Perception Is Reality

There have been a lot of opinions flying around after it became more widely known that HB1193 added an exemption to the Florida Dietetics and Nutrition Practice Law under the Occupational Freedom and Opportunity Act. See more about this exemption.

One thing I firmly believe is that the laws are designed to stop the honest people and the rule-followers. People have been providing nutrition advice without a license in Florida. This is illegal and it is not new.

RDs have been focused on “playing defense” as the nutrition license laws are systematically challenged state by state. Our associations have been working hard on this task with some success and some compromise. I do not want to downplay their efforts. They are working hard for what they believe is right. I respect that. More people should do the same.

My belief is that we should stop wasting resources, time, and money, on fighting attacks on the nutrition license laws. There are states without nutrition license laws and the sky has yet to fall. Let others onto the playing field. Competition is good for us all. It makes us be creative and grow. It fills the needs of the public – and they need help with nutrition and health.    

See this idea through.

Some people will provide excellent, well-researched, and appropriate nutrition advice and people will thrive and those providers will be rewarded with referrals and reputation-building.

Others will provide crap advice, trigger or glorify disordered eating, and make people sicker and those providers will not survive for long.

Yes, people may be harmed as this sorts itself out – but people have a right to make their own choices. And no law is going to prevent them from seeking out the latest BS MLM shakes or miracle pills anyway. If you believe, as an RD, it is your job to protect everyone from harmful nutrition advice – well, that will be tiring and frustrating and I wish you luck.

In the end, those who provide the best service and solve people’s nutrition problems will be the ones who thrive.

Yes, you absolutely need to be an RD to calculate a tube feeding.

No, you absolutely do not need to be an RD to coach a generally healthy person on nutrition.

In fact, RDs who calculate tube feeds are typically lousy coaches. But that’s okay. Good coaches probably suck at calculating tube feeds.

So… I propose to you that perception is reality and RDs need to focus on MARKETING what differentiates RDs from other health providers and coaches.

Picture of looking through a glass ball showing the landscape upside down with text Perception is Reality. How Does this Impact RDs?

I think that RDs have buried their heads in the sand about their (our) reputation. Sadly, I refer to myself as an RD very rarely offline because I have been listening to what people think in the wellness and fitness arenas.

I asked a kick-ass, supportive Facebook group that focuses on exercise with a CrossFit leaning about their perceptions of RDs. While far from being a methodologically sound study, it provides some information us RDs would be wise to pay attention to.

My post request: Would like to do an informal request for info: What is your opinion of Registered Dietitians? Do you think you need to see an RD to get valuable nutrition advice? Disclosure – I’m an RD fighting to change our organizations, so we work more with others… and am hoping to show my peers the truth about how we are perceived. I want the good, the bad, and the ugly!

In 8 hours, there were 76 comments and responses. I stopped counting at that point. Here is what those 8 hours reflect. There were 25 (33%) positive opinions, 16 (21%) neutral or no opinions, and 35 (46%) negative opinions.

There is no amount of legislation that is going to make 46% of people say, “I really need help with food and I think RDs suck but since it’s the law I’ll go to the RD who won’t help me instead of the nutrition coach who will help me.”

THIS is the problem. It is in how RDs are perceived not how nutrition advice is legislated. We need a marketing campaign, not another lobbyist.

Let’s look at some of the comments. RDs there are a lot of things we can learn from here.

Positive Comments

I think it sounds cool but also expensive. It would be great to sit down with someone and go over meal plans, goals, macros, etc. BUT there is so much info online, it’s hard to justify spending the money.

I honestly would totally use the hell out of the services of a registered dietitian, but I can’t afford it. I would love to see all insurance companies covering this service.

 I’m one who would work with someone. I was looking into it before all the lockdowns started. I know all the info is online, but I have no desire to figure it out. The amount of information can be overwhelming. I also like the idea of someone checking in on me. That helps me to keep at it.

 I think that RDs could make a HUGE impact within the fitness community if they marketed themselves right. I firmly believe that abs are made in the kitchen, and a lot of people fall victim to unhealthy dieting and/or eating habits. I hate seeing personal trainers with no formal nutritional training trying to play the role of an RD. Basically, I think there is a place for RDs in the fitness world, but it would take a lot of effort to get a strong foothold and get the public to truly recognize your value (because y’all are worth your weight in gold IMO).

We are working with one right now since my daughter is struggling with her IBS. We tried a low FODMAP diet on our own but struggled when trying to reintroduce foods. We needed advice about what and how to add foods back into her diet. This is a time when common sense and self-education weren’t enough and a dietician was definitely needed.

 I’ve been meeting with an RD for a bit over a year. She’s free to me through my employer which is awesome. She’s helped me transition from weight loss into eating for performance and weight maintenance. She’s not pushed any specific diet plans to me, just giving me advice like how to adjust my food intake before half marathons and longer training runs and what I needed to do nutritionally to avoid muscle cramps during runs. She’s done metabolism testing on me (again, free to me) to get a baseline of how much food I really need to be eating and found I was severely under eating.

I’ve used weight watchers, nutritionists and registered dietitian. RD worked more in my mindset, which will help me more in the long run.

I have been seeing an RD for a little over a year now at the recommendation of my doctor. She has helped me. She keeps me in check and I have been successful.

 Nutritional intake are the basic building blocks for these beautiful body machines. RDs are the best asset to help get the most from your efforts.

I had a great experience with a dietician in my health plan when I went in with really detailed questions and wanted recommendations about how I could increase protein as a vegetarian without going over my carb limit or eating too much fat. If I had just gone for a basic education appointment that was planned I would have felt like I already knew the information, but I took so many specific questions. The dietician gave me a lot of suggestions and some free hacks like use the information she gave to go to the local grocery store that offers a shopping trip with a dietician and some blogs that have super simple recipes that combined foods I already liked. I really wish that part of my yearly checkup included a referral back to the dietician.

 I have met one twice and due to her limitations in time she could give me (a state sponsored one) I was impressed with how much she gave me personalized advice. So overall I’m positive. I’m not sure I would want to pay for the service though without someone who I trust recommending them as I feel I have a lot of knowledge myself and if someone isn’t knowledgeable enough and try to sell me a one size fit all I would not feel like it’s worth it at all.

Having an RD has definitely helped me. Even though I am now post-bariatric, even before having surgery it definitely helped change my mental mindset to help me make better choices and allow me to educate myself better with certain foods.

I think RDs are invaluable. Having said that, it is very difficult where I live to find one that understands fitness nutrition. I’ve talked to several, but they seem focused on weight loss rather than fuel for fitness. It’s frustrating.

Depends on the dietitian. Mine is amazing and covered as preventative care (zero copay) by my insurance. He specializes in working with athletes, ed folks, and special diets. He is rated as one of the best in the city to boot. Just make sure they have credentials and a good reputation.

I saw one. She seemed really strange. Had my proteins stupid low (70 g). But she helped me realize I have a body that can’t handle a lot of fat! So once I kept my fat macro under 38 g, the weight has been flying off. I did up my proteins because I was in so much pain and really hungry. I wasn’t eating enough carbs! So that was upped and man I feel a lot better. I’m glad I was open minded enough to try what she had to say.

Neutral Comments

I’ve worked with 3 different dietitians: the first gave me a standard meal plan; the second gave me a macro plan; the third and current one actually started with some simple habits and exploring the deeply rooted issues I have with food. The third time was the charm.

I did WW and lost 30 pounds. But, got stuck. I am now working with a coach at EAT TO PERFORM. I love the program. That being said I don’t know if I would go to just any RD.

In this day where you can find any information online – the good, the bad, and the fake, RDs are where I turn for a way to sort through the bs. We get free access to them, sometimes you just have to wait awhile for an appointment. And I’m seriously contemplating becoming one.

 I have had great nutritionists and bad nutritionists… for my goals. Some nutritionists (most of them) didn’t hear my goals and famished me trying to make me reach fat percentages in a short span of time, which was extremely frustrating. I wanted to be healthier, not stop living entirely.

When I had gestational diabetes I was referred to a RD. I already tracked everything I ate and worked out daily. Our conversation was eat more veggies, less bread, drink diet soda instead on coke… this is prior to her knowing or asking about my current diet. I asked her if I could show her my food journal, she looked at it, looked at me and said, “keep doing what you’re doing.” End of session.

 I honestly can’t decide how I feel about RDs. I don’t know how or if an RD is different from a nutritionist and I don’t really understand what they do. Are they covered by insurance? Are they medical professionals? I sort of view them as being on the fringes of health and medicine with a mix of voodoo nonsense and science mixed in. I prefer science and evidence-based studies, to someone telling me what I *should* be doing. I want to know why I should be doing what you’re telling me to do and how to eat. Obviously, nutrition is important. I know I’m supposed to eat fruits, veggies and real food. So what would be the point in seeing a nutritionist/RD for them to tell me to eat more fruits, veggies and real food? I’m sorry if that sounds harsh – I really don’t mean it to be, but it’s the truth from my perspective. Maybe I just don’t know enough about them.

I think RDs are vital for those that are on tricky meditation, after surgery, cancer treatment, etc. However the vast majority of people just want to lose weight and keep it off. That is less about counting calories/macros and more about teaching habits and getting to the bottom the whys (why they do what they do with food and moving forward) to develop new strategies. This can be done with a certified nutrition coach (a good one). *Just like in any field you will find people that are good/exceptional at their job and others that give that profession a bad rap – do your research and go to someone with good referrals

I think for coaching after something like weight loss surgery, it’s important. I feel like helping someone in general, it depends on their age and where they went to school… If they still live by the food pyramid and pass that shit out, then it’s useless.

 I am split down the middle as to whether or not we need them for valuable advice because I do think RD’s have the knowledge and the background/education to help, but I also think we are capable of finding most answers without them. Of course, this changes with different conditions a person might have or inherit. I’m currently in school and before starting I was really considering a local dietetics program, but decided that I’d rather go into the educational side of nutrition and health for varying reasons including having a better grasp on helping people from a different angle when it comes to healthy lifestyles.

I think you need an RD for certain medical conditions. My diet coach has a Ph.D. In sports physiology and he’s been amazing and I’ve had way more success with him then I ever had with the 3 RD’s I sought out at first. The RD’s gave me a basic AF “meal” plan, lectured me, and EVERYTHING was super restrictive. I don’t do well that way. I was honestly not excited when my son had to see a metabolic nutritionist the first time due to my experiences with an RD (he has a metabolic disease, so it’s necessary and she’s actually amazing).

Most RD I meet are locked in a cycle of standard American diet advice. The majority are stuck because of the healthcare system they work in. It’s always interesting when you meet an RD that will not follow their own advice because they know it doesn’t work for them. I’ve also met a few that actually we’re able to design a eating plan that was helpful to their client’s needs without sticking to SAD. It’s such a mixed bag and most are full of good intentions. But no one wants the liability of suggesting or prescribing food that might not work.

Honestly, I don’t think the designation is worth all much in the fitness industry. There are so many programs and certifications now. This coming from someone who went to grad school for nutrition.

 I’m currently using Macrostax. Before I started that I had an appointment with a RD. I was kind of underwhelmed. I felt like I got the “my plate” handout and nothing I didn’t already know, and no idea what to change to actually start making progress where I’d been stalling. That said I’m sure RDs have different specialty areas and the one I met with probably just wasn’t the right fit for me and what I already knew (which is prob more than your average person). The other side to this coin is there are so many people out there spewing absolute BS and I would love to see RDs out there more. There’s an RD behind Macrostax and I have been very happy with that program

Negative Comments

 I don’t really trust the recommendations of registered dieticians. There have been so many past cases of medical doctors and dieticians recommending specific diets based on assumptions with inadequate research that later turned out to be false. I absolutely believe that it’s not done intentionally or maliciously, and y’all are following your training, but I don’t really trust your training, and I don’t want to pay for a service I don’t trust, you know?

I had to see a registered dietitian when I was diagnosed with gestational diabetes. The sample meal plans were so bunk (like have milk or orange juice with each meal or do jello or 7 grapes – pure silliness for blood sugar control). It was super unhelpful and I found better info online (like carb to protein pairing and the awesomeness of fiber).

I’ve only seen one so I don’t have a ton of experience, but my frustration was I paid a good amount of money to get a boilerplate plan she gave everyone, nothing personalized. Even when I told her I don’t do well on carbs and wanted to balance more towards proteins and fats (I’m insulin resistant and me + carbs just don’t work well, but I also know I need a little before I work out). She gave no options and said that this was what her clients were successful on.

I have only had interactions with a registered dietitian for my high cholesterol and possible diabetes. Unfortunately, I was just told the foods to avoid.

 I’ve only met with a dietician once. And the diet was so strict, I couldn’t maintain it.

I don’t want to pay a ton of money to be ordered around.

 I was referred to an RD when I was Dx’d with gestational diabetes. I realize it is a specialized field BUT I absolutely couldn’t follow her dietary advice. I would have ended up on insulin. Too many net carbs. T2/GD/IR is different than T1 (unless you’re a T2 burnout) and they don’t seem to get that. I did my own thing and managed my numbers quite well through to 41wks. I’d probably use one if I could pick my own vs insurance assigned.

I have seen 3 different RDs and none of them listened. All three told me to eat things I am allergic to (yes they were told in advance what my allergies are) and I also need to follow a low oxalate diet due to my body not processing things correctly which causes all sorts of mineral deposits including kidney stones.
Well all three of them told me to eat more dark leafy greens and switch to soy or nut “dairies”. All things that will put me in the hospital. As soon as they start with that shit I’m done. I can’t trust another thing that comes out of their mouths. I know I’m a difficult case that’s why I wanted to find expert help but well that’s apparently not going to work. Obviously I have to just figure it out on my own.

I was referred to an RD after I was diagnosed with celiac disease years ago. I worked with her for a while and while she helped me figure out what foods were gluten free, she also helped me make my undereating worse. After a couple of months gluten free, I started gaining weight. She had me eating 1,000 calories a day, while I continued running 3 times, 2 strength training days, 2 dance classes, 2 days running 100 flights of stairs each week plus just every day walk everywhere NYC life. I was exhausted and afraid to eat more because I didn’t want to gain weight. It was a bad experience for both my mental and physical health, and that makes me not trust RDs and not willing to pay the money to try again.

I have a very negative opinion of RDs. When I was 5 years old, I was diagnosed with hypercholesterolemia. It’s genetic (thanks Dad) and rather than immediately going on meds I was told to try diet first. So off to the RD we went. She was nice enough, but the eating plan was boiler plate. I spent the next decade on a low-fat diet, terrified of meat and fats of all kinds. I developed eating disorders I’m only now starting to get past. It was one meeting and done. No follow up, no checking in, no tailoring anything. Nutrition is such a personal thing, especially as a child, and I felt like this was just a stamp in my file to say they tried it. I know this is just one experience and not all RDs will be like this. But the issues I was left with have made me never want to try again. I would love to have somebody able to work with me and help me get past some of my food issues but this isn’t the route I would take.

 I’ve only been to one, once and I’ve never been back. She printed out a plate image off the USDA website and gave generic advice. All for $225 an hour which was really 40 minutes. I had been hoping to get guidance on how to build a meal plan and was clear in that when I made the appt so waste of money for my experience. I know there are great ones out there I just don’t know how to find one

I had a couple appointments with an RD. I felt like she didn’t really listen to me. Her recommendations were basically what I was already doing and she was spoon feeding me chapters of The 10 Principles of Intuited Eating (one chapter per appt). The book from which she was directly providing the info was $14.99 on Amazon, which is significantly less than RD appointments. The book has some good points, but most of which I already had a good grasp. I expressed concern, but felt like she wasn’t really listening, so I didn’t go back.

When I went to see one after I went to my doctor asking for a hormone panel because I have PCOS I was referred to a dietitian instead. I am a vegan and I eat very clean yet I am 230 lbs and I log my food daily and I’m still not losing weight. When I met with one, she told me I was unhealthy and told me I needed to eat meat and dairy products even though I am getting all the vitamins and protein I need. She then told me she had no idea why I wasn’t losing weight after looking at over 3 months of food logs and gave up on me. After one meeting. I never went back.

Unfortunately, I think that the idea forced upon us that from a legal standpoint, only doctors and nutritionists, or registered dietitians, can give nutrition advice, breeds the idea they are infallible. I have seen them push artificial sugars, care more for calories than vegetables and also have no idea (or maybe just not interest) in working with and for people who are athletes.

I have seen one several times for myself and my child, but they never go past the basics everyone knows. They have never asked our goals or tried to tailor instruction. I had one just show the My Fitness Pal app.

For me personally, I’m in a different situation than most people. I have my PhD in biochemistry and cell biology and have studied metabolism for years. So I know what my body needs to thrive. My problem has never been what to eat, or even how much to eat, it’s to follow it. That is on me. No one can force me to do that. I do think RDs are good for people that are not knowledgeable in what to do or how to eat. And I do think it gives a level of accountability to people when they first start a healthy eating lifestyle. But the biggest thing is people need to find a good one that will not just give a cookie cutter diet plan. The plans need to be tailored to each person, their needs, and their preferences, which from what I have heard from friends, never happens.

Every RD I have spoken to has looked at my list of food allergies and given up. “Good luck” is the only response I’ve received, which felt discouraging and dismissive each of the 3 times I saw someone. I know my allergies make things challenging, that’s why I was seeing someone who was knowledgeable, or so I thought.

I’ve seen a couple RDs and they both put me on plans that were too low calorie for me that left me constantly hungry and pushed shitty processed foods at me. I’ve steered clear of them ever since.

My totally honest opinion-I am an RN and have gotten better advice from non-RDs. RD training is antiquated, many push the same ADA, AHA diets that are showing to not work (I.e. low fat). I saw an RD when I was pregnant for gestational diabetes. It was the worst thing I could have done and in hindsight, knowing what I know now, I would not do it again. I was shamed and told I wasn’t eating enough carbs and was hurting my baby. I followed their recommendations to a T-kept a daily food journal with carbs. I gained 40 lbs and my blood sugar was worse and ended up on meds. The best person I saw was trained in functional nutrition. He was going to sit for RD boards, but he customized and worked with me as individual and didn’t blame me when things didn’t work. We just changed courses and tried something until it worked.

 I went to see a RD once and was told that my food is fine and balanced and that was pretty much it even though I asked about eating for fat loss I was told maybe my body likes this weight and was sent on my way. I never went back.

 Rd only know what they are taught, most of it is false info bought and paid for.

I’ve been to 4 RDs. NOT ONE could tell me about PCOS, high testosterone or Metformin. Every single one said, “I don’t believe in Metformin for anything except diabetes.”

 I’ve been to 2. One wanted me to eat real food, which I already did but wouldn’t give me any guidance in amounts. The second one lowered me to 1100-1200 calories a day, only green veggies, minimal carbs. I was already working out 6 days a week, she told me to add an extra 150 mins cardio a week on top of 6 hours I was already in the gym. I did see results and then stalled to which she lowered my calories again and suggested fasting. I was exhausted and starving ALL the time. I loved her don’t get me wrong but not sure 1200 calories is sustainable long term.

 I have had terrible experiences with RDs. In general, it’s that even five years ago I was getting the advice to eat a bagel with no butter or cream cheese for breakfast (for example) and do like 60-70 percent carbs, 20 percent protein and as little fat as possible. My fitness coaches have me on a 40/30/30 plan which is much easier to follow and seems to work. I am thrilled with the idea that RDs are out there who are open to change but just have not personally met one who is.

Nope. I do not agree with the pyramid with cereal and grain at the bottom.

I honestly have never used a RD, but I have had several friends who had. There was nothing positive said. They said they never really learned anything. They were just told to cut calories very low and received lectures. Very restrictive type eating and told certain foods were 100% off limits. Never explained proper combinations ie protein/carb/fat, just calorie intake.

When my husband was in end stage renal failure and starting hemodialysis we had a RD stop by the hospital room and go over his diet and tell him all the things he couldn’t eat or had to restrict, hand us a bunch of papers for detail and ask us if we had any questions. That lasted 10-15 mins.

I’ve been to two RD’s. One pushed a strict vegan lifestyle. She had great ideas for whole food subs for meat, but I had/have no desire to be vegan and to fit her plan it was all or nothing. The other preached that only the quantity of calories mattered, not the quality. With both I could not get the scale to move and I felt like garbage more often than not. We worked with an RD when I was caregiving for my mother in law as well. She mostly gave us “eat this, not that” pamphlets and minimally answered questions. I was very disappointed with all of them and honestly haven’t taken most seriously since.

Hubs saw a RD for diabetic nutrition and the advice was not good. Eat whatever and take metformin.

 I’ve had 5 try to help me lose weight. 3 flat-out quit on me because my body doesn’t lose weight easily/at all and they thought I was cheating on the plans we had set up. 2 I had to stop seeing because after 6 months of only losing 7 pounds and then the scale going up again, my mental stability couldn’t handle it anymore.

I saw one for a while and she did nothing for me. I am now on a program with a great “coach” who has done more for me than anything else I’ve ever tried.

I saw one that was a total waste of my time and money! I have a severe intolerance to salicylates… and week after week I was lectured that I wasn’t eating enough green vegetables and I needed to eat more fruit and to cut out sugar! It was either dump her sorry ass or get really really sick…. so her ass got dumped!

 I got sick many years ago with a rare disease (Porphyria). I lost a lot of weight due to not being able to eat, spent two months in the hospital, had to relearn how to walk, etc.. After the hospital, I started gaining weight. 50 pounds one month, then another 20, then another 20; I went from 135 to 215 in a very short time. My doctor sent me to a dietitian who had me keep food diaries. Then she told me I was lying, that I couldn’t gain weight with what I was eating! Turns out that my medications had a lot to do with my weight gain. I will never forget her calling me a liar.

3 thoughts on “Perception Is Reality

  1. Pingback: Ep. 86 – Should crossfit trainers be allowed to give personalized nutrition guidance? | VIVE NUTRITION

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