Nutrition Care and Health Systems

The Academy of Nutrition and Dietetics believes it is vital to ensure everyone has continuous, consistent, timely, affordable and transparent access to safe and effective nutrition services, provided by registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs), to improve their health and prevent, treat and manage health conditions and disease across the life cycle.

Impact Goals:

• Achieve access and utilization of nutrition services, particularly medical nutrition therapy, as pillars of health equity
• Identify and treat all forms of malnutrition
• Demonstrate the impact of access to health equity and effectiveness of nutrition and dietetics care
• Position RDN/NDTR as key players on the interdisciplinary team/health-care system

RDNs are the nutrition experts and are essential to ensuring that person-centered health care delivery models meet individuals' health care needs. Decision makers within health care delivery and payment, both in the public and private sectors, must create policies and systems that recognize the multidimensional role and contributions of nutrition and dietetics practitioners toward achieving health equity, enhancing quality, controlling costs and improving patient, client and practitioner experience within health care.

Inequities in U.S. Chronic Conditions

More than half (51.8%) of adults in the United States have at least one chronic condition and nearly one-third (30%) have two or more chronic conditions.³⁵ Current evidence in the United States suggests that chronic disease among young people is a growing problem; however, the prevalence of chronic diseases in this population is generally understudied.³⁶

It is estimated that 1% to 3% of American children have hypertension and stroke is among the top 10 causes of childhood death. One in five U.S. children has obesity and the prevalence of Type 2 diabetes is projected to quadruple nationally in 2050 among people younger than 20 years.³⁷

Ninety percent of U.S. health care spending goes toward treating individuals with one or more chronic condition.^38,39 Chronic conditions disproportionately affect specific populations, including American Indians, Alaska Natives, people of Hispanic origin and non-Hispanic African Americans.^40-45 Many minority populations in the United States have long faced chronic disease health disparities due to socioeconomic inequities, barriers to education, systemic racism, insufficient access to health care and limited access to healthful and affordable foods and safe places to be active.⁴⁶ These root causes of health disparities and inequitable access to nutrition care services, must be addressed to achieve health equity.

The Role of RDNs and NDTRs in Addressing the Problem

To achieve the goals of health care system redesign and to meet the National Academy of Medicine's quadruple aim,⁴⁷ a high-performing multidisciplinary team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated and cost-effective RDNs and NDTRs impact quality measures that lead to enhanced payments under numerous value-based payment programs. Studies of RDNs using medical nutrition therapy (MNT) show improved patient outcomes in diabetes, hypertension, lipid metabolism disorders, celiac disease, HIV infection, pregnancy, chronic kidney disease, cancer, weight management and unintended weight loss in older adults.^48-57 RDNs deliver care that supports higher performance in value-based models of care through improved clinical outcomes and reduced costs for physician time, medication use and hospital admissions.^58-62 Armed with broad skill sets, RDNs are well-positioned to lead in value-based care environments, developing or advocating for policies, strategies, goals, models and tools to achieve outstanding outcomes, deliver value and increase engagement and satisfaction of providers, patients and clients.^63,64,65

Safe and effective health care requires qualified health care practitioners, necessitating state regulation of professional practice including dietetics and nutrition.⁶⁶ Licensing also provides benefits to health care providers, such as RDNs, by enabling them to work at the height of their scope of practice with greater autonomy and by recognizing the gold standard of RDNs' accredited education and training. Strong and uniformly consistent licensure laws and regulations are important for protecting the public. Tools such as the Academy's Model Practice Act and a potential licensure compact aid in establishing consistent and uniform standards that states can adopt to streamline licensure requirements and facilitate interstate and telehealth practice.

RDNs and NDTRs are uniquely positioned to respond to and address disparities in health equity and emerging needs within health care systems. Now more than ever, it is vital to ensure that everyone has continuous, consistent, affordable, timely and transparent access to safe, effective nutrition services throughout the life cycle. The Academy is strongly committed to improving the nation's access to and utilization of effective nutrition and dietetics care, achieving health equity, identifying and treating malnutrition and positioning RDNs and NDTRs as key players on the interdisciplinary health care team.

See references.