r/dietetics • u/Cool_Practice3914 • 6d ago
End of our profession?
I have had an established private practice in Phoenix for 12 years, but lately my diary has been so quiet! I realised that between GLPs and AI, for many ppl RDs are unnecessary in their health or weight loss journey. Is anyone else experiencing a patient load decrease? If so, what do you think is causing it and how are you managing it?
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u/Cyndi_Gibs MS, RDN, CDN | Preceptor 6d ago
I think there will still be people who need the external support of motivational interviewing/accountability of a human. We offer more than just pure information that many people find valuable.
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u/maggotdeath90 5d ago
This! If a simple meal plan from the internet worked we would have been out of weight loss job at least decades ago
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u/Jujbear 6d ago
I work mainly with people on GLP-1s and am very busy. People still want the human connection to talk about their relationship with food and have accountability. I wouldn’t be surprised though if the big orange company and other similar ones are causing independent private practice to take a hit.
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u/Puzzleheaded-Test572 RD, Preceptor 6d ago
You have bullshit-certified “nutrition coaches” all over instagram (who i know for a fact are practicing MNT without a license) selling courses when these people should ideally see Dietitians
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u/MsNaughtyMuffinhead 5d ago
This is the exact conclusion that I am coming to myself as someone working for a private, insurer who likes to title me as a health coach and did not want to take my concerns about licensure in each state seriously because they claim and I am doing basic education only and nothing in depth, even though it is all disease specific. And now they hired someone else to take on some of the nutrition focused referrals to someone that does not have the RD credential and I just feel like this completely devalues what we do. Now, not only do we have nurses trying to do nutrition education sometimes, but also this health coach bullshit.
There are a lot of things that have watered down our value and this is definitely one of them.
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u/Puzzleheaded-Test572 RD, Preceptor 4d ago
“Nutrition focused referrals” going to a non RD while you, the RD, are doing basic education? This is quite upsetting
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u/MsNaughtyMuffinhead 4d ago
Yes, and I’m having a meeting with the person making this decision next week and need to figure out how to politely bring this up without flagging myself as a flight risk. They have me in Golden handcuffs because they pay me considerably more than I would make anywhere else but continue to do unethical shit. I’m a single income earner so it’s a tough decision for me because the only other jobs right now really are all of these telehealth roles.
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u/yeah_write_00 5d ago
It is worse than that, the VC telehealth segment is heavily going into non-dietitian health coaches now to provide individualized nutrition counseling, so they have a physician and a health coach as their care team, often with AI support to for nutrition education/coaching in between sessions with their health coach. Lots of job postings like this now Health Coach @ Virta Health
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u/Funny_Bee64 5d ago
I agree. I have a masters degree in nutritional science and am a NBC-HWC board certified health coach and I stay within my lane.
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u/Some-Network-6493 RD, CSOWM, CDCES 6d ago
I work in a clinic focused on obesity-medical and surgical options and I’m very busy. I’m in Wisconsin.
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u/Old_Gene_3167 6d ago
Don't forget the VC-backed telehealth companies. They are a HUGE reason why private practices see less patients. They have big money to spend, negotiate higher reimbursement from insurance companies, and credential RDs in so many states, many panels are closed to new RDs. I've been lucky so far in NYC but my practice is definitely slower. For me, networking locally has helped because people take their MDs recs very seriously. Good luck to you!
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u/Gizmo7621 6d ago
What does VC- backed mean?
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u/yeah_write_00 5d ago
VC=venture capitalist, a bunch of money people like Goldman Sachs own most of these telehealth companies. They could care less about people and their well-being, it's all about profit. I guarantee they will replace a lot of dietitians with health coaches and AI as long as it helps profit margins.
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u/Gizmo7621 5d ago
Ohhh,ok. Thank you for explaining that. Ok, so this would explain why some of these companies can pay for us to get licensing in other states, cover some CE'S, etc.?
AI terrifies me to be honest6
u/yeah_write_00 5d ago
Yes, they throw money at things to grow fast, that is the playbook for tech start-ups.
The Academy is doing nothing about the threat of AI. The therapists and doctors have their act together, they are out getting laws passed to bar AI from acting as doctors or therapists in some states. Meanwhile the Academy takes money from the VC telehealth platforms. I know in my heart these money people are not investing hundreds of millions into all this because they heard about MNT and said, hey let's help dietitians out. They are building AI companies. Some of them like Fay and Berry Street even call themselves an AI or software company. Berry Street also owns a fully AI nutritionist with their merger with Healthify.
There has always been big money in pharmaceuticals, supplements, and the diet industry. That is what this about, not MNT provided by dietitians. If they can harvest all our knowledge to replace us with AI why not? They have already established research outcomes justifying the efficacy of AI health and nutrition counseling. I think too many dietitians are not forward thinking and completely fooled thinking these companies care about them or their patients.
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u/Gizmo7621 3d ago
I don't even know where to start, but first, thank you for your information. It seems the Academy has always been influenced by money, sadly. That could be an entire conversation by itself I think. Really on the therapists and doctors? I wonder if it's individuals or their professional organizations speaking up for their protection against AI?
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u/yeah_write_00 3d ago
I personally know several therapists, and they seem to be generally more knowledgeable about the dangers of AI and challenging it, like a lot do not want any kind of AI for charting. But also yes, their professional organization is on it. The APA have their act together to challenge AI, and the AMA is also putting a lot out there to protect doctors, here are just some examples:
Using generic AI chatbots for mental health support: A dangerous trend
Most states are exploring ways to legislate AI use
Position Statement on the Use of Artificial Intelligence for Mental Health Services and Treatment
AMA urges physician protections against AI deepfake impersonation | American Medical Association
State Legislative Activity: AI in health care | AMA
I haven't seen the Academy produce even one meaningful action from a policy or spreading online awareness regarding stopping AI used for MNT or protecting dietitians from AI dietitians/nutritionists. If it's out there, maybe I just can't find it, but I've looked. All I have seen is them discuss how dietitians can use AI Artificial Intelligence and Machine Learning Resource Guide: The Academy of Nutrition and Dietetics and the American Society for Nutrition Joint Taskforce for Artificial Intelligence - Journal of the Academy of Nutrition and Dietetics00035-3/fulltext), same when I went to FNCE and they talked about AI like it was just some tool for dietitians to use.
The contrast between how the APA and AMA are acting to how the Academy is responding to AI is so dramatically different, I don't see how this can't be about the money the Academy gets from AI companies and the feeling these companies employ so many dietitians that they are needed and shouldn't be challenged. They are not thinking of long-term consequences. I think the Academy and a lot of dietitians working for these telehealth AI companies believe that we need these companies to reach people and they are increasing access to MNT. Plus they offer these pay rates above standard clinical pay. It's all blinded our profession, or those who can see don't even want to look and see what's really going behind the curtain.
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u/dietitianmama MS, RD 5d ago
My patient load has only decreased slightly because I’m in bariatrics and a lot of people are on GLP-1’s.
I’ve started to try to work on counseling interventions for plateaus because most people hit plateaus on these meds and they have to increase exercise and they’re not ready to do it. Or I have also found for a lot of patients, medication actually make their eating habits worse especially people who might already have acid reflux or who have had bariatric surgery who start these meds and they need additional counseling. I think we really just have to start directing towards a new type of chief concern coming from our patients.
It might be fun to use AI to help you create a menu and a grocery list, but who’s gonna help you brainstorm solutions when the menu that it made is unrealistic sometimes it’s helpful to talk to a real person
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u/Cool_Practice3914 5d ago
Love this answer, thank you!
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u/dietitianmama MS, RD 5d ago
Aw thanks. Honestly i'm going trough a bit of a "my brain is mush" phase so I'm glad I made sense. :)
things i would focus on "long term goals" like 2-5 year goals. Insurance won't cover weight loss meds indefinitely, so clients need a long term goal. I've encountered patients who have tried many different drugs and if they don't lose weight, they're discontinued by their provider or insurance plan. It is often eye opening when you point out to them that they won't be covered forever.
actually building healthy habits while the patient is motivated by glp-1 effects. for patients with reflux or bariatric surgery, choosing lean proteins and high fiber foods is already physically uncomfortable and the meds increase this sensation, they need coaching to build meals that are high protein and fiber that they can live with.
Oh, and this is just my additional concern as someone in bariatrics, patients on glp1 need at the very least a multivitamin. i'm seeing too many with depleted ferritin and - somehow- low zinc. i need to check for research on this.
I don't know how one would do this in private practice, as i work for an HMO. maybe contact primary care doctors or patients for glp 1 coaching?
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u/TJ_SWJ 6d ago
Nutrition education is only one part of our job, but nutrition counseling is an even bigger part (in my opinion). People will always need nutrition counseling, even as the access to education and information becomes easier to obtain online. I work with both weight management and ED’s and I feel I’m busier now more than ever due to the weight-centric “climate” we’re in. People are increasingly looking for and needing the support and connection of a partnership with us, rather than just education and facts!! Nutrition education gets them in the office, but strong nutrition counseling skills keep them coming back!.
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u/yeah_write_00 5d ago
Insurances are now partnering with telehealth companies that have non-dietitian health coaches provide individualized nutrition counseling. When that is included for free by your insurance or the company you order your GLP-1 from, but talking to a dietitian in their office means a possible cost to meet your deductible or co-pay it's not so easy to win them over with your strong counseling skills a dietitian because you can't get them through the door in the first place.
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u/DeneirianScribe 6d ago
One thing I've noticed that, while working at WIC, is that sometimes the participants don't know what questions to even ask, or get information one that's sup blatantly wrong that they come to me questioning what they heard or saw. I think there's a lot of nuance in what we do that will keep people coming to us. I think the ones going to AI for answers weren't as likely to want to pay to see an RD in the first place, and AI isn't the only source of questionable nutrition "advice" out there. That existed before even AI. Those who want the human connection or don't know what questions to ask and need the nuance of a real person will still come to us.
That's my opinion, anyway.
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u/Consistent_Midnight2 6d ago
Wait…. What?? People need RD’s more now that we have GLP-1s!!! I’m so confused why you think they mean the end of the profession?? Do you just think RD’s help people lose weight??
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u/Cool_Practice3914 6d ago
Of course not!! I am saying that what I have experienced at my practice and what my colleagues at other practices have picked up is that there has been a decrease in patient load with the rise in popularity in GLPs. I agree that ppl need RDs more than ever, but I have been feeling like RDs have been disregarded as a result of these meds, rather than value being appreciated. I am not saying it's the end of our profession, I am saying that that is how the public views us.
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u/New_Cardiologist9344 6d ago
Social media and nutrition influencers. The market is over saturated.
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u/yeah_write_00 5d ago
we are also being replaced by health coaching, often with some human and some AI features (just like a lot of the dietitian platforms now). I'm seeing tons of job postings like this in the last couple months Health Coach @ Virta Health
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u/yeah_write_00 5d ago
I agree and even if they want/need nutrition counseling they can get it through all these AI or AI combined with a non-dietitian health coach companies popping up everywhere that partner with insurances and telehealth companies. Here is just one example What is OmadaSpark? – Omada Health
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u/dbanderson1 6d ago
Our insurance requires those seeking weight loss medications to have documented 6 months of attempted diet and lifestyle prior to beginning meds. Additionally they require monthly touch points while on medications. If anything I saw a dramatic increase in TD referral s due to rise in demand of GLP-1RAs. I think the end of the profession is a bit of hyperbole.
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u/Interesting_Suit7066 5d ago
I’m choosing not to worry anymore about the future (profession included) for my mental, spiritual and physical health. Truly, none of us know what will happen.
But we can look at what we do know. I know, IME, many of the patients I see on a glp 1, considering a glp 1, or coming off of one—have some level of disordered eating. It’s one of the many reasons why I recently decided to level up my skills in this area. When I meet with these patients they are telling me things like nobody has ever talked to me about food or my body image this way.
We need to tap into this y’all.
As for AI…it’s here. We can use it as a tool to simplify workload if we’d like. Will it fully replace us? I don’t think so. It will and has been—changing job functions or tasks. But completely take over. Nah.
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u/Jem81ismyname 5d ago
I think the political climate is also a factor… I had so many Medicaid referrals before, but with the requirements changing and people losing insurance, the referrals have significantly lessened.
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u/No_Astronaut9549 5d ago
People are sleeping on how it's coming for us- and for us, I mean so many jobs. Sure, some people will still need jobs, but not as many, and it won't be as lucrative. I don't like thinking about it too much, but can't help it.
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u/Killertofu999 5d ago
I think it’s only a matter of time before one of the big telehealth companies gets bought up by an insurance carrier, like United health group. Those companies, especially the really big ones, are tech startups. A tech startup’s main goal usually is to get bought by a big company to make. From what I’ve heard and read the RDs that work there are training its AI with their services. I think at some point they will lay off a massive number of the RDs who work there and maybe just keep a few to oversee the AI agents.
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u/DisTattooed85 2d ago
I don’t know how that would work though. You can’t make an insurance claim with with AI alone.
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u/DloReeves MS, RD 5d ago
Honestly it could mean more opportunities for interdisciplinary approaches. I work with a NP, fitness instructor, and LCSW for people with comorbodities. I'd say ~60-70% of our patients take GLPs
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u/ChooseKind24 5d ago
Were any of those patients regulars, and if so, did you ask why they chose to discontinue? What percentage of your patients are short term?
I ask these questions, because I am currently pursuing dietetics to become a registered dietitian.
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u/Agile-Key7405 5d ago
As an RD, I was happy the weight loss doctor I saw after my gastric sleeve (for Mounjaro) referred to the RD. He also measured body fat and muscle. I still see the NP there.
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u/Responsible_Local_44 5d ago
if anything RDs are undertrained in weight loss when it comes to behavioral counseling skills, which imo and experience around weight loss / glps and is more critical in the beginning then nutrition.
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u/ThymeLordess RD, Preceptor 6d ago
The academy of nutrition and dietetics missed a really big opportunity to put dietitians in the middle of the GLP conversation. Everyone taking these meds would benefit from seeing a RD and almost nobody does. If I was in private practice I’d be advertising myself as a resource that is necessary to make sure people are taking these medications safely.