HD23 - The Need for the Regulation of Dietitians and Nutritionists

  • Published: 1987
  • Author: Department of Health
  • Enabling Authority: House Joint Resolution 150 (Regular Session, 1986)

Executive Summary:
The Virginia Council on Health Regulatory Boards (CHRB) has studied the need to regulate dietitians and nutritionists in the Commonwealth. The study was requested by House Joint Resolution 150, passed by the Virginia General Assembly in March 1986.

The workplan for the study included an informational hearing; a review of the history of consumer complaints related to the practice of dietitians and nutritionists; a survey of the advertised activities and/or services of dietitians, nutritionists, and weight control businesses; a review of federal and state policies and regulatory programs related to dietitians and nutritionists; and a review of recent literature on this subject.

The study used as its evaluative framework the six formal criteria adopted by the Council in 1983 for evaluating whether a health occupation should be regulated. The most important of these is the determination of whether a risk for harm to the public health, safety, and welfare is created by the unregulated practice of a health occupation.

Based on its study, the Council concluded that the occupational practices of dietitians and nutritionists do not currently require state regulation. Objective evidence from the public record does not document widespread abuse of consumers by either unregulated or presently regulated providers of dietary or nutrition-related health services in Virginia. The small number of consumer complaints that have been documented fall into three categories, and appropriate mechanisms to protect the public exist for each type of documented abuse.

The first type of documented harm stems from those unregulated providers who violate the laws of the Commonwealth by diagnosing and/or treating conditions statutorily defined as within the scope of practice of licensed providers (physicians, pharmacists, psychologists, counselors, etc.). These problems are addressed properly through enforcement of the laws and rules covering currently regulated health service providers.

A second type of documented harm emanates from service providers of dietary and nutrition services who engage in fraudulent or deceptive business practices. Public protection against these abuses is best provided by enforcement of the Virginia Consumer Protection Act (Code of Virginia, Sec. 59.1-196 to 207), as amended by the General Assembly in 1986.

A final category of documented complaint pertains to the harmful practices of already licensed providers. The record demonstrates that when these occur and when consumers make formal complaints, licensed practitioners are appropriately disciplined. In the extreme, licenses to practice are revoked, and this action is reported to Commonwealth Attorneys and to the public.

The Council found that when consumers have made valid complaints of unlawful or harmful practice, existing public protection mechanisms have been sufficient to provide redress. Furthermore, public protection laws are being strengthened continually in the interest of consumers. Examples of efforts to strengthen public protection include new regulations proposed by the Board of Medicine to better protect consumers from prescription of dietary or nutrition supplements or treatments of no therapeutic value and amendments to the Consumer Protection Act adopted by the 1986 General Assembly to require fuller disclosure of information regarding business practices.

The Council's recommendations in this report focus on the use of means other than the occupational regulation of dietitians and nutritionists by the Commonwealth to address potential harm to consumers.

Professional associations serving dietitians and nutritionists and private credentialing organizations formed to enhance standards of care by these practitioners provide information to assist the public in the selection of qualified practitioners and appropriate services. These groups are encouraged to intensify public education activities and provide greater disclosure of relevant information to clients and consumers. The General Assembly may also wish to consider mechanisms to strengthen further consumer disclosure requirements in the Consumer Protection Act. The Council believes that strengthened requirements for disclosure of relevant information (educational credentials held by the practitioner, the nature and expected course of treatment, anticipated cost of services, and projected treatment outcomes) to consumers may be warranted in the rapidly growing industry offering dietary and nutrition services to consumers.

In the final analysis, state health occupational regulation is defensible only when it is demonstrated that the lack of regulation presents a substantial risk to the public health, safety, and welfare, and that members of the public cannot adequately protect themselves by making informed choices in the marketplace and by other means. Occupational regulation, when it is appropriate, comes at increased cost to the consumer, and it should be implemented only when other mechanisms such as strengthened enforcement of existing laws and rules, public disclosure, and consumer redress for documented abuse are not feasible. The Council respectfully submits that these conditions are not met in the present case. It is therefore recommended that no state regulation of dietitians or nutritionists be implemented in the Commonwealth at this time.