produces a statement of conduct which describes the
role and responsibilities of the registered dietitian and
failure to work within this statement of conduct may
result in disciplinary action and removal from the
register. Registration in one country does not auto-
matically mean that a dietitian can work elsewhere in
the world as levels of education and training are not
always comparable from country to country. Each
registering body will therefore consider applications
from dietitians from other countries and suggest fur-
ther training if appropriate.
0008 Continuing education and demonstration of con-
tinuing competence to practice is increasingly being
seen as vital in this rapidly changing profession; in the
USA there has long been a requirement to demon-
strate continuing education and continuing registra-
tion is dependent on this. In the UK it is not yet a
registration requirement to demonstrate continued
competence to practice, although this was considered
as part of the recent review of the Act of parliament
defining Professions Supplementary to Medicine and
is likely to become mandatory now that the Health
Professions Council has succeeded the CPSM. How-
ever, the BDA, the professional association for diet-
itians, has recently introduced a Diploma in
Advanced Dietetic Practice, which has as part of its
remit the recognition of continuing education.
The Role of the Dietitian
0009 The first dietitians (with the exception of those con-
cerned mainly with food service provision) worked
mainly in hospitals. Clinical dietetics and the acute
hospital service still claim a large proportion of the
graduates from dietetics training but other areas of
work are increasingly becoming more important. In
the UK changes in the emphasis of health care, par-
ticularly the change of emphasis from acute (hospital)
care to care in the primary health care setting, has
resulted in a marked increase in the number of ‘com-
munity-based’ dietitians and the Community Nutri-
tion Group of the BDA has been the fastest-growing
specialist group in recent years.
0010 Dietitians also have many other roles outside the
health services. In industry they may work as advisors
to food companies, wholesale and retail suppliers of
food, and companies producing specialized dietary
products. They also work with government agencies,
e.g., in dietary surveys of the population, in evalu-
ation of intervention programs, and advising on the
practical application of policy. In addition dietitians
are increasingly working independently as consult-
ants, e.g., in private practice, journalism, and sports
nutrition. Whatever aspect of work a dietitian
chooses, one of the primary roles will be that of an
educator, whether in assisting individuals to under-
stand and apply a therapeutic regimen, teaching
doctors, nurses, or other health professionals about
nutrition and dietetics to help them carry out their
functions, teaching groups of people about aspects of
preventive nutrition, or writing an article for the
scientific or lay press. The ability to communicate is
therefore central to every dietitian’s role.
The Dietitian’s Role in Food Service
0011In the USA and countries which follow the US model,
hospital dietitians work in either administrative or
clinical (therapeutic) areas. Administrative dietitians
manage the provision of food services for all patients
and staff. They are responsible for food production
and quality control in the delivery of the hospital
meal service as well as insuring their nutritional ad-
equacy. They are also often responsible for budgeting
and staffing of the dietary departments and usually
relate to other administrators and managers, having
little or no direct contact with patients or medical
staff. The clinical dietitian is the person who has
direct contact with patients and the medical and
paramedical staff involved in their care.
0012In the UK the practice of dietetics has evolved along
a different route and dietitians do not usually have
overall responsibility for food service. However, there
is usually close liaison between dietitians and the
catering manager to insure the provision of nutrition-
ally sound selective menus. The dietetic manager will
also be consulted on matters of policy such as the
implications of changes in food preparation systems
or the introduction of healthy eating policies. It is
acknowledged now that many patients (especially
elderly people) are malnourished when they enter
hospital and that this often becomes worse during
their stay. Dietitians are therefore very much involved
in attempts to insure that every patient has a nutri-
tionally adequate diet.
Clinical or Therapeutic Dietetics
0013The term ‘therapeutic dietetics’ is used to describe the
work of the dietitian in his or her direct dealings with
patients who require special diets, for various
reasons, as outlined in Tables 1 and 2. The role of
the clinical dietitian has broadened in the last decade,
both with respect to the range of conditions which are
encountered and the setting in which the work is
done. In the past the role of the therapeutic dietitian
was to calculate, teach, and facilitate compliance to a
range of dietary regimens prescribed by medical or
surgical practitioners for specific disorders. These
functions are still important and, indeed, are
DIETETICS 1887