Hot Nutrition Topics - Dietitian Registration

Hong Kong Practicing Dietitians call for local statutory registration

The weight loss industry has been blooming in recent years. Many companies have make use of the title “dietitians/nutritionists” for the marketing of nutrition therapy services. The community has also been overwhelmed by loads of health product advertisements, involving dietitians/nutritionists for product marketing and promotion. . Would you be convinced by these kinds of advertisement? Have you ever thought that some of these “professionals” are in fact not qualified? The worse scenario is that some unqualified personnel even advise medical nutrition therapies to patients, publish recipe books for medical nutrition, conduct health talks and carry out media interviews. Due to the unregulated qualification of dietitians or nutritionists in Hong Kong, not only the general public, but also the mass media could hardly differentiate their qualification standards.

The Local Dietitian Registration Task Force which is composed of three local dietitian groups (the -Hong Kong Dietitians Association, Hong Kong Nutritionists Association and Hong Kong Practicing Dietitian Union) carried out a survey from April to November in 2009 to investigate how the public feel about health product promotion by dietitians or nutritionists. Among the 700 respondents, about 65% agreed that they would be more convinced by those advertisements of health products promoted by dietitians or nutritionists. About 50% trusted the health information provided by dietitians or nutritionists more than doctors and nurses. Only 30% knew that there is currently no local statutory registration of Hong Kong practicing dietitians. Over 90% supported the local statutory registration to be put in place for the protection of public interests.

No protection over the title “Dietitian/Nutritionists”

Currently, there are about 2000 internationally registered dietitians in Hong Kong. Dietitians are health professionals graduated from Master degree, Post-graduate Diploma or Bachelor degree in Nutrition and Dietetics from university accredited dietetic programs inclusive of a 6 to 24 months internship (including clinical, community and food service internship). In countries like Australia, United States, United Kingdom and Canada, the title “Dietitian” is protected by law. And dietitians have to register to their local registration body in order to practice.

Yet without local statutory registration of Hong Kong practicing dietitians, anybody can call themselves a dietitian or a nutritionist. They can prescribe medical nutrition therapy without violating the law (See attached table). Nevertheless, people having received false information and inappropriate dietary interventions have no channel to file complain. The unregulated professional standards and service quality puts public health at great risk. Therefore, when consulting a dietitian, one could ask for their registration certificates if needed.

Reported Cases

§ It was noted that some Form 5 graduates only having taken some short nutrition course claimed themselves as “dietitians/nutritionists”. They are involved in selling nutritional supplements and carrying out dietary counseling, yet the health information they provided might not be evidence based or accurate

§ In the past few years, a high-profile unqualified dietitian claimed himself to have registered with American Dietetic Association (ADA).He has been widely invited by the mass media to give nutrition information to the public, publish books on nutritional management for diabetes. After enquiring with the ADA, it was discovered that this self-claimed dietitian has never completed a dietetic program thus is not a registered dietitian. Yet no legal action could be taken without local statutory registration of Hong Kong practicing dietitians.

Misleading product information delivered by unqualified dietitians/nutritionists

Many advertisements have used dietitian/nutritionist as an icon for product promotion; however, the qualifications of these personnel are being suspected. Some information they provided along with the advertisements are often found to be misleading and not based on scientific evidence, which could pose serious health risk to the public (see attached table). According to the Code of Professional Conduct of Hong Kong Dietitians Association, registered dietitians should not directly endorse any commercial products with biased. It is best for the public to seek professional advice from registered dietitians before purchasing any nutritional products.

Reported Cases

§ Misleading information are provided by unqualified personnel along with promotion or endorsement of certain health products, like “Belly fat-burning pill” or supplements claimed to have blood sugar lowering or cholesterol-lowering effect. However, the effects of these products have never been proven by scientific researches.

§ A mother was misled by an advertisement on fish liver oil, and gave her children high doses of fish liver oil in an attempt to manage their asthma. The children ended up developing Vitamin A toxicity and one of them required liver transplant due to advanced liver cirrhosis.

§ An old man was misled by an advertisement on the function of Vitamin C, and overdosed on Vitamin C (6 times of recommended intake). Consequently, he developed chronic kidney disease and required long-term dialysis.

Nutrition therapy by unqualified personnel poses threat to public health

All registered dietitians have undergone clinical training and placement in hospitals, and medical nutrition therapies they provided must be evidence-based. However, it was also noted that some unqualified personnel had provided poor quality nutrition therapy which poses threat to public health (See attached table). It is particularly important for those with cancer, diabetes, high cholesterol or kidney diseases to receive correct diet therapy otherwise will further worsen their health condition.

Reported Cases

§ A 30-year-old woman who had followed a weight loss meal plan prescribed by an unqualified dietitian/nutritionist who was told to have oatmeal for every meal. She ended up developing cardiac arrhythmia and requiring hospital admission after several months.

§ A 20-year-old woman with normal weight joined a weight loss plan at a slimming centre. The unqualified dietitian/nutritionist put her on a very low calories diet plan and asked her to go jogging for 30 minutes every day. Despite reaching a BMI of 19-20, she had developed symptoms of eating disorder.

§ A mother followed the advice of an unqualified dietitian/nutritionist and put her son with eczema on a very restrictive eating plan requiring nutritional supplements. Her son’s condition did not improve at all. It is discovered that the multi-vitamin supplements provided by the unqualified dietitian/nutritionist did not contain any corresponding active ingredients upon laboratory testing.

Local statutory registration of Hong Kong practicing dietitians

In order to protect public interest, local statutory registration of Hong Kong practicing dietitians is indispensable to ensure the professional standards and the service quality of nutrition professionals. The public has the right to receive accurate nutrition information and effective nutrition therapy from qualified practitioners. Dietitians are the qualified experts in food, nutrition, dietetic and disease management who must continuously updated themselves with the latest scientific evidence. Local statutory registrations of dietitians in other Asian countries such as Taiwan, Japan and Korea have already been established. Hong Kong Government is suggested to review and revise Supplementary Medical Professions Ordinance, so as to regulate the qualification standards of registered dietitian in Hong Kong. As a result, the public shall be protected as misleading operators can be litigated or monitored by law.