Currently 47 states, Puerto Rico and the District of Columbia have statutory provisions regulating the dietetics profession or associated titles such as "dietitian" and "nutritionist." The Academy is dedicated to protecting consumers by maintaining existing dietetics licensure laws and enacting or strengthening licensure laws in states that lack sufficient regulations to protect the public.
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Our consumer protection efforts ensure that consumers are able to identify and access qualified professionals who demonstrate the knowledge, skill and competency necessary to provide safe and ethical nutrition therapy. As the public increasingly understands the importance of good nutrition, some individuals without any formal education, training or expertise in human nutrition or dietetics are exploiting this newly recognized market.
States’ professional licensing laws help consumers identify who is a qualified practitioner to provide a particular set of specified services, known as the profession’s scope of practice. Some individuals are not qualified for licensure because they lack the objective accredited education, experience and examination demonstrating their competency to provide services within the regulated profession’s scope of practice. The Academy shares elected officials’ interest in supporting licensure to prevent harm for our communities, workplaces, families and friends. This means protecting against unsafe or inaccurate nutrition advice or interventions that may lead to poor or even dangerous health outcomes — and unnecessary, expensive products or services.
In addition to helping the public identify and access qualified practitioners, licensure often provides health insurance companies and state and federal governments with the assurance that these practitioners meet standards of professional competence in order to be reimbursed for providing nutrition care services. In states without licensure, other nutrition professionals or paraprofessionals may be reimbursed for nutrition services despite meeting only some of the qualifications required to become a registered dietitian nutritionist.
The Academy supports professional licensure for RDNs and other qualified nutrition professionals to protect the public by enforcing objective standards in education, work experience and exams. These standards ensure competency to provide complex care, such as medical nutrition therapy. Requirements to become a licensed dietitian nutritionist in most states are generally similar to those required to become a registered dietitian nutritionist.
As noted in the map and table above, many states have adopted licensure laws and regulations specifying the minimum credentials required to (1) use various titles, such as “dietitian,” “nutritionist,” “licensed dietitian nutritionist” or “registered dietitian nutritionist” and (2) provide MNT or other dietetics and nutrition services. Other states take a less protective approach, such as regulating the practice of licensed RDNs and other nutrition service providers, and offering licensees the ability to use certain protected titles — but stopping short of limiting who can provide complex nutrition care services to patients, clients, and other consumers. These different levels of consumer protection are discussed in more detail below.
State governments play a vital role in creating and implementing policies that serve and protect the public. In the areas of food, nutrition and health, states may:
States also license healthcare providers such as physicians, dentists, pharmacists, and dietetics and nutrition professionals to ensure that individuals providing health and personal services have met high objective education, experience and examination requirements.
To protect the public, the majority of states have enacted laws that regulate the practice of dietetics. State licensure and state certification are entirely separate and distinct from the registration or credentialing RDNs and NDTRs obtain from the Commission on Dietetic Registration or the “certification” provided by private "certifying bodies." State regulation of dietetics and nutrition comes in one of three names, although there is some substantive overlap in what is regulated between each form.
State Regulation of Food, Nutrition and Health
Overlapping Scopes of Practice
It is not uncommon for two or more professions (particularly in healthcare fields) to have certain overlapping elements of their scopes of practice. For example, RDNs, nurses and pharmacists all deliver Diabetes Self-Management Training, which is within their respective scopes of practice and in line with their respective training and qualifications.
Sometimes a member of one profession will go beyond their scope of practice and engage in activity for which they are not qualified. Often referred to as “scope creep,” this can be dangerous and put patients and clients at risk of harm. The Academy believes that the provision of medical nutrition therapy and other complex dietetics and nutrition services should only be provided by individuals who have at minimum the specialized training and competencies of RDNs. Therefore the Academy works with other disciplines practicing in the nutrition space — such as physicians, chiropractors, pharmacists, certified nutrition specialists, naturopaths, health coaches and others — on various legislative and licensure activities. When appropriate and necessary, the Academy provides feedback and testimony to legislative bodies to ensure MNT is exclusively provided by licensed professionals who have, at minimum, met the standards of an RDN.
State and Federal Facility Regulations
State and federal statutes and regulations may specifically require or exempt licensure or an RDN credential in order to practice. Additionally, individual facilities may have their own standards beyond those based in law. Qualified nutrition practitioners are encouraged to consult their specific statutes and/or facility policies for clarification.
Collecting Stories of Success and Adverse Events
Although professional standards of practice and existing consumer protection laws are effective in keeping the number of incidents of harm low, it is crucial to document instances when a consumer has reported harm — either directly to one of our members or through the media or courts. This documentation demonstrates to state legislators the risks of failing to sufficiently protect consumers from incompetent or unethical providers who practice in states without sufficiently strong licensure laws that include an exclusive scope of practice for licensed dietitian nutritionists.
CMS Rules on Therapeutic Diet Orders
The Center for Medicare and Medicaid Services rules regulating the ordering of therapeutic diets in various facilities (such as acute care hospitals, Critical Access Hospitals and long-term care facilities) allow RDNs to order diets in accordance with state law and facilities’ policies and procedure approvals. The Academy has prepared state-by-state guidance documents for hospitals and for long-term care facilities.
Consumer Protection Issue Brief and Leave Behind
In the Issue Brief, review detailed background information on consumer protection concerns, the need for licensure laws, and the various methods by which states regulate the practice of dietetics and nutrition and the provision of medical nutrition therapy, and utilize its one page synopsis as a Leave Behind when meeting with state and federal policymakers about consumer protection and professional regulation issues.