March 2013 Issue
Illinois Defeats RD-Only Licensure Bill — The Vote Overturned One of the Most Restrictive Dietetics Laws in the Country
By Lori Zanteson
Vol. 15 No. 3 P. 12
Legislation mandating that only licensed dietetics professionals can provide nutrition counseling in the state of Illinois, the headquarters of the Academy of Nutrition and Dietetics (the Academy), was recently defeated.
The landslide victory in the House of Representatives in December 2012—following a unanimous Senate vote the week before—dismantled the 10-year dietetics law, which was considered one of the most restrictive pieces of legislation in the country. The Senate bill would have extended the state of Illinois’ Dietitian and Nutrition Services law for another 10 years and increased the penalties for practicing without a license to $10,000 per offense.
With the renewal blocked, the new bill, signed by Gov Pat Quinn on December 28, 2012, ends the RD-only monopoly in Illinois and allows the licensing of non-RD nutritionists who have certain nutrition degrees from accredited regional schools. The nutritionists must have 900 hours of supervised experience and pass a clinical nutrition exam instead of the RD exam. The new law accepts a broader range of nutrition majors from accredited colleges and the authority of the Department of Financial and Professional Regulation to include additional licensure exams to qualify nutrition professionals to practice, such as the Clinical Nutrition Certification Board, the Certified Board for Nutrition Specialists (CBNS), and the American Clinical Board of Nutrition. Moreover, the new legislation states that general nutrition information about healthful foods, supplement use, and reading nutrition labels may be provided by individuals such as health food store operators who sell health food and dietary supplements.
To help support the changes and revisions to the old regulations, the new legislation calls for the establishment of a licensing board representative of this more inclusive nutrition community.
Public Safety or Monopoly?
The defeat of the bill in Illinois comes on the heels of widely publicized accusations that the Academy is using state legislatures to block unlicensed nutrition providers, including those with advanced degrees and certifications in nutrition, from practicing nutrition counseling. The opposition to RD-only nutrition licensure gained greater attention following an article by Michael Ellsberg, published in Forbes, who accused the Academy of intentionally using state legislatures to limit market competition in nutrition counseling for RDs without intent to protect public health. (For more on this topic, read the feature “RD Licensing Legislation” in our November 2012 issue.)
The Academy, however, denied those claims, stating that licensure is intended to protect the public from practicing incompetent nutrition providers.
Pepin Andrew Tuma, Esq, director of regulatory affairs for the Academy, says the organization’s Model Practice Act doesn’t prohibit anybody from providing “general nonmedical nutrition information.” The Academy objects when nutrition advice becomes healthcare treatment or medical nutrition therapy. Tuma and the Academy stand behind the need for licensing to ensure nutrition professionals have met a rigorous set of standards to protect public health.
This debate in the dietetics community uncovered a growing demand for the Academy to update and expand its stance on licensing to allow a broader, more inclusive definition of nutrition practitioners and to recognize and acknowledge their education, training, and credentials to show that RDs aren’t the only qualified professionals to provide expert, safe nutrition counseling.
The growing demand for the Academy to update its RD-only licensure position became evident in the almost year-long effort to repeal the Illinois licensure law, during which time the CBNS committee attended the hearings. The certified nutrition specialist (CNS) is the only credential other than RD that’s accepted under the licensing laws in many states.
“We played a key role in educating legislators about nondietetics training pathways for nutrition professionals and in crafting the amendment, which reflected that,” says Corinne Bush, MS, CNS, chair of the outreach/legislative committee for the CBNS.
Bush says the CBNS worked with the original dietitian/nutritionist bill sponsor, Sen Iris Martinez, and several influential organizations and groups, such as the Illinois Department of Financial and Professional Regulation, the Illinois Dietetic Association, and various national nutrition and health organizations.
“Our approach is simply raising awareness among legislators, organizations, and citizens of the states where we’re working to balance licensing laws,” Bush adds. “Nutrition science and training options for nutrition professionals have grown exponentially since nutrition licensing laws were first put in place over 30 years ago. We’ve found that being able to discuss and document those shifts leads legislators to enact more fair and balanced laws that truly serve the public. That’s exactly what happened in Illinois.”
While Bush laments that the legislation that was in place for the past 10 years in Illinois and the many other states that maintain restrictive licensing laws that bar qualified nutrition professionals from practicing and who may be forced to leave their state to run their business, the doors have opened and change is imminent. This is good news for nutritionists and even better news for the public, who will now have a much more diverse range of nutrition care available to them.
According to Bush, the passing of the new law in Illinois “ensures much broader access to qualified nutrition practitioners who typically focus on prevention and management of chronic disease, which is rampant in Illinois, where more than 27% of citizens are obese.”
At the time this article went to press, the Academy hadn’t responded or made a public statement about nutrition professionals who aren’t RDs being allowed to provide nutrition services.
Some dietitians question the wider scope of practice given to non-RDs and what this may mean for the integrity of the nutrition profession. “Being an RD, all professions have to be regulated to make sure we’re all competent. This is why we want to always hold to a high level of expertise to protect the public,” says Angela I. Dougé, MPH, RD, LDN, assistant director of the didactic program in dietetic and nutrition science at Dominican University in Illinois. “Now we’ve added bodies to share this umbrella, and they need to be held at the highest level.”
Dominican University doesn’t plan to change its programs, which include several paths that lead to an RD degree, in response to the new licensing law. However, Jill H. White, EdD, RD, LDN, chair of the university’s nutrition science department, would like to see the nutrition field include alternative nutrition through holistic medicine and advocate sustainability. “There needs to be a bigger discussion. We need to be questioning and looking for things to be broader.”
Many believe the victory in Illinois is profound, not merely because it’s the home of the Academy, but because it may represent a trend that other states embrace. Bush and members of the CBNS are hard at work developing new legislation in multiple states.
“We expect that the trend toward including other approaches will continue,” Bush says, “as more and more legislatures recognize the benefits of a broad range of qualified providers and more citizens with access to a wider range of quality care.”
— Lori Zanteson is a food, nutrition, and health writer and editor based in southern California.