Professionalization of Dieting

In the history of dieting, various groups and individuals have been responsible for handing out dieting advice. From the 1860s to the 1950s, the church and religious groups, as well as celebrity and socialites from Lord Byron to Upton Sinclair, emphasized the importance of keeping the body pure (Griffith 2004: 50). In the 1960s, people shifted from following traditional diet advice of keeping the body clean to conforming to a thinness campaign (Bordo 2003: 102-3). Restrictive diets became popular and, thus, the average American looked to supermodels like Twiggy for "advice." Again, in the 1980s, celebrity figures and fad doctors published the bulk of dieting books and gave out dieting tips on how they were able to achieve a slim figure. Celebrities like Jane Fonda and Oprah, among others, provided their personal dieting stories for Americans to follow. Currently, the research-driven food and dieting industry has caused a shift in dietary advice, which emphasizes the expertise of medical doctors with university degrees in diet and nutrition.

In order to understand to whom people are turning for advice at the beginning of the twenty-first century, it is important to understand the difference between a nutritionist and a dietitian. A dietitian is a healthcare professional who has received specialized accredited tertiary education and training. Dietitians are also required to adhere to regulatory rules and guidelines. A nutritionist, on the other hand, advises people on dietary issues related to health, well-being, and proper eating. Even though no formal organization regulates the work and advice of a nutritionist, these specialists often write dieting books and appear on television programs publicizing their advice (Anon. "Dietitian/Nutritionist" 2007).

The shift from individuals following the advice from diet gurus to diet professionals is evident in the increasing number of members of the American Dietetic Association (ADA). As of 2006, the ADA had 65,000 members and was the U.S.A.'s largest food and nutrition organization. The ADA was founded in 1917 in Cleveland, Ohio by a group of women who wanted to enhance America's health and nutrition during World War I. Since the early 1900s, the ADA has evolved into an organization of people with diverse practice areas (ADA). Whether dieters actually check to see if their dietitian or doctor is a member of the ADA is unknown; however, as in other professions, belonging to the national organization is important. According to the ADA's vision statement, its "members are the most valued source of food and nutrition services," because of their extensive training.

However, becoming a professional dietitian is not easy. In order to join the ADA, one must hold one of numerous degrees. Most common among members of the ADA are registered dietitians (RD), who are food and nutrition experts. RDs are required to meet extensive academic and professional requirements, including holding a bachelor's degree with coursework approved by ADA's Commission on Accreditation for Dietetics Education (CADE). Courses typically focus on food and nutrition sciences, food-service systems management, business, economics, computer science, sociology, biochemistry, physiology, microbiology, and chemistry. Seventy-five percent of the ADA is comprised of registered dietitians, and the remaining members are made up of dietetic technicians, food-service managers, educators, researchers, and other dietetic professionals. As of November 2006, there were approximately 228 bachelors and masters programs all over the U.S.A. approved by CADE in which one could begin one's career in dietetics. In addition, potential candidates for licensing must complete a CADE-accredited supervised program at a healthcare facility, community agency, or food-service corporation. Such a practice program typically lasts six to twelve months. In addition, one must take and pass the national exam given by CADE. Lastly, registered dietitians must complete continuing educational requirements to maintain registration. The ADA believes that such a rigorous program guarantees expertise and quality advice which consumers now demand.

After completing their degree, about half of all registered dietitians work in clinical settings, private practice, or healthcare facilities. Others work in community and public health settings, academia and research, business, journalism, sports nutrition, and wellness programs. According to the U.S. Department of Labor Bureau of Labor Statistics, heightened public interest in nutrition and health has increased the job market in areas such as food manufacturing and advertising where dietitians analyze aspects of foods and report on their nutrition value. The employment of dietitians is expected to grow through the next ten years as disease prevention and nutrition are growing public concerns and as people are continuing to live longer. Specifically, the Department of Labor predicts that employment will increase in nursing homes, residential care facilities, and physician clinics. The growth for dietitians and nutritionists, however, may be sustained by limitation on insurance and reimbursement for dietetic services. Nevertheless, the diversity of jobs available for graduates with degrees in dietetics reflects the growing demand for professionals to give diet advice.

Clearly, there are many trained dietitians in the U.S.A.; however, can average Americans actually afford a dietitian? Several years ago, the cost of seeing a dietitian was considered an unnecessary visit and thus not insured by healthcare companies. However, a recent survey of twenty-three healthcare plans in the U.S.A. conducted by the Journal of the American Dietetic Association found that more healthcare companies are covering a visit to a dietitian (Tufts Health and Nutrition Letter 2004). In other words, when a primary-care physician refers a patient to a dietitian, a growing number of health-insurance companies are beginning to pay for the 100-dollar session. While the restrictions are tight, such as one must seek "medical nutrition therapy" or the dietary treatment should be medically necessary to treat a chronic illness, the ball is rolling for more coverage. Health-insurance companies have recognized that correcting one's dietary problems can help general illness, prove more cost effective, and even prevent future conditions (Tufts Health and Nutrition Letter 2004).

Now that more and more people are looking to professionals for dieting advice, and people can actually afford the care, those who hand out diet advice are being held to higher standards. People who claim to be "diet experts" may have to seek the advice of legal counsel because of faulty claims of their dieting regimens. In the case of television's Dr. Phil McGraw, three irate dieters from Los Angeles sued Dr. Phil for claims made in his "Shape Up!" diet plan (Casewatch 2007). In both his television program and book, Dr. Phil promotes his Shape Up! plan by recommending dieters to take twenty-two herbal supplements and vitamin pills daily at a cost of 120 dollars a month in addition to exercising regularly. According to the product label, the pills "contain scientifically researched levels of ingredients that can help you change your behavior to control your weight." Disgruntled dieters were sure that the plan was useless as they found themselves losing money, not weight (Roope 2005). Their dissatisfaction led the Federal Trade Commission to investigate McGraw's advertising.

In late 2004, the Los Angeles Times reported that CSA Nutraceuticals discontinued Shape Up! products amid the FTC's investigation. A settlement of 10.5 million dollars came in September of 2006, and customers will be able to choose either replacement products or small cash reward as part of the settlement. Luckily for McGraw, CSA Nutraceuticals' insurance will cover the cost of the settlement, and he will have no personal responsibility for his unsubstantiated claims. Dr. Phil has since denied all allegations (American Broadcasting Corporation). A class action lawsuit such as this may illustrate how some consumers are changing whom they trust for such advice.

However, it is hard to hold those who give out dieting advice accountable because it is inherently difficult to prove or disprove the effectiveness of their plans. First, it is tough to prove which diets work because there are no double blinds; only dieters know what they are eating, and thus studies cannot accurately report whether weight changes occur because of the plan and not other factors. In addition, when it comes to dieting, people feel embarrassed about their eating habits and thus misreport unhealthy meals and choices. Also, each dieter's body functions in a unique way, and genetics and exercise play important roles that are difficult to measure. Therefore, there is no real mechanism to resolve the problems that lie in the way of studying diet.

While there is a growing movement that prefers professional advice, there are limits on this trend. The limits are that consumers want cheap and convenient advice that will provide "quick fixes" to their dieting dilemmas. Some Americans may see no need in paying high prices to a professional when they can buy a dieting book or surf the Internet for advice. Professionals usually require more long-term commitments and cost much more. The overwhelming amount of dieting advice available in accessible and inexpensive ways is evident when the word "diet" is entered into amazon.com's book search and more than 183,000 results pop up. In addition, at any one time, a diet book is on the charts on the Publisher's Weekly National Bestseller list (Dahlin and Hix 2006). Moreover, the dieting community continuously changes who is admitted into the professional crowd or quack doctor circle. With the rise of dieting books, internet advice, and more and more diet gurus making faulty claims, it is hard to predict where the next wave of dietary advice will rise.

SLG/Jessica Sawhney

See also Byron; Fonda; Hornby; Internet; McGraw; Self-help; Sinclair; Winfrey

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