Dietitians and Nutritionists

• Most jobs are in hospitals, nursing care facilities, and offices of physicians or other health practitioners.
• Dietitians and nutritionists need at least a bachelor’s degree in dietetics, foods and nutrition, food service systems management, or a related area.
• Faster than average employment growth is expected; however, growth may be constrained if employers substitute other workers for dietitians and if limitations are placed on insurance reimbursement for dietetic services.
• Those who have specialized training in renal or diabetic diets or have a master’s degree should experience good employment opportunities.

Dietitians and nutritionists plan food and nutrition programs and supervise the preparation and serving of meals. They help to prevent and treat illnesses by promoting healthy eating habits and recommending dietary modifications, such as the use of less salt for those with high blood pressure or the reduction of fat and sugar intake for those who are overweight.

Dietitians manage food service systems for institutions such as hospitals and schools, promote sound eating habits through education, and conduct research. Major areas of practice include clinical, community, management, and consultant dietetics.

Clinical dietitians provide nutritional services for patients in institutions such as hospitals and nursing care facilities. They assess patients’ nutritional needs, develop and implement nutrition programs, and evaluate and report the results. They also confer with doctors and other health care professionals to coordinate medical and nutritional needs. Some clinical dietitians specialize in the management of overweight patients or in the care of critically ill or renal (kidney) and diabetic patients. In addition, clinical dietitians in nursing care facilities, small hospitals, or correctional facilities may manage the food service department.

Community dietitians counsel individuals and groups on nutritional practices designed to prevent disease and promote health. Working in places such as public health clinics, home health agencies, and health maintenance organizations, community dietitians evaluate individual needs, develop nutritional care plans, and instruct individuals and their families. Dietitians working in home health agencies provide instruction on grocery shopping and food preparation to the elderly, individuals with special needs, and children.

Increased public interest in nutrition has led to job opportunities in food manufacturing, advertising, and marketing. In these areas, dietitians analyze foods, prepare literature for distribution, or report on issues such as the nutritional content of recipes, dietary fiber, or vitamin supplements.

Management dietitians oversee large-scale meal planning and preparation in health care facilities, company cafeterias, prisons, and schools. They hire, train, and direct other dietitians and food service workers; budget for and purchase food, equipment, and supplies; enforce sanitary and safety regulations; and prepare records and reports.

Consultant dietitians work under contract with health care facilities or in their own private practice. They perform nutrition screenings for their clients and offer advice on diet-related concerns such as weight loss and cholesterol reduction. Some work for wellness programs, sports teams, supermarkets, and other nutrition-related businesses. They may consult with food service managers, providing expertise in sanitation, safety procedures, menu development, budgeting, and planning.

Most full-time dietitians and nutritionists work a regular 40-hour week, although some work weekends. About 1 in 4 worked part time in 2004.

Dietitians and nutritionists usually work in clean, well-lighted, and well-ventilated areas. However, some dietitians work in warm, congested kitchens. Many dietitians and nutritionists are on their feet for much of the workday.

High school students interested in becoming a dietitian or nutritionist should take courses in biology, chemistry, mathematics, health, and communications. Dietitians and nutritionists need at least a bachelor’s degree in dietetics, foods and nutrition, food service systems management, or a related area. College students in these majors take courses in foods, nutrition, institution management, chemistry, biochemistry, biology, microbiology, and physiology. Other suggested courses include business, mathematics, statistics, computer science, psychology, sociology, and economics.

Of the 46 States and jurisdictions with laws governing dietetics, 31 require licensure, 14 require certification, and 1 requires registration. Requirements vary by State. As a result, interested candidates should determine the requirements of the State in which they want to work before sitting for any exam. Although not required, the Commission on Dietetic Registration of the American Dietetic Association (ADA) awards the Registered Dietitian credential to those who pass an exam after completing their academic coursework and supervised experience.

As of 2004, there were about 227 bachelor’s and master’s degree programs approved by the ADA’s Commission on Accreditation for Dietetics Education (CADE).

Supervised practice experience can be acquired in two ways. The first requires the completion of a CADE-accredited program. As of 2004, there were more than 50 accredited programs, which combined academic and supervised practice experience and generally lasted 4 to 5 years. The second option requires the completion of 900 hours of supervised practice experience in any of the 265 CADE-accredited internships. These internships may be full-time programs lasting 6 to 12 months or part-time programs lasting 2 years. To maintain a registered dietitian status, at least 75 credit hours in approved continuing education classes are required every 5 years.

Students interested in research, advanced clinical positions, or public health may need an advanced degree.

Experienced dietitians may advance to management positions, such as assistant director, associate director, or director of a dietetic department, or may become self-employed. Some dietitians specialize in areas such as renal, diabetic, cardiovascular, or pediatric dietetics. Others may leave the occupation to become sales representatives for equipment, pharmaceutical, or food manufacturers.

Dietitians and nutritionists held about 50,000 jobs in 2004. More than half of all jobs were in hospitals, nursing care facilities, outpatient care centers, or offices of physicians and other health practitioners. State and local government agencies provided about 1 job in 5—mostly in correctional facilities, health departments, and other public-health-related areas. Some dietitians and nutritionists were employed in special food services, an industry made up of firms providing food services on contract to facilities such as colleges and universities, airlines, correctional facilities, and company cafeterias. Other jobs were in public and private educational services, community care facilities for the elderly (which includes assisted-living facilities), individual and family services, home health care services, and the Federal Government—mostly in the U.S. Department of Veterans Affairs.

Some dietitians were self-employed, working as consultants to facilities such as hospitals and nursing care facilities or providing dietary counseling to individuals.

Employment of dietitians is expected to grow faster than the average for all occupations through 2014 as a result of increasing emphasis on disease prevention through improved dietary habits. A growing and aging population will boost the demand for meals and nutritional counseling in hospitals, residential care facilities, schools, prisons, community health programs, and home health care agencies. Public interest in nutrition and increased emphasis on health education and prudent lifestyles also will spur demand, especially in management. In addition to employment growth, job openings will result from the need to replace experienced workers who leave the occupation.

The number of dietitian positions in nursing care facilities and in State government hospitals is expected to decline, as these establishments continue to contract with outside agencies for food services. However, employment is expected to grow rapidly in contract providers of food services, in outpatient care centers, and in offices of physicians and other health practitioners. With increased public awareness of obesity and diabetes, Medicare coverage may be expanded to include medical nutrition therapy for renal and diabetic patients. As a result, dietitians that have specialized training in renal or diabetic diets or have a master’s degree should experience good employment opportunities.

Employment growth for dietitians and nutritionists may be constrained if some employers substitute other workers, such as health educators, food service managers, and dietetic technicians. Growth also may be curbed by limitations on insurance reimbursement for dietetic services.

Median annual earnings of dietitians and nutritionists were $43,630 in May 2004. The middle 50 percent earned between $35,940 and $53,370. The lowest 10 percent earned less than $27,500, and the highest 10 percent earned more than $63,760. In May 2004, median annual earnings in general medical and surgical hospitals, the industry employing the largest number of dietitians and nutritionists, were $44,050.

According to the American Dietetic Association, median annualized wages for registered dietitians in 2005 varied by practice area as follows: $53,800 in consultation and business; $60,000 in food and nutrition management; $60,200 in education and research; $48,800 in clinical nutrition/ambulatory care; $50,000 in clinical nutrition/long-term care; $44,800 in community nutrition; and $45,000 in clinical nutrition/acute care. Salaries also vary by years in practice, education level, geographic region, and size of the community.

Workers in other occupations who may apply the principles of dietetics include food service managers, health educators, dietetic technicians, and registered nurses.

• • Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition,