Careers in Dietetics and Nutrition
Valora Tom
counsels
a client.
Good nutrition is basic to good health. Healthy diets can
help people maintain and even enhance their well-being,
prevent obesity, and help protect against and control such
diseases as diabetes and heart disease. Special diets and
supplements are needed for people with a wide range of
conditions.
Public interest in the health benefits of food is at an
all-time high, but in this economic downturn, many people
and institutions struggle to purchase and plan healthy
meals. In addition, most food contains additives and is
processed in some way, so people need help in understanding
what is in the food and how these substances might impact
their health and the health of their families or those they
serve. Special diets and nutritional supplements can be
even more complex. This means people and their health care
providers often need the advice of experts to help design
special diets and determine the optimal use of supplements.
Registered Dietitians (RDs) are the experts who are
uniquely qualified to respond to these needs. They
interpret the latest scientific findings regarding
nutrition and translate these findings into practical plans
for their patients, their communities, other health
professionals, schools, corporations, policy makers, and
the media.
Wynona Woolf
talks
with a patient.
Nutrition in Indian Country
Dietitians are
needed throughout the United States, but the opportunities
to make a difference are particularly great in American
Indian communities where the descendents of once healthy
people are dealing with such problems as obesity, diabetes,
and cardiovascular disease, which were almost unknown to
their ancestors. Kibbe Conti, Lakota,
MS, RD, says that since contact with non-Native settlers
“loss of traditional lands, of plants, of animal herds
and fish/shellfish, and of traditional water sources
have nearly destroyed traditional American Indian food
systems.” But there are reasons for hope, she says,
“Numerous examples exist across Indian Country showing
tribes’ involvement in strengthening, protecting, or
restoring traditional food practices; restoring buffalo
herds back to tribal lands; planting gardens consisting
of traditional foods; increasing water-quality
standards' establishing game reserves; teaching
traditional ways of preparing meats and vegetables; and
re-assuming/claiming traditional land to put into food
production.”
In her work with her people Conti found that her clients
didn’t respond to conventional nutrition education
approaches. To help her people better grasp the current
nutritional problems and what can be done to address them,
Conti, in collaboration with Elder Bob Chasing Hawk,
Cheyenne River Sioux, developed the Four Winds Nutrition
Model, which other tribes have adapted to their own
traditions and situations. The Four Winds model, based on
the Medicine Wheel, illustrates the foods used by Northern
Plains Nations’ ancestors as well as healthy foods that are
available in today’s world.
The
Four Winds Model
The West Wind
brings life-giving rains. Traditionally, pure water and
teas were the main drinks. Today the lesson of the West
Wind is to enjoy the ancestors’ drinks as well as
sugar-free, alcohol-free drinks.
The North Wind brings cold winds that are associated with
the strength and endurance of the Buffalo. The ancestors
ate the Buffalo and other lean meats, which are
increasingly available again today, along with low-fat,
high protein foods.
The East Wind brings new plant growth and the season when
the ancestors gathered roots, berries, seeds, and leafy
greens. Many of these foods are available today.
The South Wind represents the warm summer wind and the
energy received from plants that require a long growing
season. Some tribes grew corn, beans, potato, and squash.
These foods are still available, as are the wheat, rye,
oat, barley and rice that were introduced by Europeans. A
lesson from the South Wind and the ancestors is to use
minimally processed foods.
Libby Watanabe
encourages
Alaska Natives to eat their traditional food, such as
salmon.
Encouraging
Breastfeeding
Helping more women breastfeed is another way that
dietitians can help American Indian and Alaska Native
people use a traditional practice to restore health. When
talking with women, Cheri Nemec, Red Cliff Band of Lake
Superior Chippewa in Wisconsin, RD, CDE, says that she and
her colleagues emphasize that babies who are breastfed have
a reduced risk of obesity and diabetes. Nemec says that
several tribes in the Great Lakes Inter-Tribal Council are
developing peer programs in which women can receive support
from women who have successfully breastfed. Nemac adds, “We
know how a woman’s mother and grandmother can influence her
feeding choice, so we work to include Elders in the process
of promoting and encouraging breastfeeding.”
Jean
Charles-Azure, Lummi
Nation, MPH, RD, Principal Nutrition Consultant with
IHS, says, “RDs make a difference in the health of
Native people by getting involved in issues, such as
Maternal Child Health; promoting the use of traditional
foods; chronic disease treatment and prevention;
promoting health lifestyles and healthy nutrition
environments; food security and advocacy; nutrition
education and skill development; research and
evaluation; and policy development.” Charles-Azure
underlines the importance of policy development by
noting, “A group of committed RDs (many of whom are
Native) and Tribal community members recently
successfully passed a Tribal Law called, “Healthy Start
Act,” requiring that employers on the Navajo Reservation
be “baby friendly” toward women who choose to breastfeed
their babies. This is the first such law in Indian
Country!” Charles-Azure notes that RDs were also
instrumental in the development and approval of a
Lactation Support Policy that is in effect nationwide
for IHS facilities.
Different
Paths
Regardless of
the population that you serve, a variety of jobs in many
different settings are available to registered dietitians.
It’s not uncommon for dietitians to have more than one
role, particularly in rural areas. During their careers,
dietitians can change their roles and focus several times.
Schedules can vary from part-time to full-time.
Clinical
dietitians
work in
clinics, hospitals, and other settings where they assess
patients’ nutritional needs, develop a nutritional plan and
monitor the outcome of the plan to help determine whether
changes are needed. When possible, clinical dietitians
include family members in discussions about how the patient
(and family) can have healthy meals in their home. Some
clinical dietitians specialize in the care of patients with
such problems as obesity, diabetes, and renal disease.
Clinical dietitians are important members of the health
team. They educate other health professionals and work with
them in developing nutritional plans that will meet the
needs and resources of their patients.
Community
dietitians/nutritionists educate and
counsel groups and individuals about nutritional choices
and practices that can prevent disease and promote health.
Their home base might be a public health clinic, health
maintenance organization, or a home health agency, but
community dietitians do a lot of teaching in schools and
worksites and at health fairs. Some dietitians take groups
of people shopping so that community members can better
analyze food products. Other dietitians support community
members in creating food gardens.
Management dietitians oversee
large-scale meal planning and preparation in such
facilities as hospitals, schools, retirement and nursing
homes, company cafeterias, airlines, and correctional
facilities. They hire, educate and supervise food service
workers who plan, prepare and serve meals. They ensure that
the kitchen is clean and safe and that the food is healthy.
They prepare budgets and purchase, food, equipment and
supplies. They also write reports and maintain records.
Administrators
oversee large
programs. Typically they help set policy, develop and write
proposals, hire and educate staff, and write and present
reports.
Consultant dietitians have their own
private practice or work under contract with health care
facilities. Their clients can include individuals, food
service managers, sports teams, supermarkets, and wellness
programs and centers. Some consultants are involved in
special projects, including research projects. Because of
the increased public interest in nutrition, opportunities
are available in food manufacturing companies where
dietitians analyze food and in advertising companies where
they prepare information about food.
Researchers
work in
universities, pharmaceutical companies and other industries
where they are involved in writing grant proposals and
planning and conducting research about diet and nutrition.
They also analyze their findings and share what they have
learned in articles and presentations.
Educators work in
colleges, universities and medical centers teaching
dietetic students as well as other students in the health
professions. In addition to full-time academics, an
increasing number of practicing dietitians are serving as
preceptors in dietetic internships. Educators also provide
continuing education to dietitians and other health
professionals.
This
article was originally published in the Summer, 2009
issue of
Winds of Change. (The cover
artist is William Rabbit, Cherokee.)