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A dietitian (also 'dietician', though 'dietitian' is used consistently by professionals) is an expert in food and nutrition.
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Dietitians help promote good health through proper eating. They supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. In a medical setting, a dietitian may provide specific artificial nutritional needs to patients unable to consume foood normally. Dietary modification to address medical issues involving dietary intake is also a major part of dietetics. The goals of the dietary department are to provide medical nutritional intervention, obtain, prepare, and serve flavorsome, attractive, and nutritious food to patients, family members, and health care providers.

In many countries only people who have specified educational credentials can call themselves "dietitians" — the title is legally protected. The term "nutritionist" is also widely used; however, the term nutritionist is not regulated as dietitian is. People may call themselves nutritionists without the educational and professional requirements of registered dietitians.

Dietetic technicians are not the same as dietitians in terms of responsibilities and qualifications. Different professional terms are used in different countries. Dietitians are a valuable member of the medical multi-disciplinary team providing nutritional knowledge and acting as consultants to other health care professionals.

Types of dietitians
The majority of dietitians are clinical, or therapeutic, dietitians. Clinical dietitians review medical charts and talk with patients' families. They work with other health care professionals and community groups to provide nourishment, nutritional programs and instructional presentations to benefit people of all ages, and with a variety of health conditions. This is accomplished by developing individual plans to meet nutritional needs. These plans include nourishment, tube feedings (called enteral nutrition), intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN), diets, and education. Clinical dietitians provide individual and group educational programs for patients and family members about their nutrition and health.

Clinical dietitians work in hospitals and other health care facilities to provide medical nutrition therapy

Clinical dietitians work in hospitals and other health care facilities to provide medical nutrition therapy to patients according to the disease processes, provide individual dietary consultations to patients and their family members and also conduct group educations for other health workers, patients and the public. They coordinate both medical records and nutritional needs to assess the patients and make a plan based on their findings. Some clinical dietitians have dual responsibilities with medical nutrition therapy and in foodservice, described below. In addition, clinical dietitians in smaller facilities will also provide or create outpatient education programs. They work as a team with the physicians, physical therapists, occupational therapists, pharmacists, speech therapists, social workers and nurses to provide care to the patients.


Community dietitians
Community dietitians work with wellness programs and international health organizations . These dietitians apply and distribute knowledge about food and nutrition to specific life-styles and geographic areas. They coordinate nutritional programs in public health agencies, daycare centers, health clubs, and recreational camps and resorts. Some community dietitians carry out clinical based patient care in the form of home visits for patients who are too physically ill to attend consultation in health facilitis.


Foodservice dietitians
Foodservice dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess and plan foodservice processes in health care facilities, school food service programs, prisons, cafeterias and restaurants. These dietitians will also perform audits of their departments, train other food service workers and use marketing skills to launch new menus and various programs within their institution. They direct and manage the operational and nutrition services staffs such as kitchen staffs, delivery staffs and dietary assistants or diet aides.


Gerontological dietitians
Gerontological dietitians are specialist in nutrition and aging. They are Board certified in Gerontological Nutrition with the American Dietetic Association. They work in government agencies in aging policy, and in a regulatory capacity in the oversight of nursing homes and community-based care facilities. They work as Consultants in Nursing Homes, and in higher education in the field of Gerontology (the study of Aging.)


Pediatric dietitians
Pediatric dietitians provide health advice for persons under the age of 18.


Research dietitians
Research dietitians are mostly involved with dietary related research in the clinical aspect of nutrition in disease states, public aspect on primary, secondary and sometimes tertiary health prevention and foodservice aspect in issues involving the food prepared for patients. Many registered dietitians also work with the biochemical aspects of nutrient interaction within the body. Research Dietitians normally work in a hospital or university research facilities. It should be noted that some Clinical dietitian's roles also involve research other than the normal clinical workload. Quality improvement in dietetics services is also one area of research.

Administrative, or manager or Director of Dietetics Department or Nutrition Services are sometimes also known as Manager instead of Director depending

Administrative, or manager or Director of Dietetics Department or Nutrition Services are sometimes also known as Manager instead of Director depending on the size, number of dietitians in the department and also the organizational structure adopted by the Health facilities or Hospital. Director or Manager acts as head of the dietitians. They also hire, train, direct and supervise employees and manage dietary departments. Administrative dietitians may also apply procedure and policy as part of their management job.

Business dietitians
Business dietitians serve as resource people for the media. Dietitians' expertise in nutrition is often taped for TV, radio, and newspapers -- either as an expert guest opinion, regular columnist or guest, or for resource, restaurant, or recipe development and critique. Dietitians have served as show hosts on major television stations and as drive-time radio news anchors. Dietitians write books, appear on television cooking channels, and author corporate newsletters on nutrition and wellness. They also work as sales representatives for food manufacturing companies that provide nutritional supplements and tube feeding supplies.


Consultant dietitians
Consultant dietitians work under private practice. The title 'consultant' in this case should not be confused with the identical title given to certain medical doctors in countries such as the United Kingdom and Ireland. The term consultant in this instance is synonymous with the title attending as used in countries such as the United States. Consultant dietitians contract independently to provide nutrition services and educational programs to individuals, nursing homes, and in health care facilities. As recent studies have shown the importance of diet in both preventing and managing disease, many US states have moved towards covering medical nutrition therapy under the Medicaid/Medicare making consulting a much more lucrative option for dietitians due to insurance reimbursement.


Other nutrition workers
These designations apply principally to the US although the generic classifications are likely to be applicable elsewhere.


Registered Dietetic Technicians
Dietetic Technicians, Registered (DTR), also commonly known as "Diet Techs", possess a specialized Associate Degree from Community College programs which are accredited by the Commission on Accreditation of Dietetics Education (CADE) of the American Dietetic Association. In many settings they work alongside Registered Dietitians, and like Registered Dietitians, they have in-depth knowledge of nutrition. They must complete a dietetic internship with a minimum of 450 supervised practice hours in the areas of Food Service Theory and Management, Community Dietetics, and Clinical Dietetics. They must also complete a national registration examination administered by the Commission on Dietetics Registration (CDR) of the ADA. Although the DTR is an independently credentialed nutrition practitioner, when performing clinical dietetics, they must work under the supervision of a Registered Dietitian. In addition, some states have current legislation specifying the scope of practice for the DTR.


Dietary assistants
Dietary assistants or dietary aides are responsible for assisting and carrying out the medical nutrition therapy prescribed by the Dietitians and to ensure that food for the patients as instructed by the Dietitians are carried out correctly by checking menus against recent diet orders before tray assembly begins and being physically present in the kitchen plating-lines at meal hours. Dietary aides in some countries might also carry out a simple initial health screening for newly admitted patients and only inform the Dietitians if any screened patients requires a dietitian's expertise for further assessments or interventions.Technorati Profile

Dietary managers are responsible for retail, catering and tray lines. If an operation is large, there may be one or more managers

Dietary clerks
Dietary clerks perform clerical tasks such as entry and maintenance of dietary requirements to a database. They also track financial information, such as the number of meals served each day.


Dietary managers
Dietary managers are responsible for retail, catering and tray lines. If an operation is large, there may be one or more managers to help in directing the dietary workers.


Dietary workers
Dietary workers prepare the food and meal trays in the kitchen. They check for accuracy and completeness. They also maintain the storage area for food supplies and ensure practice of sanitary procedures. Dietary workers are trained on the job and can work in any commercial kitchen.


Dietary hosts
Dietary hosts or hostesses deliver and bring back the meal trays to patients. They distribute and collect menus and help the patients to make complete selections.


Required qualifications and professional associations

USA
In the US nutrition professionals include the registered dietitian (RD) and the dietetic technician, registered (DTR). These terms, as well as simply dietitian, are legally protected terms regulated by the American Dietetic Association (ADA).

Dietitians are registered with the Commission on Dietetic Registration (the certifying agency of the ADA) and are only able to use the label "Registered Dietitian" when they have met strict, specific educational and professional prerequisites and passed a national registration examination.

A dietitian's education in health science involves significant scientific based knowledge in anatomy, chemistry, biochemistry, biology, physiology, nutrition, medical science. It is these strong foundations in advanced scientific knowledge and an internship that equipped with counseling skills and aspects of psychology enable a Registered Dietitian to assess, analyze, intervene, and educate a patient in relation to the diet and disease.

There are a few different academic routes to becoming a fully qualified registrable dietitian:

A professional bachelor degree in Dietetics which requires four years of studies
or

A bachelor of science degree and a postgraduate diploma in Dietetics
or

A bachelor of science degree and a master's degree in Dietetics
Besides academic education, registered dietitians must complete up to a year long dietetic internship of at least 1200 hours through an accredited program before they can sit for the registration examination. The dietetic internship requires the intern to complete several areas of competency including rotations in clinical, community, long-term care nutrition as well as food service, public health and a variety of other worksites.

Once the degree is earned, the internship completed, and registration examination passed, the individual can now use the nationally recognized legal term, Registered Dietitian and is able to work in a variety of professional settings. Most states require additional licensure to work in most settings. To maintain, the RD credential, professionals must participate in and earn continuing education units 75 hours every 5 years.


Canada
In the United States and Canada the Dietitian, Registered Dietitian (RD), etc. are similarly protected titles. The professional association in Canada is the Dietitians of Canada. The US equivalent of it is American Dietetic Association.

In Canada, each province has an independent professional college (for example, The College of Dietitians of Ontario) which is responsible for protecting the public and regulating the profession. The colleges are entirely funded from licencing fees collected from dietitians. Each college must have both public and professional members, and is empowered to investigate and censure (when malpractice/negligence is found) members of the profession who breach either their scope of practice or harm/endanger the health of a patient/client, and receive a complaint against them from a member of the public or another health care professional. To practice as a registered dietitian within a province, a dietitian must register with the college and obtain a licence. The activities of the college are governed by legislation passed by the provincial government. It is the presence of this regulatory body which distinguishes registered dietitians from nutritionists in Canada.

In Canada, the colleges also set the minimum entry requirements for admission into practice as a registered dietitian. Requirements to entry into practice as a dietitian include a four year undergraduate degree from an accredited university (which includes courses in science, foods, nutrition, management, communication and psychology/sociology, among others), a 10 - 12 month supervised practice period (called an internship) and successfully passing a board exam in nutrition and dietetics.

Australia
In Australia, the qualified dietitian is called Accredited Practising Dietitian (APD). To be a qualified Dietitian in Australia requires a 4 year professional university degree, or a 2 year coursework Masters Program accredited by the DAA (Dietitian's Association of Australia). APDs (Accredited Practicing Dietitians) are Dietitians engaged in the Continuing Professional Development program offered by the DAA. While not a legal requirement of practice, in order for patients to receive a rebate from Private Health insurance APD status is required.

Body mass index

The body mass index (BMI), or Quetelet index, is a statistical measurement which compares a person's weight and height. Though it does not actually measure the percentage of body fat, it is a useful tool to estimate a healthy body weight based on how tall a person is. Due to its ease of measurement and calculation, it is the most widely used diagnostic tool to identify weight problem within a population including: underweight, overweight and obesity. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing "social physics". Body mass index is defined as the individual's body weight divided by the square of his height. The formulas universally used in medicine produce a unit of measure of kg/m2. BMI can also be determined using a BMI chart, which displays BMI as a function of weight (horizontal axis) and height (vertical axis) using contour lines for different values of BMI or colors for different BMI categories.

SI units
UK/US units

As a measure, BMI became popular during the early 1950s and 60s as obesity started to become a discernible issue in prosperous Western societies. BMI provided a simple numeric measure of a person's "fatness" or "thinness", allowing health professionals to discuss over- and under-weight problems more objectively with their patients. However, BMI has become controversial because many people, including physicians, have come to rely on its apparent numerical authority for medical diagnosis, but that was never the BMI's purpose. It is meant to be used as a simple means of classifying sedentary (physically inactive) individuals with an average body composition. For these individuals, the current value settings are as follows: a BMI of 18.5 to 25 may indicate optimal weight; a BMI lower than 18.5 suggests the person is underweight while a number above 25 may indicate the person is overweight; a BMI below 17.5 may indicate the person has anorexia or a related disorder; a number above 30 suggests the person is obese (over 40, morbidly obese).

For a given height, BMI is proportional to weight. However, for a given weight, BMI is inversely proportional to the square of the height. So, if all body dimensions double, and weight scales naturally with the cube of the height (as is the case with a spherical cow), then BMI doubles instead of remaining the same. This results in taller people having a reported BMI that is uncharacteristically high compared to their actual body fat levels. This anomaly is partially offset by the fact that many taller people are not just "scaled up" short people, but tend to have narrower frames in proportion to their height. It has been suggested that instead of squaring the body height (as the BMI does) or cubing the body height (as seems natural), it would be more appropriate to use an exponent of between 2.3 to 2.7.


BMI Prime
BMI Prime, a simple modification of the BMI system, is the ratio of actual BMI to upper limit BMI (currently defined at BMI 25). As defined, BMI Prime is also the ratio of body weight to upper body weight limit, calculated at BMI 25. Since it is the ratio of two separate BMI values, BMI Prime is a dimensionless number, without associated units. Individuals with BMI Prime < 0.74 are underweight; those between 0.74 and 0.99 have optimal weight; and those at 1.00 or greater are overweight. BMI Prime is useful clinically because individuals can tell, at a glance, by what percentage they deviate from their upper weight limits. For instance, a person with BMI 34 has a BMI Prime of 34/25 = 1.36, and is 36% over his or her upper mass limit. In Asian populations (see International Variation section below) BMI Prime should be calculated using an upper limit BMI of 23 in the denominator instead of 25. Nonetheless, BMI Prime allows easy comparison between populations whose upper limit BMI values differ.

A frequent use of the BMI is to assess how much an individual's body weight departs from what is normal or desirable for a person

A frequent use of the BMI is to assess how much an individual's body weight departs from what is normal or desirable for a person of his or her height. The weight excess or deficiency may, in part, be accounted for by body fat (adipose tissue) although other factors such as muscularity also affect BMI significantly (see discussion below and overweight). The WHO regard a BMI of less than 18.5 as underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is considered overweight and above 30 is considered obese. These ranges of BMI values are valid only as statistical categories when applied to adults, and do not predict health.


Category BMI range - kg/m2 BMI Prime Mass (weight) of a 1.8 metres (5 ft 11 in) person with this BMI
Severely underweight less than 16.5 less than 0.66 under 53.5 kilograms (8.42 st; 118 lb)
Underweight from 16.5 to 18.5 from 0.66 to 0.74 between 53.5 and 60 kilograms (8.42 and 9.45 st; 118 and 132 lb)
Normal from 18.5 to 25 from 0.74 to 1.0 between 60 and 81 kilograms (9.4 and 13 st; 130 and 180 lb)
Overweight from 25 to 30 from 1.0 to 1.2 between 81 and 97 kilograms (12.8 and 15.3 st; 180 and 210 lb)
Obese Class I from 30 to 35 from 1.2 to 1.4 between 97 and 113 kilograms (15.3 and 17.8 st; 210 and 250 lb)
Obese Class II from 35 to 40 from 1.4 to 1.6 between 113 and 130 kilograms (17.8 and 20.5 st; 250 and 290 lb)
Obese Class III over 40 over 1.6 over 130 kilograms (20 st; 290 lb)

The U.S. National Health and Nutrition Examination Survey of 1994 indicates that 59% of American men and 49% of women have BMIs over 25. Extreme obesity — a BMI of 40 or more — was found in 2% of the men and 4% of the women. The newest survey in 2007 indicates a continuation of the increase in BMI, 63% of Americans are overweight, with 26% now in the obese category. There are differing opinions on the threshold for being underweight in females, doctors quote anything from 18.5 to 20 as being the lowest weight, the most frequently stated being 19. A BMI nearing 15 is usually used as an indicator for starvation and the health risks involved, with a BMI <17.5 being an informal criterion for the diagnosis of anorexia nervosa.


BMI-for-age

BMI for age percentiles for boys 2 to 20 years of age.
BMI for age percentiles for girls 2 to 20 years of age.
BMI is used differently for children. It is calculated the same way as for adults, but then compared to typical values for other children of the same age. Instead of set thresholds for underweight and overweight, then, the BMI percentile allows comparison with children of the same sex and age.[6] A BMI that is less than the 5th percentile is considered underweight and above the 95th percentile is considered obese. Children with a BMI between the 85th and 95th percentile are considered to be overweight.

Recent studies in England have indicated that females between the ages 12 and 16 have a higher BMI than males of the same age by 1.0 kg/m2 on average.


International variations
These recommended distinctions along the linear scale may vary from time to time and country to country, making global, longitudinal surveys problematic. In 1998, the U.S. National Institutes of Health brought U.S. definitions into line with World Health Organization guidelines, lowering the normal/overweight cut-off from BMI 27.8 to BMI 25. This had the effect of redefining approximately 30 million Americans, previously "healthy" to "overweight".[citation needed] It also recommends lowering the normal/overweight threshold for South East Asian body types to around BMI 23, and expects further revisions to emerge from clinical studies of different body types.

In Singapore, the BMI cut-off figures were revised in 2005 with an emphasis on health risks instead of weight. Adults whose BMI is between 18.5 and 22.9 have a low risk of developing heart disease and other health problems such as diabetes. Those with a BMI between 23 and 27.4 are at moderate risk while those with a BMI of 27.5 and above are at high risk of heart disease and other health problems.

Category BMI range - kg/m2
Starvation less than 14.9
Underweight from 15 to 18.4
Normal from 18.5 to 22.9
Overweight from 23 to 27.5
Obese from 27.6 to 40
Morbidly Obese greater than 40

The Body Mass Index is generally used as a means of correlation between groups related by general mass and can serve

The Body Mass Index is generally used as a means of correlation between groups related by general mass and can serve as a vague means of estimating adiposity. The duality of the Body Mass Index is that, whilst easy-to-use as a general calculation, it is limited in how accurate and pertinent the data obtained from it can be. Generally, the Index is suitable for recognising trends within sedentary or overweight individuals because there is a smaller margin for errors.

This general correlation is particularly useful for consensus data regarding obesity or various other conditions because it can be used to build a semi-accurate representation from which a solution can be stipulated, or the RDA for a group can be calculated. Similarly, this is becoming more and more pertinent to the growth of children, due to the majority of their exercise habits.

The growth of children is usually documented against a BMI-measured growth chart. Obesity trends can be calculated from the difference between the child's BMI and the BMI on the chart. However, this method again falls prey to the obstacle of body composition: many children who primarily grow as endomorphs would be classed as obese despite body composition. Clinical professionals should take into account the child's body composition and defer to an appropriate technique such as densitometry e.g. Dual energy X-ray absorptiometry, also known as DEXA or DXA.


Clinical practice
BMI has been used by the WHO as the standard for recording obesity statistics since the early 1980s. In the United States, BMI is also used as a measure of underweight, owing to advocacy on behalf of those suffering with eating disorders, such as anorexia nervosa and bulimia nervosa.

BMI can be calculated quickly and without expensive equipment. However, BMI categories do not take into account many factors such as frame size and muscularity. The categories also fail to account for varying proportions of fat, bone, cartilage, water weight, and more.

Despite this, BMI categories are regularly regarded as a satisfactory tool for measuring whether sedentary individuals are "underweight," "overweight" or "obese" with various qualifications, such as: Individuals who are not sedentary being exempt - athletes, children, the elderly, the infirm, and individuals who are naturally endomorphic or ectomorphic (i.e., people who don't have a medium frame).

One basic problem, especially in athletes, is that muscle is denser than fat. Some professional athletes are "overweight" or "obese" according to their BMI - unless the number at which they are considered "overweight" or "obese" is adjusted upward in some modified version of the calculation. In children and the elderly, differences in bone density and, thus, in the proportion of bone to total weight can mean the number at which these people are considered underweight should be adjusted downward