CrossFit & Registered Dietitians as a whole have had beef for many years. This isn’t anything new.
On June 30, 2020, Governor Ron DeSantis signed the Occupational Freedom and Opportunity Act (HB 1193), permitting CrossFit trainers (and other nutrition coaches), across the state of Florida to provide nutrition guidance to their members and clients. Previously, Florida law only permitted dietitians and other select licensed professionals to provide nutrition recommendations to their clients.
Many Registered Dietitians/Registered Dietitian Nutritionists across the nation were enraged because of this. And as an RDN, I can empathize, but am strongly in support of this act.
Before we proceed, remember:
1) There is more than enough work to go around.
2) There is no need for a scarcity mindset in the field of nutrition. This doesn’t take anything away from RD/RDNs.
3) This doesn’t inherently cause harm on public health.
Argument for Nutrition Coaches
Nutrition coaches in gyms are often the first contact for people wanting to make healthy changes. There is a public need for coaches who can help with practical, health-promoting actions within scope of practice, as they are often a crucial part of their client’s social support system and wellbeing.
Nutrition coaches can, and many do, stay within scope of practice and are able to refer out when needed. There is enough space for RDs and Nutrition Coaches to work together. Working together with nutrition coaches and helping teach them how to appropriately refer out is what many RDs, including myself, are already successfully doing.
Wanting and protecting a monopoly over nutrition coaching for generally healthy people can be harmful on many accounts.
Concern Over Public Safety
Nutrition coaches aren’t fighting for the ability to do tube feeding orders, parenteral nutrition, kidney dialysis diets, pressure ulcer nutrition care, oncology nutrition, or other areas of Medical Nutrition Therapy (MNT). MNT is still protected, as it should be. The spectrum of helping someone with nutrition is wide. And no part of the spectrum is better, just different.
Per the CrossFit post, they write: “The Act now permits unlicensed persons to provide individualized dietary recommendations, as long as they do not do so for any client under the supervision of a medical doctor and do not make themselves out to be a dietitian.”
The actual document, referring to 468.505 Exemptions; exceptions, states:
“(1) Nothing in this part may be construed as prohibiting or restricting the practice, services, or activities of:
(n) Any person who provides information, wellness recommendations, or advice concerning nutrition, or who markets food, food materials, or dietary supplements for remuneration, if such person does not provide such services to a person under the direct care and supervision of a medical doctor for a disease or medical condition requiring nutrition intervention, not including obesity or weight loss, and does not represent himself or herself as a dietitian, licensed dietitian, registered dietitian, nutritionist, licensed nutritionist, nutrition counselor, or licensed nutrition counselor, or use any word, letter, symbol, or insignia indicating or implying that he or she is a dietitian, nutritionist, or nutrition counselor.”
I’m not a lawyer, but in my understanding, this doesn’t allow wellness recommendations, or advice concerning nutrition, if the client is under care and supervision of a medical doctor for a disease or medical condition requiring nutrition intervention, not including obesity or weight loss. As a side note, I have a big concern with weight-focused practice, but that is a different topic.
Basically, they can provide nutrition coaching to people who aren’t under a doctor’s care and who are generally healthy. And they can’t call themselves a “nutritionist”, but they can call themselves a “Nutrition Coach.”
Note: I have worked with clients who came to me with digestive problems, orthorexic & disordered eating habits stemming from nutrition programs done out of scope, however, I believe this is not the fault of licensure, but instead poor nutrition coaching “certifications” that have popped up because of how difficult we’ve made it for people to talk about nutrition and scope of practice. As a side, I recommend Precision Nutrition for coaching certificates (note, they don’t certify as “nutritionist”, but “nutrition coach” instead), which many CrossFit coaches are part of and which has many RDs on staff.
So what can nutrition coaches do?
Nutrition coaches can stand at the grassroots level for supporting actions that support whole health (physical, mental, social wellbeing), doing work to balance out the social determinants of health, and stay well within scope of practice.
Some actions they do/can do include:
– Collaborate with licensed health professionals.
– Opening a conversation about how their client’s nutrition, fitness, lifestyle, skills, practices, and daily actions might be related to one another.
– Provide support.
– Help their client collect data about themselves – noticing, naming, being more mindful, and intentional.
– Helping their client gain interoceptive awareness (appetite, hunger, fullness, etc.).
– Actively listen and empathize with their struggles.
– Help clients advocate for themselves to their medical team.
– Share reputable and helpful information.
– Provide behavior-based coaching to help them develop fundamental nutrition and lifestyle skills and practices that don’t contradict Medical Nutrition Therapy.
– Help clients implement a plan from medical team.
Example: I can give someone a protocol for their Hypothyroidism, and a nutrition coach can then come in and help them make a plan for building food preparation skills, hunger awareness, etc.
It is well within scope to help on the behavior-side of coaching; i.e. coaching focused on changing and developing behavioral skills, as opposed to providing medical or nutrition counseling therapy, which this Act still prohibits.
The Need for Diversity
On another note, a concern we face within the health & fitness industry is a lack of diversity. It’s well known within RD circles that becoming an RD presents many challenges for many people within marginalized communities. Having a requirement for a Master’s degree and unpaid internship/residency keeps many from pursuing this credential. It’s against most internship rules to have a paid job during this time – making this even more difficult for many. It’s well understood that lack of diversity will hinder any health promotion on many levels. Encouraging and supporting responsible coaching can help with the lack of diversity in the industry we face.
Wrapping Up
Many RDs, including myself, are already working with CrossFit gyms across the nation. I’ve felt welcome and respected by the majority of CrossFit coaches and have been sought out for my skills to provide higher level nutrition work within their community.
We can work together with trainers and nutrition coaches to ultimately help people with a whole health approach. There is a safe place for everyone to play.
Lastly, if you’re worried about people taking your job, you’re probably not doing it well.
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Resources:
Bill info: https://www.flsenate.gov/Session/Bill/2020/1193/BillText/er/PDF
CrossFit info release: https://www.crossfit.com/battles/florida-nutrition-bill-state?fbclid=IwAR2EDjxwL_hWGNVi6d-AB8G3siJmSDOpePHh0pqg254amXSXmjpxzvSS_Gk
Precision Nutrition level 1 & 2 coaching courses: https://www.precisionnutrition.com/nutrition-certification-level-1-presale-list