CADE)
- Completion of a CADE-accredited or -approved supervised practice program at a healthcare facility, community agency, or a foodservice corporation in conjunction with undergraduate or graduate studies
- Completion with a passing grade of a national examination administered by the Commission on Dietetic Registration (CDR)
- Continuing professional education to maintain registration
The RD is governed by the Commission on Dietetic Registration (CDR) and is designed to protect the consumer and the dietetic professional. It offers four distinct credentials that are accredited by the National Commission on Certifying Agencies (NCCA) of the National Association for Competency Assurance (NACA) in Washington, DC:
- Registered dietitian (RD)
- Dietetic technician, registered (DTR)
- Board-certified specialist in renal support (CSR)
- Board-certified specialist in pediatric support (CPS)
- Board-certified specialist in sports dietetics (CSSD)
In 46 states, anyone who wants to provide advice or services related to nutrition needs to be licensed. Only state-licensed dietetic professionals can provide nutrition counseling in these areas; unlicensed practitioners may be subject to prosecution.
The certified sports dietitian
When you have a client who is seeking sport-specific advice, it’s the Board Certified Specialist in Sports Dietetics (CSSD) that you need. This individual is an RD that has a minimum number of years of experience with sports nutrition and has passed the certification exam. According to
www.scandpg.org, CSSDs:
- Apply the science of sports nutrition to fuel fitness and performance
- Provide personalized sports medical nutrition therapy for special populations, such as bone mineral disturbances, cardiovascular conditions, diabetes, disabled athletes, disordered eating, female athlete triad, food allergies, gastrointestinal disorders, high blood pressure, iron depletion, iron-deficiency anemia
- Create customized sports nutrition programs for individuals, sports teams and organizations
Open to the publicEven though exercise is your main focus, there are certain ways that nutrition can be discussed. Here are some tips to help you handle the topic with your clients:
Be a proxy. It is perfectly acceptable to relay national guidelines and dietary regulations to your clients. Organizations you can seek information from include:
- MyPyramid.gov
- Food and Drug Administration
- Food and Nutrition Information Center
- Healthy People 2010
- Nutrition.gov
- National Cancer Institute
- National Diabetes Education Program
- National Heart, Lung and Blood Institute
- National Library of Medicine — Medline
- National Library of Medicine — PubMed
- USDA Center for Nutrition Policy and Promotion
- Weight Control Information Network
Know when to refer. When you find yourself in a sticky situation, it’s time to seek counsel from an RD to protect yourself.
Sticky Situations
In some situations, it is best for a fitness professional to document a client’s progress, then refer the client to an RD. Cases that involve eating disorders, morbid obesity, vitamin/mineral deficiencies, and food allergies can be best dealt with by a dietitian. It is often the role of a fitness professional to observe the warning signs of these conditions, helping to provide solutions to the disorder in its earliest stages.
- Anorexia nervosa can be identified by abnormal weight loss, excessive exercise despite weakness and fatigue, and a heightened sensitivity to cold temperatures
- Bulimia nervosa can be identified by depressive moods and altered eating patterns, especially binging on high-calorie foods. Unlike individuals suffering from anorexia, most bulimia sufferers are of moderate weight
- Trainers can observe other disorders, such as vitamin and mineral deficiencies. Although it can be difficult to identify a vitamin and mineral deficiency, symptoms such as muscle weakness, nausea, slow wound healing, and some skin diseases are considered indicators
Help me help you
With the help of an RD, you can create an exercise plan to maximally challenge the individual. The marriage between fitness and nutrition is an important one, especially in competitive fitness environments. The presence of both fitness and nutrition services creates a whole new fitness center in which the promotion of mind/body wellness is key. Having an RD to whom you can refer your clients will help them meet their goals and enhance their club membership value. You can offer a variety of services, such as hiring an RD strictly for a per-client consultation, creating a package deal for clients that includes personal training and nutritional consultation, or starting nutrition classes or seminars at your club. One of the most important steps in bringing a nutritional component to your club is finding the right RD to join your team. You can find a qualified dietitian in your area by searching the American Dietetic Association’s dietitian listings at
www.eatright.org, by visiting
www.scandpg.org to find a CSSD, or by simply linking to the RD community at
powerbar.com.
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