On not being a dietitian.

by Michelle

Just a note – this is a post directed at systemic issues, and specifically the way my field is structured, and is not at all a complaint about the work I do currently, which I love, or about my readers and clients, whom I also love. It’s also an explanation of sorts for the media, who often mistake me for a dietitian.

Many of my fellow dietetics students have expressed similar frustrations. If you don’t live in Ontario, AND you want to tell me to just get over it already and do an internship, since it’s so easy, then please don’t bother commenting. Something like 66% of students who apply for an internship in Ontario this year will not get one, since there are simply not enough spaces. Internship is not included as a part of our degree program, nor is there financial aid available for doing one. It is expected that a person will be in a position to not work for a year in order to afford an internship. I am not.

I am also not expecting to be given an RD credential simply for getting my degree and having some experience – not at all. I believe internship is crucially important – I just also believe that dietetics students in my area have been neglected and forced into a ridiculous bottle-neck that will leave many of them hanging if they don’t happen to be one of the lucky ones. I may very well do an internship when I am able to do so – but when I was graduating, I had a lot of feelings about it, and I wrote them down here. This is not meant as a personal affront to all dietitians everywhere.

So, here’s the thing: I’m not a registered dietitian.

I know it’s confusing, since I have an accredited degree in dietetics, I’m a member of Dietitians of Canada (and formerly of the American Dietetic Association too, but they sent me too much crap in the mail from food and diet companies), I’ve received extra training through DC- and ADA-approved workshops, I’ve attended honest-to-goodness dietetic conferences, and I’ve worked in legit hospitals doing legit clinical nutrition stuff.

But, still, I’m not a dietitian – and I use the generic, mostly meaningless term “nutritionist” to describe myself.

What I am is someone who teaches people about normal, healthy eating.

I teach people to give themselves permission to enjoy food and eat enough to feel satisfied, to have regular, reliable meals, to find out which foods help them to feel good, to pay attention when they eat so that they can enjoy it and learn from it, and to learn to value healthy eating in its own right, because it feels good and makes one’s life better, without it being contingent on weight loss.

Here’s what I don’t do: clinical nutrition. I don’t assess, diagnose, or treat disease with nutritional therapies.

Sometimes my clients, people who want to learn the basics of normal eating, also have diseases with a nutritional component – diabetes, celiac disease, high cholesterol, etc. And I don’t refuse to work with people who have diseases, provided they receive diagnosis, support, and treatment for that disease from a qualified professional – who isn’t me. Because I don’t practice clinical nutrition.

In October I graduated with a science degree that, without the attached RD behind my name, is essentially worthless in my field. I have spent the last nine years not only learning about nutrition at an accredited school, but working in nutrition at various hospitals, and, according to the way the profession is set up in Ontario, I have achieved nothing. I am qualified to do…nothing. Because I have not endured the professional hazing of dietetic internship.

I’m sure you can detect my bitterness.

I am, and always have been, a fan of the scientific method. I believe science is limited in what it can prove, but remains the best way we have to investigate the natural world. Is it perfectly objective? No, but only because it is practiced by hopelessly flawed human beings. But, battered as its practice has been by our nasty little biases, I still love it, and still believe it is the closest we can come to being objective, to learning whatever does exist of universal truth.

I’m a science girl, and a nutritionist in the lay sense of the word. I have a good education, good training, and good experience. The one thing I’m not is a registered dietitian.

When I refer to a dietetic internship as a “hazing,” it’s not because I believe dietitians are mean or evil. In my five years working in various nutrition departments at various hospitals, my bosses have always been dietitians, and I have loved, really loved, them – as people, as practitioners, and as scientists. Because that’s exactly what they are, despite hardly ever being credited as such.

But I’ve also experienced the necessary underbelly of that world. The conveniently gender-, race-, and class-stratified social and professional hierarchies of the clinic. The interpersonal tensions, the brutal systemic limitations. I got my experience, learned what I could learn from the truly remarkable women whose decades of experience made me feel like a tiny speck in a huge, wondrous world; I took my lumps; I jumped through hoops; I got out so I could finish what I started.

Eleven years ago, I decided to study nutrition because I read a passage about normal eating from Ellyn Satter in the book Losing It by Laura Fraser. It was a revelatory answer to the question I’d asked myself – “How should I eat?” – and spent my time and energy searching out, only to find lies, disorder, unscientific thinking, and shameless contortions of logic. I decided then that this – teaching ordinary people to eat normally, based on sound science – was what I wanted to do.

Ellyn Satter was (and is still) a registered dietitian, and I wanted to do what she did – so I set out to become a dietitian and to learn about the science in the answer I’d stumbled upon.

Along the way, I figured out that I may not actually want to be a dietitian, nor did I need to be to do what I’ve wanted to do all along.

So in October, I walked across a stage and took possession of a hard-won piece of paper that made me…nothing. After spending a third of my life and tens of thousands of dollars on this project, I’m no one of consequence to anyone who matters professionally, and may eventually be called a quack and a charlatan because I do a job that hardly anyone in the world does – defending normal eating against the encroachment of a disordered, deeply classist culture, helping ordinary people pick their steps through the muck of anti-intellectual horseshit that is pop nutrition – and I do it audaciously without those two letters, R and D, behind my name.

Because I don’t have the resources, emotionally or financially, to spend a year doing unpaid labour as an intern at the same hospitals that used to pay me by the hour.

I have an education that makes me more qualified than most of the authors who write mass-market diet books – but because I’m not a dietitian, it doesn’t matter. I exist in the gray margins, professionally and scientifically – and our society does not do margins (or shades of gray) very well.

Do I think it’s unfair? Yes. Does it make me angry? Yes. But I accept it for now, because, thankfully, what I do and what I’ve learned still matters a whole lot to me. If you’re reading this, I suspect it matters to you, too.

So, until I figure out all of this big professional mess, I remain

Yours truly,
Not a dietitian.