Over the last several decades, the fitness industry has grown extensively. In fact, fitness professionals are often considered the gatekeepers of dispensing information on exercise and nutrition. But while most fitness and nutrition professionals, including registered dieticians, licensed nutritionists, licensed dieticians, certified nutritionists and licensed dietetic nutritionists, agree that healthy nutritional practices are paramount to achieving optimum performance, ideal body composition, fitness and health, not everyone agrees on how much nutritional education, counseling or advice fitness professionals can legally and ethically provide their clients and athletes. This confusion may be the result of several factors, including, but not limited to, the differences in the state laws that govern nutritional practices, a lack of operational definitions and misinformation.
The Perplexity of Nutritional Advice
The confusion over the boundaries of nutritional counseling has never been more evident than when this topic arises in fitness or sports conferences. In addition to being authors, we are also national presenters, and we often find ourselves attempting to clarify many of the issues discussed in this article. Our collegiate teaching experience is that many exercise science and related academic programs perpetuate the notion that all nutritional counseling, education and recommendations should be referred to nutrition professionals.
As of the writing of this article, a person would be hard-pressed to find a consistent guideline from the American Dietetic Association (ADA) or any of the state organizations we have contacted in researching this topic that clarifies when it is more appropriate for fitness professionals to refer a client to a nutrition professional (e.g., a registered dietitian) instead of providing basic advice on nutrition and health promotion. These situations all contribute to the significant confusion in the fitness industry regarding what a personal trainer or coach can do when it comes to providing nutritional information. The nature of such confusion is echoed by the
". . . Dietetics licensure laws generally do not limit the right of an individual or of groups to provide nutrition advice and information related to non-medical nutrition therapy. Individuals and groups continue to successfully operate businesses that sell health foods, health products, dietary supplements and/or nutritional literature. Individuals and groups conduct classes or share information about nutrition without being affected by dietetics licensure laws."
State vs. State
The treatment of this issue varies greatly from state to state. Some address the issue directly by delineating the difference between dietetics and other forms of nutritional counseling, while others equate dietetics to nutrition practice. Still, others simply preclude unlicensed individuals from using specific titles that hold out to the public that they are dietitians, licensed dietitians, licensed nutritionists or similar practitioners.
According to the
nutritionists. The rationale for legislatures acting to protect these titles is simple: the public deserves to know which individuals are qualified by education, experience and examination to provide nutrition care services." However, nowhere on the site or in response to our inquiries has the ADA provided even general definitions of relevant terms (e.g., nutritional counseling, nutritional education or nutritional advice) or general statements on the scope of practice of
licensed dietetic and nutrition professionals. In addition, each state has its own independent agencies (i.e., Department of Professional Regulations)
responsible for governing the individual state's professional regulations.
Although clearly outlined in some states, many of the definitions provided by the state statutes are extremely restrictive or ambiguous. For example, according to the definitions provided by
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ü Dietetics and nutrition practice shall include assessing nutrition needs and status using appropriate data; recommending appropriate dietary regimens, nutrition support and nutrient intake; improving health status through nutrition research, counseling and education; and developing, implementing and managing nutrition care systems, which includes but is not limited to evaluating, modifying and maintaining appropriate standards of high quality in food and nutrition care services.
ü Nutrition assessment is the evaluation of the nutrition needs of individuals or groups, using appropriate data to determine nutrient needs or status and make appropriate nutrition recommendations.
ü Nutrition counseling is advising and assisting individuals or groups on appropriate nutrition intake by integrating information from the nutrition assessment.
ü Nutritional assessment is the evaluation of the nutritional needs of individuals and groups based on appropriate biochemical, anthropometric, physical and dietary data to determine nutrient needs and to recommend to the primary health care provider appropriate nutritional intake including enteral and parenteral nutrition regardless of setting, including (but not limited to) ambulatory settings, hospitals, nursing homes and other extended-care facilities.
ü Nutritional counseling is the provision of individualized guidance on appropriate food and nutrient intake for individuals with special needs, taking into consideration health, cultural, socioeconomic, functional and psychological facts from the nutritional assessment. Nutritional counseling may include advice to increase or decrease nutrients in the diet, to change the timing and size of and composition of meals, to modify food textures and, in extreme instances, to change the route of administration.
ü Nutrition education is the imparting of information about food and nutrients, diet lifestyle factors, community nutrition resources and services to people to improve their nutrition.
Nutrition assessment, counseling and education, as directed by the Louisiana Revised Statutes for Dietitians and Nutritionists, are part of the scope of practice of LDNs. However, professionals of other disciplines can provide nutrition education as long as the information presented is general and accurate and the presenter does not individualize the information by answering any questions that are specific to an individual's diet or nutritional status. Answering the type of question such as whether to substitute vegetables for candy specific to an individual's diet is not a violation of any kind.
According to Mr. Busey (personal communication, November 16, 2006), "Florida, in particular, defines "dietetics" as "the integration and application of the principles derived from the sciences of nutrition, biochemistry, food, physiology and management and from the behavioral and social sciences to achieve and maintain a person's health throughout the person's life." It goes on to define dietetics and nutrition practice as including "assessing nutrition needs and status using appropriate data; recommending appropriate dietary regimens, nutrition support and nutrient intake; improving health status through nutrition research, counseling and education; and developing, implementing and managing nutrition care systems, which includes, but is not limited to, evaluating, modifying and maintaining appropriate standards of high quality in food and nutrition care services." Ultimately, no person may engage for remuneration in dietetics and nutrition practice or nutrition counseling or hold himself or herself out as a practitioner of dietetics and nutrition practice or nutrition counseling unless the person is licensed in accordance with the provisions of the statute.
Although each state is not strictly monitored by the
Part II: What Can the Fitness Professional Do?
Since many individuals seek the advice of fitness professionals on achieving optimum performance, weight loss and improved physique, fitness professionals (i.e., trainers and coaches who have degrees or certifications with a comprehensive curriculum covering basic nutritional practices) are in a perfect position to provide fundamental nutritional advice such as reading food labels or implementing healthy nutritional strategies to improve overall health and well-being. Furthermore, in light of the new public health issues regarding the rates of obesity in the United States (and other Western countries), the fitness professional can be of great assistance in combating the health-related challenges that face our society.
For instance, a recent investigation found that in 2003 and 2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Approximately 30% of non-Hispanic White adults were obese, as were 45.0% of non-Hispanic Black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese, while 36.8% of adults aged 40 to 59 years, and 31.0% of those aged 60 years or older were obese in 2003 to 2004. According to the authors of this study, "These estimates were based on a six-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women." Nonetheless, these numbers point to a staggering health cost associated with obesity. Given this information, it is possible to argue that the fitness professional, possessing basic nutritional knowledge, is morally and ethically obligated to assist these individuals. Therefore, it is critical to define the fitness professional's role in nutrition education in order to allow trainers and coaches the opportunity to better serve their clients, their athletes and the public at large.
Nutrition professionals provide an essential service in disseminating nutritional information to a population that desperately needs it. Additionally, nutritional professionals also provide information concerning the basic guidelines and the benefits of an active lifestyle, an aerobic training program (e.g., walking, swimming or biking activities) and other fundamental information regarding physical activity. The nutrition professional may even provide a copy of a standard exercise routine (e.g., a general and well-accepted machine-based fitness program or basic calisthenics) and suggest a client consider a similar plan to improve overall health and fitness. No fitness organization or legal mandate that we are aware of has ever suggested that a nutrition professional refer a client to a certified fitness professional to recommend the basics on physical activity and related lifestyle. We believe it is the professional and ethical responsibility of nutrition professionals to assist the fitness industry by providing basic information on exercise and active lifestyle to their clients while referring the client to a certified fitness professional for a more individualized fitness program, instructions on specific exercise techniques, the manipulation of specific program design variables, such as appropriate training volumes and loads, and so on. It only makes sense that fitness professionals assist the nutrition industry in the same way nutrition professionals help the fitness industry.
Given our observations, our review of various laws related to nutrition and our official communication with the
Frequency — Eating five small meals is better then eating two big ones.
Quality — Unprocessed foods are better than processed foods.
Quantity of meal planning — Eating five 500-calorie meals can constitute a 2,500-calorie daily intake.
Lifestyle modifications and strategies that positively impact health and wellness — food market tours, food selection, basic meal planning, combinations of foods, cooking and so on.
Interestingly, many gyms and health clubs are hiring personal trainers and requiring or commissioning them to sell dietary supplements. This means trainers not only are providing nutritional counseling and education but also are recommending specific dietary supplements. A signed informed consent and general hold harmless release may also be obtained from the client to further reduce the risk of liability on behalf of the gym or training facility. Many personal trainers and training facilities are working under the flag of weight management, body transformation and other classifications that do not infringe on protected phrases and titles such as nutritional counseling, registered dietician or dietetics and nutrition. Furthermore, the nutritional programming is bundled into the exercise program so that no charges of "remuneration in dietetics and nutrition practice" can be levied. This apparently legal practice is acknowledged by one of Mr. Busey's quotes from Part I.
The blind and specific recommendation of dietary supplements, without the interaction of the client's physician, a registered dietician or an informed consent, a waiver or a release from the client is considered irresponsible, unprofessional and negligent and is a practice not endorsed by us or by any legitimate organization. The irresponsible act of practicing outside the scope of practice not only unduly places the fitness professional at an increased risk of litigation but also, and more importantly, places consumers and the general public at risk of dangerous recommendations.
Many certifications, such as the CSCS and NSCA- CPT , require the strength and conditioning professional to demonstrate a certain level of knowledge on basic nutritional information. Additionally, many exercise science and allied health programs offer both basic and advanced nutrition courses as part of their curriculum. Therefore, individuals who have attained degrees or certifications that require coursework in nutrition sciences should posses enough fundamental knowledge of nutrition to provide apparently healthy clients with generally accepted nutritional information. This is the case for most individuals who have successfully achieved certification status from an organization with third-party accreditation, such as the National Strength and Conditioning Association, and who are degreed from an accredited health-related four-year program. Additionally, many educational resources (i.e., books, seminars and conferences) provided by these same accredited organizations supply the fitness professional with continuing education regarding proper strategies for optimal nutrition. It seems reasonable that fitness professionals are within the scope of their practice when providing clients and athletes with scientific research, position statements and other dependable resources to help their clients make an informed decision regarding the use of a supplement. It seems logical that this same process could be applied to the dissemination of any information on any type of food or nutritional strategy. However, it appears that many nutrition professionals, health care professionals and fitness professionals have a major source of contention over whether the education and supporting materials provided are considered educating, counseling, advising or recommending. We venture to say it is all of the above.
Since fitness professionals must demonstrate that they posses adequate knowledge of fundamental nutritional concepts in order to attain an exercise science or related degree or accredited certification, they are not only equipped but also ideal individuals to disseminate credible and well-accepted nutritional information. Most clients and athletes depend on the fitness professional to educate, guide and support them on basic and advanced nutritional strategies, as they are typically not as knowledgeable in this area. Without the advice of a qualified fitness professional, many of these individuals would be more vulnerable to risky nutritional practices, gimmicks and quick-fix claims and products perpetuated by health care frauds and charlatans. Nutrition-related laws have this exact purpose — protecting consumers — in mind, and that is exactly why fitness and nutrition professionals must work together to protect the public.
Thanks to the cooperation of the ADA, and especially Mr. Busey, many issues surrounding the dissemination of nutritional information are becoming much clearer than they have been in the past years. It does not appear necessary that a fitness professional be licensed or have a nutrition degree to make basic recommendations such as the following:
· Eat five to six frequent meals throughout the day instead of eating two large meals.
· Eat natural foods instead or processed foods.
· Try to eat lean protein, unprocessed carbohydrate and healthy fat in most meals.
· Eliminate or limit intake of soft drinks and other sugar-filled beverages.
· Drink plenty of water to avoid dehydration (e.g., drink 70-80 ounces of water per day).
These are just a few of the many basic concepts that are well within the scope of expertise for fitness professionals to discuss with their clients and athletes. Additionally, clients and athletes are not well-served by referrals to software programs for nutritional analysis or assessments. Nor is it in the client's best interest to be referred to a book to estimate daily caloric requirements. Both of these practices have been suggested as measures to be used to keep fitness professionals from practicing nutritional counseling. Although this basic nutritional assessment information is in the public domain and easily accessible by fitness clients, the information is not easy to understand by someone not educated in basic nutrition concepts and computer usage. Fitness professionals can easily assist fitness clients in acquiring this basic information and easily provide basic information regarding these topics. It is critical that the personal trainer recognize situations in which more precise nutritional approaches are required, such as nutritional issues concerning individuals in a diseased state or in a clinical environment, and refer these situations to an RD or a physician.
Certified fitness professionals who have an accredited certification, which covers basic nutritional information, have sufficient education to provide well-accepted nutritional education to apparently healthy clients and athletes. The restrictive nature and ambiguity of the nutrition and dietetic laws, as well as the lack of communication between related organizations,actually reduces the number of prime opportunities to help the personal training client. In conclusion, we believe that certifying and regulatory organizations must cooperate to create clear, consistent and reasonable guidelines regarding the specific roles of the certified fitness professional and the nutrition professional relating to the dissemination of nutritional education, advice and counseling. We believe that this two-part article series, along with the cooperation of the ADA and NSCA, will mark the beginning of a synergistic relationship between the two professions so that we can all better serve the American public.
Juan Carlos Santana is the director and CEO of the Institute of Human Performance. For more info, email him atjcs@ihpfit.com.
