Nutrition misinformation in Australia is increasingly apparent. Currently anyone can call themselves a nutritionist or dietitian, regardless of whether they obtain the appropriate qualification to do so. This allows for under-qualified nutritionists and dietitians to get away with potentially giving unsafe and non-evidence based advice to the public. It is clear that the nutrition and dietetics profession and health professionals across Australia are ready to embrace a national regulatory framework for the benefit of society.
A dietitian is a person with a qualification in nutrition and dietetics recognised by a national authority (such as the Dietitian’s Association of Australia). As defined by the DAA, dietitians apply the science of nutrition to the feeding and education of groups of people and individuals in health and disease. Although the title ‘dietitian’ is not legally protected in Australia, a person cannot call themselves an ‘Accredited Practising Dietitian’ without meeting the competency standards outlined by the DAA. Accredited Practising Dietitians are recognised by the Australian Government, Medicare, the Department of Veterans Affairs and most private health funds as the quality standard for nutrition and dietetics services in Australia. It is a recognised trademark protected by law. Whereas, a nutritionist is a person with a tertiary qualification in nutrition, food science and/or public health. The role of a nutritionist is to help people achieve optimal health by providing information and advice about health and food choices. There is currently no legal protection whatsoever for nutritionists, with just a voluntary register by the Nutrition Society of Australia.
Legally regulating the titles nutritionist and dietitian would require the Australian Health Practitioner Regulation Agency (AHPRA) to register the titles under the National Registration and Accreditation Scheme (NRAS). AHPRA are governed by the Health Practitioner Regulation National Law, which protects and regulates fourteen health professions across Australia. AHPRA administer the NRAS with their main goal being to ensure that health professionals are appropriately qualified and trained in order to protect the public from dangerous practitioners. They currently exclude health professionals such as speech pathologists, social workers (who are currently in the process of applying for their profession to be included in the NRAS, see here for more), exercise physiologists and more.
The exclusion of the nutrition and dietetics professions from the NRAS likely reflects the AHPRA’s view that both nutritionists and dietitians pose a low risk to patient safety. However this view is clearly flawed with sufficient evidence to demonstrate the detrimental effects that non-evidence based nutrition advice can have on our health (just think about the poor advice you see on the internet that practically promotes eating disorders, as well as the constant recommendation to exclude major food groups by social media ‘gurus’ – and think about the stories you have read about people visiting naturopaths for Vitamin C and turmeric IVs and end up dying or become seriously ill!). AHPRA should therefore reconsider their stance and include both nutritionists and dietitians in the NRAS.
If the profession were to be regulated under the NRAS, an appropriate legislative framework would be developed to ensure that Australian consumers can be confident that they are consulting with a qualified and regulated nutrition professional. Australian nutrition and dietetics courses would also need to be reviewed to assess whether they meet the appropriate competency standards for graduates to become registered nutritionists or dietitians under NRAS. Ideally this would mean using the Nutrition Society of Australia competencies for nutrition graduates and the Dietetics Association of Australia competencies for Dietetic graduates (this is currently in use to ensure that Australian dietetic graduates meet the requirements to become Accredited Practising Dietitians). These changes will pave the way for the better management of the nutrition and dietetic workforce in the future across Australia and as a result, it can be trusted that people using these titles are appropriately qualified to practice.
Nutritional quackery is everywhere
Currently, Australians are able to purchase a nutrition qualification online, it’s as simple as a few clicks.Health Academy Australia. Certificate in Human Nutrition [Internet]. Australia: Health Academy Australia; 2014. Available from: http://www.healthcourses.com.au/product_info.php/products_id/48?osCsid=523482636bceb8531d949226e399a959 Online Academies. Clinical Nutrition Diploma Level 4 [Internet]. United Kingdom: Online Academies; 2017. Available from: https://www.onlineacademies.co.uk/details/251/clinical-nutrition International Academy of Nutrition. Course Overview [Internet]. New South Wales: International Academy of Nutrition; 2012. Available from: http://www.intacad.com.au/diploma-in-clinical-nutrition-2/course-overview/ Health and Harmony Colleges. Clinical Nutrition Consultant- Specialised Distance Education [Internet]. Brisbane: Health and Harmony Colleges; 2014. Available from: http://healthandharmony.com.au/index.php/catalog/product/view/id/79/s/clinical-nutrition-consultant/#.WQm-tYmGNE5 The Health Sciences Academy. Nutritional Therapist Professional Diploma level 5 [Internet]. United Kingdom: The Health Sciences Academy; 2017. Available from: https://thehealthsciencesacademy.org/nutritional-therapist-professional-diploma-level-5/ Upon completion of these short courses, many websites advertise that you can practice as a nutritionist, despite a clear lack of knowledge and experience that is required to do so. Yet, qualified nutritionists spend a minimum of 3 years at University and dietitians spend at least 4 years at University completing an undergraduate degree and/or an additional 2 years completing a masters degree as well as over 800 hours of placement experience. These extensive periods of study allows both health professionals to learn important skills to become ethical, safe and evidence based nutrition experts.
Have you ever found yourself taking the advice of a ‘nutritionist’ in a health/vitamin shop? Nutritionists working in health/vitamin shops may encourage you to purchase an overwhelming amount of supplements, whether it be to help treat a rash or to help with headaches. Not only are supplements expensive, but there is very little evidence that many of them are effective and are often unnecessary as many of the nutrients and compounds in supplements can be easily sourced from the diet (which is a much cheaper alternative that is more likely to be absorbed by our bodies). Some supplements can also be dangerous, particularly when taken with certain prescription medications. An example of this is St John’s Wort. Dangerous interactions can occur between St John’s Wort and medications such as warfarin, the oral contraceptive pill and antidepressants (notice that these are all common medications taken by Australians). These are the kind of dangers that Australians face if they unknowingly obtain advice from unqualified professionals; this could have been a detrimental drug interaction for somebody, severely impacting on their health. It is important to check a persons qualifications if they are providing you with nutrition advice, particularly in these instances as some nutritionists have obtained their qualification from only completing a short online course. Also, always inform you Doctor or Pharmacist of any supplements you may be taking in order to avoid any dangerous interactions that can occur.
Currently, how am I able to make a complaint about a Nutritionist or Dietitian?
If someone wanted to make a complaint about a nutritionist (such as the one in the above scenario) they would have to search on the Nutrition Society of Australia (NSA) website to see whether they were a registered nutritionist or member of NSA. If they weren’t then the NSA Professional Affairs Committee has no jurisdiction to investigate the person as the person is not accountable to the NSA’s Code of Ethics. There is no other viable alternative pathway to make a complaint about a nutritionist, so they will continue to practice. This is the same for when making complaints about dietitians- if they aren’t registered with the DAA and an Accredited Practising Dietitian, then the complaints process is practically non-existent. This gap in regulation is clear, and a need to fill this void is therefore highly warranted.
It is therefore very difficult to make a complaint about an unregistered health professional such as a dietitian or nutritionist, especially if they are not members of a self-regulatory body such as the DAA or NSA. This means fake professionals get away with their poor practice. If these titles were to be registered, the Health Practitioner Regulation Laws (Section 113, 118 and 133) would be able to be enforced on the nutrition and dietetic profession meaning anyone who knowingly or recklessly uses any of these titles and induces belief towards the public that they are a qualified health professional, such as through advertising, will face the court of law with large penalties.
It is unfair to expect the Australian public to check the credentials of all health professionals they encounter. It should be AHPRA that instead regulate these health professions to prevent individuals from misusing these protected titles. Of course, regulating and protecting these titles will never offer complete protection against all forms of poor nutrition practice. There will still be social media gurus, models and celebrity chefs providing Australians with unsafe, non-evidence based and sometimes crazy advice to the public. However, this change has the ability to deter untrained individuals from advertising themselves as qualified experts, therefore preventing a major form of poor health practice that is currently going on in Australia.
The most pressing reason to regulate the nutrition and dietetics profession under the NRAS is to protect the Australian public and reduce their risk of harm. However, there are other reasons as to why we need this mandatory regulation and title protection. This includes to ensure that the profession will not be bought into disrepute by unqualified people and to ensure more clarity of what is nutrition misinformation and what is evidence based advice. It is also important as it has the opportunity to support the development of this profession and increase the public’s confidence in utilising both nutritionists and dietitians.Why Professions have Protected Titles? The Pharmaceutical Journal [Internet]. 2009;282:343. Available from: http://www.pharmaceutical-journal.com/news-and-analysis/news/why-professions-have-protected-titles/10778347.article This change will allow Australians seeking nutritional advice to know that they are accessing a qualified nutrition health professional. For these reasons, AHPRA need to consider registering both the titles ‘nutritionist’ and ‘dietitian’ under the NRAS.
At this point in time if you are looking for evidence based nutrition advice, look for nutritionists who are registered with the Nutrition Society of Australia or dietitians who are also Accredited Practising Dietitians.
References [ + ]
|1.||⇪||Health Academy Australia. Certificate in Human Nutrition [Internet]. Australia: Health Academy Australia; 2014. Available from: http://www.healthcourses.com.au/product_info.php/products_id/48?osCsid=523482636bceb8531d949226e399a959|
|2.||⇪||Online Academies. Clinical Nutrition Diploma Level 4 [Internet]. United Kingdom: Online Academies; 2017. Available from: https://www.onlineacademies.co.uk/details/251/clinical-nutrition|
|3.||⇪||International Academy of Nutrition. Course Overview [Internet]. New South Wales: International Academy of Nutrition; 2012. Available from: http://www.intacad.com.au/diploma-in-clinical-nutrition-2/course-overview/|
|4.||⇪||Health and Harmony Colleges. Clinical Nutrition Consultant- Specialised Distance Education [Internet]. Brisbane: Health and Harmony Colleges; 2014. Available from: http://healthandharmony.com.au/index.php/catalog/product/view/id/79/s/clinical-nutrition-consultant/#.WQm-tYmGNE5|
|5.||⇪||The Health Sciences Academy. Nutritional Therapist Professional Diploma level 5 [Internet]. United Kingdom: The Health Sciences Academy; 2017. Available from: https://thehealthsciencesacademy.org/nutritional-therapist-professional-diploma-level-5/|
|6.||⇪||Why Professions have Protected Titles? The Pharmaceutical Journal [Internet]. 2009;282:343. Available from: http://www.pharmaceutical-journal.com/news-and-analysis/news/why-professions-have-protected-titles/10778347.article|