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By Mark Rifkin, MS, RD, LDN Consumer Protection Coordinator For the Maryland Academy of Nutrition and Dietetics Annual Conference April 24, 2015

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Discuss the socio-political nutrition context Review the legal status of other professions who practice nutrition Identify common training paths undertaken by unlicensed violators Identify the impacts of these factors on our profession Review procedures to find, report violators Become a prepared and active defender

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Epidemics continue Chronic disease, esp obesity and DM2 Associated high costs Although rate of increase not as fast us usual Effects of ACA Nutrition services covered for certain conditions Marylands Essential Health Benefits Package For individual and small-group markets Nutrition services covered beyond fed requirements

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Important trends Interest in nutrition/food issues exploded Organic/GMO/Local/Sustainability Vegetarian/Vegan Food Security and Health Disparities Aging pop Baby boomers boomed to Medicare age Interest in overall prevention and wellness Omnipresent concerns about health costs

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Nutrition and You: Trends 2011 Webinar eatrightpro.org/resources/media/trends- and-reviews/nutrition-trends

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Poor image of AND, RDNs among some Alternative/holistic health Vegetarian/vegan Food activists RDNs motherjones.com/environment/ 2014/05/my-trip-mcdonalds- sponsored-nutritionist- convention

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wsj.com/articles/program-to-put-kids-eat- right-logo-on-kraft-singles-ending- 1427806089

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More consumers Seeking nutrition services Questioning credibility of recognized credentials Questioning credibility of AND and RDNs Therefore High demand for nutrition services may mean Some segments of public deliberately seek Non-RDNs Those with alternative credentials Legislators pressured to recognize others Various bills introduced since 2009

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Everybodys doin it! (offering nutrition services) Licensed Nutritionists (CNS, others)* Chiropractors (DC)** Nurses (RN)*** Pharmacists (RPh, PharmD)*** Naturopaths (NMD, ND)* Certified Clinical Nutritionists (CCN) Herbalists (????) Acupuncturists (L Ac) Holistic health coaches and counselors (CHHC) Certified nutrition consultants (CNC) Even your plumber can tell about G-F diet for wgt loss RDNs must actively defend their license

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Nutritionists Licensed term in MD, 15 other states CNS (certified nutrition specialist), but not CCN Estimate

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Chiropractors (DC) Written into scope of practice with no clear limits Nurses (RN) Not in scope of practice Many are CDEs Pharmacists (RPh, PharmD) Not in scope of practice Naturopaths (NMD, ND) License-eligible if graduate of accredited school Can practice nutrition as therapy

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Restricts practice of dietetics (aka MNT) to treat an individuals diagnosed disease or condition LDN licensees Physicians Chiropractors Naturopaths Exception: obesity is not within the license scope Without a license Anyone can provide non-medical/general advice Advice for weight loss, including obesity (despite CDC: Dx) How to prevent hypertension or diabetes Group (non-individualized) guidance to reduce BP or A1c How to read a food label What is included or excluded on a GF diet

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Active RDN defenders must Know the law and its limits Know what is/isnt a violation Regularly explore non-usual Websites Media Food establishments Retail establishments Know who your friends are Not likely to be CNS and their Board

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Unaware of law, or apathetic towards it New Health Freedom Movement Hostile to any regulation Complain of Unjustified monopoly by AND Restraints on freedom Of consumers Of practitioners Cost Michigan its licensure 1 obstacle to licensure in remaining states nationalhealthfreedom.org anh-usa.org

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Institute for Integrative Nutrition, NYC 100% online, 40 modules, completed over 1 year Each module requires < 10 hours Graduates receive health coach certificates Claims to have graduated over 60K students Board certified by Amer Assoc of Drugless Practitioners Clayton College of Natural Health, Alabama Granted BS, MS, ND and PhD Claimed to have graduated over 25K students Closed in 2010 due to action by state of Alabama Scores of others too numerous to count

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Loren Lockman Operated residential fasting facility near Frederick In 2004, admitted 31 yo DM1 woman Ceased all food, insulin Patient was deceased within 7 days Civil conviction: practicing medicine w/o license Fined $320,000 Ran to Central America, where he now practices Source: mbp.state.md.us/forms/Lockman08.317.pdf An underweight pancreatic cancer pt provided nutritional supplement formula by RDN Advised not to drink it by CHHC First ingredient is corn syrup!

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Generally not mainstream media Holistic health Personal growth Metaphysical/spiritual Media not likely at mainstream outlets Natural food stores Metaphysical products stores Yoga/fitness centers Womens health providers Health Fairs

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Websites easy to find Search regularly Maryland or specific county, city or town Holistic Weight loss (legal in MD, but other services not) Health coach Nutritionist (licensed in MD, but abused!) Nutrition counselor, nutrition consultant CNC, CHHC, AADP Results: individual sites or directories Lets go a-searchin!

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Marie Savage, Exec Dir, Board of Dietetic Practice marie.savage@maryland.gov http://dhmh.maryland.gov/dietetic/SitePages/Home.aspx http://dhmh.maryland.gov/dietetic/SitePages/Home.aspx As much documentation as possible Web address with reference to content of concern Brochure, flyer or print ad Report of client interaction Notify CPC of complaint so MAND can track Dont rely on CPC as complaint gateway Complaints mean more coming from members Supports continued authorization of licensure law Lets Board know members actively involved

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May be more difficult to challenge Nurses, since theres usually no advertising Acupuncturists, since advertising excludes nutrition Chiropractors, since legal limits undefined in law Naturopaths, since few or no limits defined in law If evidence of violation of a professional licensed by another Board Report to their board, not to Board of Dietetic Prax.

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Circumstances have put us in a serious struggle A case (NC Dental Examiners) went to SCOTUS Not nutrition-related, but violators won Be an active defender, even if you are Retired Working in clinical/LTC or a non-patient setting Do it for Yourself and your salary Your colleagues The safety of the public Thanks! Mark Rifkin, MS, RD, LDN preventive_nutrition@verizon.net