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Dietitian Organization Attempts to Cash In on Obesity

It’s politics as usual, but at a cost: the health of the American public. Action Alert! [1]

The Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association) has collaborated on a Medicare bill that will ensure that Registered Dietitians receive Medicare reimbursement for weight loss counseling. This bill excludes most other nutrition professionals, including many nutritionists and health coaches, limiting consumers’ options.

HR 2415 [2], the Treat and Reduce Obesity Act of 2013, would allow Registered Dietitians (that is, dietitians who go through the AND’s credentialing program), Certified Diabetes Educators, and instructors trained and certified by the National Diabetes Prevention Lifestyle Coach Training Program (funded by the Centers for Disease Control and Prevention) to perform intensive behavioral therapy, communicate nutrition plans to an individual’s primary care physician or practitioner, and be reimbursed for these services by Medicare. It would also provide Medicare coverage on new prescription drugs for obesity management (note that Medicare does not currently provide coverage for weight loss drugs—see our article on that subject in this issue [3]).

The AND is primarily responsible for creating this legislation. An AND spokesperson said [4], “For nearly two years, the Academy has been working on developing legislation to expand coverage for registered dietitian nutritionists to provide intensive behavioral counseling for obesity outside of the primary care setting.” This, unfortunately, is a ruse: yes the bill expands coverage for RDs, but in whose best interest is this? Only the RDs. It’s certainly not in the best interest of consumers, who now will have even fewer options.

Registered Dietitians (RDs) are allowed to perform services and receive reimbursement on their own merits, while other nutrition professionals, even those with higher educational credentials and twice as many clinical hours to their credit, are excluded unless they have gone through one of the other two listed programs. In other words, the bill would create a distinction that does not currently exist in federal law (the Social Security Act, which controls Medicare, provides equal treatment for RDs and other qualified nutrition professionals).

Medical Nutrition Therapy (MNT) services [5] for people with diabetes are covered under Medicare part B. Currently, federal rules state that RDs or qualified nutrition professionals may provide services so long as they meet certain education and experience requirements and have been certified by a national nutrition organization. If other qualified nutrition professionals can provide MNT services under Medicare, why in the world should they be edged out of reimbursement for obesity management services?

More importantly, it is difficult to believe that the AND is qualified to address our obesity crisis, considering their widely known conflicts of interest: AND receives funding from junk food companies [6] like Coca-Cola, Hershey, Council, Mars, and PepsiCo—the very agents of the obesity epidemic. Furthermore, they conduct continuing education courses sponsored by Coke [7] in which RDs are told that sugar, artificial colors, and nonnutritive sweeteners are perfectly fine for children, and concerns to the contrary are merely “urban myths”!

RDs are credentialed by the Commission on Dietetic Registration, a private organization. “Registered Dietitian” is not a government-based credential, so there is no reason it should be awarded preferential treatment over other credentialing organizations—particularly when it excludes those who possess Masters and PhDs in nutrition from accredited colleges and universities, as well as professionals qualified by other worthy nutrition credentialing organizations.

The bill’s introduction trails an announcement by the American Medical Association that they’ve decided to classify obesity as a disease (see our article in this issue [3])—and it’s clear that the AND is attempting to cash in on it. Whether you think obesity should be classified as a disease or not, we can all agree that it’s a worsening epidemic in the US. We should be increasing coverage and reimbursement for nutrition professionals who offer nutrition counseling for obesity, not restricting access! More than 104 million Americans are obese; obesity-related conditions include heart disease, strokes, type 2 diabetes, and certain types of cancer. Obesity and related conditions are the leading cause of preventable death. It’s expensive, too [8]. In 2008, medical costs associated with obesity were $147 billion; annual medical costs for individuals were $1,429 higher for obese people than for people of normal weight.

Access to a variety of nutrition professionals is vital to consumers: it allows them to choose a practitioner who aligns with their natural health lifestyle and values. With obesity as widespread and as costly as it is, why should only one organization’s nutrition professionals be given the exclusive right to counsel patients on ways to treat it?