Nutritionist vs. health coach. How are you supposed to tell who does what?
Let’s say you have a chronic disease, and/or you want to improve your health and lifestyle. Who do you call?
Navigating the terminology in the health field is difficult at best.
That’s why I’m sharing this guide on the difference between a nutritionist and health coach, and how to know which one you need. Let’s dive in.
Nutritionist
What is a nutritionist?
A few types of nutritionists exist in the US, due to the varying state laws across the country.
In a nutshell, nutritionists are health professionals who deliver nutrition assessment, nutrition counseling, and individualized diet/meal plans to clients and patients. Some types of nutritionists can legally perform medical nutrition therapy, which is the treatment of disease through diet and nutritional supplements.
What kind of education and credentials do nutritionists have?
The short answer is, it depends on the state.
The most common pathway is to become a Registered Dietitian Nutritionist (RDN) or Nutrition and Dietetic Technician, Registered (NDTR).
To become an RDN, a person must obtain a bachelor’s degree in a health science field (preferably nutrition or dietetics). After that, they must complete a master’s degree in nutrition or dietetics accredited by the Academy of Nutrition and Dietetics (ACEND) and 900-1200 supervised practice hours. Finally, they must pass the Commission on Dietetic Registration (CDR) exam.
To become an NDTR, a person must obtain an ACEND-accredited associate’s degree in nutrition or dietetics plus 450 supervised practice hours, or an ACEND-accredited bachelor’s degree in nutrition or dietetics without the supervised practice hours. Finally, they must pass the CDR exam. NDTRs often work under RDNs, but can also work alone.
In all 50 states, RDNs and NDTRs are legally able to practice nutrition – including nutrition assessment, nutrition counseling, individualized diet/meal plans, and medical nutrition therapy.
In 12 states, only RDNs and NDTRs are legally able to practice nutrition. These include:
- Alabama
- Florida
- Louisiana
- Maine
- Mississippi
- Missouri
- Montana
- Nebraska
- Ohio
- Rhode Island
- South Dakota
- Tennessee
However, some people don’t want to pursue the RDN or NDTR pathway to becoming a nutritionist. Why?
ACEND-accredited nutrition programs and supervised practice hours heavily involve inpatient clinical (hospital) work, community nutrition, and food service. For people who are solely interested in outpatient clinical practice, this is a big drawback.
Not to mention, it’s not a friendly pathway for people who were practicing in another science or health field and want to transition to nutrition later in their career.
15 states require anyone practicing nutrition to be licensed, but allow other pathways to licensure than just RDN or NDTR.
The alternate pathways:
The American Clinical Board of Nutrition (DACBN). Requirements include:
Doctoral degree and healthcare license (MD, DO, ND, DC, NP)
300 clock hours of specialized post-doctoral nutrition education
1 year of clinical experience in the practice of nutrition
Submission of a nutrition-oriented paper with at least 10 references
Passing the DACBN exam
The American Nutrition Association (CNS). Requirements include:
Regionally accredited master’s degree or higher in nutrition OR a doctorate degree in a clinical healthcare field that includes the coursework required by the ANA
1000 supervised practice hours
Passing the CNS exam
In some states, a regionally accredited master’s or doctorate degree in nutrition (approved by the state) qualifies a person for licensure without being a DACBN or CNS.
The 15 states that allow for these alternate pathways to licensure are:
- Alaska (DACBN & CNS)
- Delaware (CNS)
- Illinois (DACBN & CNS)
- Kentucky (accredited bachelor’s or higher degree in nutrition, as long as it includes the 45 specific credit hours required by the state)
- Maryland (CNS)
- Massachusetts (CNS)
- Minnesota (CNS, accredited master’s or doctorate degree in nutrition)
- New Jersey (DACBN & CNS)
- New Mexico (DACBN, accredited master’s or doctorate degree in nutrition)
- New York (CNS)
- North Carolina (DACBN & CNS)
- North Dakota (DACBN, accredited master’s or doctorate degree in nutrition)
- Pennsylvania (CNS)
- Virginia (DACBN & CNS)
- Washington (accredited master’s or doctorate degree in nutrition)
What about the other states?
The other 23 states offer licensure and/or title protection to RDNs and NDTRs, but allow anyone to practice nutrition (assessment, counseling, and individualized diet plans; but no medical nutrition therapy) without a license or any other requirements.
As you might imagine, this lack of regulation has both upsides and downsides.
The good part is that other legitimate health professionals like functional medicine doctors and National Board Certified Health and Wellness Coaches can practice nutrition counseling without needing to go through unnecessary red tape.
The bad part is that you’ll run into a lot of sketchy “nutrition professionals” advertising their services, when they don’t have the necessary education or experience to safely and effectively practice nutrition.
If you’re in one of these 23 states and the nutritionist you want to see is not an RDN or NDTR, make sure of the following things:
- They have an accredited degree in nutrition or dietetics, or in another health-related field that includes substantial nutrition coursework
- They have significant clinical experience, preferably in your area of concern
- They’ve received a lot of good reviews
- As a bonus, they have CNS or DACBN credentials or other board certification like NANP
The 23 states that provide licensure and/or title protection for RDNs and NDTRs but don’t require licensure for other types of nutritionists are:
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Georgia
- Hawaii
- Idaho
- Indiana
- Iowa
- Kansas
- Michigan
- Nevada
- New Hampshire
- Oklahoma
- Oregon
- South Carolina
- Texas
- Utah
- Vermont
- West Virginia
- Wisconsin
- Wyoming
What do nutritionists do?
Most RDNs and NDTRs work in inpatient clinical practice (hospitals), community nutrition (WIC, Food Stamps, public schools), or food service (kitchens).
Some RDNs and NDTRS and all other types of nutritionists work in outpatient clinical practice, which is the branch of nutrition practice we’re focusing on in this post.
A good nutritionist completes a nutrition assessment on each new client or patient, often utilizing lab work to check vitamin, mineral, blood sugar, and lipid levels, sometimes even including inflammatory markers. Then, they craft a personalized diet and meal plan for each client, taking into account any health conditions and specific nutritional needs. The nutritionist might also suggest or prescribe nutritional supplements. In most cases, nutritionists without other education or credentials are not very knowledgable about bodywork or herbal medicine.
Who should see a nutritionist?
- People with chronic conditions that have caused weight gain or loss, trouble with digestion or metabolism, may be improved through diet changes, or were caused by a poor diet. These include prediabetes and diabetes (type I & II), high blood pressure, high cholesterol, IBS, Celiac disease, IBD (Crohn’s and Ulcerative Colitis), SIBO, food allergies, Hashimoto’s hypothyroidism, Graves’ disease, cancer, Addison’s disease, Cushing’s disease, adrenal fatigue, and more.
- People with chronic illness or autoimmune disease who want a treatment plan centered around diet and nutritional supplements.
- Anyone wanting to attempt a restrictive diet safely (eg. they want to go vegan, but already have food allergies)
- People in recovery from an eating disorder (eg. Anorexia Nervosa, Bulimia Nervosa, Binge ED, ARFID) who want to address the physical component of their disorder alongside the mental/emotional aspect.
- Anyone wanting to lose or gain weight by following an individualized diet plan.
Health Coach
What is a health coach?
A health coach is a healthcare professional who specializes in health and lifestyle behavior change. They understand theory of mind, the transtheoretical model of behavior change, what it takes to move a client along the scale of readiness to change, and how to increase motivation.
Health coaches are adept at motivational interviewing, which involves open ended questions, affirmation, reflective listening, and summarizing. They understand how to take a client’s long term health goals and break them down into smaller, acheiveable SMART goals. With every setback, a health coach is there to help their client reassess and readjust their plan, ultimately to achieve permanent behavior change, self efficacy, and goal success.
Health coaches have a comprehensive understanding of public health, chronic disease, the health effects of poor lifestyle choices, nutrition, exercise, stress management, and how positive lifestyle choices influence health.
What education and credentials do health coaches have?
Health coaching is not a federally or state regulated profession yet. In all states, health coaches can help their clients with health and lifestyle behavior change, including motivational interviewing, development of SMART goals, nutrition and health education, grocery shopping tours, weekly meal planning, cooking classes, exercise demonstration and planning, and stress management techniques.
In the 23 states that don’t require licensure to practice nutrition, health coaches can also offer nutrition assessment and counseling, and deliver individualized meal plans. They must take care not to practice medical nutrition therapy (treat disease with diet and nutritional supplements) or call themselves an RDN or NDTR.
Even though becoming a health coach doesn’t require federally or state mandated education or licensure yet, there are industry standards.
Most employers seeking to hire health coaches require at least an accredited associate’s degree and preferably a bachelor’s degree or higher in a health related field, plus a health coaching certification.
The National Board for Health and Wellness Coaches is quickly becoming the preferred health coaching certification among employers. To become board certified (NBC-HWC), the NBHWC requires at least an associate’s degree, completion of an approved health coaching program, completion of at least 50 supervised health coaching sessions, and passing the NBHWC exam. NBHWC has approved 94 health coaching programs so far and the number is growing, so you’ll be sure to find one that fits your interests and study needs.
If you’re working with a health coach through your employment, insurance, or medical network, you can rest assured they meet these industry standards.
If you’re working with an independent health coach on the other hand, take the time to make sure they have completed the above requirements as a minimum. This helps ensure you don’t work with an under-qualified or inexperienced coach.
What do health coaches do?
When first beginning to work with a client, a health coach assesses the client’s readiness to change and builds rapport through motivational interviewing. If needed, the coach continues to use motivational interviewing to help move the client into the latter stages of readiness to change so they can move forward with the coaching process.
Then, the health coach and client begin to explore the client’s health goals and current roadblocks and frustrations. If a physician or nutritionist referred the client to the health coach, they also go over the changes their health practitioner wants them to make.
Little by little, the health coach helps the client develop, implement, and tweak SMART (specific, measurable, achievable, relevant, and time-bound) goals. With time, the client overcomes roadblocks, achieves their long term health goals and improved lifestyle, and builds long-lasting health literacy and self efficacy.
Who should see a health coach?
- People who have developed poor lifestyle habits out of necessity or as a coping mechanism and want to improve their health and habits, but don’t know how to make it happen practically
- People who have been told by their health practitioner (doctor or nutritionist) to lose weight, eat better, exercise more, etc. but don’t know how to start doing it because there are too many roadblocks
- Anyone who has attempted to change their lifestyle, diet, health habits, exercise routine (or lack thereof), sleep schedule, or stress level unsuccessfully and doesn’t know what to try next
- Anyone who thinks or says any of the following to themselves:
“I can’t eat better because –
It’s too hard.
I don’t have the time.
I can’t cook well enough.
Healthy food is too expensive.
I wouldn’t even know what to eat.
I can’t give up (fill in the blank).
Healthy food doesn’t taste as good as what I like.
I’ve always eaten this way and I’m really fine.”
“I can’t exercise because –
It’s too hard.
I don’t have time.
I don’t like exercise.
What normal adult actually exercises on a regular basis? Nobody I know.
It’s too difficult to find a type of exercise that won’t flare up the symptoms of my health problems.”
“I don’t really need to change my lifestyle or improve my health. It’ll be fine.”
“I can’t manage my stress because –
I have a stressful life and there’s nothing I can do about it.
Everyone is stressed, I just need to deal with it.”
“I can’t prioritize rest, that’s selfish.”
“I can’t focus on my health, other things are much more important.”
Let me know in the comments which type of health professional you might try next. Was this guide helpful? I’d love to chat and answer your questions.
Click here to read more about choosing the right health practitioner for your needs.
