By Dr. Brian Biagioli
NCSF Executive Director
Is nutrition really within the scope of professional practice(s) of exercise professionals? Clearly, role delineation studies identify nutrition and weight management competencies as roughly 10% of an exercise professional's job. So it must have some place within the scope of practice. Additionally, certified fitness trainers, strength coaches and Pilates teachers are constantly asked by their clients to provide information regarding novel dietary strategies, the latest trends in pop-culture (diets), as well as what vitamins and performance-enhancing supplements work (or don't). So what is appropriate behavior?
To start the conversation, it is important to first recognize that the nutrition profession is regulated at the State level. This means two things: 1) no federal laws exist regarding the practice, so it is up to each State to make determinations of practice requirements and scope; and 2) it is up to the practitioner to know and understand the laws in the State where they work to ensure they are compliant and not overreaching.
The Center for Nutrition Advocacy has done a great job of helping professionals better understand the specific laws of each State on their website: http://www.nutritionadvocacy.org/laws-state. The State map of current laws is "clickable" by State and provides summaries and insight into what an exercise professional can and can't do; and the legality varies fairly widely. According to the legend, in red States it is illegal to perform individualized nutritional counseling unless licensed or exempt from licensing by the State. In green States on the other hand, it is legal for anyone to perform individual nutritional counseling. Yellow and orange states have specific requirements, but in all States the ability to provide some level of nutritional education exists. A complete list of States where licensing exists can be found on the website of the Academy of Nutrition and Dietetics at https://www.cdrnet.org/state-licensure.
So this begs the question how does an exercise professional ensure they are not breaking the law? It all comes down to what is said and done, and how it is presented. Most registered dieticians agree that individualized nutrition recommendations are outside the exercise professional's scope of practice. But disseminating information is not. For instance, exercise professionals may come under legal challenge if they write specific diets, particularly for those clients with disease or a special condition; or provide nutritional care plans or modify medical nutrition regimes. But in even the most regulated States, exercise professionals can perform anthropometric assessments, provide information about energy and non-energy yielding nutrients, explain the risks associated with nutrient insufficiency and deficiency, explain caloric values and metabolic concerns of consuming certain foods like processed carbohydrates and alcohol. For the most part, the greatest risk of legal challenge or liability is associated with the descriptive title employed by the professional, the specific prescription of dietary plans, and providing nutritional advice in regulated States.
Some States provide resources that aid is determining what is regulated by law and what is not. For instance, the Ohio Board of Dietetics has a link to scope of practice rules found at http://dietetics.ohio.gov/guidelines/guidelineD1.pdf which is consistent with the requirements in most of the States identified by the legend as red. Exercise professionals who are educating clients to better lifestyle habits and activities that reduce risk for disease should evaluate the tools available from the State to ensure they remain in compliance. That said, disseminating published nutrition recommendations from government agencies including the CDC, NIH and DPHP (https://health.gov/dietaryguidelines/2015/) is very much a part of an exercise professional's job. Americans need help losing weight and reducing the risk for disease and the government wants exercise professionals to help. On the 2015-2020 Dietary Guidelines for American Webpage it states:
"The 2015–2020 Dietary Guidelines is designed to help Americans eat a healthier diet. Intended for policymakers and health professionals, this edition of the Dietary Guidelines outlines how people can improve their overall eating patterns — the complete combination of foods and drinks in their diet."
Chapter 3 of the aforementioned Dietary Guidelines is titled "Everyone Has a Role in Supporting Healthy Eating Patterns". Exercise professionals should be encouraged to get informed and then get to work on the national obesity issues.