What Do RDs/RDNs Actually Do?

Framed differently, most RDNs do not promote food rules. Nor do they expect you to eat only organic or “natural” food. RDNs do listen and carefully assess your situation and help clients and patients create a realistic food and activity plan.

Recently there has been a lot of chatter amongst nutrition professionals on LinkedIn following a post by Jill Castle MS, RDN about a report that stated roughly 20% of nutrition messages from health professionals, especially RDNs, is deemed to be out of touch with reality and one’s lived experience. As a seasoned nutrition professional and former director of a graduate program that prepared the next generation of practitioners, I am troubled by this report. 

No ”good” food, “bad” food

For years our profession has been misunderstood by consumers, the press and other health professionals. Aside from being called the food police, RDNs have been accused of simply telling people what to eat and what to avoid without any regard for the patient/client experience. This dichotomous thinking, where a food is either “good” or “bad” is far from what we teach and practice. However, most people think of foods this way, taking a guilt trip whenever they “go off” their diet to enjoy a bag of chips or a dish of their favorite ice cream. I cringe when my clients, friends, family, and colleagues talk about “being bad” because they ate a “forbidden” food.

I work as a nutrition consultant with a local area agency on aging. My task is to help people make food and lifestyle changes to manage their chronic conditions. It is heartbreaking to talk with women in their 70’s who have been a prisoner to the diet culture for all their lives and no longer trust their instinct about what to eat. Sadly, they have spoken with assorted well-meaning RDNs who have plenty of food information to share. For decades these older clients have lost touch with the #1 principle about eating: enjoy your food. 

Now faced with multiple chronic conditions that can be managed with diet changes, they expect me to give them more diet advice. I sit and I listen. Eventually the focus of the conversation turns to food and their medical condition. I assure them that I’m not here to tell them what to eat. Rather, we discuss their usual food pattern, how that relates to their medical condition, and oftentimes foods to add to their plates rather than foods to remove. Like many RDNs, it sometimes feels like I am undoing years of misguided advice about healthy eating (that dichotomous mindset).

It's an ethical issue

An early lesson in the preparation of new practitioners is to eliminate the good food/bad food mindset and instead, encourage working with people to find a way that all foods can fit, in moderation, of course (that term, moderation, can be a slippery slope). Aside from being the right approach, we have an ethical obligation to “act in a caring and respectful manner, mindful of individual differences, cultural, and ethnic diversity”. 

Behavior change agents

Another key tenet of nutrition practice, and thus the training of emerging professionals, is helping people change their behaviors related to food and lifestyle. Sustainable behavior change requires goal setting, baby steps to achieve goals, practice, re-setting goals, more practice, and patience. The latter is a tough sell for our profession. There are no promises of instant weight loss or reduced blood pressure or glucose levels. Behavior change is hard work. The RDN is trained to:

• listen to clients and patients, consider their circumstances (including but not limited to finances; ethnic, cultural and religious background; access to food; their built environment; allergies)

• discuss options to help them change behaviors

• guide them through the process of setting realistic goals

• identify workable strategies to achieve those goals. Since behavior change is fraught with many challenges, the RDN will continue to work with the individual to modify goals, try new strategies and celebrate their success.

All of these skills require education, training and supervised practice before earning the RDN credential (passing a national exam is also required).

Making healthy foods accessible

Another criticism lobbed at our profession is how little regard we have for the affordability of healthy foods. Again, we have an obligation to meet people where they are. Although the national guidelines for healthy eating (aka the MyPlate model and Dietary Guidelines for Americans) are lofty aspirations for people with limited resources, our job as RDNs is to help them find ways to eat nourishing foods that are culturally appropriate, available, and affordable. For example,

• Eat more fruit and vegetables. Fresh is nice, however canned vegetables and fruit are perfectly nourishing options.

• Eat more fish. Because fresh fish is often too expensive or unavailable, canned tuna, salmon and sardines are excellent sources of lean protein and omega-3 fatty acids.

RDNs need to know how to cook with these non-perishable sources of food. That’s where we blend the science of nutrition with the food people eat.

While I am not exonerating RDNs and nutrition professionals who ignore people’s lived experience and are promoting unreachable or quick-fix solutions, I urge people in need of solid, credible nutrition services to locate a qualified RDN.

Returning to my original question - what do RDNs do? Contact us for more ideas on how to develop effective strategies for making meaningful connections with your clients and patients.