Nutrition Business Journal

The Battle for the Future of the Nutrition Profession

… and for trust in the nutrition industry

At July’s NBJ Summit, I was struck by a pervasive theme: Mounting pushback from forces opposed to natural products on science, media and public fronts … is sowing doubts about natural products’ safety and efficacy … thus eroding trust in the nutrition industry’s companies and products.

In short, the industry’s “circle of trust” is under assault. Restoring that circle requires asking: Who do consumers trust? We know that consumers trust their health professionals, especially when it comes to nutrition products. As one indicator, 23% of supplement sales are based on practitioner recommendation, according to research published by JAMA. An indispensable link in the nutrition industry’s circle of trust is a strong, aligned nutrition profession.

Yet the nutrition profession itself is engaged in a pitched battle for practitioners’ right to practice nutrition and receive insurance benefits. The nutrition industry and the nutrition profession thus have common cause in assuring the public has access to quality nutrition advice and quality nutrition products.

Products of other industries, such as pharma, do not face the same barriers to public trust and acceptance as nutrition industry products, despite their less favorable risk/benefit ratios. Why? Pharma has built a tightly bonded circle of trust by cultivating a strongly aligned health profession—allopathic MDs—who have the de facto effect of a salesforce, marketing team, media spokespeople, policy advocates and researchers for those products. The nutrition industry needs to cultivate an aligned profession for many reasons:

Sales—If 23% of supplements are used on the advice of health care professionals, that translates to $8 billion of the $35 billion in annual industry sales—$2.5 billion from practitioner channel sales alone, according to NBJ research, plus $5.5 billion more through other channels but still due to health professional recommendations.

Marketing—Companies are muzzled from educating consumers about science-based benefits of natural products. Nutrition professionals and our associations are under no such restrictions. The nutrition profession can be a powerful source of science-based information about supplements’ impact on health, but only if the profession itself is not muzzled by anti-competitive regulation.

Communications & advocacy—Nutrition professionals and their associations can be powerful messengers to media and policy makers. They can speak to the effectiveness of the industry’s products, and point consumers to the highest-quality brands based on clinical experience.

What is our profession?

What differentiates nutrition practice is that unlike, say, dentistry, it is not a self-enclosed profession. For some health professionals, nutrition is just one tool among many (think integrative MDs, NDs, DCs). For others, nutrition is their profession (think nutritionists). At the Board for Certification of Nutrition Specialists (BCNS), our Certified Nutrition Specialist (CNS) credential reflects that duality. CNSs include MDs, DCs, PharmDs and NDs, as well as full-time PhD- or Master's-degreed clinical nutritionists.

So, the aligned practitioners for the nutrition industry are actually two groups: (1) “Nutrition as Tool” practitioners, and (2) “Nutrition as Profession” practitioners. Both are crucial channels for the nutrition industry. Both face threats from exclusionary practice regulation.

The “Nutrition as Tool” group represents a diverse base of ambassadors for the industry.  These practitioners have developed a nutrition skillset, and many but not all have obtained nutrition credentials.

The “Nutrition as Profession” providers are a hugely valuable yet untapped resource, as these practitioners “do” nutrition full-time with every client and have the most unalloyed stake in the future of the industry. This group includes a wide variety of nutritionists, from very highly credentialed clinical nutritionists—such as CNSs, Certified Clinical Nutritionists, Diplomates of the American Clinical Board of Nutrition—to holistic nutritionists to health coaches. Clinical nutritionists, highly trained in the use of supplementation for the management of health conditions, are vital sources of information to patients, media, and the scientific community about the efficacy and safety of high-quality supplements.

Inclusive rights & benefits

While the supplement industry is under assault, its aligned profession is facing threats on several fronts as well. As one example, the Academy of Nutrition and Dietetics (AND, formerly American Dietetic Association) leadership has engaged in a divisive 50-state and federal effort to create an exclusionary regulatory regime for nutrition counseling to benefit its own private credential, the Registered Dietitian (RD).

AND’s state licensing bills make it a crime to give nutrition and supplement advice without a dietetics/nutrition license or another healthcare license that has nutrition explicitly in its scope (most do not). Where passed, these laws often bar entire segments of nutrition practitioners—such as credentialed nutritionists, naturopathic physicians, chiropractors, acupuncturists, pharmacists, herbalists, sports nutritionists, product retailers and distributors—from legally providing individualized nutrition advice.

For example, an extremely qualified practitioner and professor, Dr. Liz Lipski, PhD, CCN, CNS was forced out of practice in North Carolina due to its exclusionary nutrition licensing law. These laws are destructive not just to the “Nutrition as Profession” group, but also to many “Nutrition as Tool” practitioners. Naturopathic physicians are licensed in only 18 states. Therefore, in any state with (1) exclusionary RD licensure, and (2) no naturopathic physician licensure, such as Florida, it is illegal for naturopathic physicians to provide individualized nutrition counseling, including supplement recommendations. Many other “Nutrition as Tool” practitioners are similarly barred across many states. These restrictions significantly narrow the industry’s practitioner channel, and thus the crucial link in its circle of trust.

Moreover, the RD credential is far from the highest qualification. The RD credential requires a Bachelor’s degree, while several other nutrition credentials require a Master’s or Doctoral-level degree and require substantial training in the use of supplements. And NDs are among the most knowledgeable of all health professionals about clinical nutrition and botanical medicine.

While a small percentage of RDs pursue advanced clinical nutrition training, dietetics degrees offer minimal and fairly rudimentary training on supplements. Much of this stems from AND’s attitude as an association toward supplements, which is tepid to hostile. Witness its Position Statement on supplements:
“It is the position of the American Dietetic Association that the best nutrition-based strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards such as the Dietary Reference Intakes.”

Eighteen states have exclusionary RD-only licensure laws, 12 have laws that exclude many but have some provision for some credentialed nutrition professionals, and 16 allow all to practice but only RDs to have a state credential—key to insurance reimbursement for covered services.

AND has also ratcheted up enforcement by urging RDs to report “unlicensed activity.” Professionals are increasingly being forced to stop providing nutrition advice through cease and desist orders or prosecutions. AND has also launched a “Public Protection” campaign which encourages RDs to file “complaints of harm” against non-dietitians. In one state, almost two-thirds of complaints generated by RDs focused on supplement use.

AND’s and RDs’ aligned industry is not the natural products industry. For example, AND’s current main sponsors are: Abbott Nutrition, National Dairy Council, The Coca-Cola Company Beverage Institute for Health & Wellness, General Mills, Kellogg Company, McCormick, PepsiCo, and Unilever.

Enter BCNS & CNA

Fortunately, although the battle continues, we have turned the tide. Previously, AND leadership was able to pass exclusionary licensing laws because opposition was dispersed. No longer.

At BCNS, we work tirelessly for an inclusionary nutrition regulatory environment through our Center for Nutrition Advocacy (CNA), whose mission is to advance nutrition care providers’ pivotal role in healthcare through effective public and private policy. We work to protect and advance a robust nutrition profession, in which all nutrition practitioners are able to practice to the level of their training. Our Board of Directors includes far-sighted nutrition thought leaders, such as Tom Aarts, Jeff Bland, Jeff Blumberg, and others.

CNA, with our allies from across the nutrition spectrum, has been extremely successful forging a more inclusive nutrition regulatory environment. Our website is the clearinghouse for information about laws and regulations affecting nutrition practitioners, and a hub for action. We spearhead opposition to anti-competitive bills and laws, and have initiated a sea change in the regulatory environment.

Nutrition licensure is just one issue CNA tackles. There are myriad other state and federal issues related to nutrition practice rights and benefits. Just one example: the American Association of Diabetes Educators (AADE) is seeking 50-state licensure for “Diabetes Educators,” which would detrimentally impact most practitioners who provide nutrition counseling to diabetics and pre-diabetics.

These exclusionary efforts have a huge cost, not just to the nutrition industry, but to society. CNA’s work is crucial and needs the support and engagement of every stakeholder in the nutrition community. As much as practitioners need high-quality products to remain available, the industry needs a strong, aligned profession. The future of the nutrition profession—and the circle of trust for the nutrition industry—is at stake.

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