Is It Illegal For Personal Trainers To Give Nutritional Advice?
A medium height man, of medium build, a tucked in polo (with no belt), and a pocket protector barged into my office—without an appointment. Ok, so my door was slightly ajar. Also, yes, he did offer a small knock before entering. I glanced huffily at this unfamiliar face, preparing to explain to him that I was busy—until I noticed a badge on his hip.
We made eye contact, I nodded, and he began to speak. He had come to communicate the conclusion of an already completed undercover investigation surrounding “unlicensed activity” in the field of nutrition and dietetics…
Chuckling nervously to myself, I futilely explained to the straight-edged investigator, through age-old academic humor, that “I’m not that kind of doctor.” He chuckled and explained anonymous reporting suggested I might be acting otherwise.
Unfortunately, he was not going to just tell me whether or not I was in trouble. He felt compelled to drag me by the ankles through the bureaucratic muddy water that is “scope of practice.” Knowing this was going to take a minute, I subconsciously reclined in my chair and interlaced my fingers across the back of my shiny head. Simultaneously, as if to make up the difference in space, the investigator hunched over and crossed his arms over his knees.
I knew I was about to get schooled, and I am going to pass that schooling on to you.
He explained the two components to a scope of practice: “The part I care about and the part you care about,” and why both are of dire importance to your career in the health and fitness industry.
“The part I care about” – The (state) law
- You cannot say you are a registered dietitian (RD) if you are not a registered dietitian
- You cannot say you are a licensed nutritionist if you are not a licensed nutritionist
State statutes are one piece of the puzzle. Verbiage is general, maybe including education requirements and an ambiguous list of services. General language puts the onus on professionals, and the organizations that credential them, to self-regulate within the law.
- Statutes define the scope of practice for licensed and unlicensed individuals
Look up your own state’s guidelines here– if it is not clear to you? Contact the representative in your state. Since nutrition regulations vary by state, It is in your best interest to speak with a representative to clarify it for you.
Further, yes, there are statutes for the scope of practice, at least defined by North Carolina, when providing nutrition programming online. In other words, offering advice on an individual basis, even online, may be seen as disregarding state statutes. Additionally, the North Carolina state board said, despite disclaimers, “life coaching” services (and testimonials from them) could be considered the practice of dietetics, and websites should be altered to reflect general information under threat of legal action.
“The part you care about” – Personal ethics, and not acting like a knucklehead
This is where your type of education matters, where you got it, and what bodies recognize it. Credible organizations will draft their scope of practice documents taking state laws into account. Further, becoming a member of a credible organization may have specific educational requirements, supervised hours, and comprehensive examinations.
Familiarize yourself with the published scope of practice guidelines from your organization.
The scope of practice can be funneled this way:
- State statutes determine the legal scope of practice.
- Credentialing agencies (or partners) define scope of practice within a profession.
- Individuals determine a scope of practice based on personal competencies within their profession.
It is the responsibility of self-governed organizations to define the scope of practice of their members. It is the individual’s responsibility to recognize their competence within the scope of practice and practice accordingly.
“Just because you are technically qualified doesn’t mean you are ethically qualified.”
For instance, a Registered Dietitian is unique in their ability to perform medical nutrition therapy. That is, treat disease, or manage chronic conditions with nutrition, utilizing diverse methods including, but not limited to: IV solutions, tube feeds or being cognizant of drug-nutrient interactions.
Each method requires theory and hands-on education. Formulating oral feeds is within the scope of practice of an RD. Indeed, if you are not personally competent in that method, it is unethical to provide the service without supervision. Having the proper credentials and not correctly applying them is a bad situation. It is the responsibility of the practitioner to only practice in areas where they are qualified AND competent.
Want a bulletproof way to provide nutrition advice without a license?
Is there a nutrition professional, that requires a license, in your state?
Look up their scope of practice, and DON’T DO ANYTHING ON IT.
How does one act outside of their scope of practice?
We can break down the scope of practice and acting outside of your specific scope in two distinct areas:
- Offer a service defined within licensure language… without a license.
- You act like knucklehead:
- Not referring out when you should
- Giving misinformation
- Not taking precautions for specific populations
- Having proper credentials but not responsibly applying the knowledge
- Acting beyond your means or education, even if it is legal
“How you doin’, pal?”
Asked the investigator as he cracked his knuckles. I came to, over 90 minutes had passed, and I had not moved a bit, only nodding and grunting in agreement as he told his well-practiced tale. In the end, he winked and said I was acting as an appropriate adjunct to the convoluted healthcare system.
All of this got me thinking: how can I run a business without crossing all the boundaries the man laid out? If I stick explicitly to the rules, can I still help people?
After some soul searching, here’s what I determined:
Be up front about it: Who are you? What do you do?
When treating disease, it does not matter how much formal education you have if you are not licensed. The scope of practice is the same for any unlicensed person, but the ethics of acting within your knowledge and experience still apply.
Refer to a specialist
Just recently, a runner came to my office looking for sports nutrition guidance to improve her performance. She could not seem to hack anything after mile six. As we spoke, she would absentmindedly palpate her hip and knee “this has troubled me for years” she said, and only after I inquired.
Not knowing a darn thing about orthopedics except how to say it, I gave her the card of a local practitioner. After a few weeks of targeted rehabilitation, her time to exhaustion skyrocketed, and her pace went down besides. No nutrition trickery involved. It turns out you will complete a run faster if you run in a straight line!
Admitting you are not qualified doesn’t tell people you are useless—it tells them the exact opposite, that you know where your competencies lie. Referring to a qualified professional builds trust between you and the client and signals compatibility with the specialist you refer to. Next time my local orthopedist has a patient that runs in a straight line but could use some extra fuel, guess whom he is going to refer?
In my experience, the more support your client has, the more likely they are to improve the quality of their lives. Successful clients will act as inspiration for others. Take a guess as to where those motivated people will go for help. I never gave that runner nutrition advice, but a few days after her next competition I started getting a steady stream of inquiries from her friends.
Not only should a professional know their scope of practice, but it would behoove them to have an understanding of the scope of practice of related professionals, clinical or otherwise. If you are not licensed, and a person is adamant about getting tailored instruction on a particular intervention, like the DASH diet? Refer out.
Indeed, Manore et al. concluded the lack of referrals between fitness professionals and clinicians had largely to do with misinterpretation, or complete ignorance of, each profession’s respective scope of practice. Skepticism and apprehension are further exacerbated by poor understanding of their scope of practice! To drive this point home, the scope of practice document for the RD is behind a paywall exclusive to the Journal of Academy of Nutrition and Dietetics members. Nevertheless, the onus is on the professional to ensure their qualifications and competencies are known to potential partners. Knowing what you are capable of as a professional, and what other specialists are capable of, builds trust by proxy. Once professionals have a working relationship, personal trust builds on top of professional confidence. The pie does not get divvied up; it gets bigger.
Know the difference between prescription and practicality
Language matters. It matters a lot. How you say it, and what context it is said.
What is being addressed, and how is it being addressed?
Talking about nutrition and lifestyle is not the same as treating disease or providing medical nutrition therapy. Along those lines, describing the principles behind an intervention is not the same as tailoring that intervention to them.
- Going over a client’s medical records is assessment
- Identifying a condition is diagnosis
- Setting the priorities, goals, and develop action steps is intervention
- Keeping track of their adherence to your prescription is monitoring
- Discussing changes in medically relevant information is evaluation
Look at how intensive that is? Further, look how much the client is not involved? In fact, that does not sound like a client at all… it sounds like a PATIENT.
If you considered medical advice to be specific, single variable and focused on exactitude, then non-medical information could be regarded as broad, holistic, and focused on fundamentals. Providing basic information, and direction toward credible literature is a moral imperative.
When it comes to chronic disease mediated by lifestyle, the cause-effect relationship is not a linear one. Rather, it is nonlinear and multi-causal. Indeed, the exactness of prescription may provide urgency for behavior change, but it will not provide what most people need to sustain any changes. The client’s reason behind the modification of behavior, and the mindset during the modification, will determine how likely an intervention will work in the long term.
Is this person begrudgingly following a directive from an authority figure? OR… Is this person internally motivated and needs clarity?
Consider the following:
Telling a person fish is a source of Omega-3 fats? Awesome.
Telling a person to eat a certain amount of fish to improve their dyslipidemia? Not awesome.
Showing how to include fruit in a balanced diet? Great.
Prescribing grapefruit juice to alter drug metabolism purposefully? Not great.
Be aware of the base-knowledge disconnect
The whole point of the client-professional relationship is to provide clarity and hit goals meaningful to the client. People do not want to know about statins, ACE inhibitors, or glycemia; people want to play with their family in the park without apprehension or have a more productive relationship with themselves and their environment. Helping people reach milestones THEY want will improve their prognosis as a side effect.
Most people just want to lose fat or improve some impairment that affects their daily life. Seldom does anyone want to see blood work change for the sake of it. More likely, it is something they lost (or never had) that caused the preoccupation with their nutrition. It is not the twenty pounds they think they want (or need) to lose… It is wanting to feel how they believe they are going to feel when they lose that twenty pounds.
Not only does focusing on the last help delineate medical and non-medical advice, but it also makes intervention more palatable to the client. Being able to walk to the mailbox without fear, or not needing the help of others to do basic tasks, like dress themselves, are great intrinsic motivators without the need for “medicine.” Nevertheless, that does not mean the outcome is not clinically significant. It is just… accidental.
Do you want to change a number on a chart or do you want to help people?
Can you develop strong enough relationships to determine the intention-intervention gap? That is, can you assist in determining why, when they mean well, they cannot translate their motives into sustainable behavior?
Some questions to prioritize:
- Do they know how to cook?
- Do they have regular eating patterns?
- Are their food choices balanced?
- Are they eating enough food as per national guidelines?
Let that be your guide.
Make a Difference Without Being a Clinician
Ease of access routinely puts fitness professionals before clinicians. It can be a role of the fitness professional to provide encouragement to a person following a healthcare plan prescribed by their clinician. Additively, increased communication builds trust and improves adherence.
I take a firm position in approaching health from the bottom up (origin) rather than the top down (presentation). According to the CDC’s chronic disease index page (last updated 2014), some 86% of health care costs correlate with conditions related to lifestyle.
What does “lifestyle” mean? The American College of Lifestyle Medicine places emphasis on the six following categories: Nutrition, Exercise, Tobacco and Alcohol, Stress, Sleep, and Healthy Relationships. Lifestyle medicine, at its core, is disease management and prevention without the use of surgery or pharmacy (or lightly augmented by pharmacy).
Everyone can play a role in improving the health of others. Everyone.
Addressing a significant gap in lifestyle has far reaching benefits when compared to targeted pharmacotherapy. Although out of the scope of this article, it is interesting to posit whether or not pharmaceuticals, used to manage chronic conditions perpetuated by lifestyle, enable the very behavior that justified the initial prescription.
Whether or not this is the case, if the lifestyle is considered the precipitating factor, there is no need to concentrate on a medical condition. Addressing lifestyle gaps will improve the quality of a person’s life this way. If that improved quality of life leads to amelioration of a disease state? Well, let us egregiously call it “spontaneous coalescence.” I am cool with that.
About The Author
Dr. Trevor Kashey – Armed with a Ph.D. in biochemistry, Trevor Kashey traverses the globe seeking enlightenment, the perfect four-leaf clover, and trying to maximize humans. His passion for education and outreach in the realm of nutrition, dietary supplements, and quality of life can be found in his lectures at colleges and conventions, in his writing and edits for various media outlets and at “bagels” for the regular Sunday morning crowd in Vero Beach, FL. Trevor utilizes body composition as a fulcrum for longstanding health benefits, with increases in performance as a side effect. Trevor’s goal is to blend anecdotal, academic and clinical data, harmonizing it into something palatable.