Celebrating 25 Years!
By Carrie Dennett, MPH, RDN
Today’s Dietitian
Vol. 26 No. 1 P. 18

It’s been one-quarter of a century since Today’s Dietitian (TD) debuted, and it goes without saying that while much has changed in the nutrition and dietetics landscape since 1999—hello electronic charting, telehealth, and continually evolving research—a great deal hasn’t changed. Dietitians still strive to provide the best care and nutrition information possible based on research evidence and their own clinical experience.

The five years since TD last looked back were dominated by an event no one saw coming—a global pandemic. That event changed dietitians’ personal and professional lives and similarly impacted that of the clients and patients we serve and the consumers we inform.

In honor of TD’s 25th anniversary this month, we take a look at some of the most significant current trends in the food and nutrition world and how they can help dietitians guide the people they serve toward better health.

Impact of a Pandemic
No forecast for how the dietetics profession might change could have included the COVID-19 pandemic. While the many effects were devastating, the pandemic also produced career pivots that were somewhat of a silver lining for some dietitians, largely due to the explosion of telehealth.

“My practice went fully virtual in March 2020 and has remained that way ever since,” says Chicago-based dietitian Taylor Wolfram, MS, RDN, LDN, founder of Taylor Wolfram, LLC, which specializes in vegan nutrition and intuitive eating. “This widely increases the accessibility of our services, especially since insurance has been covering telehealth sessions.”

Ginger Hultin, MS, RDN, CSO, owner of Ginger Hultin Nutrition in Seattle, and author of Anti-Inflammatory Diet Meal Prep, says she’s grateful for telehealth and Zoom gatherings becoming the norm: “It’s been very positive. I, and many dietitians, have become really great at making virtual presentations entertaining and engaging. I’ve been able to talk to audiences around the US and around the world with ease and that was a pandemic shift.”

While private practice dietitians largely were able to shift to telehealth, those in clinical dietetics and health care foodservice were hit harder, says Jen Bruning, MS, RDN, LDN, a spokesperson for the Academy of Nutrition and Dietetics (the Academy) in Chicago. “They were on the front lines and saw a lot of difficult things. For some, this may galvanize their feelings that they are meant to continue serving in health care. For others, it may have spurred the need for a change and led to a career pivot,” she says. “I think as more and more workplaces sort themselves out with regards to work-from-home policies, employee benefits, recruitment strategies, etc, dietitians have an opportunity to have their voices heard and considered in the reshuffling. If there’s something you want to see in your workplace, now’s the time to ask.”

Throughout the COVID-19 pandemic, TD covered several articles on its negative and positive impacts on dietetics, nutrition counseling, and the foodservice industry and the manner in which it changed the way RDs work in clinical and nonclinical settings. The pandemic also affected the health of their clients and patients.

Eating disorders were on the rise during the pandemic, which created increased demand for dietitians specializing in this area. “I saw [that] a lot of people [found] that their eating disorder behaviors increased during the initial months of the pandemic and lockdown. For other people, the extra time at home helped them to realize that their relationship with food was not healthy,” says Alissa Rumsey, MS, RD, CDN, CSCS, author of Unapologetic Eating and founder of Alissa Rumsey Nutrition and Wellness in Brooklyn, New York. “So, I saw both an increase in people new to eating disorder treatment, as well as an uptick of people who had been treated for an ED in the past but now their symptoms were returning.”

Bruning says one positive aspect of increased time at home was a return to cooking and the craft of making food. “We had more time to spend in our kitchens, and the influx of virtual cooking classes only bolstered the creativity and learning that was happening at that time. Many of those classes are still happening, and folks have found that they want to keep cooking at least some days of the week.”

On a less positive note, the pandemic exposed the vulnerabilities of our food supply chain and labor force, says Lauren Harris-Pincus, MS, RDN, founder of NutritionStarringYOU.com, in Basking Ridge, New Jersey, and author of The Everything Easy Pre-Diabetes Cookbook. “First, the masses were unable to access certain foods, while others, for the first time, relied on food banks and other assistance programs. Now due to inflation, our food costs have increased substantially, making it more difficult for families to meet nutritional needs,” she says.

Early in the pandemic, TD looked at the impact of food insecurity, giving an overview of nutrition’s importance, how the pandemic affected the US food supply, the risk of hunger, and the roles RDs played.

Harris-Pincus adds, “It’s critical for RDs to understand social determinants of health and take accessibility and affordability into account when making recommendations to clients and the public. Food isn’t healthful if you can’t afford to buy it. The pandemic brought this issue to light for many of us.”

Technology Boom
Zoom and telehealth aside, the past five years have brought technology more firmly into the nutrition world. Consumers are seeking artificial intelligence (AI)-generated meal plans, and tech companies are moving into the nutrition sphere by developing apps and coupling home genome and microbiome testing with nutrition advice. Hultin says AI’s leap to the forefront this year via ChatGPT and other applications already has changed and will continue to change the nutrition landscape significantly, while Bruning says that, for the most part, technology has advanced in ways that can better support dietitians and those in their care.

The use of AI is on the rise and making inroads in various medical specialties. TD has provided an overview of where AI applications stand in the fields of CVD, renal care, and diabetes management and whether it will soon find its place in MNT.

“I think the biggest thing is that folks really need the guidance of an RD alongside these technologies,” she says, because many apps and other nutrition-related technology produce automated or generalized advice, which runs counter to the individualized care dietitians provide. “Working with a dietitian in tandem with using these technologies can steer clients and patients toward a better individualized understanding of generalized information.”

Shifting Approaches to Weight
Five years ago, dietitians Evelyn Tribole, MS, RDN, CEDRD-S, and Elyse Resch, MS, RDN, CEDRD-S, FAND, creators of the Intuitive Eating model and authors of Intuitive Eating, filled a massive ballroom at the Food & Nutrition Conference & Expo (FNCE®) in Philadelphia. It was a sign of the increased interest in nondiet approaches to health, as is the growing success of Weight Inclusive Nutrition and Dietetics, a group founded by Heather Caplan, RD, which held its annual conference in 2023.

TD covered Tribole and Resch’s FNCE® talk, in which they explored four myths about intuitive eating.

Rumsey says she’s seen more interest in a nondiet approach to nutrition and eating—especially among people tired of dieting or affected by disordered eating and eating disorders—driven in part by increased media and social media coverage of intuitive eating. “At the same time, I am also seeing a rise in the number of dietitians and dietetics students being interested in and embracing a nondiet approach to nutrition,” she says. “As the harms of dieting, weight cycling, and weight stigma continue to be highlighted, I see more nutrition professionals embracing a weight-inclusive, nonstigmatizing approach to nutrition and health.”

In recent years, TD has covered the nondiet approach in articles on weight bias in dietetics education, focusing on health behaviors instead of the scale and whether promoting body positivity is compatible with weight management in dietetics practice.

According to Ketchum PR’s 2023 report, “Tomorrow’s Dietitian: A First Look at Gen Z RDs!,” 33% of Generation Z RDs and nutrition students say they came into the profession because they want to help others heal their relationships with food, significantly more than other generations of nutrition professionals. Gen Z RDs are significantly more interested in intuitive eating and eating disorders than other generations of dietitians—and are considerably more likely to have their own history of disordered eating, eating disorders, or negative body image.

Hultin says dietitians are leading the pack on improving the damaging societal “diet culture” of the past. “A lot of non-RDNs out there online are still touting ‘bad’ and ‘good’ messaging and driving food fear, but dietitians have been influential in shifting that conversation,” she says. “I feel that five years ago, the RDN community was more divided on the subject—nondiet vs traditional weight management approach—but over time, I think we’ve all settled where we practice the best. As a profession, I think we’re more comfortable with people practicing in different ways. I’ll often hear things like, ‘Oh, do you do intuitive eating with your clients? Great, I’ll refer to you!’ and vice versa.”

Bruning says she’s seen a broadening of approaches as new RDs enter the field and that “the embracing of healthful behaviors and eating patterns irrespective of body weight/weight loss is a desperately needed avenue of treatment for so many who’ve been hurt by pervasive and inaccurate messages that thin = healthy.”

Harris-Pincus says she’s observed a significant shift in thinking about the philosophy of weight management both societally and within the nutrition profession in the past five years. “We have seen an explosion of self-identifying ‘antidiet’ dietitians [with] an approach that focuses on health behaviors and access to health care, rather than on weight as a mediator of health, and intuitive eating practitioners. With more evidence of the damage of weight bias and stigma being published, it’s logical that we must reevaluate how we treat clients and how we message to the public about diet and weight,” she says.

“It’s fascinating to see RDs battling it out with different philosophies when in reality, we are all on the same page, though potentially through different lenses. Diet culture is harmful, full stop. We can all agree on that. As in life, each human body is unique, as is each life circumstance.”

Nuanced Conversations About Ultraprocessed Foods
Life circumstance also comes into play with discussions of ultraprocessed foods. Dietitians have been talking about processed vs unprocessed foods for decades, but the past five years brought the term “ultraprocessed” fully into the mainstream. A PubMed search for “ultraprocessed” shows a steep spike in published research, and those results have leapt off the journal page and into mainstream and social media—which, indubitably, brings it into dietitians’ counseling sessions with clients and patients.

“It seems that concern about ultraprocessed foods has grown thanks in part to hyperbole on social media. This, unfortunately, creates a lot of fear among consumers and can even drive disordered eating,” Wolfram says. “Meanwhile, this fearmongering does nothing to increase accessibility to nutritious foods or address root issues in our food system.”

Harris-Pincus says she sees an endless cycle of blame placed on food companies that produce processed/ultraprocessed foods and on the consumers who purchase them. “The tricky part is defining ‘ultraprocessed’ because the multiple systems available for reference are inconsistent with each other. Nuance is important here because some nutrient-dense foods like soymilk qualify as ultraprocessed, yet they fall into the same category as packaged cupcakes,” she says. “It’s important for RDs to educate consumers about the different types of processed foods, how to include them strategically, and reduce feelings of guilt or shame if social determinants of health play a role in limiting access to less processed, fresh foods.”

TD recently provided a primer on ultraprocessed foods, including their classification, consumption patterns, and health effects.

Bruning says dietitians are the experts to help introduce that nuance to the conversation, including helping consumers understand that some people have real barriers to cooking with whole foods, such as access, time, skills, and money. “If a family is struggling to pay the energy bill, then shelf stable, potentially more processed foods that they know the whole family will accept may be more realistic choices,” she says. “And some processed foods are better choices than others: those that contain fiber, healthful fats, lean protein, and micronutrients can still be healthful choices despite being processed. There are so many more options out there than 10 or 20 years ago.”

Food as Medicine
Another term spiking in search results—and being applied in clinical and community settings, is “food as medicine.”

“I’ve always been in this space because my background is integrative nutrition,” Hultin says. “For me, food as medicine has always been my reality,” she says, adding that she does see it trending, and the fact that the Dietitians in Integrative and Functional Medicine dietetic practice group has grown to be one of the largest DPGs indicates there’s tremendous interest in the topic.

Bruning says the food as medicine messaging has been adopted by more and more entities, including the Academy and its foundation. “Often, food as medicine refers to programs such as fresh produce prescriptions and medically tailored meals. Essentially, treating food as a form of medicine. This is a dietitian’s sweet spot—it’s what we do. Retail dietitians have an essential role in executing this idea and making it real for people.”

TD’s coverage of the food as medicine movement includes articles on how the trend is supporting cancer treatment and where curricula are being introduced in medical schools.

Hultin notes that there’s been some confusion about food as medicine, along with push-back that food isn’t the same as medicine and dietitians shouldn’t step out of their scope of practice by promising to cure disease through nutrition. “To me, that’s not what food as medicine means,” she says. “Food as medicine is more about the fact that diet (and lifestyle factors like sleep, stress management, and physical activity) are linked clearly to better health outcomes, and we should be taking a food first approach and including nutrition as part of the plan and preventive care.”

Bruning agrees that incorporating dietary changes shouldn’t be mistaken for substituting food for medicine. “It’s important that folks work with a dietitian or other qualified health care professional and see if with the right food comes less need for medicine/medication.”

Gut Health Going Forward
When it comes to MNT in an outpatient or private practice setting, gut health continues to be a growing focus, Harris-Pincus says. “As consumers are becoming more aware of the importance of gut health, more people seem to be recognizing their own GI discomfort as something treatable with nutrition intervention,” she says. “I’ve seen a marked increase in clients asking about low-FODMAP and gluten-free diets in an attempt to alleviate their GI symptoms through diet.”

TD’s robust coverage of gut health and the gut microbiome includes how the gut microbiome interacts with eating disorders, bone health, mental health, and the endocannabinoid system, as well as at-home micro- biome testing and how soil health influences gut health.

Hultin says she’s also seeing more focus on gut health—including small intestinal bowel overgrowth—but also on women’s health issues such as polycystic ovary syndrome, perimenopause, and menopause. “The world of personalized medicine/nutrition and nutrigenomics is also emerging and I’m very excited about that. I’m hoping that someday soon, it will be standard of care in nutrition, pharmacy, and medicine.”

Along with polycystic ovary syndrome, Wolfram has seen a greater awareness of postural orthostatic tachycardia syndrome (POTS) and ADHD. “Not all conditions have a dietary cause but may benefit from condition-specific nutrition strategies. For example, food can’t cure POTS or ADHD, but folks with these conditions may find meal planning and preparation particularly depleting or daunting and benefit from personalized strategies from RDs,” Wolfram says. Notably, RDs for Neurodiversity, founded by Naureen Hunani, RD, owner of Naureen Hunani Nutrition in Montreal, Canada, offers online continuing education for dietitians wanting to better help clients and patients with ADHD, autism, and other types of neurodiversity.

Honoring Cultural Foodways
Similar to the growing focus on gut health and personalized nutrition, there’s greater interest in achieving cultural competency and cultural humility through the recognition of the nutritional value of heritage foods. While the 2020–2025 Dietary Guidelines for Americans encourages customizing recommendations based on cultural traditions, a lack of research on most cultural diets means these diets haven’t found their way into the guidelines. To try to bridge that gap, many dietitians—including Caribbean-based Amber Alexis, MSPS, RDN, owner of The Cultural Dietitian (@theculturaldietitian); Clara Nosek, MS, RDN, owner of Clara Nosek Nutrition (@yourdietitianbff) in Modesto, California; Diana Mesa, RD, LDN, CDCES, founder of En La Mesa Nutrition in Miami (@enlamesanutrition); and Sharon Swampy, RD, in Calgary, Canada (@indigenousnutritionist)—have taken to social media to talk about how and why their cultural foods are nutritious and healthful. Fortunately, it appears that this messaging is resonating within the broader field of dietetics.

“There are so many good conversations happening around heritage eating patterns, respectful recipe development and naming, appreciation of cultural foodways that avoid appropriation, and the need for more dietitians from diverse backgrounds to be able to serve the public,” Bruning says. “Dietitians of color and those from many diverse religious and cultural backgrounds are leading the way.”

TD’s coverage of cultural foodways has included ethics in the plant-based food movement, cultural humility, the need for diversity in the dietetics field, counseling Hispanic clients, the history of West Indian plant foods, and a look at global holiday food traditions.

Rumsey says that while the dietetics profession is more aware of the importance of cultural competency when it comes to food and nutrition, the reality is that the majority of dietitians are white. “We still have a long way to go when it comes to diversifying the profession; however, through the work of organizations like Diversify Dietetics, it’s a topic of conversation and, hopefully, training,” she says. “The racial justice uprisings of 2020 helped to put even more attention on not only culturally competent nutrition care but also the importance of confronting and interrogating our biases and learning from people with different lived experiences than our own.”

Hultin agrees that dietitians have much more work to do towards increasing equity in the dietetics profession and promoting diversity, “but at least the conversation is now being had and there are positive changes in this area,” she says. “Along with an increased awareness about the importance of diversity and inclusion, cultural foods are getting highlighted in meaningful ways. I see so many more cookbooks, recipes, blogs, and resources being shared than ever before.”

From Present to Future
Many of the changes of the past five years will shape the future of dietetics. For example, Bruning says she’s observed a welcome broadening of the dietetics profession far beyond the traditional options of clinical, foodservice, community, or private practice, with many internships offering rotations in gardening, culinary nutrition, informatics, corporate wellness, and more. “Now, we can create roles for ourselves with our combined areas of specialty, such as agriculture/sustainability, AI, cultural competency, sports performance, etc.”

Rumsey says she’s excited to see the role of the dietitian expanding and diversifying beyond nutrition education and prescriptive eating recommendations. “Dietitians have so many avenues through which they can offer exceptionally valuable and meaningful support and care. More dietitians are focusing on things like increasing access to food, reducing food insecurity, healing people’s relationship with food, advocating for health care free of weight stigma, and helping people build self-care skills around food and eating.”

Both Rumsey and Wolfram say they’ve noticed more of an emphasis on social determinants of health, trauma-informed care, and the effects of systemic oppression, something that was reflected in multiple 2023 FNCE® sessions. “I am delighted with these trends and feel we’re serving our clients much better by using a systems approach and treating our clients more holistically rather than boiling everything down to behavior change,” Wolfram says.

— Carrie Dennett, MPH, RDN, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy for Your Life: A Non-Diet Approach to Optimal Well-Being.