Dietitians and Mental Health

A nutritious diet leads to better mental health outcomes. More recently, the inverse has been shown: a poor diet increases one's likelihood of developing depression and anxiety. However, it can be difficult to find a clinic or practitioner that deeply examines the connection between a patient's diet and mental health.

Dietitians and mental health professionals alike continue to explore the link between psychology and nutrition. Harvard calls the fairly new interdisciplinary subject "nutritional psychology," although it has also been referred to as behavioral health nutrition.

What is a Dietitian?

Dietitians or dieticians (both spellings are considered correct) assess patients' unique dietary needs and help them develop nutrition plans. They can work in clinics, nonprofit agencies, hospitals, nursing homes, rehabilitation centers, or through telehealth.

The majority of states require dietitians to meet educational, experiential, and exam requirements. A registered dietitian (RD) – sometimes referred to as a registered dietitian nutritionist (RDN) – has met the requirements of their state.

State requirements typically include earning a bachelor's degree accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) and completing a certain number of internship hours. You then qualify to take the Commission on Dietetic Registration (CDR) exam.

However, in 2024, a master's degree will become the minimum requirement to take the CDR exam.

State licensure is separate from the RD credential. While it's not a requirement in every state, many employers prefer to hire licensed dietitians (LDs) because they are considered providers by insurance companies and can perform nutrition counseling.

How Can Dietitians Coordinate with Psychologists?

When a patient is hospitalized for a mental health condition, they often require help from a multidisciplinary team of healthcare professionals. For example, a patient with an eating disorder (ED), such as anorexia nervosa, needs medical, psychological, and nutritional experts to address all aspects of their condition.

In this environment, dietitians work with physicians, psychologists, and other healthcare professionals to design a patient's recovery plan. Studies show that when dietitians are involved in the process, ED patients' body mass index, weight, and nutritional intake consistently improve.

While each team member brings their own expertise to the treatment plan, there is significant overlap and collaboration between roles. Psychologists often ask for the opinion of dietitians throughout the therapy process. Research shows that many therapists are uncomfortable administering family based therapy to ED patients without a dietitian's input.

During treatment for an ED, the dietitian's role is to challenge a patient's distorted thoughts about food and educate them about nutrition. This helps them reframe their mindset. They also help educate patients' families about the ED, including how to model healthy eating and positive attitudes about different body types.

Dietitians also participate in multidisciplinary teams outside of the hospital environment at outpatient clinics. These clinics provide services to previously hospitalized ED patients that need help staying on track. They also care for non-emergency ED patients in need of intervention.

Frequently Asked Questions

What's a dietitian vs. nutritionist?

In many states, nutritionists are not licensed or regulated, whereas dietitians must meet certain experiential and educational standards to call themselves dietitians.

What's the difference between an RD and an LD?

RDs and LDs have both completed the CDR exam. However, LDs have additional licensure.

Are dietitians doctors?

Dietitians do not complete a medical degree, so they are not doctors.

How long does it take to become a dietitian?

At present, you can become an RD with a bachelor's degree, but the educational requirement will be raised to a master's degree in 2024.

What Should I Look for in a Dietitian?

Before you book an appointment with a dietitian, there are a couple of steps you should take.

First, you should have a solid idea of your goals. Do you want to lose weight? Gain weight? Promote better mental health? Develop a healthier relationship with food? Improve your eating habits?

Based on your needs, you can start researching providers. While many dietitians help an array of patients, some specialize in specific groups, such as the elderly, children, athletes, people with obesity, or people with EDs.

For certain patients, such as those with EDs or co-occurring conditions, working with an experienced dietitian is crucial.

RDs commonly recommend patients to track their eating and measure their portions. Eating disorder recovery is an entirely different process. People with EDs already spend excess time thinking about food, so these strategies can worsen symptoms of an ED.

Orthorexia describes when a person is so focused on eating healthy that it becomes an obsession. Similarly to other EDs, orthorexia can have real mental, physical, and physiological consequences. Ironically, studies show that orthorexia is actually more common among dietitians than the general population.

Look for a dietitian that specializes in your area of need. Ask them about their experience helping similar patients, their strategies, and their nutrition philosophy. If they don't have experience or education in helping people with your condition, consider other options.

If you can't find an appropriate RD in your area, look into online service providers, as many dietitians now offer their services through video call.

When you've found a dietitian that suits your needs, verify their credentials online. Some people call themselves dietitians or nutritionists, but haven't completed any formal training or gained any certification.

You can check if a provider is an RD by visiting the CDR's website and using their search engine. To check if a dietitian is an LD, visit your state government's website. The CDR provides a comprehensive list of the official websites for all 50 states.

If you think tracking your meals will exacerbate an ED, skip this step.

For some patients, keeping a food diary a week prior to their appointment provides a helpful reference for dietitians to make more specific recommendations.

Some talking points you might discuss with your dietitian include:

• Appropriate serving sizes
• The times of day and frequency in which you eat
• Ingredients to look for and ones to avoid
• Local restaurants and food stores that carry appropriate foods for you
• Which foods are rich in the vitamins you need
• Realistic expectations and timeframes