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Nutrition Qualification Confusion (NQC)

By Matt O'Neill, MSc(Nut&Diet), APD

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With so many nutrition courses hitting the market, Fitness Professionals can be forgiven for being confused about how to get qualified to give clients dietary advice. Now, it's time to clear things up before you make the decision to spend thousands of dollars on a study program.

Before I get into the finer detail, here's a summary of what you need to know:

> Fitness Professionals can provide basic healthy eating information that fits with the Australian Dietary Guidelines.

> A six-month Diploma in Nutrition won't `qualify' you to design and provide meal plans for clients. The Dietitian's Association of Australia (DAA) says, “The level of training provided in the Diploma of Nutrition & Dietetics course will not ensure safe practices and treatment for these clients.”

> The Fitness Australia Scope of Practice for Registered Exercise Professionals does not include nutrition advice outside basic healthy eating information or guidelines, so you will not be insured for providing specific advice or meal plans to clients.

> Fitness Australia approved courses providing Continuing Education Credit (CECs) on nutrition offer an appropriate way for Fitness Professionals to gain knowledge and know-how about nutrition, whilst working within the Scope of Practice.

> An Accredited Practising Dietitian is the health professional who is qualified, approved and insured to design and provide specific advice and meal plans for clients.

> Fitness Professionals should work within professional boundaries and refer to a Dietitian for specific nutrition advice and meal plans to minimize medico-legal risk and maximise consumer confidence.

Why the confusion about nutrition?

The trouble with nutrition advice is that everyone seems to have their own opinions and want to share it. Anyone can write a best-selling diet book and people will read and believe it, even if the author has no training in nutrition.

Armed with the credentials of six-pack abs and an Instagram account, anyone can attract 1000's of followers to deliver nutrition advice too.

There's nothing wrong with this, as long as the nutrition advice is scientifically correct, promotes healthy eating and includes a referral to a Dietitian as standard for advice outside general guidelines.

But, the `everyone's-a-nutritionist' environment has created the misleading impression that it's ok for fitness professionals to provide specific nutrition advice and meal plans.

The risks of giving bad nutrition advice

The argument that everyone's doing it doesn't work because of the risk of harm. Only recently a Personal Trainer informed me that a client they had recommended to follow a low-carbohydrate diet lost too much weight and ended up in hospital.

Even without a hospital visit, the risks of getting dietary advice wrong can't be ignored. A common recommendation to eliminate dairy foods could result in weight gain as there's now evidence that dairy foods assist body weight regulation.

Another example is giving up wheat-based grains without medical diagnosis of gluten-intolerance or even an understanding of what gluten is. Just watch this video.

Nutrition is more complex than ever

Nutrition is a complex science that gets more complex every year. Maintaining a healthy weight is no longer a simple matter of balancing calories-in versus calories-out.

Nutrition for weight management now requires choosing foods to reduce cellular inflammation, to promote healthy gut bacteria and effectively manage appetite.

Designing meal plans to meet this level of complexity requires at least, and often more than four years at university in a dietetic qualification approved by the Dietitian's Association of Australia (DAA).

This level of tertiary study includes units on physiology, biochemistry and clinical dietetics to be competent to deliver expert advice and dietary prescription.

Recognising the expert

Dietitians are qualified to assess clients for the medical risks and benefits of making dietary changes. They ensure that any prescribed meal plan meets requirements for diagnosed food intolerances and nutrient adequacy.

This is why Dietitians receive referrals from General Practitioners and Medical Specialists and are recognised by the Federal Government to work within the Medicare system.

Sure, not every Dietitian has a six-pack. But would a six-pack be a requirement for selecting a heart surgeon. You'd want a surgeon to be academically, clinically and professionally qualified to fix your heart.

And you'd expect your GP would refer you to a surgeon rather than perform open-heart surgery in their clinic.
This is why a referral to a Dietitian as the expert is so important. And clients respect this kind of professionalism.

Dietitian or Nutritionist?

All Dietitians are Nutritionists but not all Nutritionists are Dietitians.

In Australia you can get listed with the Nutrition Society of Australia as a Registered Nutritionist if you have a relevant tertiary degree. But this can just mean you have studied the broad topic of nutrition and not the science of dietetics, which includes a deep knowledge of food chemistry and its effects on biochemistry, physiology and disease.

The defining difference is the ability of Dietitians to design meal plans to safely match these requirements.

Another way to think of a Dietitian is like an Architect, who can produce a designer meal plan to meet all your specifications. A meal plan from a Nutritionist may not stand up to the test of being safe or nutritionally adequate and result in deficiencies.

What if Dietitians started Personal Training?

OK, let's reverse the situation just to show that Dietitians are not just protecting their turf.

What if a Dietitian started Personal Training clients in the gym? They'd need to know correct exercises, safe technique, optimal sets, repetitions and recovery periods.

A Dietitian is clearly not qualified or approved to prescribe exercise programs, so they refer to a Certificate IV Personal Trainer or Exercise Physiologist for this specific programming.

The prescription of specific exercises, sets and reps in an exercise program is the fitness equivalent of prescribing specific foods, serving sizes and eating frequencies in a meal plan.

A Dietitian would limit their fitness advice to promoting the benefits of regular exercise, cardiovascular and resistance training.

Just as a Dietitian shouldn't prescribe exercise programs, a Personal Trainer shouldn't prescribe meal plans.

Insurance for providing nutrition advice

Insurance is a key requirement for providing any heath related advice. If you give incorrect or unsafe nutrition advice and it is believed to cause harm to a client, you could be sued for damages.

Guild Insurance, the recommended insurer by Fitness Australia informs me that they cover fitness professionals for what Fitness Australia says in its Scope of Practice for Registered Exercise Professionals.

This means “basic healthy eating information and nationally endorsed nutritional standards and guidelines”.

This suggests that specific nutrition advice and meal plans are not covered.

Will a Diploma in Nutrition and Dietetics allow me to provide specific advice and meal plans?

Recently, there has been keen interest by some fitness industry education providers to offer a diploma-level qualification in nutrition for fitness professionals that would allow the provision of specific advice and meal plans.
But there are some serious problems with a six-month diploma in nutrition.

If you are a Registered Exercise Professional who is not a Dietitian, you'd be operating outside your professional scope if you provided specific advice and meal plans.

More importantly, a 26-week study program is inadequate and inappropriate to equip Personal Trainers with the required nutrition knowledge and skills.

For example, in April 2014, FIAFitnation promoted a new Diploma in Nutrition and Dietetics for Personal Trainers at the Australian Fitness & Health Expo in Melbourne.

The Dietitian's Association of Australia (DAA) has responded to this;

“DAA believes the title of this course to misleading for both consumers and potential students and has serious concerns over the aspirational and potentially dangerous skills graduates are believed to attain on completion.”

DAA will be taking its concerns to the Australian Competition & Consumer Commission (ACCC) if requests to remove the dietetics component of the title are not met within a specified time frame.

DAA has also contacted the Australian Skills Quality Authority (ASQA), Service Skills Australia and the Commissioner of the Community Services and Health Skills Council regarding the course's scope of practice and ethical responsibilities.

When I asked a FIAFitnation representative at their expo stand in April, “Will this Diploma allow me to put together meal plans for clients?” - the answer was “Yes”.

When I then asked, “If a client has diabetes, will I be able to give them a meal plan? - the answer was “Yes”.

DAA says, “Working with clinical populations is a high-risk activity… The level of training provided in the Diploma of Nutrition and Dietetics course will not ensure safe practices and treatment for these clients.”

Read the DAA's full statement here (PDF).

Given the level of concern about this program from DAA and also an apparent lack of fitness industry consultation on this program's development, I believe the Australian Skills Quality Authority (ASQA) should review the appropriateness of the Diploma in Nutrition and Dietetics.

Does a Diploma in Nutrition offer a career pathway to becoming a Dietitian?

The answer here also appears to be no. Completing a Diploma in Nutrition will show your interest in nutrition, but won't give you prior learning credits for a Dietetic qualification.

The majority of nutrition units of competency included in the FIAFitnation Diploma are nationally recognised, but usually as part of a Certificate III in Nutrition and Dietetic Assistance qualification.

As the name of this program suggests, it is designed for people who want to gain qualification to `assist' Dietitians working in hospitals. These units are not designed to approve graduates to work independently of Dietitians to deliver meal plans.

Another fitness training provider, Sage Institute of Fitness in Victoria has included the Certificate III in Nutrition and Dietetic Assistance on its “A New Breed of Personal Trainer” brochure at the Australian Fitness Expo.

This just doesn't make sense if students think they will be approved to deliver specific advice and meal plans.

What about a Diploma in Fitness (Nutrition Specialisation)?

Service Skills Australia is currently seeking public comment (May 2014) on a potential new Diploma in Fitness, having a nutrition specialisation.

For all the reasons and risks discussed above, it is clearly not the way forward for fitness professionals to become qualified in nutrition at the diploma level.

Spending thousands of dollars and hundreds of hours on a Diploma in Fitness (Nutrition Specialisation) that won't offer you a higher qualification than a Certificate IV Personal Trainer level is an expensive way to obtain CECs.

Rather than develop a Diploma in Fitness (Nutrition Specialisation), Services Skills Australia should include a unit about the risks of providing nutrition advice, professional standards and appropriate referral practices within the Certificate III (Gym Instructor) and Certificate IV (Personal Trainer) qualifications.

This will better inform and empower fitness professionals as well as reduce the nutrition confusion plaguing the fitness industry.

So, what can Personal Trainers say about nutrition to clients?

To help understand more clearly what sort of advice is on and off the approved list for fitness professionals, let's start with the Fitness Australia Position Statement: Scope of Practice for Registered Exercise Professionals - April 2014.

It says:

"The Registered Exercise Professional Scope of Practice does not include:
Provision of nutritional advice outside of basic healthy eating information and nationally endorsed nutritional standards and guidelines."

To me, this means approval to provide basic healthy eating information that fits with the Australian Dietary Guidelines, which have the current version as recent as 2013.

Nutrition units covering Dietary Guidelines are included in the Certificate III (Gym Instructor) and Certificate IV (Personal Trainer) qualifications.

The Dietary Guidelines are an excellent basis for nutrition education by Fitness Professionals. Unfortunately, in all the confusion, fad diets and supplement sales guidelines about real food have been overlooked as a resource for fitness professionals.

My advice would be to embrace the basics of nutrition and do it confidently for your clients.

Here are the sorts of things, I'd encourage you to do:

  • Assess eating habits based on Dietary Guidelines

  • Discuss foods to be included in a healthy diet

  • Provide practical examples of how to meet the Dietary Guidelines
If you are a Fitness Australia Registered Fitness professional, approved programs that provide Continuing Education Credits (CECs) from Fitness Australia provide a way to develop your knowledge and practical nutrition skills within the Scope of Practise.

For example, you might learn about healthy food shopping, food label reading or appetite management to feel more confident and skilled to deliver nutrition advice. I recommend you choose a CEC program designed and delivered by a Dietitian.

What can't you say about nutrition to clients?

There are no published guidelines from Fitness Australia as to what you can't say about nutrition. I'm sure fitness professionals would find it useful for Fitness Australia to provide additional guidance on this and I have asked it to do so.

As a starting point, I'd say it is inappropriate and you would not be approved to do the following, even at a diploma level:

  • Design or disseminate a daily or weekly meal plan with specific foods, unless this has been developed and endorsed by an Accredited Practising Dietitian (APD).

  • Nutritional assessment to determine individual nutritional needs and nutritional status and to recommend nutritional intake.

  • Provide advice to clients to avoid a specific food group.

  • Provide specific dietary advice for people with chronic disease.

  • Provide advice to clients regarding food allergies or intolerances, other than the referral to a General Practitioner or Accredited Practising Dietitian.

  • Provide advice to take a dietary supplement without a referral to a Doctor or Dietitian prior to taking the supplement.

  • Medical nutrition therapy.

  • Promote yourself as a 'Nutritionist' or a 'Dietitian'.
This list is not all inclusive or official. But I believe it needs to be to offer Fitness Professionals adequate guidance.

Fitness Australia should either expand the Scope of Practice to include more guidance or produce a Fact Sheet on Providing Nutrition Advice and this should be provided as mandatory in all Cert III (Gym Instructor) , Cert IV (Personal Trainer) and Approved CEC programs.

Advice for getting approved to give nutrition advice, further learning and career development

I hope you've found this article useful to gain some clarity about nutrition qualifications on offer in the fitness industry.

My advice for fitness professionals is to choose a CEC-based program on nutrition, delivered by a qualified Dietitian, that will enhance your knowledge and practical nutrition skills to be a more effective change agent for better nutrition.

If you then feel you'd like to further your studies on nutrition, consider spending money on a tertiary Dietetic qualification and becoming a qualified Dietitian.

You may say that I am biased being a Dietitian, and that would be true. I have fixed many diets broken by so-called Nutritionists and Personal Trainers.

I have also seen amazingly powerful and practical nutrition advice delivered confidently by fitness professionals.

This issue is about safety, ethical boundaries, legal responsibility, appropriate referral processes and most importantly, ensuring consumers can be confident they are dealing with health and fitness professionals who apply the highest professional standards.

Eliminating Nutrition Qualification Confusion (NQC) is the way we can take the fitness industry forward to make a real difference.

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About the author

Matt O'Neill is a qualified Dietitian with an undergraduate degree in Exercise Science. As Director of the SmartShape Centre for Weight Management, Matt has been teaching Fitness Professionals about nutrition for 25 years.

SmartShape provides continuing education courses for Fitness Professionals and Matt's Metabolic Jumpstart program has partnered with fitness businesses to deliver Dietitian-designed meal plans to almost 20,000 people.

Previously, Matt was the Nutritionist and Senior Policy Officer for the Australian Consumers' Association / Choice Magazine. He has been a member of numerous committees, including; the NH&MRC Overweight & Obesity Working Group and the Food Regulation Review Committee. He currently sits on the Deakin University Post-Graduate Nutrition Advisory Board.

Matt has been a recipient of the Australian Fitness Network Author of the Year and Presenter of the Year Awards. He has also been the Sports Dietitian for the Sydney City Roosters Rugby League and Eastwood Rugby teams.

Matt appears regularly on Channel 7's The Morning Show and is an advocate for fitness, nutrient-rich eating and quality nutrition education.



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