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Connect the Patient to the Expert: Referral to a Registered Dietitian Nutritionist

      To the Editor:
      The Commentary “A deficiency of nutrition education in medical training”
      • Devries S.
      • Dalen J.E.
      • Eisenberg D.M.
      • et al.
      A deficiency of nutrition education in medical training.
      correctly points out longstanding issues affecting physician education, patient treatment, and issues of cost and reimbursement for nutrition care. Each of these issues can be appropriately addressed through a team setting—a critical member of which is a registered dietitian nutritionist (RDN) providing medical nutrition therapy.
      We members of the Academy of Nutrition and Dietetics agree that the nutrition competency of physicians should be more adequately addressed both in their educational training and on an ongoing basis, particularly as nutrition science evolves. An excellent starting point is interprofessional education that includes medical students and dietetics interns, among others. It is unfortunate that the American Association of Medical Colleges does not include tracking exposure to dietetics; we call on medical educators to include dietetics to meet their interprofessional education competencies. Physicians need to stay up to date on recent scientific information regarding nutrition, but they realistically do not have time to provide patients with the depth and breadth of medical nutrition therapy provided by an RDN.
      Studies confirm positive outcomes and cost-effectiveness of medical nutrition therapy,
      • Bradley D.W.
      • Murphy G.
      • Snetselaar L.G.
      • Myers E.F.
      • Qualls L.G.
      The incremental value of medical nutrition therapy in weight management.
      and recent surveys show that the public recognizes RDNs as a credible source of services.

      International Food Information Council Foundation. 2014 food and health survey. Available at: www.foodinsight.org/surveys/2014-food-and-health-survey. Accessed December 8, 2014.

      Moreover, increasing numbers of third-party payers are reimbursing for RDNs' services. Because the optimal approach to keeping people healthy involves a team effort, we encourage physicians to include RDNs as part of their team, either in their offices or via referral. Patients correctly view physicians as a trusted source of information and treatment, and physicians need to determine the nutrition and obesity prevention and treatment messages they have the time and skill to provide to their patients.
      • Kolasa K.M.
      • Kay C.
      • Henes S.
      • Sullivan C.
      The clinical nutritional implications of obesity and overweight.
      However, there is an important difference between advising patients on the basics—promoting lifestyle changes and adopting a healthy diet, which most MDs, physician assistants, health coaches, and other professionals can do—and the counseling provided by an RDN who has the knowledge and skills needed to help individuals make changes that can impact outcomes. Referring patients to RDNs “could be one of the most important ways that health care professionals help patients learn about, implement and sustain behavior changes”.

      Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: training doctors for prevention-oriented Care. Available at: http://bipartisanpolicy.org/library/report/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention. Accessed December 8, 2014.

      The Academy of Nutrition and Dietetics maintains a national, searchable online referral service enabling consumers and health practitioners alike to locate an RDN in their area: www.eatright.org/programs/rdnfinder/.

      Academy of Nutrition and Dietetics. Find a registered dietician. Available at: www.eatright.org/programs/rdnfinder/. Accessed December 8, 2014.

      If all health professionals practice to the top of our competencies, patients will benefit through consultations with the most highly educated and experienced professionals in the area of food and nutrition: registered dietitian nutritionists.

      References

        • Devries S.
        • Dalen J.E.
        • Eisenberg D.M.
        • et al.
        A deficiency of nutrition education in medical training.
        Am J Med. 2014; 127: 804-806
        • Bradley D.W.
        • Murphy G.
        • Snetselaar L.G.
        • Myers E.F.
        • Qualls L.G.
        The incremental value of medical nutrition therapy in weight management.
        Managed Care. 2013; 22: 40-45
      1. International Food Information Council Foundation. 2014 food and health survey. Available at: www.foodinsight.org/surveys/2014-food-and-health-survey. Accessed December 8, 2014.

        • Kolasa K.M.
        • Kay C.
        • Henes S.
        • Sullivan C.
        The clinical nutritional implications of obesity and overweight.
        N C Med J. 2006; 67: 283-287
      2. Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: training doctors for prevention-oriented Care. Available at: http://bipartisanpolicy.org/library/report/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention. Accessed December 8, 2014.

      3. Academy of Nutrition and Dietetics. Find a registered dietician. Available at: www.eatright.org/programs/rdnfinder/. Accessed December 8, 2014.

      Linked Article

      • A Deficiency of Nutrition Education in Medical Training
        The American Journal of MedicineVol. 127Issue 9
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          We do not need to wait for more studies on nutrition and health. Although additional research will add refinements to current knowledge, we need more action on what we already know.
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      • The Reply
        The American Journal of MedicineVol. 128Issue 5
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          We appreciate this thoughtful letter and are in complete agreement with the comments that emphasize the specialized training and critical role of registered dietitian nutritionists (RDNs) in the health care team.
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