Dietitians, Where are you?
Claudette (Cee) Josephs, MS, RD

In presenting expert insight on the clinical significance and relevance
of new data on insulin therapy, (based on findings presented at the
2009 World Diabetes Congress of the International Diabetes Federation),
Dr. Phillip Home, and others concluded that insulin therapy should be
initiated when the diagnosis of diabetes is made. The barriers, they found,
is physicians’ reluctance, due in part, to fear on the part of their
patients.1The truth of the matter is that, when diet and exercise changes
are initiated as first line of treatment, there are positive outcomes.
The problem is that patients do not always get the medical nutrition
therapy needed to effect these changes. Many physicians do not refer
their patients to nutritionist/dietitians. It may be that they are not
aware of the value of the dietitian, or they believe that the little
knowledge of nutrition imparted to their patients is enough for
successful treatment.

Dietitians, where are you?

By not demanding that people get the best of care through our therapy
offerings, we leave it to the other disciplines to convince patients
that the little knowledge given is sufficient. And so, when the diet
(or lack thereof) fails, and blood sugar, blood pressure, or weight
increases,the patient has no choice but to take the MD’s recommendation
to go on insulin therapy.

The claim that there is a better quality of life on insulin may be due
to the very fact that the ‘diet and exercise’ failed, and after being
placed on insulin, the body now begins to correct itself, and patients feel much better.

But listen to this fact: most insulin therapies tend to cause weight gain
and increased incidence of hypoglycemia (low blood sugar) – the very
symptoms of diabetes we try to avoid, and which cause patients great

Dietitians, where are you?

Forty-one percent of African Americans with diabetes have never seen a
dietitian, or given nutritional counseling or teaching2 -now, why is that?
Are we not the nutrition experts? Is that not what we spend at least
four years of college learning, and more time doing internships, and
taking exams for licensure? Is it to give away our healing and prevention
expertise to psychologists, chiropractors, and anyone who call
themselves nutrition counselors? Why are we not always the ones
interviewed on television, or other media giving correct nutrition
advice? We are the experts. We have allthe knowledge and understanding
needed to change eating behavior for good outcomes, including prevention
of diseases. No other discipline does.

Thank God for the medical institutions, and Congress, that makes it
mandatory for the dietitian to be part of the medical team in treating
inpatients. And yes, we have an opportunity to teach, heal and also
show our vast knowledge and skills to other staff. But what of the
majority who are in the community, with, as yet no need of acute care?
Here we are, lined up, at the door of the hospital, or nursing home –
welcoming the broken. Yet they may not have needed to be there if we had
given them the care needed to stay away, in the first place. Is it any
wonder that obesity and diabetes are epidemic?

We not only can heal, through medical nutrition therapy, but we can keep whole, through education and training. We have an integral part to play in keeping America healthy.

So, dietitians, where are you?