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Dietitian Jobs

By an allied health world contributing writer
Published: January, 12 2010

There are dietitian jobs for both in patients and outpatients. The below information provides examples of the types of patients a dietitian would see in either scenario.

Reasons an outpatient may need to see a dietitian

• Cardiovascular disease/ Hyperlipidemia
  Eating plans for these individuals involve lowering LDL, total cholesterol, triglycerides and inflammation. This can be accomplished through increasing the amount of Omega-3 fatty acid and fiber rich foods and decreasing the amount of saturated fat consumed to a more acceptable level. Also, increasing the amount of fruits, vegetables, and legumes will be helpful for this population to increase fiber as well as essential vitamins, minerals and antioxidants.

• Heart disease
  (under the umbrella of cardiovascular disease) Heart disease and cancer are the top two killers in the United States so dietitians see many patients in these categories. Heart disease is a term that could mean a couple different things. These may be individuals who have high triglycerides and cholesterol and who need to lower their saturated fat intake and concentrated sweets. Or it could mean someone reaching congestive heart failure who needs a sodium restricted diet. So the diet recommendations will vary depending on severity of disease. However, most diets for heart patients focus on the amount and types of fat the patient is eating, as well as emphasizing fruit, vegetable and whole grain intake to increase fiber levels. Salt intake may be limited and monitored as well.
• Cancer
  Dietitians work with cancer patients who have decreased appetites and need to take in more calories. Oftentimes diets for cancer patients consist of eating only cooked foods to decrease the chances of bacteria from the food getting into the person’s suppressed immune system.
• Diabetes
  Dietitians help diabetic patients learn how to monitor their carbohydrate, fat, protein, and salt intake. They teach patients how many carbohydrates they need for each meal and how to monitor carbohydrate intake at home. Diabetics are also prone to high levels of inflammation, which can promote heart disease such as atherosclerosis and lead to decreased immune system on top of contributing to their diabetes.



• Kidney/renal disease
  The parameters for these individuals differ based on whether they are on dialysis. Pre dialysis diets may be more restrictive in protein, phosphorous, sodium, potassium, and fluid intake. Once a person is on dialysis they may have a little more flexibility in choices because the dialysis removes the metabolized nutrients from the blood similar to that of normal kidneys. A renal dietitian, when counseling dialysis patients, monitors their phosphorus, calcium, potassium, and albumin. The albumin tends to be low so high protein foods are encouraged. On the other hand, potassium and phosphorus tend to be high and so dairy products and foods high in potassium (oranges, bananas, potatoes) are restricted. Fluid overload is also a concern so the dietitian helps patients limit their fluid intake to 4-6 cups per day on average.
• High blood pressure
  Current nutrition recommendation for preventing and treating high blood pressure include limiting sodium, limiting calories to maintain a healthy weight, limiting animal protein, while increasing potassium, magnesium, and calcium from higher intakes of fruits, vegetables, nuts, seeds, beans, and low-fat or skim dairy foods. Potassium, magnesium, and calcium are beneficial in controlling blood pressure. Today our society consumes less of these food groups and more processed foods, which contain little fiber and too much sodium.
• Overweight and obese individuals
  Over 60% of people in the U.S. are overweight or obese which can lead to chronic diseases. Dietitians can help devise eating guidelines, meal plans and tools to assist in lowering the amount of fat and calories an individual is consuming. Dietitians also emphasize the importance of helping individuals follow a healthful diet versus trend diets.
• Digestive Disorders
  Digestive disorders would include conditions like constipation, Irritable Bowel Syndrome, Chrohn’s disease, celiac disease, lactose intolerance or even gastrointestinal cancers. Depending on the exact problem, they may require high or low fiber, elimination of wheat gluten or lactose, specialized formulas for preventing malabsorption, and specific recommendations for types of fat.
• Food allergies
  Dietitians working with patients with food allergies help them eliminate foods that trigger allergies. Examples of individuals with food allergies would include anyone with celiac disease (gluten allergy), lactose intolerance, metabolic disorders such as PKU, peanut, egg, fish, shellfish, treenuts, or any other allergies. A dietitian can help assure they are getting all the nutrients they need on a highly restricted diet. Also a dietitian can help them learn what to look for on food labels to avoid allergic reactions.
• Sports nutrition
  Sports dietitians work with athletes to determine appropriate hydration and muscle fueling strategies to enhance physical performance. This may mean determining when and how much of a sports drink, carbohydrates, protein, and other nutrients an athlete needs based on physical requirements of their sport, and intensity and duration of training. Nutrition can also play a role in optimizing body composition, endurance, and muscle repair and recovery following intense training. Some athletes may require nutritional supplementation.

What are some reasons an in-patient may need to see a dietitian?

When a patient is admitted to the hospital, they are asked a series of questions on an Admission Screening Tool. If a patient answers yes to any of the questions, it is an automatic referral to the registered dietitian. Some of the questions include:

• What type of diet do you follow at home?
• Do you currently consume nutritional supplements? (Example: Ensure)
• Do you have any skin ulcers that will not heal?
• Have you lost or gained weight recently (last 6 months)?
• Have you experienced a recent weight loss without trying?
• Are you currently receiving enteral (tube feeding) or parenteral (feeding through a vein) nutrition?
• Are you pregnant or breastfeeding?
• Are you taking any medications?

What is the typical age range of most patients a dietitian sees?

Any and all ages seek the services of Registered Dietitians from neonates all the way through geriatric patients. Some dietitians may be more specialized on specific populations. There are dietitians who have more training in neonatal and infant nutrition as well as pediatrics. An inpatient dietitian can see individuals of all ages. Depending on the focus of the type of job, a dietitian may give nutrition advice to specific age groups. For example, a dietitian working for Child Nutrition Programs would be working with school-aged children. A WIC dietitian would work primarily with women, infant and children and have an understanding of the nutritional needs during pregnancy and post-partum. A dietitian in an eating disorder clinic may work more regularly with adolescents and young adults (mostly women).

Do dietitian jobs involve seeing a lot of repeat clients?

Typically patients come in for their first appointment, and depending on their specific situation, have a follow up appointment. Many patients will obtain specific nutrition recommendations (cholesterol or food allergy) in one to three sessions, each being an hour long. For a patient with diabetes, typically ten hours of diabetes education at the hospital is required. That length of time is often broken into four visits and some of those visits are spent with a nurse and others with a dietitian. Dietitians who work frequently with diabetes patients often obtain an extra certification in diabetes education so they are more qualified to address the needs of these patients. Outpatient dietitians that are focused on helping clients with weight-loss or eating disorders may see patients several times over the span of a year or two. Sometimes patients will come back repeatedly as needed or as covered by their insurance plan.

How many patients do dietitians see per week?

The total number of patients a dietitian will see depends on the setting and type of position. A dietitian working in an acute care (hospital) facility may see anywhere from 8-12 patients per day, depending on the size of hospital and other job duties.

Do dietitians work independently or in collaboration with a team of health care professionals?

Dietitians work as a team; collaborating with other healthcare professionals including doctors, nurses, physical therapists, speech & language pathologists, social workers, psychiatrists and pharmacists. Many hospital settings have team meetings daily to review patients’ courses of treatment and bring in the necessary health care professionals. For instance, if there is a stroke patient a dietitian must collaborate with other health care professionals to determine the best care plan for the patient. For the stroke patient, a nurse is involved in the patient’s care and may have the issue of not being able to get them to take their medication. A speech language pathologist and occupational therapist may also need to be involved to help the patient function more normally. It is important for all these health care professionals to work in collaboration to provide the best care possible for the patient. The medical/healthcare team works best when everyone is communicating effectively.

Does insurance cover the cost of a dietitian?

Depending on the state where services are rendered, insurance companies may provide reimbursement for Medical Nutrition Therapy (MNT) provided by credentialed and/or licensed dietitians. Insurance companies vary in their policy to cover services rendered by a Registered Dietitian. In most cases, insurance companies will cover diagnoses that require nutrition education as a medical necessity. The necessity is determined by the health plan. In many situations, diagnosis including anorexia or bulimia may not be covered by insurance. The coverage for these diagnoses typically falls within the realm of behavioral medicine. In addition, Medicare, the federally funded insurance for individuals over 65 years of age, will cover specific diagnoses rendered by credentialed dietitians. At this time, there are only two diagnoses, including end-stage renal disease and diabetes that is covered by Medicare. These services must be rendered by a Certified Diabetes Educator or Renal Dietitian.

What types of meal plans do dietitians assist with?

A dietitian is mainly responsible for educating their patients and providing them with guidelines on the proper ways to eat in their given situation. It is the patient’s job to then execute the plan and stay within the guidelines. For instance, dietitians educate diabetes patients on what a carbohydrate is and provides examples of types of food that fall into this category.

For each patient the types of foods they should limit or consume will vary but education on the types of foods that fall under which category is essential regardless. For instance, diabetes patients who see a dietitian learn how to monitor their carbohydrates and what time of day to consume carbohydrates. Patients with cardiovascular issues need to find foods low in fat and cholesterol. Those with kidney disease are concerned with sodium, potassium, phosphorus, and protein. Those with high blood pressure need to cut back on sodium and increase calcium and potassium. A dietitian then will provide calorie ranges and options for certain food groups per meal based on the nutritional assessment of the individual.

Some patients may have difficulty understanding how to count calories and which foods fall under which umbrella. In these situations a dietitian will provide sample menus with a few different scenarios, factoring in foods the patient likes and doesn’t like. With a few sample menus the person is able to have several choices for breakfast, lunch, dinner, and snacks. Each of these menus has the exact number of calories they need in each of the food groups so the patient does not have to get bogged down with these details. Most people enjoy flexibility in choosing their own foods so dietitians are accustomed to providing education and guidelines and allowing each individual to choose their specific menus based on foods that will improve their nutritional status.

What factors does a dietitian take into account while planning menus for patients?

Of course the most important factor in developing eating guidelines is the actual reason a patient is being referred to a dietitian. A menu for a diabetic patient will look very different from one developed for an underweight child. Other factors include the patient’s age, gender, height, weight, activity level, and food likes and dislikes. Depending on the patient’s ailment, exercise may be suggested by the dietitian as an important factor in his or her overall wellness. For example, fitness is a crucial component for controlling diabetes, decreasing the risk of heart disease and osteoporosis to name a few. While a dietitian does not have the same knowledge regarding fitness as a personal trainer, they are able to reinforce the basics of how often these patients should be taking part in cardiovascular exercise per week.

In the hospital setting, oftentimes dietitians have premade guidelines for different conditions. So there are materials already prepared for educating diabetic patients, heart disease patients, etc. While these materials are premade and provide the patient with a great deal of information, each individual is different and the dietitian still needs to make modifications to tailor the diet and guidelines to meet his or her specific needs.