FROM THE ACADEMYScope of Practice

Academy of Nutrition and Dietetics: Scope ofPractice for the Registered Dietitian

The Academy Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee

THE ACADEMY OF NUTRITIONand Dietetics (Academy) is theworld’s largest organization offood and nutrition practiti-

oners and the professional associationfor credentialed dietetics practitio-ners—registered dietitians (RDs) anddietetic technicians, registered (DTRs).The Academy’s mission is to empowermembers to be the nation’s food andnutrition leaders. The Scope of Practicefor the Registered Dietitian reflects theposition of the Academy on the essen-tial role of the RD in the direction anddelivery of food and nutrition services.The Scope of Practice for the Regis-

tered Dietitian is used in conjunctionwith the Academy’s Scope of Practice inNutrition andDietetics,1 the 2012 Stan-dards of Practice in Nutrition Care andthe Standards of Professional Perfor-mance for Registered Dietitians.2 TheStandards of Practice address activitiesrelated to direct patient and client care.The Standards of Professional Perfor-mance address behaviors related to theprofessional role of RDs. These stan-dards reflect the minimum competentlevel of dietetics practice and profes-sional performance for RDs. A compan-ion document addresses the Scope ofPractice for the Dietetic Technician,Registered.3

RDs are committed to optimizing thenation’s health and advancing the pro-fession of nutrition and dieteticsthrough safe, person-centered, cultur-ally competent, quality food and nutri-tion services. Food and nutrition ser-vices provided by RDs assist individualsand populations in developing andmaintaining eating and lifestyle behav-iors that enhance health and quality oflife. RD services span a continuum thatincludes nutrition care, foodservicesystems and food systems manage-

2212-2672/$36.00

doi: 10.1016/j.jand.2012.12.008

© 2013 by the Academy of Nutrition and Dietetics.

ment, education, research, technology,business, communication, health pro-motion, disease prevention, and nutri-tion policy.

PURPOSEThe document describes the Scope ofPractice for RDs. RDs are educated andtrained in food andnutrition and are in-tegralmembers and leaders of interdis-ciplinary teams in health care, foodser-vice systems, education, and otherpractice environments. They provideservices in varied settings, includinghealth care, business and industry,communities and public health sys-tems, schools, colleges and universities,the military, government, research, fit-ness centers, private practice, and com-munications. The purpose of the docu-ment is to:

1. Identify the education and cre-dentialing requirements for theRD in accordance with the Ac-creditation Council for Educa-tion in Nutrition and Dietetics(ACEND) and the Commissionon Dietetic Registration (CDR),which is the credentialing age-ncy for the Academy.

2. Describe the scope of practicefor the RD.

3. Educate colleagues in otherhealth care professions, educa-tors, students, prospective stu-dents, foodservice providers,health care administrators, regu-lators, insurers, business ownersand managers, and the generalpublic about the qualifications ofthe RD, competence, and profes-sional services provided by RDs.

4. Describe the relationship of theRD to the DTR to illustrate thework of the RD/DTR teamprovid-ing direct patient/client care, and

to describe circumstances in

JOURNAL OF THE AC

which the DTR works under thesupervision of an RD.4-6

5. Guide the Academy, ACEND, andCDR in developing and promot-ing programs and services to ad-vance the practice of nutritionand dietetics and the role of RDsas leaders in providing qualityfood and nutrition services.

EDUCATION ANDCREDENTIALING REQUIREMENTSThe RD designation is a national legallyprotected title. The RD is a voluntaryprofessional credential granted to anindividualwhomeets the qualificationsestablished by ACEND and CDR.

EDUCATION• Completion of the minimum of a

Baccalaureate degree granted by aUS regionally accredited univer-sity or college, or foreign equiva-lent. Coursework typically in-cludes foodandnutrition sciences,foodservice systems manage-ment, community nutrition, life-span nutrition, communications,business, computer science, psy-chology, sociology, anatomy andphysiology, pharmacology, genet-ics, microbiology, organic chemis-try, and biochemistry.

• Completion of required dietetics

Approved November 2012 by the QualityManagement Committee of the Academyof Nutrition and Dietetics (Academy) andthe Academy House of Delegates. Sched-uled review date: November 2017.

Questions regarding the Scope of Practicefor the Registered Dietitian may be ad-dressed to the Academy Quality Manage-ment Staff: Karen Hui, RD, LDN, manager,Practice Standards; and Sharon M. Mc-Cauley, MS, MBA, RD, LDN, FADA, director,Quality Management at quality@eatright.org.

coursework and supervised prac-

ADEMY OF NUTRITION AND DIETETICS 1

FROM THE ACADEMY

tice through a Didactic Program inDietetics and Dietetic Internshipor a Coordinated Program in Di-etetics accredited by ACEND,which is theaccreditingagency fordietetics education programs ofthe Academy. ACEND is recog-nizedby theUSDepartment of Ed-ucation as the accrediting agencyfor education programs that pre-pare RDs. For more informationregarding the academic require-ments and supervised practice forRDs, refer to ACEND’s website atwww.eatright.org/ACEND/.

CREDENTIALING• Successful completion of the

Registration Examination for Di-etitians administered by CDR.The CDR RD certification pro-gram is fully accredited by theNational Commission for Certify-ing Agencies, the accrediting armof the Institute for CredentialingExcellence. Accreditation by theInstitute for Credentialing Excel-lence reflects achievement of thehighest standards of professionalcredentialing.7 For more infor-mation regarding RD credential-ing, refer to CDR’s website atwww.cdrnet.org/.

• Compliancewith the CDR Profes-sional Development Portfoliorequirements to maintain regis-tration8 including 75 hours ofcontinuing education every 5years.

For RDs, CDR offers Board Certifica-tion as a Specialist in focus areas ofpractice in recognition of docu-mented practice experience and suc-cessful completion of an examination.The certification period is 5 years. Re-certification is required tomaintain thespecialist credential.9 Current CDRBoard-Certified Specialist Credentialsare the following:

• Board Certification as a Special-ist in Gerontological Nutrition(CSG);

• Board Certification as a Special-ist in Oncology Nutrition (CSO);

• Board Certification as a Special-ist in Pediatric Nutrition (CSP);

• Board Certification as a Special-

ist in Renal Nutrition (CSR);

2 JOURNAL OF THE ACADEMY OF NUTRITION

• Board Certification as a Special-ist in Sports Dietetics (CSSD);and

• Fellow of the American DieteticAssociation (FADA) (Certifica-tion) (CDR is no longer accept-ing applications for the FADA).

In addition to CDR credentials, ap-proximately 50% percent of RDs haveearned advanced degrees at the mas-ter’s or doctoral levels.10 Refer to thesection on non-CDR credential and CDRCertificate options for RDs for addi-tional certifications and credentialsthat may be held by an RD to enhancequalifications, competence, and careeroptions.

WHAT IS A NUTRITIONIST?There is no uniform definition for thetitle “nutritionist,” and those states thatdefine nutritionist in statutes or regula-tions define it variantly.11 Some statelicensure boards have enacted legisla-tion that regulates use of the title nutri-tionist and/or sets specific qualifica-tions for holding the title, often but notuniformly including an advanced de-gree in nutrition. The Academy believesthat all RDs are nutritionists but not allnutritionists are RDs. Refer to your statelicensure board for your state’s specificlicensing act.

SCOPE OF PRACTICEScope of practice in nutrition and di-etetics encompasses the range of roles,activities, and regulationswithinwhichnutrition and dietetics practitionersperform. For RDs, scope of practice fo-cuses on food and nutrition and relatedservices developed, directed, and pro-videdbyRDs to protect the public, com-munity, and populations; enhance thehealth and well-being of patients/cli-ents; and deliver quality products, pro-grams, and services, including MedicalNutrition Therapy (MNT), across all fo-cus areas. Focus areas include, but arenot limited to, oncology, pediatrics, di-abetes, nephrology, sports, nutritionsupport, extended care, corrections,weight management and obesity, well-ness and prevention, behavioral health,eating disorders and disordered eating,intellectual and developmental disabil-ities, mental illness, addictions, inte-grative and functional medicine, foodand culinary and supermarkets, sus-

tainable resilient healthy food and wa-

AND DIETETICS

ter systems, communities and publichealth, education, and management.Unique to RDs is the qualification to

provide MNT. MNT is a cost-effective,essential component of comprehensivenutrition care.12-15 Diseases or condi-tions may be prevented, delayed, ormanaged, and quality of life improvedin individuals receivingMNT. During anMNT intervention, RDs counsel individ-uals on behavioral and lifestyle changesthat impact long-term eating habitsand health.MNT is an evidenced-based applica-

tion of theNutritionCare Process (NCP),including:

• performing a comprehensive nu-trition assessment;

• determining the nutrition diag-nosis;

• planning and implementing anutrition intervention using evi-dence-based nutrition practiceguidelines; and

• monitoring and evaluating an indi-vidual’s progress toward goals.16

MNT services are provided by the RDfor individuals and groups utilizingmeal plans, medically prescribed dietsand tube feedings, specialized intrave-nous solutions and specialized oralfeedings, and the analysis of potentialfood and drug interactions. MNT in-volves in-depth individualized nutri-tion assessment; determination of thenutrition diagnosis; determination andapplication of the nutrition interven-tion personalized for the individual orgroup; and periodic monitoring, evalu-ation, reassessment and interventiontailored to manage or prevent the dis-ease, injury, or condition.RDs involved in direct care perform

MNT. Examples of medical conditionsand diseases as outlined in the Acad-emy’s Nutrition Care Manual17 forwhich RDs provideMNT include but are

This document, the Scope of Practice forthe RD, does not supersede state practiceacts (ie, licensure, certification, or titleprotection laws). However, if your statelaw does not define Scope of Practice, theinformation within this document may as-sist with identifying activities that may bepermitted within your Scope of Practicebased on your qualifications (ie, training,certifications, organization policies, refer-ring practitioner-directed protocols, dem-onstrated and documented competence,and clinical privileges).

not limited to:

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w.gp 1.pdf.

FROM THE ACADEMY

• musculoskeletal conditions: ar-thritis, amputations, osteoporo-sis, osteopenia, and orthopedics;

• neurological: epilepsy, Hunting-ton’s disease, amytrophic lateralsclerosis, multiple sclerosis, andParkinson’s disease;

• behavioral health: eating disor-ders, alcohol dependency, chemi-cal dependency, disordered eat-ing,mental illness, andaddictions;

• criticalillnessorconditions:trauma,burns, wound care, pressure ulcers,malnutrition, and injury;

• oncology: care in the continuum ofcare;

• cardiovascular: cerebrovascular ac-cident, transient ischemic attack,coronary artery disease, heart fail-ure, lipid metabolism, and hyper-tension;

• renal: chronic kidney disease, de-creased kidney function to kidneyfailure, dialysis, and transplanta-tion;

• gastrointestinal: liver, cirrhosis,liver transplantation, pancreas, up-per and lower gastrointestinal, in-flammatory bowel disease, irritablebowel syndrome, peptic ulcer dis-ease, celiac disease, Crohn’s disease,short bowel syndrome, and ulcer-

On Monday, February 4, 2013, the Centeamong other things, “Save hospitals sigwhich they are trained to do, without reqphysicians and other practitioners to carmore efficiently by getting rid of regulatprivileged by the hospital inwhich theywrule, officially published in the Federal Rthe medical staff, as they “have equallypatients in the hospital.”According to CMS, “Our intent in revismaximize their medical staff opportuniscope-of-practice laws. We believe thatpractitioners to carry out the patient carpatients most efficiently and effectively.For RD reference, the relevant portions orule, qualified dietitians will be explicitltests to monitor the effectiveness of diettests, if in accordance with state laws incprofessionals who are best qualified to ain consultation with the patient’s interdThis proposed rule responds directly torevise outmoded or unnecessarily burdedards health care providers must meet iciary safety. The Academy submitted forand scientific basis upon which CMS reliIt is recommended that RDs continue cuclinical privileges) and accept and impleas outlined in this Scope of Practice for t

*Medicare and Medicaid Programs; Part II—ReFed Regist. 2013;78(26):9216-9245. http://ww

ative colitis;

Month 2013 Volume xx Number x

• diabetes: prediabetes, type 1 diabe-tes mellitus, type 2 diabetes, andgestational;

• developmentaldisabilities: intellec-tual, autism spectrum disorders,Down syndrome, Prader-Willi syn-drome, spina bifida, and inborn er-rors ofmetabolism;

• sports nutrition andperformance;• genetic disorders: cystic fibrosis, in-

born errors of metabolism, phenyl-ketonuria, andWilson’s disease;

• food allergies: food allergies andfood insensitivity;

• anemia: nutritional deficiencies;• weight management: bariatric,

overweight, and obesity;• pediatrics: failure to thrive; and• pulmonary: emphysema, chronic

bronchitis, and asthma.

RDs assess the nutrition health needsof patients/clients and develop nutri-tion-related priorities, goals, and objec-tives in order to establish and imple-ment nutrition care plans. RDs providenutrition counseling and nutrition edu-cation as components of preventative,curative, and restorative health care.RDs conduct nutrition case finding andmake referrals to appropriate resourcesand programs. RDs evaluate, educate,

Medicare & Medicaid Services (CMS) annnt resources by permitting registered dieg the supervision or approval of a physiciapatients.” This exciting development is dehat are out of date or no longer needed. It, and the changewill not take effect until ther on Thursday, February 7, 2013, also speortant roles to play on a medical staff and

he provision was to provide the flexibilior all practitioners, but within the regulareater flexibility for hospitals and medicaties for which they are trained and license

roposed rule are on pages 9216, 9221-922mitted to become privileged by the hospilans and orders, and c) make subsequentg scope of practice laws. CMSmade this ca patient’s nutritional status and to designlinary care team.”resident’s instructions in Executive Ordee rules and regulations. Many of the pro

er to participate in the Medicare and Medomments to CMS in December 2011 urginthe proposed rule.facility/organization procedures in placedisease-specific and condition-specific prgistered Dietitian until the final rule is ef

ory provisions to promote program efficiency, to.gov/fdsys/pkg/FR-2013-02-07/pdf/2013-0242

and counsel related to food�drug and

JOURNAL OF THE ACA

drug�nutrient interactions as well asdetermine appropriate nutrition qual-ity standards in foodservice and nutri-tion programs. RDs supervise and teachnutrition and dietetics personnel, su-pervise dietetic technicians, dieteticand nutrition students, and dietetic andnutrition interns in the provision of nu-trition care services.RDs accept and implement verbal or-

ders, written orders, or electronicallytransmitted orders from the referringpractitioner based on federal and statelaws and regulations and organizationpolicies. RDs implement establishedand approved disease-specific and con-dition-specific protocol orders from thereferring practitioner for timely acces-sible nutrition care. RDs performhealthcare functions as delegated by the re-ferring practitioner in collaborationwith other health care team members.RDs may assign nutrition care tasks toadministrative and technical supportpersonnel (ie, DTR).RDs conduct nutrition research or

collaborate in nutrition research for thepurpose of demonstrating nutritionoutcomes or developing nutrition rec-ommendations for individuals, specificgroups, or the public. Evidence-basedpractice that involves complex and

ed a proposed rule change* that would,s to order patient diets independently,other practitioner. This frees up time fored to help health care providers operateapply only to registered dietitians (RDs)e is finalized later in 2013. The proposedlly clarifies that RDsmay be included onthe quality of medical care provided to

at hospitals need under federal law toboundaries of their State licensing ands to enlist the services of non-physicianll allow them to meet the needs of their

33-9235, and 9244. Under the proposedaff to a) order patient diets, b) order labifications to those diets based on the labe because it “believe[s] that RDs are theimplement a nutritional treatment plan

63 urging federal agencies to reduce ord rule’s provisions streamline the stan-programs without jeopardizing benefi-s very change, providing the evidentiary

dering patient diets (ie, current grantedl orders from the referring practitioner,e later in 2013.

arency, and burden reduction; proposed rule.Accessed February 14, 2013.

rs for ouncnifica titianuirin n ore for signions t willork e rul

egist cificaimp on

ing t ty thties f torythe g l staffe du d wi”f the p 4, 92y per tal stary p modludin hangssess andiscipthe P r 135nsom posen ord icaidmal c g thied inrrent for orment otocohe Re fectiv

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conscious decision making based on

DEMY OF NUTRITION AND DIETETICS 3

FROM THE ACADEMY

the best available research/evidenceand on patient/client characteristics,situations, and preferences is a tenet ofcompetent nutrition and dietetics prac-tice for the RD. To guide the RD inmak-ing evidence-based decisions, theAcademy has developed an EvidenceAnalysis Library and position (http://www.eatright.org/positions/) andpractice papers (http://www.eatright.org/members/practicepapers/). The Ev-idence Analysis Library is a synthesis ofcontinuously updated nutrition re-search on important dietetics practicequestions and is housed within an ac-cessible, online, user-friendly library athttp://www.adaevidencelibrary.com/.18,19

Scope of Practice in Nutrition and Di-etetics for the credentialed practitioneris composed of statutory and individualcomponents. Statutory scope of prac-tice is typically established within thepractice act and interpreted and con-trolled by the agency or board that reg-ulates the practice of the profession in agiven state.1

● Statutory Scope of Practice. “Legalscopes of practice for the health careprofessions establish which profes-sionals may provide which health careservices, in which settings, and underwhich guidelines or parameters. Withfew exceptions, determining scopes ofpractice is a state-based activity. Statelegislatures consider and pass the prac-tice acts, which become state statute orcode. State regulatory agencies, such asmedical and other health professions’boards, implement the laws by writingand enforcing rules and regulations de-tailing the acts.”20 Requirements forcontinuing education can also be spec-ified. The Academy’s Definition ofTerms describes the differences be-tween licensure, statutory certification,and title protection (www.eatright.org/scope).

● Individual Scope of Practice. EachRD has an individual scope of practicethat is determined by education, train-ing, credentialing, and demonstratedand documented competence to prac-tice. An individual’s scope of practice innutrition and dietetics has flexibleboundaries to capture the breadth ofthe individual’s professional practice.Individuals and organizations mustethically take responsibility for deter-mining competence of each individualto provide a specific service.1

In keeping with the Code of Ethics,21

4 JOURNAL OF THE ACADEMY OF NUTRITION

individual RDs can only practice in ar-eas inwhich they are qualified andhavedemonstrated competence to achieveethical, safe, and quality outcomes inthe delivery of food and nutrition ser-vices. Competent practitioners use up-to-date knowledge, skills, and bestpractices; make sound decisions basedon appropriate data; communicate ef-fectively with patients, customers, andothers; critically evaluate their ownpractice; identify the limits of theircompetence; and improve perfor-mance based on self-reflection, appliedpractice, and feedback fromothers.22 Inaddition, professional competence in-volves the integrative ability to engagein clinical reasoning that facilitatesproblem solving and fosters patient-centered behaviors and participatorydecision making.23 RDs utilize theAcademy’s Scope of Practice DecisionTool, which is an online, interactivetool, to assist them in determiningwhether an activity is within theirScope of Practice.1

Depending on their knowledge,skills, expertise, individual interests,and competence, RDs can work in mul-tiple practice areas and settings, or fo-cus on a specific practice area or with aparticular age group. Integral to theRD’s commitment to lifelong learning isthe recognition that additional knowl-edge, skills, and demonstrated compe-tence are imperative to maintain cur-rency with advances in practice and inadherence to evidence-based practiceand best practices. Lifelong learning issupported by CDR’s Portfolio Develop-ment Process, which requires RDs todetermine their individual continuingprofessional education needs, developaction plans, and achieve their goals tomaintain registration status with CDR.8

RDs apply evidenced-based practiceutilizing the NCP.24 The NCP providesRDs with a systematic decision-mak-ing/problem-solving method to man-age nutrition care activities in multiplepractice environments. In addition, theAcademy has published the Interna-tional Dietetics & Nutrition TerminologyReference Manual: Standardized Lan-guage for the Nutrition Care Process16 toassist RDs who provide direct patient/client care in using standardized lan-guage to document application of the

NCP.25

AND DIETETICS

RD ROLES: SERVICES ANDACTIVITIESThe profession of nutrition and dietet-ics is dynamic, diverse, and continu-ously evolving. The breadth of practicewithin dietetics expandswith advancesin nutrition and food science, healthcare, and information technology, andis driven by public health initiativesand evidence-based research demon-strating the impact of food and nutri-tion on health status, disease preve-ntion and treatment, quality of life, andthe safety and well-being of the public.The cultural diversity of the nation, lon-ger lifespans, federal and state legisla-tive actions, and social and envir-onmental trends affect professionalpractice and the goals and objectives ofthose served by the RD. Increasingly,quality health care depends on activeparticipation by patients, clients, con-sumers, groups, and communities indecisions that promote health and wellbeing, as well as fitness and perfor-mance. Integral to this effort, RDs playcritical roles in leading the public in in-corporating healthful food supplies,food choices, and eating behaviors intodaily lives, and aiding individuals inmaking informed choices regardingfood and nutrition.RDs are nutrition and dietetics prac-

titionerswhose responsibilities includeproviding comprehensive food and nu-trition services; developing food andnutrition programs; serving on na-tional, state, and local food and nutri-tion boards; and contributing to devel-opment of nutrition policies forindividuals, groups, and populations.RDs develop and translate national nu-trition guidelines, for example, Insti-tute of Medicine, 2010 Dietary Guide-lines for Americans,26 and practiceguidelines of national health organiza-tions and the federal government (eg,American Diabetes Association andAmerican Heart Association) into prac-tical application for the individuals andpopulations they serve.Food, nutrition, and dietetic services

and activities performed by RDs illus-trate current practice and include butare not limited to the following:

1. Develop, direct, manage, andevaluate departments, units,programs, or businesses pro-viding food, foodservice, nutri-

tion, and related services to in-

Month 2013 Volume xx Number x

FROM THE ACADEMY

dividuals, groups, and thegeneral public.

2. Develop, administer, evaluate,and consult regarding food andnutrition policy, includingquality standards and perfor-mance improvement in food-service and nutrition pro-grams.

3. Collaborate in or conduct foodand nutrition research to dem-onstrate food andnutrition-re-lated outcomes and to developfood and nutrition policy andrecommendations for individ-uals, groups, and special popu-lations.

4. Consult, educate, and advocateon behalf of individuals, gr-oups, and special populationsregarding food, culinary, nutri-tion and health issues, food se-curity and insecurity, andnutrition programs and re-sources.

5. Manage nutrition care, collab-orate with other health andnutrition professionals, and re-fer to appropriate nutrition re-sources and programs or other

Figure 1. Nutrition Care Process: Roles oresponsible and accountable to the patand other technical and support staff.

health professionals according

Month 2013 Volume xx Number x

to the needs of the individualpatient or client.

6. Provide performance-basedfood and nutrition services tophysically active individuals(ie, athletes, firefighters, lawenforcement officers, and themilitary).

7. Apply the Academy’s NCP24 inproviding nutrition care of in-dividuals: 1) conduct nutritionassessments; 2) diagnose nu-tritionproblems; 3) developnu-trition-related priorities, goals,and objectives; and 4) estab-lish, implement, and provideongoing management and re-vision of interventions basedon the patient’s/client’s re-sponse to nutrition care. Roledelineation for the RD that su-pervises a DTR in deliveringnutrition care to patients/cli-ents is outlined in Figure 1; theDTR and other support staffwork under the supervision ofthe RD when engaged in directpatient/client nutrition careactivities in any setting.

8. Recommend, perform, and in-

istered Dietitians (RD) and Dietetic Technlient, employer/organization, and regul

terpret test results as related to

JOURNAL OF THE ACA

nutrition status: blood pres-sure, anthropometric mea-surements (eg, height andweight, skin fold thickness,waist circumference, calcula-tion of body mass index withclassification for malnutritionand obesity), and indirect calo-rimetry measurement, labora-tory tests, and waived point-of-care laboratory testing (eg,blood glucose, cholesterol). Ac-cept verbal, written, or electronicorders as delegated by the refer-ring practitioner for laboratorytests and waived point-of-carelaboratory testing. Waived test-ing means those noncritical testsapproved by US Food and DrugAdministration forhomeuse thataresimpleandaccurateas to ren-der the likelihood of erroneousresults negligible, or pose no rea-sonable riskofharm ifperformedincorrectly. Waived test listsare\viewed on the web at http://wwwn.cdc.gov/dls/waivedtests/and http://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.

, Registered (DTR). aThe RD is ultimatelyfor nutrition activities assigned to DTRs

f Reg icianient/c ator

pdf.

DEMY OF NUTRITION AND DIETETICS 5

FROM THE ACADEMY

9. Performassessment of a patient’snutritional statusworking closelywith interdisciplinary teammembers for care coordination(eg, ability to swallow, in the caseof patients with dysphagia, withthe speech language pathologist;consultingondrug�food interac-tions in an anticoagulation clinicwith a pharmacist; and planningmedication titrations for paren-teral nutrition with a nurse andpharmacist).

10. Complete a nutrition-focusedphysical assessment through anevaluation of body systems,muscle and subcutaneous fatwasting, oral health, suck/swal-low/breathe ability, skin condi-tion, appetite, and affect.

11. Assess, recommend, and imple-ment established and approveddisease-specific and condition-specificprotocolorders fromthereferring practitioner, executinginterventions per protocol tomeet individual nutrient andenergy needs, including but notlimited to prescribed diets;modificationof food textures fordentition and individual prefer-ences; nutritional supplements;dietary supplements; nutritionsupport therapies, for example,enteral nutrition (tube feedings)and parenteral nutrition sup-port (specialized intravenoussolutions) for neonates, adoles-cents, and adults; placement offeeding tube; provide feedingtherapy (pediatric oral aver-sion); and implement protocolor physician-order�driven me-dication titration (eg, insulin, vi-tamins/trace elements added toparenteral nutrition formula).Adjust medications per estab-lished and approved disease-specific and condition-specificprotocol orders from the refer-ring practitioner for timely ac-cessible nutrition care.

12. Provide MNT in direct care ofmedical diseases and conditionsacross the continuum of care.

13. Provide nutrition counseling;nutrition behavioral therapy;lactation counseling; healthcoaching; and nutrition, physi-cal activity, exercise counsel-

ing, and health education as

6 JOURNAL OF THE ACADEMY OF NUTRITION

components of preventative,therapeutic, and restorativehealth care.

14. Evaluate, educate, and counselrelated to nutritional genom-ics, gene�diet and diseaseinteractions, and food�drug,drug�nutrient, and supple-ment�drug�nutrient inter-actions.

15. Educate dietetics students,dietetics interns, health careprofessionals, and others asfaculty in academic pro-grams, or as preceptors for asupervised practice experi-ence.

16. Educate the public abouthealthy lifestyles (nutrition,physical activity, health-relatedbehaviors) and food choices invenues such as school class-rooms, community classes andgroups, supermarkets, elec-tronic learning formats, and so-cial media.

17. Educate the public regardingfood security, food safety, sus-tainable resilient healthy foodand water systems, and envi-ronmental foodandnutrition is-sues.

18. Perform human resource func-tions consistent with job re-sponsibilities: recruitment, hir-ing, orientation and training,scheduling, supervision, compe-tence assessment, performanceevaluation, mentoring for pro-fessional development, practiceadvancement, and progressivediscipline including termina-tion.

19. Supervise DTR,5 dietetics stu-dents, dietetics interns, and ad-ministrative and support per-sonnel assisting in the provisionof direct patient/client nutritioncare. Assignment of tasks takesinto consideration componentsof the NCP (data collection, im-plementation andmonitoring ofnutrition plan, and nutrition ed-ucation) and the training andcompetence of the DTR andother support staff in perform-ing the assigned functions witha specificpatient/clientorpopu-lation. The RD is ultimately ac-countable to the patient/client,

physician, regulators, and ac-

AND DIETETICS

creditingorganizations for func-tions assigned to support staff.

20. Design and implement out-comes-based quality assuranceand performance improvementactivities to document out-comes of services; compliancewith regulations, policies, andprocedures; and monitor andaddress customer satisfaction.

21. Supervise, manage, or directfoodservice operations from foodand equipment purchasing andprocurement through service—addressing food safety and sani-tation, menu development andfood production, customer ser-vice, financialmanagement, elec-tronic applications, emergencypreparedness and management,and kitchendesign and redesign.

22. Provide food, nutrition, and culi-nary expertise in the design, de-velopment, and production offoodproductsandmenus, includ-ingselectionofingredients,meth-ods of preparation, nutrient anal-ysis of recipes and nutrientcharacteristics, and measure cus-tomer satisfaction in the produc-tion and development of foodproducts, recipes, andmenus.

23. Develop and use electronic infor-mation management tools forpractice, research, and education.This includes electronic systemsformanagingpatient information(electronic health record or per-sonal health record), nutrient da-tabase systems for evaluatingnu-tritional composition, foodserviceand nutrition system manage-ment software, and web-basedapplications, telehealthandsocialmedia for patient education, pub-lic information, business, educa-tion, and outreach.

Advances in health care, publichealth and environmental initiatives,information technology, and variouspractice area market segments will of-fer opportunities for new services androles for RDs. With appropriate qualifi-cations and demonstrated competence,RDs can provide new services withinthe provisions of their individual scopeof practice, statutory scope of practice(if applicable), federal or state laws andregulations, and organizational policies

and procedures.

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FROM THE ACADEMY

RD ROLES: PRACTICE AREAS(ALPHABETICAL ORDER)The majority of RDs are employed inhealth care settings (eg, hospitals, clin-ics, mental health centers, rehabilita-tion centers, dialysis centers, bariatriccenters, extended care facilities)10 ad-dressing wellness, prevention, and nu-tritional management of diseases andmedical conditions. RDs work collab-oratively asmembers and leaders of in-terdisciplinary health care teams thatmay include any of the following: phy-sicians, doctors of osteopathic medi-cine, podiatrists, physician assistants,nurses, nurse practitioners, pharma-cists, speech-language pathologists, oc-cupational therapists, physical thera-pists, psychiatrists, psychologists,social workers, dentists, dental hygien-ists, exercise physiologists, respiratorytherapists, athletic trainers, lactationconsultants, and others.Other settings in which RDs work in-

clude nonprofit organizations, stateand local health departments, foodtrust organizations, communities andpublic health agencies, health insur-ance companies, child care programs,schools, home care, colleges and uni-versities, government agencies, themilitary, and research. A growing num-ber of RDs work in the food, pharma-ceutical, and health care�related busi-nesses, private practice, the media,integrative and functional medicine,corporate wellness, physical activityand athletic performance, health careinformatics, food security, sustainablefood and water systems, and emergingareas.Within the Academy, members es-

tablish Dietetic Practice Groups andMember Interest Groups to focus onspecific areas of practice and on issues

RDs operate within the directives of ap-plicable federal and state laws and regu-lations, policies, and procedures estab-lished by the organization in which theyare employed, and designated roles andresponsibilities. To determine whether anactivity is within the Scope of Practice ofthe RD, the practitioner compares his orher knowledge, skill, and demonstratedcompetence necessary to perform the ac-tivity in a safe and ethical manner. TheAcademy’s Scope of Practice DecisionTool, which is an online, interactive tool,is specifically designed to assist practi-tioners with this process.

or activities of mutual interest. RDs

Month 2013 Volume xx Number x

may assume leadership roles and re-sponsibilities in any of the practice ar-eas and settings. Examples of areas andsettingswhere RDs practice include butare not limited to the following:

● Acute, ambulatory/outpatient,home care, and extended health care.RDs participate in, manage, and directnutrition programs and services toidentify and evaluate individuals fornutritional risk, provide consultation tothe physician and interdisciplinaryhealth care teamonnutrition aspects ofa patient’s/client’s treatment plan, pro-vide MNT and nutrition education andcounseling, and care coordination andmanagement to address preventionand treatment of one or more acute orchronic conditions or diseases. RDsprovide and coordinate food and nutri-tion services and programs in healthcare settings such as hospitals, long-term acute care facilities, ambulatoryclinics, primary care medical homes,community health centers, bariatriccenters, behavioral health centers, Vet-erans Affairs’ facilities, home care, as-sisted living, skilled nursing, extendedcare, continuing care communities, andcorrectional facilities.

● Business and communications.RDs are employed as chief executiveofficers, vice presidents, directors, andmanagers in business and communica-tions, where they participate, manage,and direct in areas such as news andcommunications, consumer affairs,public relations, food commodityboards, food and culinary nutrition,supermarkets, human resources, nutri-tion and foodservice computer applica-tions, product development, market-ing, sales, product distribution, andconsumer education. RDs are authors ofbooks, professional and lay articles,print and electronic publications,newsletters, editorials, columns, socialmedia, and other forms of electronicmedia, and journalists, speakers, com-mentators, television and radio person-alities, and spokespersons. They arewebsite managers and developers.

● Community and public health.RDs with public health and communityexpertise are directors, managers, su-pervisors, educators, counselors, con-sultants, and researchers working in avariety of settings from the national tostate and local levels, such as govern-

ment agencies, community and profes-

JOURNAL OF THE ACA

sional organizations, and schools. RDsmonitor, educate, and advise the publicand populations about nutrition-re-lated issues and concerns. RDs design,implement, monitor, evaluate, and su-pervise staff involved in federallyfunded nutrition programs (eg, SpecialSupplemental Nutrition Program forWomen, Infants and Children; Supple-mental Nutrition Assistance Program;Expanded Food and Nutrition Educa-tion Program; and Indian Health Ser-vices) and community programs thatpromote equitable food systems, foodsafety, and population-based strategiesto promote healthful eating and life-style behaviors. RDs provide and coor-dinate nutrition services and programsincluding MNT to individuals andgroups; collaborate with others to de-velop nutrition programs and services;plan and deliver training and educationfor health personnel; and advocate forsound food and nutrition policies andprograms at the federal, state, and locallevels. RDs contribute to emergencypreparedness and coordinate food andnutrition services during disasters.

● Entrepreneurial and private prac-tice. RDs in private practice are entre-preneurs and innovators in providingnutrition products and services to con-sumers, industry, media, and busi-nesses. They are chief executive offi-cers, business owners, consultants,professional speakers, writers, journal-ists, chefs, educators, health and well-ness coaches, and spokespersons. Theymay work under contract for organiza-tions and government agencies, such ashealth care or food companies, busi-nesses and corporations, employeewellness programs, and the media. RDsprovide comprehensive food and nutri-tion services to individuals, groups,foodservice and restaurant managers,food vendors and distributors, athletes,sports teams, and company employees.RDs act as expertwitnesses and consul-tants on legal matters related to foodand nutrition. RDs provideMNT to indi-viduals and groups in all populations.To locate an RD, select “Find a Regis-tered Dietitian” on the Academy’s web-site at www.eatright.org.

● Foodservice systems. RDs manageand direct foodservice operations inhealth care and other institutions andcommercial settings or are employed in

these capacities as employees of con-

DEMY OF NUTRITION AND DIETETICS 7

FROM THE ACADEMY

tract foodservice management compa-nies (eg, hospitals, schools, colleges anduniversities, continuing care communi-ties, rehabilitation centers, extendedcare settings, government facilities,and correctional facilities), and com-mercial settings (restaurants, foodvending and distribution, catering). Re-sponsibilities include participating in,managing, or directing any or all of thefollowing: menu and recipe manage-ment; food, supplies, and equipmentpurchasing; food receiving, storage,preparation, and service; financialmanagement; human resource man-agement; food safety and sanitationprograms; waste management, waterconservation and composting pro-grams; vending services and cateringfor special events; foodservice in emer-gency situations, and kitchen design/redesign. RDs use awide variety of elec-tronic tools to manage data and mayspecialize in the development andmanagement of specific technologicalapplications related to foodservice op-erations.

● Integrative and functional medi-cine. RDs are skilled in functionaland integrative medicine, nutritionalgenomics, whole foods, nutrition sup-plements and dietary supplements andutilizing theNCP in a broad range of ho-listic and therapeutic modalities. RDspromote the integration of conven-tional nutrition practices, clinical judg-ment, and evidence-based alternativesthrough research, education, and prac-tice. RDs are leaders in evidence-basedand practice-based therapies, includingpersonalized nutritional genomics,gene�diet anddisease interactions, ho-listic health care, and functional nutri-tion therapies using the Integrative andFunctional Medical Nutrition TherapyRadial (http://www.integrativerd.org/site.cfm?page�ifmnt_radial_guide). TheIntegrative and Functional Medical Nu-trition Therapy Radial is amodel for crit-ical thinking that embraces both the sci-ence and art of personalized nutritioncare with consideration of multipleconventionaloralternativemedicinedis-ciplines using five key areas: lifestyle,systems (signs and symptoms), core im-balances, metabolic pathways, and bio-markers.

● Management and leadership. RDsserve in all levels of management (eg,

supervisor, manager, unit manager, di-

8 JOURNAL OF THE ACADEMY OF NUTRITION

rector, system director, administrator,vice president, president, chief opera-tions, or executive officer, owner). Prac-tice settings for RDs include health careorganizations, businesses, and corpo-rate settings such as food distribution,group purchasing, wellness/healthcoaching, nonprofits, association man-agement, and government agencies.Responsibilities range frommanaging aunit, department, and multidepart-ments to system-wide operations inmultiple facilities. Focus areas includehealth care administration, food andnutrition services, clinical nutritionservices, foodservice systems, multide-partment management, clinical ser-vices and care coordinationwithmulti-ple disciplines (eg, diabetes educationcenter, wound care program, bariatriccenter, medical home management),public health agency overseeing healthpromotion and disease prevention,promotion of programs in states andcommunities, research, communityhealth program/agency serving a spe-cific client population, and corporatewellness and/or providing consultingservices to an organization seeking aspecific product or service.

● Military service. RDs serve as Ac-tiveDuty andReserveComponent com-missioned officers in the US ArmedForces (Army, Navy, and Air Force) andwork as civilians alongside active dutyand reserve RDs. RDs provide nutritionexpertise worldwide to active duty andretired service members, their families,and other veterans who are eligible forcare in the military health care system.RDs provide nutrition expertise for theDepartment of Defense and are respon-sible for enhancing human health andperformance through policy develop-ment, applied nutrition research, com-prehensive nutrition assessment, edu-cation, and intervention. Practice areasinclude clinical dietetics, health pro-motion, wellness and physical activity,community nutrition, and foodservicemanagement. RDs serve as consultantsfor military readiness, medical educa-tion, military training, development ofoperationalmeals, Army andNavy Spe-cial Operations Forces, and overseasDepartment of Defense school nutri-tion programs. RDs educate, counsel,and advise soldiers about fueling foroperations, recovering from training/missions and injury/illness, such as

burns and trauma, achieving andmain-

AND DIETETICS

tainingmission-specific body composi-tion, optimizing mental function, andpreparing for arduous environments. Inaddition, RDsmanage, develop curricu-lum, and provide instruction for the USMilitary Dietetic Internship Consor-tium and the US Military-Baylor Uni-versity Masters Program in Nutrition.

● Nutrition informatics. Informaticsis the intersection of information, nu-trition, and technology and is sup-ported by the use of information stan-dards, processes, and technology. RDsare leaders in the effective retrieval, or-ganization, storage, and optimum useof information, data, and knowledge forfood and nutrition�related problem-solving and decision making. RDs de-sign and implement nutrition softwareand nutrition education tools, developand use technology for recipe andmenu management, perform or over-see nutritional analysis of product in-gredients to comply with state and fed-eral regulations for food labeling andrestaurant menu nutrient analysis, andparticipate in the design and imple-mentation of electronic health recordsfor acute care, outpatient and extendedhealth care settings, and other con-sumer tools for managing health caredata.27,28 RDs participate in the largerinformatics community through col-laborative development efforts forstandards, terminology, and educa-tional modalities. RDs are informaticseducators to students and practitionersand conduct research on informaticstools and processes to enhance prac-tice.

● Preventive care, wellness, andweight management. RDs are leadersin evidence-based nutrition practicesthat address wellness and disease pre-vention at all stages of the lifespan. Rec-ognizing that nutrition and physical ac-tivity interact to improve the quality oflife, RDs provide nutrition counselingand guidance for active lifestyles thatare consistent with achieving risk re-duction from chronic disease, proactivehealthmaintenance, and optimal nutri-ent intake for healthy lifestyles. RDs ad-dress prevention and treatment ofoverweight and obesity throughout thelifespan. RDs interact with the public,scientific organizations, and industry toprovide nutrition and weight-manage-ment services and programs to pa-tients, clients, and customers. National

weight-management companies/cor-

Month 2013 Volume xx Number x

FROM THE ACADEMY

Figure 2. Credentials held by Registered Dietitians (not all inclusive).

Month 2013 Volume xx Number x JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 9

aining P-home

FROM THE ACADEMY

porations employ RDs at the corporatelevel. RDs are employed as developers,managers, coordinators, and providersof corporatewellness programs, as pro-gram staff and as consultants providinghealth, weight management, wellnessprograms, fitness programs, and indi-vidualized nutrition counseling.

●Research. RDs promote, participatein, conduct, and apply research relatedto food, nutrition, and dietetics. RDs as-sist with, manage, and disseminatefindings from research projects con-ducted in clinical, community, healthcare, foodservice, laboratory, and aca-demic settings. RDs are employed in avariety of settings, including generalclinical research centers, translationalcenters, teaching hospitals, nonprofitresearch entities, academia, food andpharmaceutical companies, and mu-nicipal, state, and federal government(eg, National Institutes of Health, USDepartment of Agriculture, and Centersfor Disease Control and Prevention).They are employed in research settingsto direct and manage grants, overseeand conduct food and nutrition-relatedresearch, author publications, andguide development and implementa-tion of food and nutrition policy.

● School nutrition. RDs are em-ployed in child nutrition programs atthe local, state, and national levels tocontribute to healthy school environ-ments. They work as educators, agencydirectors, researchers, and directors ofschool nutrition programs. Responsi-bilities include adherence toUSDepart-ment of Agriculture Food and NutritionService guidance and regulations andproviding or consulting on school-based special diets. RDs are employedas corporate dietitians supplying prod-ucts or services to school nutrition op-

Table. Commission on Dietetic Registr

Title

Certificate of Training in Adult WeightManagement Program

Level 2 Certificate of Training in AdultWeight Management Program

Certificate of Training in Childhood anAdolescent Weight Management

aThe Commission on Dietetic Registration Certificate of Trself-study module and pretest, onsite program, and a take

erations and as consultants in school

10 JOURNAL OF THE ACADEMY OF NUTRITIO

nutrition and wellness. RDs provideleadership in a variety of initiativessupported and sponsored by the US De-partment of Agriculture Food and Nu-trition Service and various national,state, and local food and nutrition orga-nizations and alliances.

● Sports nutrition. RDs educate andcounsel clients of all ages and abilitiesregarding the relationships betweenfood, health, fitness, physical activity,exercise, and athletic performance.They are employed in rehabilitation;sports medicine clinics; communityand medical fitness centers; amateur,collegiate, and professional sport orga-nizations; the US Olympic Committee;academia; the military; sports perfor-mance entities; sports food businessand industry; and communications.RDs are members of interdisciplinarysports medicine and athletic perfor-mance teams,manage foodservice bud-gets and foodservice to athletic teams,and conduct research in sports nutri-tion and exercise science. RDs evaluatedietary and sports supplements forsafety, efficacy, and quality. RDs edu-cate athletes regarding banned sub-stances in sports. RDs work in preven-tion and nutrition intervention ofeating disorders, disordered eating, andthe female athlete triad. RDs developnutrition programs and counsel profes-sional firefighters, law enforcement of-ficers, and others whose job require-ments include physical performanceand/or maintenance of specified levelsof physical conditioning or bodyweightand body composition.

● Sustainable resilient healthy foodand water systems. RDs are leadersandmanagers in sustainable and acces-sible food andwater systems.29 RDs areemployed in food banks, food pantries,

Certificate of Training Programsa

No. of continuing professionaleducation units

35

50

32

rograms are intensive training programs that include apost-test.

farms, nongovernment organizations

N AND DIETETICS

in natural resource conservation andfarming groups, local, state and federalgovernment, private practice consult-ing, writing, and speaking, academia,foodservice systemsmanagement fromfarm to institution. RDs serve in leader-ship capacities on food policy councils,sustainability committees, and foodgardening groups. They promote in-creased appreciation for and under-standing of food security and resiliency,agricultural production and environ-mental nutrition issues. RDs educateand support policies, systems and envi-ronments that advance sustainablehealthy food andwater systems relatedto current and emerging food produc-tion, processing, distribution, market-ing, retail, and waste managementpractices.30

● US Public Health Service. RDs aremembers of the Commissioned Corpsof the US Public Health Service. RDswork in the US Department of Healthand Human Services and in other fed-eral agencies and programs, includingthe Health Resources and Services Ad-ministration, Food and Drug Adminis-tration, National Institutes of Health,Centers for Disease Control and Preven-tion, and Centers for Medicare andMedicaid Services. RDs in the US PublicHealth Servicemay be deployed to sitesof national emergencies within theUnited States.

● Universities and other academicsettings. RDs are program directors andfaculty for Didactic Programs in Dieteticsandprogramdirectors and faculty forDi-etetic Internships and Dietetic Techni-cian Programs. RDs are faculty and ad-ministrators in universities, communitycolleges, culinary programs, and aca-demic medical centers. They direct andmanage nutrition services and nutritioneducation programs. RDs instruct stu-dents in food, nutrition, health care,and health-related disciplines; sus-tainable resilient healthy food andwater systems; foodservice manage-ment; and public health.

CREDENTIAL AND CERTIFICATEOPTIONS FOR RDS

Additional credentials thatmay be heldby RDs and the respective credentialingagency are listed in Figure 2. This list isnot all inclusive. Obtaining additionalacademic degree(s), various certificatesor credentials are options that may be

ation

d

desirable or required for specific areas

Month 2013 Volume xx Number x

FROM THE ACADEMY

of practice or employment settings. TheTable lists Certificate of Training Pro-grams offered by the CDR and the cor-responding continuing professionaleducation units for each program. Cer-tificate programs offered by nationallyrecognized organizations also may bebeneficial to RDs.TheAcademyoffers distance learning

through online certificate of trainingprograms, teleseminars, webinars, andself-study options on various topics forcontinuing education. Refer to theAcademy’s website under the Profes-sional Development category (http://

GlossaryAcademy of Nutrition and Dietetics—DeRegistered Dietitian (RD): The CDR, thehas met current minimum (Baccalaureaand supervised-practice experiences thrhas successfully completed the RegistratProfessional Development Portfolio recevery 5 years).Dietetic Technician, Registered (DTR)minimum requirements through one ofTechnician Program as accredited by theBaccalaureate degree; met current acadesuccessfully completed a supervised praor 3) completed a minimum of a BaccaACEND.14,15 In all three routes, the indivmaintain the DTR credential, the DTRmu50 hours of approved continuing professScopeofPractice inNutritionandDietetregulationswithinwhich nutrition and dilishedwithin the practice act and interprestate.Dietetics: The integration, application,sciences, to achieve and maintain optimeffective food and nutrition services in aMedical Nutrition Therapy (MNT): Meprovision of MNT (to a patient/client)diagnosis, nutrition intervention and nmanagement of diseases and/or conditioNutrition Care Process (NCP): The Acadtional needs and includes four steps: assEvidence-Based Practice: Evidence-baspossible, that is, the most appropriate inbased practice values, enhances, and buicomplex and conscientious decisionmakpreferences. It recognizes that health carbasedpractice incorporates successful straresearch, national guidelines, policies, conknowledge, and skills of experts.Integrative and Functional Medicine:patient-centered, healing-oriented medparadigm of medicine than the currentincreasingly accepted by health careized medicine, anti-aging, nutritional mNutritional Genomics: “An umbrella tenutrigenetics and nutrigenomics.” “It is tthemolecular, cellular, organismal, andpproteins those genes produce and how whow individual genetic differences can afwe eat.”34

www.eatright.org/cpd).

Month 2013 Volume xx Number x

SUMMARYThe Scope of Practice for the RD pro-vides standards and tools to guide com-petence in performing nutrition and di-etetics practice. Composed of statutoryand individual components, the RD’sscope of practice is determined by statestatute and the RD’s individual scope ofpractice is based on education, training,credentialing, and demonstrated anddocumented competence in practice.The Scope of Practice for the RD reflectsthe Academy’s position on the RD’sscope of practice and the essential roleof the RD in directing and coordinating

on of Terms unless otherwise referenced (ntialing agency for the Academy, definesademic requirements with successful comprograms accredited by the ACEND of thexamination for Dietitians. To maintain thecation requirements (accrue 75 units of

defines the Dietetic Technician, Registroutes: 1) successful completion of a mi

ND of the Academy of Nutrition and Dieterequirements (Didactic Program in Dietetprogram under the auspices of a Dieteticate degree; successfully completed a Didl must successfully complete the Registratmplywith the Professional Development Pl education every 5 years).eScopeofPractice inNutritionandDietetics practitioners perform. For credentialed prnd controlled by the agency or board that re

ommunication of principles derived fromtrition status of individuals through the dety of settings.nutrition therapy is an evidence-based ainclude one or more of the following: nion monitoring, and evaluation, which t

’s Nutrition Care Process is a process forent, diagnosis, intervention, monitoring,actice is an approach to health care whereation available, to make decisions for indclinical expertise, knowledge of diseasemased not only on the available evidence bundividualized and ever changing and invols that improve client outcomesandarederius statements, systematic analysis of expe

ing a systems biology approach to healthat embraces conventional and complemnant biomedical model. They were drivenders and institutions. There are otherne, biological medicine, and a growing listat describes the application of genetic teudy of how dietary and other lifestyle choation levels.”32 “Nutrigenetics concerns thhose proteins work.”33 “Nutrigenomics ishewaywe respond tonutrients (andother

safe, timely, person-centered care for

JOURNAL OF THE ACAD

the delivery of quality food and nutri-tion services.

References1. Academy of Nutrition and Dietetics Qual-

ity Management Committee. Academy ofNutrition and Dietetics: Scope of Practicein Nutrition and Dietetics. J Acad Nutr Diet.2013. In press.

2. Academy of Nutrition and Dietetics Qual-ity Management Committee. Academy ofNutrition and Dietetics: Revised 2012Standards of Practice inNutrition Care andStandards of Professional Performance forRegistered Dietitians. J Acad Nutr Diet.2013. In press.

3. Academy of Nutrition and Dietetics Qual-

//www.eatright.org/scope).egistered Dietitian as an individual whoion of both specified didactic educationemy of Nutrition and Dietetics andwhoredential, the RDmust comply with theved continuing professional education

as an individual who has met currentm of an Associate degree and a Dieteticcademy); 2) successful completion of as accredited by ACEND of the Academy;ician Program as accredited by ACEND;Program in Dietetics as accredited byxamination for Dietetic Technicians. Tolio recertification requirements (accrue

ompasses therangeof roles, activities, andoners, Scope of Practice is typically estab-es the practice of the profession in a given

d, nutrition, social, business, and basicopment, provision, and management of

ation of the Nutrition Care Process. Theon assessment/reassessment, nutritionlly results in the prevention, delay, or

ifying, planning for, and meeting nutri-valuation.alth practitioners use the best evidenceals, groups, and populations. Evidence-nisms, and pathophysiology. It involveson client characteristics, situations, andncertainties and probabilities. Evidence-omvarious sourcesof evidence, includinge, quality improvement data, specialized

re, both types of medicine encompassary therapies. They represent a broaderially by consumer demand and are nows describing this paradigm: personal-thers.31logy to food and nutrition and includesnfluence the function of living beings atividual’s geneticmake-up (DNA) and thetudy of how foods affect our genes andrally occurring compounds) in the foods

finiti http:crede the Rte) ac pletough Acadion E RD certifi appro

: CDR eredthree nimuACE tics (Amic ics) actice Technlaure acticidua ion Est co ortfoionaics:Th sencetetic actitited a gulat

and c fooal nu evelvaridical pplicmay utritiutrit ypicans.emy identessm and eed pr in heform ividulds on echaing b t alsoe is i ves utegie ved frsens rienc

Shar th caicine entdomi initprovi termedici of orm th chnohe st ices iopul e indell t the s

fect t natu

ity Management Committee. Academy ofNutrition and Dietetics: Scope of Practice

EMY OF NUTRITION AND DIETETICS 11

FROM THE ACADEMY

for the Dietetic Technician, Registered. JAcad Nutr Diet. 2013. In press.

4. Academy of Nutrition and Dietetics. Prac-tice tips: The RD/DTR team. http://www.eatright.org/scope. Accessed March 10,2012.

5. Academy of Nutrition and Dietetics. Prac-tice Tips: What Is Meant by “Under the Su-pervision of a Registered Dietitian”? http://www.eatright.org/scope. Accessed March10, 2012.

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7. CommissiononDieteticRegistration.Whoisaregistered dietitian (RD)? http://cdrnet.org/about/who-is-a-registered-dietitian-rd.Accessed February 13, 2013.

8. Weddle DO, Himburg SP, Collins N, LewisR. The professional development portfolioprocess: Setting goals for credentialing. JAm Diet Assoc. 2002;102(10):1439-1444.

9. Commission on Dietetic Registration.CDR Certifications. http://www.cdrnet.org/certifications/board-certified-specialist. Ac-cessed February 13, 2013.

10. Ward, B. Compensation & benefits survey2011: Moderate growth in registered di-etitian and dietetic technician, registered,compensation in the past 2 years. J AcadNutr Diet. 2012;112(1):29-40.

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12. AcademyofNutritionandDietetics.MedicalNutrition Therapy (MNT). http://www.eatright.org/HealthProfessionals/content.aspx?id�6877&terms�MNT. AccessedMarch 10, 2012.

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15. Franz MJ, Powers MA, Leontos C, et al. Theevidence for medical nutrition therapy intype 1 and type 2 diabetes in adults. J AmDiet Assoc. 2010;110(12):1852-1889.

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22. Gates G. Ethics opinion: Dietetics profes-sionals are ethically obligated to maintainpersonal competence in practice. J AmDietAssoc. 2003;103(5):633-635.

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34. NCMHDCenterofExcellence for NutritionalGenomics. Home. http://nutrigenomics.

ucdavis.edu/?page�Information. Acce-ssed July 11, 2012.

AUTHOR INFORMATIONMembers of the Academy Quality Management Committee 2010-2011, 2011-2012, 2012-2013 and Scope of Practice Subcommittee of theQuality Management Committee 2010-2011, 2011-2012, 2012-2013: Joyce A. Price, MS, RD, LDN–Chair 2010-2011; Sue Kent, MS, RD, LD–Chair2011-2012; Marsha R. Stieber, MSA, RD–Chair 2012-2013; Valaree M. Williams, MS, RD, LDN–Vice Chair 2012-2013; Joanne B. Shearer, MS, RD,LN; Charlotte B. Oakley, PhD, RD, FADA; Sharon A. Cox, MA, RD, LD; Mary J. Marian, MS, RD, CSO; Elise A. Smith, MA, RD, LD; Pamela Charney,PhD, RD; M. Patricia Fuhrman, MS, RD, LD, FADA; Isabel M. Parraga, PhD, RD, LD; Doris V. Derelian, JD, PhD, RD, FADA; Terry L. Brown, MPH, RD,CNSC, LD; Susan L. Smith, MBA, RD; Barbara J. Kamp, MS, RD; Gretchen Y. Robinson, MS, RD, LD, FADA; Margaret J. Tate, MS, RD; Carol J. Gilmore,MS, RD, LD, FADA; Patricia L. Steinmuller, MS, RD, CSSD, LN; Jean A. Anderson, MS, RD; Lois J. Hill, MS, RD, CSR, LD; Sandra J. McNeil, MA, RD,CDN, FADA; Bethany L. Daugherty, MS, RD, CD; Pauline Williams, PhD, MPA, RD, CD; Melissa N. Church, MS, RD, LD; Karen Hui, RD, LDN; andSharon M. McCauley, MS, MBA, RD, LDN, FADA.

ACKNOWLEDGEMENTSThe Academy Quality Management Committee and its Scope of Practice Subcommittee thank the following Academy members for theirassistance with manuscript preparation: COL George A. Dilly, PhD, RD, LD, US Army; LTC Dianne T. Helinski, MHPE, RD, LD, US Army; MartinYadrick, MBA, MS, RD, FADA; Elaine Ayres, MS, RD, FAC-PPM; Christina Ferroli, PhD, RD; Katrina A. Holt, MS, MPH, RD; Claire A. Heiser, MS, RD;Betsey Haughton, EdD, RD, LDN; Helene M. Kent, MPH, RD; Marsha Spence, PhD, MS-MPH, RD, LDN; Jamie S. Stang, PhD, MPH, RD, LN; ConnieMueller, MS, RD, SNS; Diane Duncan-Goldsmith, MS, RD, LD; Angie Tagtow, MS, RD, LD; Deborah Canter, PhD, RD, LD; Glenna McCollum, DMOL,MPH, RD; and Lindsay Hoggle, MS, RD, PMP.

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