Careers in Dietetics and Nutrition

Outpatient Clinic 3 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.

DSCF1710 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.

HPIM0032 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 2 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.
cover_lg This article was originally published in the Summer, 2009 issue of Winds of Change. (The cover artist is William Rabbit, Cherokee.)