By Mark Rifkin, MS, RD, LDN Consumer Protection Coordinator For
the Maryland Academy of Nutrition and Dietetics Annual Conference
April 24, 2015
Slide 2
Discuss the socio-political nutrition context Review the legal
status of other professions who practice nutrition Identify common
training paths undertaken by unlicensed violators Identify the
impacts of these factors on our profession Review procedures to
find, report violators Become a prepared and active defender
Slide 3
Epidemics continue Chronic disease, esp obesity and DM2
Associated high costs Although rate of increase not as fast us
usual Effects of ACA Nutrition services covered for certain
conditions Marylands Essential Health Benefits Package For
individual and small-group markets Nutrition services covered
beyond fed requirements
Slide 4
Important trends Interest in nutrition/food issues exploded
Organic/GMO/Local/Sustainability Vegetarian/Vegan Food Security and
Health Disparities Aging pop Baby boomers boomed to Medicare age
Interest in overall prevention and wellness Omnipresent concerns
about health costs
Slide 5
Nutrition and You: Trends 2011 Webinar
eatrightpro.org/resources/media/trends-
and-reviews/nutrition-trends
Slide 6
Poor image of AND, RDNs among some Alternative/holistic health
Vegetarian/vegan Food activists RDNs motherjones.com/environment/
2014/05/my-trip-mcdonalds- sponsored-nutritionist- convention
More consumers Seeking nutrition services Questioning
credibility of recognized credentials Questioning credibility of
AND and RDNs Therefore High demand for nutrition services may mean
Some segments of public deliberately seek Non-RDNs Those with
alternative credentials Legislators pressured to recognize others
Various bills introduced since 2009
Slide 9
Everybodys doin it! (offering nutrition services) Licensed
Nutritionists (CNS, others)* Chiropractors (DC)** Nurses (RN)***
Pharmacists (RPh, PharmD)*** Naturopaths (NMD, ND)* Certified
Clinical Nutritionists (CCN) Herbalists (????) Acupuncturists (L
Ac) Holistic health coaches and counselors (CHHC) Certified
nutrition consultants (CNC) Even your plumber can tell about G-F
diet for wgt loss RDNs must actively defend their license
Slide 10
Nutritionists Licensed term in MD, 15 other states CNS
(certified nutrition specialist), but not CCN Estimate
Slide 11
Chiropractors (DC) Written into scope of practice with no clear
limits Nurses (RN) Not in scope of practice Many are CDEs
Pharmacists (RPh, PharmD) Not in scope of practice Naturopaths
(NMD, ND) License-eligible if graduate of accredited school Can
practice nutrition as therapy
Slide 12
Restricts practice of dietetics (aka MNT) to treat an
individuals diagnosed disease or condition LDN licensees Physicians
Chiropractors Naturopaths Exception: obesity is not within the
license scope Without a license Anyone can provide
non-medical/general advice Advice for weight loss, including
obesity (despite CDC: Dx) How to prevent hypertension or diabetes
Group (non-individualized) guidance to reduce BP or A1c How to read
a food label What is included or excluded on a GF diet
Slide 13
Active RDN defenders must Know the law and its limits Know what
is/isnt a violation Regularly explore non-usual Websites Media Food
establishments Retail establishments Know who your friends are Not
likely to be CNS and their Board
Slide 14
Unaware of law, or apathetic towards it New Health Freedom
Movement Hostile to any regulation Complain of Unjustified monopoly
by AND Restraints on freedom Of consumers Of practitioners Cost
Michigan its licensure 1 obstacle to licensure in remaining states
nationalhealthfreedom.org anh-usa.org
Slide 15
Institute for Integrative Nutrition, NYC 100% online, 40
modules, completed over 1 year Each module requires < 10 hours
Graduates receive health coach certificates Claims to have
graduated over 60K students Board certified by Amer Assoc of
Drugless Practitioners Clayton College of Natural Health, Alabama
Granted BS, MS, ND and PhD Claimed to have graduated over 25K
students Closed in 2010 due to action by state of Alabama Scores of
others too numerous to count
Slide 16
Loren Lockman Operated residential fasting facility near
Frederick In 2004, admitted 31 yo DM1 woman Ceased all food,
insulin Patient was deceased within 7 days Civil conviction:
practicing medicine w/o license Fined $320,000 Ran to Central
America, where he now practices Source:
mbp.state.md.us/forms/Lockman08.317.pdf An underweight pancreatic
cancer pt provided nutritional supplement formula by RDN Advised
not to drink it by CHHC First ingredient is corn syrup!
Slide 17
Generally not mainstream media Holistic health Personal growth
Metaphysical/spiritual Media not likely at mainstream outlets
Natural food stores Metaphysical products stores Yoga/fitness
centers Womens health providers Health Fairs
Slide 18
Slide 19
Slide 20
Websites easy to find Search regularly Maryland or specific
county, city or town Holistic Weight loss (legal in MD, but other
services not) Health coach Nutritionist (licensed in MD, but
abused!) Nutrition counselor, nutrition consultant CNC, CHHC, AADP
Results: individual sites or directories Lets go a-searchin!
Slide 21
Marie Savage, Exec Dir, Board of Dietetic Practice
[email protected]
http://dhmh.maryland.gov/dietetic/SitePages/Home.aspx
http://dhmh.maryland.gov/dietetic/SitePages/Home.aspx As much
documentation as possible Web address with reference to content of
concern Brochure, flyer or print ad Report of client interaction
Notify CPC of complaint so MAND can track Dont rely on CPC as
complaint gateway Complaints mean more coming from members Supports
continued authorization of licensure law Lets Board know members
actively involved
Slide 22
May be more difficult to challenge Nurses, since theres usually
no advertising Acupuncturists, since advertising excludes nutrition
Chiropractors, since legal limits undefined in law Naturopaths,
since few or no limits defined in law If evidence of violation of a
professional licensed by another Board Report to their board, not
to Board of Dietetic Prax.
Slide 23
Circumstances have put us in a serious struggle A case (NC
Dental Examiners) went to SCOTUS Not nutrition-related, but
violators won Be an active defender, even if you are Retired
Working in clinical/LTC or a non-patient setting Do it for Yourself
and your salary Your colleagues The safety of the public Thanks!
Mark Rifkin, MS, RD, LDN [email protected]