HISTORY
Dietetics have been a field of medicine since the days of Homer, Plato, and Hippocrates in Ancient Greece. This being said, dietetics did not progress significantly until the 19th century- this came with advances in chemistry and in nutrition science. Initially, research focused much on vitamin deficiency diseases that were common at the time, usually due to access to limited numbers of food groups. Deficiencies were often extreme enough that serious illness and even death were fairly common. More recently, however, research focuses on daily requirements for protein, fat and carbohydrates, especially while access to such groups has increased greatly. Additionally important to the growth of dietetics as a profession was the Second World War, when the importance of nutrition was recognized by the military. Leaders of battalions realized that there was efficiency in making sure that soldiers were well-nourished. Today, the field of dietetics has become quite global, with professional dietetic associations found on nearly every continent. Today, registered dietitians are involved heavily in the promotion of health, and often work in tandem with other physicians. Finally important to the growth of dietetics as a profession is growing general interest in nutrition and diet, driven largely by the rise of the internet, technology, and social media. Through these platforms, information about diet spreads more quickly- both true and false information. Because of it’s widespread accessibility and the efficiency of the spread of information, it is a dangerous force.
DEFINITION
Dietetics has been defined more recently as the integration and application of principles derived from the disciplines of food, nutrition, management, communication, biological, physiological, behavioral and social sciences to achieve and maintain human health.
Deficiency-Related Disease
Initially, research focused much on vitamin deficiency diseases that were common at the time, usually due to access to limited numbers of food groups. Deficiencies were often extreme enough that serious illness and even death were fairly common. The discovery that nutrition was an important part of health led chemists and scientists to focus more heavily on how to eat in a way that was effective for health and well-being.
Some examples of diseases that were fairly common and nutrition-related included green sickness, iron-deficiency anemia, and goitre.
Vitamins and Minerals
The early years of the 20th century were characterized by an enormous expansion of nutrition knowledge, and were referred to as the “vitamin era”. During this period of time, most vitamins were discovered. In particular, there developed an efficient scheme for identifying vitamins by chemistry. The classification and discovery of the function of all of the kinds of vitamins increased the efficiency with which people were able to get all of the nutrients that they needed in their food.
Food Enrichment
Later in the 20th century, scientists began to engage in the enrichment of certain foods with special nutrients. Iodized table salt was added to things as a remedy for iodine deficiency, and the enrichment of bread, flower, cornmeal, and grits became mandatory. The council on Foods of the American Medical Association discussed the possibility of improving the health of the public by the addition of other nutrients to food. Later on, the fortification of margarine with vitamin A and the addition of calcium and iron to cereals were approved. These improved the efficiency of nutrition even further for the average citizen. In short, one had to eat less in order too gain the same amount of nutrition.
Quantitative Nutritional Studies
o Quantitative nutritional studies expanded with progress in chemistry in the 19th century. These focused on the calculated amount of nutrition required for the average laborer.
o Voit (1831-1908) was a dominant figure in physiological chemistry in the latter half of the 19th century, and developed the techniques for metabolic studies which instituted nutrition as a science.
o He recommended a daily dietary allowance for an average laborer, which included protein, carbohydrate, and fat.
o The laborer was a major focus in dietary studies, because, from the standpoint of the state, it was a calculated benefit to focus science efforts on the laborer, as a more effective laborer adds more to the economy.
FAD Diets
Around the time of the 20th century, there came about the existence of FAD diets. These are not provided by and are often discouraged by dietitians, but they are quite important to the profession. These diets promise patients a “quick” fix to their nutrition goals, often promising that change will happen in a given, and very short, amount of time. Some services are mail-order, sending a package of some mystery powder, drink, or milkshake that will supposedly solve diet or weight concerns. Others provide a description of a strict diet that one is meant to maintain for a few weeks so as to solve all of one’s problems.
TECHNOLOGY
Telehealth
One of the primary ways in which the dietitian profession has been impacted by rationalization involves the efficiency that is brought forth by the use of telehealth. Telehealth is a platform that has existed for a number of years, but came to the forefront of the profession during covid. For many patients, meeting with a dietitian is absolutely necessary, and dietitians needed to adapt in order to make meetings during quarantine efficient and accessible for patients.
Online Scheduling
This allows dietitians to simply input their schedule, and patients automatically know when they are available to be seen. On the patient’s end, they can simply submit paperwork and intake forms through the online portal, and make their own appointment. All of this removes the extra factor of a middle-man trying to line up schedules and file paperwork.
Apps
An important development in the industry of dietitians includes the use of smartphone applications for the treatment of eating disorders. For patients, the use of non-human technology to monitor their eating habits provides more predictability in the way that they log their food and exercise. Rather than reporting to a dietitian directly, patients are prompted by their app to log food for the day, and a sequence of questions about their energy level, movement habits, and mood typically follow.
TRENDS
o Rapidly advancing nutritional knowledge has led to the development of evidence-based nutrition. Official nutrition bodies (such as the American Dietetic Association), are promoting evidence-based medical nutrition therapy- this is a practice that evolved from the use of published scientific evidence and best-practices. This means that nutrition advice and recommendations are based on evidence which has been assessed in an unbiased or impartial manner. Recommendations related to relationships between a specific nutrient or food component and a disease are only made if there is sufficient evidence to support them. Being able to provide how a food contributes to a health outcome adds credibility. They have determined that intervention studies supply the best evidence for determining how a nutrient affects health. This involves setting limitations and nutrient composition data of foods, and large numbers of people are roped in as participants in a study to detect an effect from diet. All of this has standardized the way that nutrition information is found and disseminated. Further, large bodies like the American Dietetic Association provide people with a reliable source when they are seeking out verified information.
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