It’s no secret that prevention is a big buzzword in healthcare, or that a healthy diet is a cornerstone of preventative care. So it shouldn’t come as a surprise that one of the fastest growing fields in healthcare is nutrition. In fact, with obesity on the rise and more people concerned with the links between diet and overall quality of life, the demand for nutritionists and dietitians is expected to grow at an impressive rate of 21 percent through 2022, according to the latest Bureau of Labor Statistics analyses. As policies aimed at decreasing healthcare costs nationally gain ground, and new research confirming the benefits of eating well is published, that promising trend should continue, opening new avenues for careers in nutrition and for those looking to enjoy the benefits of becoming a nutritionist.
The Role of the Nutritionist/Dietitian
Over a century ago, the famed inventor and groundbreaking entrepreneur Thomas Edison made a bold, and in many ways prescient prediction about healthcare: “The doctor of the future,” he surmised in 1903, “will give no medicine, but will instruct his patient in the care of the human frame, in diet, and in the cause and prevention of disease.”
He didn’t get everything right. Obviously, medications have continued to play a major role in the practice of medicine. Where Edison was right, however, was concerning his vision of a more holistic and preventative approach to the treatment of disease – one that counts diet and nutrition as central components in the health and welfare of any patient.
In a sense, this represents a return to the conventional wisdom that “you are what you eat.” It’s also a vivid reflection of ongoing advances in medical science research, and a revolution in thought about approaches to healthcare, which has expanded the horizons for those interested in pursuing professional careers in the thriving field of nutrition. As the Bureau of Labor Statistics’ Occupational Outlook Handbook emphasizes, “the importance of diet in preventing and treating illnesses is now well known.” The same report goes on to say, “In recent years, interest in the role of food in promoting health and wellness has increased, particularly as a part of preventative healthcare in medical setting.”
Evidence of this sea change is all around us. An October 24, 2014 story in the Houston Chronicle carried the headline, “Dietary, Nutrition Specialists Key in Patient Care.” In it, Robert E. Blake, the chief operations officer at Houston’s Memorial Hermann Southwest Hospital, points out, “Registered dietitians and certified food management aides are difficult to find, and it goes without saying, it takes a certain personality who has the interest and the curiosity to know anatomy and physiology of the human body as well as the chemistry involved in the body’s conversion of nutrition into energy and what’s needed to keep the body functioning properly.” Blake also notes, “Because of the high demand and small supply of these professionals, we hold hiring fairs, work with college- and university-based degree programs and speak to students in training programs. Competition for these professionals has remained strong as demand has continued to grow.”
In the Los Angeles area, Cedars-Sinai Medical Center is taking the gospel of good nutrition to the streets – quite literally – through a new initiative that targets young people in low-income areas with mobile teams of nurses and nutritionists in brightly colored vans. As the Los Angeles Times reported in February of 2015, “in an area where 55 percent of teenagers are overweight or obese, its most important product [of the van program] may be health and nutrition advice, clearly explained and gently delivered.”
Hospitals aren’t the only ones that are on the lookout for nutritionists. In December of 2014, Louisiana State University announced plans to build Tiger Athletics Nutrition Center, a $12 million, state-of-the-art facility designed to do more than just feed its student athletes. While First Lady Michelle Obama has made food literacy a top priority on a national level, in local communities, certified nutritionists and dietitians are finding jobs in sectors of the economy ranging from healthcare and education, to food service, wholesaling and manufacturing; from assisted-living facilities to daycare programs for children; from corporate cafeterias to fast-food chains. Career opportunities for personal nutrition counselors, for corporate welfare consultants, as well as for nutritionists who specialize in working with children, athletes, or the elderly are also on the rise.
How does one become a nutritionist? What are the degree and certification requirements for those looking to enter the field? Where do careers in nutrition generally lead in terms of salary, work environment, and day-to-day routine? Who becomes a certified nutritionist or dietitian, and how do those specific designations differ? These are just some of the question we’ll address as we explore the range of rewarding career paths in the field of nutrition.
Being a Nutritionist/Dietitian
As with any area of study or expertise that has a broad array of real-world applications, nutrition lends itself to a number of possible career paths, each with its own unique rewards and challenges. However, there are three principle divisions in the field of nutrition that offer a useful means of conceptualizing the various career paths in nutrition.
Clinical: Clinical nutritionists and dietitians, as one might expect, work in clinical settings, often in one-on-one situations with inpatients and/or outpatients, as well as with their families, in assessing, designing, and implementing dietary strategies and nutritional therapies. Often the aim is to address a particular medical issue, which can include hypertension, diabetes, or obesity, although clinical nutritionists are also called upon come up with a plan of action in situations where a treatment protocol, such as chemotherapy, impacts a patients overall diet or creates particular food sensitivities.
Community: Schools, community health clinics and recreational centers, local, state, and federal governmental agency programs, and health maintenance organizations (HMOs) are some of the places you’re likely to find nutritionists and dietitians working in this capacity. Often, in these settings, specific subgroups (children, the elderly, at-risk families) and their specific needs are targeted in programs designed to address specific nutritional issues. For example, when the U.S. Departments of Agriculture and Heath and Human Services unveil revised dietary guidelines based on the latest scientific data, it’s the job of community-based nutritionists and dietitians to explain the implications, educate the public, and implement plans of action for achieving the new goals.
Management: Institutions that depend on large-scale food-service operations to feed employees, patients, and/or the public, require nutritionists and dietitians to help manage and optimize the performance of these facilities. Responsibilities can include recipe testing, menu planning, food sourcing, and long-term budgeting, all with the goal of meeting the latest standards and recommendations for health and nutrition.
There are further areas of specialization within those general parameters for those pursuing careers in nutrition, whether it be in the realm of pediatric or gerontological nutrition, or moving into the field of sports and fitness. Increasingly, there are opportunities for nutritionists and dietitians to work in private practice, as consultants with individuals, or with larger healthcare and foodservice companies. We’ll explore some of those career paths more fully below. But first, it’s important to accurately define the difference between a nutritionist and a dietitian.
Becoming a Nutritionist/Dietitian
While it’s fairly common to use the terms nutritionist and dietitian interchangeably in an informal context – and they are clearly related – on a professional level the designations each have distinct and different meanings. The best way to frame the difference is this: only a nutritionist who has fulfilled the requirements set out by the Commission on Dietetic Registration (CDR), which entails completing a program of study approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) and passing an exam, is considered to be a Registered Dietitian (RD) or a Registered Dietitian Nutritionist (RDN). In other words, a dietitian is a nutritionist who is registered with and licensed to practice by the CDR. In most states, nutritionists are free to practice without such licensure, as long as they don’t advertise themselves as registered dietitians/nutritionists.
Of course, there are job and salary advantages of attaining RD and RDN certification. As the BLS’s Occupational Outlook Handbook explains, “dietitians and nutritionists who have earned advanced degrees or certification in a specialty area may enjoy better job prospects.” There are other levels of ACEND-approved CDR licensing in several areas of specialization. In addition, the Board for Certification of Nutrition Specialists (BCNS), which is separate from ACEND’s Commission on Dietetic Registration, offers two different types of nationally recognized, advanced certifications in the field of nutrition. Let’s go over the various requirements and levels of licensure.
In most cases, a professional career in nutrition begins in a 4-year bachelor’s degree program, with a focus in dietetics, nutrition, food management, biology, or a related field in the physical sciences. ACEND has also helped develop a Didactic Program in Dietetics (DPD), which can be incorporated into a BA degree program. It includes comprehensive coursework in a wide range of subjects, including food and nutrition, foodservice systems management, business, economics, computer science, culinary arts, sociology, communications, biochemistry, physiology, microbiology, anatomy and chemistry. There are currently over 200 such programs accredited in the US.
In addition to a bachelor’s degree, RD and RDN certification requires 1200 hours of supervised training through an approved internship or work-study program. There are over 250 ACEND-accredited dietetic internship (DI) programs in the US, and there are also Coordinated Programs in Dietetics offered by schools that give students the opportunity to complete all or part of their supervised training as part of a four-year bachelor’s degree. Either way, the system is set up to allow and indeed encourage those pursuing a career in nutrition to begin working in the field prior to taking the CDR exam that confers formal RD or RDN licensure. It should also be noted that in some states, RDs and RDNs are also eligible for additional credentialing as a Certified Dietitian Nutritionist (CDN) or Licensed Dietitian Nutritionists (LDN), which may be a necessary to practice in that state. However, these licenses do not have additional requirements beyond what’s necessary to attain RD or RDN status.
The CDR also offers an intermediate level of certification for those who have completed a 2-year associate’s degree program, plus an additional 450 hours of supervised internship or work-study experience. Licensing as a Dietetic Technician, Registered (DTR) or a Nutrition and Dietetic Technician, Registered (NDTR) can be sufficient for entry-level positions in the field of nutrition, and are also available to those who have finished a 4-year bachelor’s degree but have not yet completed the full internship requirements for RD/RDN licensure.
For those looking to move beyond RD/RDN certification, and into the upper echelons of a career in nutrition, there are further options. Two years in the field as a nutritionist/dietitian registered with the CDR, qualifies candidates advanced levels of licensing in areas of specializing, as noted below
Board Certified Specialist in Renal Nutrition (CSR): Works on dietary concerns with patients under treatment for kidney problems, dialysis, and/or transplant.
Board Certified Specialist in Pediatric Nutrition (CSP): Works directly with children and their parents on nutrition and dietary issues.
Board Certified Specialist in Sports Dietetics (CSSD): Works with athletes and/or teams on nutrition and dietary concerns specific to the demands of particular sports.
Board Certified Specialist in Gerontological Nutrition (CSG): Works with older adults on nutritional strategies for optimal health and quality of life, and on managing various diseases associated with aging through diet and nutrition.
Board Certified Specialist in Oncology Nutrition (CSO): Works with cancer patients on nutrition and dietary concerns before, during, and after treatment.
The uppermost level of certification in the field in nutrition is conferred by the Board for Certification of Nutrition Specialists (BCNS), and is reserved only for candidates who have completed a master’s or doctoral degree in nutrition or clinical healthcare, and at least 1000 hours of supervised work in the field. The BCNS award two different credentials: the CNS, or Certified Nutrition Specialist certification indicates that an “individual has the advanced knowledge and clinical experience suited for the practice of science-based clinical nutrition;” and the CNS-S, or Certified Nutrition Specialist-Scholar certification is designed specifically for those who are pursuing research in the field of nutritional science and dietetics.
Interview with a Nutritionist
As we’ve mentioned, there are myriad career paths in the field of nutrition. To illustrate this point, we spoke to Jennifer Schonburg, a practicing nutritionist in Brooklyn, NY, who’s in private practice as a holistic nutrition counselor. She took a non-traditional path to a non-traditional career in nutrition, attending the Institute for Integrative Nutrition and then receiving board certification as a holistic health practitioner from the American Association of Drugless Practitioners (AADP).
How did you find your way to career in nutrition?
I worked for about 15 years in media. I was a senior editor at MTVnews.com, which I left in 2006 to become the executive editor or Elle.com. And being in media was a lot of fun. I got to interview Britney Spears on the phone and that sort of thing. But, as I was winding up my time at Elle in 2009, I started to realize that I wasn’t excited about staying in the business. I think I was just burning out on that kind of work. A year earlier, I’d seen an article about the Institute for Integrative Nutrition. It was all about this new kind of career path in nutrition, and getting an alternative education in the field of nutrition. The graduates worked one-on-one with patients, and instead of writing prescriptions for medication, they would write prescriptions for better food. I thought that was really interesting, and maybe one day…I saved the article, and it was literally in a file cabinet for a couple of years before I decided to take the next step, and I enrolled. Part of what made it possible was that I already had a bachelor’s degree, and they had weekend classes, so you could continue working your regular job during the week. Also, in addition to learning about nutrition, you’re shown how to set up a practice, how to get clients, and to this day I use website they provided the template for and that they host.
What drew you toward a career in nutrition?
I found myself having a growing interesting in nutrition and the impact food has on our health. I also liked the idea of helping people. I wanted to help people lose weight and improve the quality of their lives through the food they eat. I think it’s as simple as seeing that you’re making a difference in people’s lives, and witnessing that first hand. When a person has chronic digestive pain that a doctor can’t figure out, or when a person’s having difficulty sleeping, it can seriously affect every part of that person’s life. So, of course it feels good when you’re help a person like that. I’ve had a lot of people tell me that I’ve changed their life.
What does a typical workday look like for you?
I work from home, so I may see up to five or six clients a day in 1-hour sessions. I meet with them and provide them with recommendations. So, the bulk of my day is working with people right at my dining room table. I begin by checking in with them about how they’re feeling and how things are working out with whatever recommendations I’ve given them. We figure out what’s working and what isn’t, and we make adjustments. I ask a lot questions about how they’re sleeping, are they cooking at home, are they exercising. We talk about certain types of foods and recipes. At the end of the session I’ll give them further recommendations based on what the person’s needs are. If they’re having trouble falling asleep at night, I’ll suggest ways to address that. Some people know what they should be doing, but I’m there to hold them accountable. And I also explain in a detailed way why, for example, they really should eat whole grains instead of processed flour and sugar, and what all of that does to their bodies. What they’re getting is concentrated attention from a professional who knows how food works in the body. It can make a huge difference. People who have tried to lose weight and haven’t been able to come to me. And, I’ll get referrals from doctors in cases like that, and in cases where a patient has a chronic digestive problem that the doctor can’t figure out. We might discover that there’s a food sensitivity, or that it has something do with outside stress or with when they’re eating. It all comes down to listening, figuring it out and then finding a solution to the problem.
Nutritionist Careers on the Rise
The outlook for job growth over the next decade in the healthcare industry is quite strong across the board, thanks in large part to the demand an aging baby boomer population will continue to put on the medical and social service sectors of the economy, and also to the Affordable Care Act, which has given millions of Americans new access to such services. Well-trained and certified nutritionists and dietitians are particularly well positioned to reap the benefits of these factors, especially as the healthcare industry continues to focus on the social and economic advantages of preventing disease, rather than waiting until a person is sick to provide treatment.
The latest projections from the BLS are for a robust 21 percent increase in job for nutritionists and dietitians through 2022. CBS News’ MoneyWatch included dietitian on its list of “Top 10 Healthcare Jobs for 2015,” and Fox Business ran a story in the summer of 2012 that detailed some of the reasons that careers in nutrition have been on the rise. With a headline that read, “Need a Job? Check out the Nutrition Field,” the article pointed out that “the increase in jobs in the nutrition and dietetics space is a direct result of more schools, corporations and health insurance companies hiring health professionals to educate students, employees and clients.” It also quoted Dr. Ann Kulze, a family physician and author of the book Dr. Ann’s Eat Right For Life, assessing the situation this way: “The perfect storm has been brewing for a while. There has been this flood of dazzling science telling us that diet and great health and diet and disease are inextricably linked.” Moreover, it referenced a 2012 study by the International Food Information Council Foundation finding that 52 percent of Americans admit that doing their own income taxes would be easier than knowing how to eat a healthy diet.
Another alarming statistic that has created a growing demand for nutritionists and dietitians is cited in the BLS’s Occupational Outlook Handbook: “According to the Centers for Disease Control, more than one-third of U.S. adults are obese.” As a result, “more dietitians and nutritionists will be needed to provide care for people with these conditions.”
Of course, even the perfect storm impacts some areas with more force than others. So, while overall demand for knowledgeable nutrition specialists who can translate the latest USDA and HHS dietary guidelines into plain English and steer individuals, institutions and companies toward the right food choices, has increased, there are some sectors of the market that are expected to grow at a faster rate than others. For example, a breakdown of the BLS employment predictions reveals that jobs for self-employed nutritionists are only expected to increase by a modest 2.9 percent through 2012. At the other end of the spectrum, employment for nutritionists and dietitians in physicians offices is expected to grow by 29.2 percent over the same period; for elderly and disabled services that number jumps to 63.9 percent; and it’s a whopping 68 percent for careers in nutrition related to outpatient care centers.
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Professional, scientific, and technical services
25.5%
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Management, scientific, and technical services
40.8%
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Healthcare and social assistance
30.2%
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Offices of chiropractors
23.7%
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Child daycare services
23.1%
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Colleges, universities, and professional schools
12.8%
Sports Nutrition Specialist
Nutritionists in this area of specialization might work in a number of settings, including at a college or university with an athletic program, or as part of the services offered by a fitness or recreational sports center. In the later context, a nutritionist might offer guidance to clients on how best to integrate a healthier diet into their fitness regimens, or work in tandem with a food-service provider on recipes and menu planning for the facility’s dining area.
Growth: 12.8%
Pediatric Nutrition Specialist
This area of specialization lends itself to a wide array of career paths, including hospital and clinic work, school cafeteria consulting, and child daycare center oversight. In the latter role, a nutritionist or dietitian might help plan snacks and meal for children, counsel parents on home meal preparations, or teach the children the fundamentals about good eating habits.
Growth: 23.1%
Home Heath Care Nutrition Specialist
For the right kind of person, a career in nutrition can mean going out into the community and working with individuals and families who require dietary guidance. In some cases, this work funded by hospitals, in others by local or state governmental agencies, and in others by nonprofit organizations.
Growth: 58.4%
Nutritionist/Dietitian Job Growth: State-by-State
Another important consideration when planning for a career in nutrition is location. Demand for nutritionists and dietitians can vary from city to city, state to state and region to region. The BLS is estimates that 14,200 new jobs for nutritionists and dietitians will be added by 2012, bringing the total to 81,600. The map below will help delineate where those new jobs are likely to appear over the next decade.
Choosing a Career Path in Nutrition
The range of options for a person embarking on a career in nutrition may not be limitless, but they’re expansive enough to accommodate a wide array of personalities and preferences. If you’re an analytically-minded science buff who’d rather spend time in a lab than in a bustling community health clinic, you’re likely to find what you’re looking for in a nutritional research setting. If, on the other hand, you’re more of a people person who likes working with children, then you’d be better off gravitating toward a clinical nutritionist position in a family clinic.
Career Spotlight: Outside the Numbers
According to the BLS, 31 percent of the nutritionists and dietitians currently working are employed by state, local and private hospitals; 13 percent have government jobs; 9 percent work in nursing or residential care facilities; and 14 percent are employed in the offices of healthcare practitioners and outpatient care centers. That only adds up to 67 percent, which means there are a whole lot of people working in the field of nutrition who fall outside of those numbers. For example, as the farm-to-table, sustainable food movement has taken hold, positions for trained nutritionists have opened in the grass-roots agricultural industry. Indeed, anywhere that food is grown, prepared, or served, nutritionists may find themselves welcome, particularly as awareness about allergies, food sensitivities and healthy living grows. Somewhere out there, there’s an opening for a gluten-free nutrition specialist – or there will be soon.
The graph below offers a visual representation of some of the data on employment listed above:
31%
of the nutritionists and dietitians currently working are employed by state, local and private hospitals;
9%
work in nursing or residential care facilities;
13%
have government jobs;
14%
are employed in the offices of healthcare practitioners and outpatient care centers.
= 67%
Like many of the most challenging and rewarding pursuits, a career in nutrition is something of a hybrid calling that blends the science of medicine and biology with intuition, empathy and communications skills of a psychologist or a social worker and blends in some of the flair of the culinary arts. It all depends on which path you chose in nutrition, but there is a baseline combination of knowledge and skill that can be helpful across the wide array of jobs in the field.
For starters, a nutritionist or dietitian should have a firm grounding in the life sciences, including biology, physiology and biochemistry, and be comfortable with medical terminology and protocols. Obviously, this is crucial for anyone seeking to pursue a career in nutritional research or aiming to work in a clinical setting. But, even for community-based nutritionists, it’s important to be able to explain the biological, physiological and medical basis for a healthy diet. For example, a client with hypertension is probably more likely to heed dietary advice if it is clearly and thoroughly explained, and if the risks of deviating from that diet are clearly illustrated. So, communications and language skills are also important on the job.
A nutritionist or dietitian working one-on-one with patients can also benefit from the training associated with therapy and counseling. A big part of successfully working in the community is gaining the trust of your clients, and understanding the underlying psychology of the kind of behavior modifications that’s necessary to improve one’s diet. Even nutritionists and dietitians who gravitate toward the management positions have to be able to successfully work together in teams with other healthcare professionals or corporate decision makers. A little psychology can go a long way in such situations.
Finally, careers in nutrition are often centered on general problem solving. That may mean using whatever data you have on hand to figure out why a particular patient or client is having difficulty with certain foods, or it could come down to trying to find the right balance between short-term food costs and the long-term benefits of a healthier diet. In either case, intellectual flexibility, deductive reasoning and knowledge of the most up-to-date research in the field can be a major advantage. It goes without saying that those who cultivate these skills most assiduously often happen to earn larger salaries.
Salary for Nutritionists and Dietitians
The BLS data on wages, from May of 2013, puts the average annual salary for nutritionists and dietitians at $56,300, with those in the top 10 percent of earners pulling in closer to $80,000 a year, and those in the bottom 10 percent earning a little less than $34,000. That reflects the kind of variation you’d expect to see in a field that encompasses so many different kinds of job description, especially since there are differences from state-to-state in terms of what constitutes a nutritionist or a dietitian.
However, it appears to offer a fairly accurate picture of the range of salaries in the general field of nutrition. So much of that can depend on what kind of degrees and certifications an individual has attained. For example, ACEND’s Academy of Nutrition and Dietetics surveyed its members in 2009 and found that, “half of all RDs in the US who have been working in the field for five years or less earn $51,100 to $62,200 per year.” The same survey found that DTRs, or those who have not yet reached the rank of full Registered Dietitian or Registered Dietitian Nutritionists ”who have been working in the field full-time for less than five years earn between $33,800 and $37,700 per year.” So, yes, that bachelor’s degree and internship we mentioned earlier does indeed make a big difference.
The Academy’s 2009 Dietetics Compensation and Benefits survey also found that RDs in management position earned incomes in the range of $85,000-$88,000, proving that rank and seniority count as well.
The BLS numbers are also well supported by other sources, like Salary.com, which breaks it down this way: dietitian/nutritionist technicians earn $35,506 annually, while full-fledged RDs are closer to $60,000. Homecare dietitians are listed as having an average expected salary of $61,160, and the “senior” dietitians (i.e., dietitians with at least three years of experience in the field, as opposed to dietitians who work with seniors) earn a bit more than that: $62,176.
The full story is even rosier than that. In the Fox Business report we mentioned earlier, Chad Oakley, the president and chief operating officer at human resources consultancy Charles Aris, gets in the final word, and it’s good news for those pursuing a career in nutrition. “The demand for nutrition talent is growing dramatically on a global scale,” he explains. “Nutrition has not been an oversubscribed career path so you have a low supply base of professionals for something that is suddenly experiencing a high demand. I cannot imagine seeing a glut of nutritionists for a really long time. I advise all young people against getting into an industry with an oversupply, but I would say they are totally in the clear to go and pursue this, and they will have plenty of demand for their services when they graduate.”
Nutritionists/Dietitians Job Search
