Thoughts on Dietician/Nutritionists

[HMD]

What are your thoughts on dieticians? I have almost completed my degree in dietetics and I am observing that only a minority of people are actually interested in listening to what dieticians have to say on nutrition. They believe that dieticians are mostly delusional and have no idea what  good nutrition really is. On the other hand, the same people would go on to trust doctors that give them unnecessary pills to please the pharmaceutical company that makes the doctors rich. 
 
What are your thoughts on this? 

[undeather]

3 hours ago, HMD said:

What are your thoughts on dieticians? I have almost completed my degree in dietetics and I am observing that only a minority of people are actually interested in listening to what dieticians have to say on nutrition. They believe that dieticians are mostly delusional and have no idea what  good nutrition really is. On the other hand, the same people would go on to trust doctors that give them unnecessary pills to please the pharmaceutical company that makes the doctors rich. 
 
What are your thoughts on this? 

Let me share my perspective as a MD who has worked in this field for the last 10 years. 

Like in any other occupational category, you will find dieticians/nutritionists all across the competence-spectrum. I have worked with almost genius level individuals who managed to change peoples diets to a lifechanging degree and with a success/repition-rate almost unheard of in the medical field. I have also witnessed blatant incompetence, lackluster cookie-cutter diet plans completely unfit for the specific needs of the patient and especially in the online communities, dangerously off-evidence approaches that will shorten someones lifespan in the long run.

I think that outstanding performances in the medical field or in general, humanistic sciences boil down to a few, very distinct common denominators. Above all stands the validity of your treatment approach. As Hippocrates said 2500 years ago - "Primum non nocere" - which translates to "first, do no harm"! Is the thing you are doing (the new diet, the drug..) actually improving the patients life, or are you doing him worse? It's really bioethics 101. The next question that naturally follows: How do I know? And right here we to enter into the domain of science & scientific evidence. If you want to be an outstanding practitioner, then you need to be up to date with the best available evidence to the problem you are trying to solve. This also includes where science falls short. I have so many colleagues that just blindly trust everything that stands in a scientific paper, without critically evaluating the data at hand. In fact, a shitload of doctors are just algorhytmically following treatment guidelines without ever reading first hand evidence at all - which is good, because it brings everything to a pretty high quality baseline - but lack's nuance when nuance is called for. 

The other extreme is what you see in the dietician-influencer sphere. The carnivore-nutritionist who tells people to not give a shit about their LDL-cholesterol is doing harm. Their approach is not based on a legit heuristic and it takes quite a lot of cognitive dissonance and avoidance mechanisms to keep up a completely ludicrous worldview. If you want to become a more heterodox dietician, then at least stay honest and engange with the arguments - have a strong "Why" for what you are doing. 

Now my next point speaks to compliance. If you want to reach your patient/the person you are working with - if you want him to follow through with a new diet plan, then there are ways to influence that which are inside of your control. We have known for years that the exact same drug will increase/decrease in effect depending on the person prescribing it. Placebo effects are an often ignored part of todays medical practice - but it's  everywhere and all the time (almost like conciousness is fundamental ... ). The way you engange with your patient, the words you use, your vibe, the way you carry yourself, the motivational aspects you build into the conversation - all that and much, much more infleunces the outcome on the other side of the equation. The best nutrionists I have worked with have one very succinct feature: They care! They give a shit! They listen - and they actually try to find the best way forward for the individual sitting across them. This is the art of medicine. This is where the good and the great practitioners part ways. This explains why one nutritionist might have an 80% compliance rate, while others are at 20%. 

This explains why some dieticians are highly respected by colleagues, doctors and patients, while others are deemed delusional or supbar.

Alright, and lastly - because you mentioned it. I don't know where this myth of doctors and pharmaceutical companies comes from. Very, very few doctors actually make money from selling big pharma drugs. You don't get money from that - at least not where I live. I have not recieved a single euro in my life from a pharma company. In fact, most of my colleagues are highly annoyed by pharmaceutical representatives who constantly come to the hospital and you need to sit through their boring presentation about their "!new wonder drug!". But hey, at least I can stock up on ballpens that way. Drugs just work. They do. It's fine to criticise our current medical paradigm that too often relies on drugs where real changes could be achieved through simple lifestyle changes - but then do that without enganging with conspiratorial arguments. 

Edited January 16 by undeather

[Schizophonia]

They are trained to teach people how to eat properly for their health and/or weight management.

Nutritionists have completed longer studies in the medical field and I believe that they most often work in hospitals, to create diets that meet very specific needs.

There are charlatants and madmen everywhere, probably the whole world can be wrong, in fine it's up to you to decide what is common sense.

Edited January 16 by Schizophonia

[Yimpa]

The level of development of the dietitian makes all the difference. 

You get a good sense of sniffing out the frauds.