For Sound Diet Recommendation, See a Registered Dietitian

The ABA’s motivation for paying these nutrition experts was simple: to downplay the potential negative health impacts of aspartame, a commonly-used ingredient in diet soda and artificially sweetened packaged foods. The campaign was reportedly a direct response to the World Health Organization (WHO), which, earlier in 2023, had recommended that people stop using artificial sweeteners like aspartame due to evidence of potential health risks, like type 2 diabetes, heart disease, cancer, and mortality. In the paid videos, labeled with the hashtag #safetyofaspertame, dietitians and other influencers told their millions of followers that the studies the WHO used to make its recommendation were not solid enough to warrant its warnings. The videos, which appeared across social platforms (including Instagram, TikTok, and Facebook) also highlighted that the sweetener was considered safe by the U.S. Food and Drug Administration (FDA).

The fact that these videos were linked to an undisclosed paid ad campaign by Big Soda was not an isolated incident. After analyzing thousands of social media posts from 68 RDs with 10,000 or more followers, The Washington Post team found that “companies and industry groups paid dietitians for content that encouraged viewers to eat candy and ice cream, downplayed the health risks of highly processed foods and pushed unproven supplements—messages that run counter to decades of scientific evidence about healthy eating.”

Some dietitians say the effects of the paid influencing extend beyond the videos themselves; even RDs who have nothing to do with influencer culture are dealing with tarnished credibility that touches all professionals who hold the title. “It is unfortunate that these dietitians are agreeing to these advertisements and not always fully disclosing who is paying them. It discredits us dietitians who work hard and do not agree with these practices,” shares New York-Based clinical dietitian Tina Covone, RD, CDN.

“It is unfortunate that these dietitians are agreeing to these advertisements and not always fully disclosing who is paying them. It discredits us dietitians who work hard and do not agree with these practices.” —Tina Covone, RD, CDN

Perhaps more importantly, many health and nutrition experts (myself included) feel that the WaPo story itself lacked nuance, more acutely impacting the reputation of registered dietitians and value we offer than shedding light on misinformation. “The piece left out key information, shaping it into a one-sided narrative that unfairly tries to discredit dietitians,” says Bianca Tamburello, RDN, dietitian at FRESH Communications. “For example, part of the article also talks about dietitians promoting sugar consumption but leaves out the fact that some of these dietitians practice a food philosophy that helps clients destigmatize food, including sugar, to combat disordered eating.”

“Using examples of only seven registered dietitians, the authors imply it is common practice for RDNs to have undisclosed affiliations with food companies and sponsors. This could not be further from the truth,” wrote Lauri Wright, PhD, RDN, in an official statement as president of the Academy of Nutrition and Dietetics (AND), a non-profit professional organization representing dietitians. Dr. Wright emphasized that influencer dietitians are a vast minority within the profession, and agreed that these RDs in question did not follow ethical practice standards in their posts.

“Using examples of only seven registered dietitians, the authors imply it is common practice for RDNs to have undisclosed affiliations with food companies and sponsors. This could not be further from the truth.” —Lauri Wright, PhD, RDN

As a registered dietitian of nearly a decade myself, I couldn’t agree more. The article really doesn’t capture what the majority of RDs are doing on a daily basis and the education we’ve completed and continue to engage in. Many of us are not working in the digital space at all, but rather consulting with clients and patients all day long in clinics and hospital settings. Yet there are a few RDs with outsized influence on public nutrition information due to their significant social media presence. And the actions of those RDs, unfairly or not, end up reflecting poorly on the rest of us. Add to this the compounding gap of missed or misunderstood nuance surrounding sweeteners (and nutrition in general), and you can see why the dietitian community deserves better.

When it comes down to it, (ethical) dietitians are who the public should look to for nutrition advice for a plethora of reasons. For one, it is possible to have an ethically sound paid partnership with a food brand as a registered dietitian. For another, in its pursuit of exposing RDs who hold questionable ethics, what The Washington Post article actually does threaten to upend the credibility of the entire dietitian community. And that’s a problem, because we are the most trained, most knowledgeable nutrition experts in the U.S.

The intended role of the trained, accredited registered dietitian

In short, “RDs work with individuals to help them make dietary changes that can help prevent chronic illnesses such as heart disease, type 2 diabetes, and stroke,” says Joan Salge Blake, EdD, RDN, LDN, FAND, nutrition professor at Boston University, author, and host of the nutrition and health podcast, SpotOn!. “Many physicians, based on the diagnoses of their patients, refer them to RDNs for nutrition advice and guidance.”

“Registered dietitians are specifically trained to provide evidence-based nutrition recommendations that translate nutrition science into digestible, actionable, and personalized food and nutrition guidance,” adds Tamburello.

What is it that makes RDs (or registered dietitian nutritionists, RDNs; the credentials are equivalent and interchangeable) so trustworthy? Their extensive education and training focused on nutrition that starts in college—and never stops. “The RDN has completed at least a bachelor’s degree in dietetics at an accredited university or college in the United States that has incorporated specific coursework and supervised practice that have been approved by the accrediting body of the Academy of Nutrition and Dietetics (AND),” says Salge Blake. The coursework required is extremely comprehensive and spans chemistry, biology, epidemiology, human physiology, metabolism, food science, and business in addition to practical skills like counseling and nutrition assessment. Starting this year, just having an undergraduate degree won’t cut it; RD candidates will also need to have a master’s in science before taking the national certifying exam.

After their schooling is over, a prospective dietitian must complete an internship to get experience working with clients. These six- to 12-month internships are typically unpaid, and are very competitive, says Covone. Future RDs spend this time shadowing dietitians working in the clinical, community, or food service settings. This leaves us with “an understanding of medical nutrition therapy, which is an integration of nutrition counseling and dietary changes based on an individual’s medical history and current health needs to improve that person’s health,” says Salge Blake.

The intern experience is similar to that of a medical doctor’s residency, in that students rotate through every subspecialty of the profession. Interns shadow the dietitian in each setting to get a full understanding of the assessment and treatment process. Then, we spend time in commercial kitchens to see how food service operations are run, and complete the experience with community nutrition rotations through settings like Women, Infants, and Children (WIC) programs or food banks. Some internships may also include research or other subspecialties like public health nutrition.

After this, RD (or RDN) candidates must pass a national credentialing exam offered by the Commission on Dietetic Registration (CDR), the national accreditation organization for the profession where the first time pass rate is just over 65 percent. (Translation: It’s a tough test.) As part of accreditation, dietitians must also agree to follow the Code of Ethics for the Nutrition and Dietetics Profession. This code states that as professionals, we will work under a set of obligations centered around “customer focus, integrity, innovation, social responsibility and diversity.”

To maintain accreditation, registered dietitians are also required to engage in at least 75 hours of continuing education every five years in order to stay up-to-date with the constantly emerging field of nutrition. “Registered dietitians are required to complete ethics training during each period of continued education,” says Tamburello. Once you pass the accreditation test, “most states require licensure to practice,” adds Brianna Wieser, RDN, LDN, RYT, registered dietitian nutritionist and Senior Clinical Program Specialist. While licensure doesn’t require an additional exam, it is an extra annual fee RDs must pay.

There’s a lot of work and training that goes into being a registered dietitian—which sets the credential apart from other nutrition or wellness “experts.”

There’s a lot of work and training that goes into being a registered dietitian—which sets the credential apart from other nutrition or wellness “experts.”

“Anyone can call themselves a nutritionist, but only those who went through the above training can be considered ‘registered dietitians,’” Covone says. While there are some holistic nutritionist and health coach certification programs, like the Institute of Integrative Nutrition (IIN) and ACE, these programs are not nearly as rigorous as what one goes through to be a registered dietitian. Many of these education programs can be completed in less than six months.

Once you have your RD training and credentials, there are a lot of different ways you can use it. “The job landscape for dietitians was once confined to inpatient and outpatient hospital positions. Now, RDNs work in a variety of sectors and roles,” explains Wieser. These settings can include “private practice, universities, medical schools, professional athletic teams, food companies, and other nutrition-related businesses,” says Salge Blake. The clinical dietitian role, for example, is to “ensure that every hospital patient is meeting their nutrition needs either orally, through a feeding tube, or via a line directly into their bloodstream,” says Wieser. And then, of course, RDs are also now moving into digital spaces like social media.

The complicated nature of “influencing” as a dietitian

As a registered dietitian, my clients constantly request specific brand or product recommendations—and I gladly share my thoughts. “When we discover products that align with our values and could be helpful to others, we want to share them with the many people who are confused and overwhelmed in the grocery store,” agrees Tamburello. “Product discovery can be daunting, especially for people with issues like food allergies and diabetes—this is where dietitian advice is key.”

Sometimes, these personal endorsements might evolve into paid partnerships of some kind between dietitians and influencers—which is not inherently problematic. Often, the intention is for RDs to offer their expert insight and nutritional analysis of the products in question. “Guidance provided by dietitians to food companies drives creation of more health-promoting foods,” says Tamburello. “Additionally, nutrition education provided by dietitians in counseling and public health settings drives consumer demand for health-promoting foods.”

“Guidance provided by dietitians to food companies drives creation of more health-promoting foods,” says Tamburello. “Additionally, nutrition education provided by dietitians in counseling and public health settings drives consumer demand for health-promoting foods.”

The gray areas begin when dietitians have paid partnerships with brands to promote their products (or talking points) to the public. While it’s predicted that $7.14 billion will be spent on influencer marketing in 2024, there isn’t clear data about how many social media-famous dietitians will be cashing in. The Washington Post found that half of the 68 influencer RDs it examined (so, around 34) promoted food, drinks, and supplements to their combined 11 million followers within the past year. (For context, there are around 100,000 registered dietitians in the U.S. Older data from 2019 shows that 54 percent of registered dietitians have a social media page for professional purposes; 26 percent of them use social media to promote products and services.)

Again, there may not be anything wrong with RDs taking to social media to share their expertise or product recommendations to a wider audience—especially when not everyone has the time or resources to be able to consult an RD in person for nutrition advice. But things get dicey when these influencer dietitians don’t pay mind to facts. If RDs are promoting products that show no evidence for improving health, or worse yet, have possible evidence of negative health outcomes—as it can be argued is the case for diet sodas and other aspartame-containing products—then that is going against the purpose, values, and mission of the dietitian. It can make any reasonable consumer wonder: “Is this person saying this because this product actually is okay to consume, or because they were paid to say it?” That’s why the AND (which writes the ethics code all RDs have to follow) actually discourages “accepting gifts or services which potentially influence or which may give the appearance of influencing professional judgment.”

The other key potential problem with sponsored RD content is lack of disclosure. The above-mentioned code of ethics for RDs is also informed by the Federal Trade Commission’s (FTC) regulations on financial disclosures in social media posts by which  all influencers are expected to abide. The regulations stipulate that influencers must make clear somewhere in their post that they are being paid by the brand, which could look like a person verbalizing that the post is a paid partnership, or including that information clearly in the post description. This seems simple to follow—and yet many influencers, including RDs—fail to do this. (Even Kim Kardashian was hit with a $1.3 million fine last year for promoting crypto on her social media accounts without disclosing that she was paid by a brand to do so.)

In November, the FTC sent warning letters to several influencer RDs, plus American Beverage, stating that their #safetyofaspertame videos may have violated federal regulations due to their lack of clear disclosure.

Misinformation in nutrition goes beyond influencing

Full disclosure about paid partnerships matters, because consumers deserve to know the full story behind a post telling them that an ingredient is safe, or that a product is worth buying. Not being upfront about that potential conflict of interest can mislead people into thinking that a recommendation is more credible than it is. Lack of disclosure might also make a person more likely to buy a product or change a behavior than they would if they were aware of the paid nature of the partnership.

The potential pitfalls of brand partnerships don’t just apply to a few influencer RDs. Some of the longest-standing brand deals within our profession are those between the Academy of Nutrition and Dietetics and food companies like Nestlé, Coca-Cola, and PepsiCo. These major companies donate millions of dollars to the AND; the AND also invests in stocks of major food companies. While the AND says only a small amount of its revenue comes from sponsorships, the fact that there are any to begin with is a major point of contention within our profession.

Full disclosure about paid partnerships matters, because consumers deserve to know the full story behind a post telling them that an ingredient is safe, or that a product is worth buying. Not being upfront about that potential conflict of interest can mislead people into thinking that a recommendation is more credible than it is.

Yes, many of these food companies do offer more products than just sugar-sweetened, ultra-processed foods (excessive consumption of which has been linked to many health problems). But it’s hard to deny that the partnerships are not a good look for our profession, considering that the AND also plays a big role in shaping American food policy (like the USDA nutritional guidelines). I personally have not been a member of AND since I was a dietetic intern because of these partnerships.

Further complicating matters is the fact that food corporations also pay for a lot of nutrition research. A 2020 study published in the journal PLOS One found that 13 percent of the research published across the 10 most-cited nutrition journals in 2018 were funded by a variety of food companies. In the studies funded by the food industry, 56 percent had findings favorable to industry interests, compared with just 10 percent of the studies that were not funded by the food industry. This biased evidence is a big concern, considering that health experts of all stripes (including RDs) rely on research and studies to help drive their recommendations.

Even so, these business relationships within the Academy and the research community do not equate to all individuals also supporting Big Food companies. Many dietitians, myself included, are committed to continuing to seek unbiased evidence and latest findings to do right by their clients. We don’t feel that the brand deals AND engages in represents who we are as professionals or our food values and beliefs.

The importance of repairing trust

Amid these details lies plenty of opportunity for public doubt of the dietitian profession. If your only experience with RDs comes from social media and you learn that the RD you trusted has been engaging in brand partnerships that seem untrustworthy—it stands to reason that you would start to doubt the entire profession.

It is crucial to repair this potential breach in trust of the profession. RDs are the most educated and best qualified to deliver nutritional advice and therapy. The last thing I want is for people to doubt us and then turn to other, less credible sources for information.

So how do we as professionals start to repair that trust? It starts with how all of us approach social media, says Wieser. “As our reach grows it’s critical that we all remain committed to the established ethics of our profession,” she says. I think that we can demonstrate this commitment to our clients and followers by being forthcoming with the level of our expertise as well as unbiased, peer-reviewed evidence that supports our recommendations. Considering how many unfortunate conflicts of interest there are in food research, for example, there is additional responsibility on dietitians to find unbiased evidence when engaging in continuing education and source sharing to back up our recommendations—whether that’s in one-on-one sessions with clients or in a quick video on TikTok.

When it comes to brand deals between food companies and RDs, I think the responsibility ultimately falls on the dietitian to maintain ethical practices. As we’ve seen from the WaPo article, plenty of less-than-healthy brands are jumping at the chance to partner with us. “Ethics can be upheld in brand deals between dietitians and corporations by providing proper disclosures and evidence-based recommendations,” says Tamburello. This can be done by, again, explicitly disclosing the paid partnership and how that doesn’t impact the nutrition facts and health benefits of the product in question. “Registered dietitians value our credibility, and ethical brand deals are a big part of that for those of us who work in the communications category,” she continues.

“Ethics can be upheld in brand deals between dietitians and corporations by providing proper disclosures and evidence-based recommendations. Registered dietitians value our credibility, and ethical brand deals are a big part of that for those of us who work in the communications category.”

To that end, it’s our responsibility to choose brand deals that champion products that don’t just “do no harm” but actually improve and champion best health for a large audience. Nutrition is not a one size fits all science, Covone says—which adds another layer of complexity to influencing a specific product to millions of people. Every body reacts uniquely to different foods and that nuance is difficult to address on a large scale. Ideally, the products we choose to share with the masses would be universally healthy foods for most people: low to no added sugar, minimally processed, and high in fruits, vegetables, nuts, seeds, or whole grains. Products that help us to eat more whole foods, like cooking utensils, appliances, and smart food storage solutions are also great brand choices for influencer RDs.

Most of us entered into this profession because we want to be of service to our greater community, helping people to lead healthier lifestyles to feel better in their day-to-day lives and prevent chronic disease. Large financial gains are not a typical part of that equation—in fact most of us are vastly underpaid with the mean hourly wage of RDs being just over $33 per hour, a far cry from the tens of thousands of dollars influencers RDs can make per post. This makes paying off student loans for the high level of education the profession requires and affording life in a post-inflation world a real challenge for many of us.

The unfortunate unethical activities of a small number of RDs, not even remotely representative of the profession as a whole, threatens the public’s trust of us as a group. This is why we must remain vigilant in our commitment to ethical practice, continued education, and evidence transparency behind our recommendations with our clients and followers.

Salge Blake sums it up perfectly: “If you want legal advice, you seek the expertise of a lawyer. If you need a knee operation, you should visit an orthopedic surgeon. If you want nutrition advice based on your personal medical history, you should seek the expertise of a registered dietitian.”