Position of the American Dietetic Association: food and nutrition professionals can implement practices to conserve natural resources and support ecological sustainability

It is the position of the American Dietetic Association to encourage environmentally responsible practices that conserve natural resources, minimize the quantity of waste generated, and support the ecological sustainability of the food system-the process of food production, transformation, distribution, access, and consumption. Registered dietitians and dietetic technicians, registered, play various roles in the food system and work in settings where efforts to conserve can have significant effects. Natural resources that provide the foundation for the food system include biodiversity, soil, land, energy, water, and air. A food system that degrades or depletes its resource base is not sustainable. Making wise food purchases and food management decisions entails understanding the external costs of food production and foodservice and how these external costs affect food system sustainability. This position paper provides information, specific action-oriented strategies, and resources to guide registered dietitians and dietetic technicians, registered, in food decision making and professional practice. Food and nutrition professionals also can participate in policy making at the local, state, and national levels, and can support policies that encourage the development of local sustainable food systems. Our actions today have global consequences. Conserving and protecting resources will contribute to the sustainability of the global food system now and in the future.     

American Dietetic Association Revised 2008 Standards of Practice for Registered Dietitians in Nutrition Care; Standards of Professional Performance for Registered Dietitians; Standards of Practice for Dietetic Technicians, Registered, in Nutrition Care; and Standards of Professional Performance for Dietetic Technicians, Registered

The 2008 ADA SOP in Nutrition Care and SOPP for RDs and DTRs, practice-specific SOP/SOPP, and the ADA Code of Ethics are used collectively to gauge and guide a competent level of dietetics practice and performance. These resources continue to be reviewed and updated as new trends in the profession of dietetics and external influences emerge.All RDs and DTRs should have in their personal libraries the most recent copies of the resources that compose the ADA Scope of Dietetics Practice Framework. To ensure that ADA members always have access to the most up to date materials, each resource is maintained on the Practice tab of ADA's Web site (www.eatright.org).     

Practice Paper of the Academy of Nutrition and Dietetics Abstract: The Role of Nutrition in Health Promotion and Chronic Disease Prevention

Food intake, lifestyle behaviors, and obesity are linked to the development of chronic diseases such as type 2 diabetes, certain cancers, and cardiovascular diseases. It is recognized that physical and social environment influences individuals' behaviors, and some population subgroups such as racial/ethnic minorities and individuals with low socioeconomic status or limited literacy or language abilities seem to be especially vulnerable to disparities in disease risk factors, disease prevalence, or health outcomes. Certain life cycle phases appear to be especially important for health promotion and disease prevention as the development of chronic diseases can take several decades. Such complex health issues often require system-wide, multifactorial, and multidisciplinary solutions. Social ecological models, with approaches spanning from individual level to macro policy level, can provide registered dietitians (RDs) and dietetic technicians, registered (DTRs) with a comprehensive framework to promote health and to prevent chronic diseases. Furthermore, the Nutrition Care Process can be utilized in carrying out the health promotion and disease prevention efforts. RDs and DTRs have the training and requisite skills to be leaders and active members of multidisciplinary teams to promote health and prevent chronic diseases across the life span. The position of the Academy of Nutrition and Dietetics states that primary prevention is the most effective, affordable method to prevent chronic disease, and that dietary intervention positively impacts health outcomes across the life span. RDs and DTRs are critical members of health care teams and are essential to delivering nutrition-focused preventive services in clinical and community settings, advocating for policy and programmatic initiatives, and leading research in disease prevention and health promotion. In concordance with the Academy's position, this practice paper provides an overview of practice examples, effective program components, and a comprehensive range of health promotion and chronic disease prevention strategies for RDs and DTRs. This paper supports the “Position of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention” published in the July 2013 Journal of the Academy of Nutrition and Dietetics.     

Position of the American Dietetic Association: Providing Nutrition Services for People with Developmental Disabilities and Special Health Care Needs

It is the position of the American Dietetic Association that nutrition services provided by registered dietitians (RDs) and dietetic technicians, registered (DTRs), are essential components of comprehensive care for all people with developmental disabilities and special health care needs. Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community-based, and culturally competent. People with developmental disabilities and special health care needs frequently have nutrition concerns, including growth alterations (failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, medication-nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Individuals with special needs are also more likely to develop comorbid conditions such as obesity or endocrine disorders that require nutrition interventions. Poor health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Health maintenance and avoidance of complications can be promoted by timely and cost-effective nutrition interventions. Public policy for individuals with special needs has evolved over time, resulting in a transition from institutional facilities and programs to community living. The expansion of public access to technology and health information on the Internet challenges RDs and DTRs to provide accurate scientific information for those with developmental disabilities and special health care needs. Nationally credentialed RDs and DTRs are best prepared to provide appropriate nutrition information for wellness and quality of life.     

Minority recruitment and retention in dietetics: issues and interventions

To better understand the reasons why minorities and males are underrepresented among registered dietitians (RDs) and dietetic technicians, registered, (DTRs) and to develop focuses for intervention, the investigators performed a telephone survey of newly credentialed RDs and DTRs and directors of RD and DTR education programs. Using lists of students recruited by the American Dietetic Association for participation in the survey, the investigators interviewed 83 RDs and DTRs and 20 education program directors. RDs and DTRs attributed minority underrepresentation primarily to the field's lack of visibility and underrepresentation of men to the traditional association with women. Education program directors attributed minority underrepresentation to educational disadvantages, particularly in scientific subjects. Findings from this study support program-level interventions such as increasing program flexibility, initiating outreach to K-12 schools and lower-division college students, providing tutoring in a nondemeaning atmosphere, and visibly expressing commitment to minority representation. More fundamental changes in the profession itself appear necessary for large-scale increases in minority representation. These include increasing internship opportunities; raising the profession's level of remuneration, prestige, and independence; increasing scholarship support; and advertising nationally through channels capable of reaching minorities.     

Position of the Academy of Nutrition and Dietetics: Nutrition Security in Developing Nations: Sustainable Food,Water, and Health

It is the position of the Academy of Nutrition and Dietetics that all people should have consistent access to an appropriately nutritious diet of food and water, coupled with a sanitary environment, adequate health services, and care that ensure a healthy and active life for all household members. The Academy supports policies, systems, programs, and practices that work with developing nations to achieve nutrition security and self-sufficiency while being environmentally and economically sustainable. For nations to achieve nutrition security, all people must have access to a variety of nutritious foods and potable drinking water; knowledge, resources, and skills for healthy living; prevention, treatment, and care for diseases affecting nutrition status; and safety-net systems during crisis situations, such as natural disasters or deleterious social and political systems. More than 2 billion people are micronutrient deficient; 1.5 billion people are overweight or obese; 870 million people have inadequate food energy intake; and 783 million people lack potable drinking water. Adequate nutrient intake is a concern, independent of weight status. Although this article focuses on nutritional deficiencies in developing nations, global solutions for excesses and deficiencies need to be addressed. In an effort to achieve nutrition security, lifestyles, policies, and systems (eg, food, water, health, energy, education/knowledge, and economic) contributing to sustainable resource use, environmental management, health promotion, economic stability, and positive social environments are required. Food and nutrition practitioners can get involved in promoting and implementing effective and sustainable policies, systems, programs, and practices that support individual, community, and national efforts.     

Capacity-building for health research in developing countries: a manager's approach.

Research may be viewed as rigorous inquiry to advance knowledge and improve practices. An international commission has argued that strengthening research capacity is one of the most powerful, cost-effective, and sustainable means of advancing health and development. However, the global effort to promote research in developing countries has been mostly policy driven, and largely at the initiative of donor agencies based in developed countries. This policy approach, although essential, both contrasts with and is complementary to that of research managers, who must build capacity "from the ground up" in a variety of health service settings within countries and with differing mandates, resources, and constraints. In health organizations the concept of research is broad, and practices vary widely. However, building research capacity is not altogether different from building other kinds of organizational capacity, and it involves two major dimensions: strategic and operational. In organizations in the health field, if reference to research is not in the mission statement, then developing a relevant research capacity is made vastly more difficult. Research capacities that take years to develop can be easily damaged through inadequate support, poor management, or other negative influences associated with both internal and external environments. This paper draws from key international research policy documents and observations on the behavior of research and donor agencies in relation to developing countries. It examines capacity-building primarily as a challenge for research managers, realities underlying operational effectiveness and efficiency, approaches to resource mobilization, and the need for marketing the research enterprise. Selected examples from South Asia and Latin America and the Caribbean are presented.     

Perceived continuing education needs of RDs and DTRs

The American Dietetic Association (ADA) Council on Practice Continuing Education Committee conducted a study to ascertain the perceived continuing education needs of registered dietitians (RDs) and dietetic technicians registered (DTRs) to assist ADA and other program providers in developing relevant programming. It surveyed 5,000 RDs and DTRs to determine current and preferred continuing education activities, factors influencing the selection of activities, topics most likely to be selected, and demographic characteristics. Results show that RDs and DTRs use a variety of mechanisms and pursue a large number of topics. Continuing education needs are most often met through locally available activities. Preferred mechanisms are workshops and lectures. ADA and state/district associations are major, but not exclusive, providers of programming. Practitioners tend to choose topics related to their practice area. Topics requested at an advanced level of presentation related to traditional dietetic practice; topics requested at a basic level were new or not specific to nutrition. The data will be incorporated into the ADA continuing education programming plan and will provide direction for ADA's exploration of new methods of continuing education delivery.     

基于“SPIRIT”框架的成都健康城市建设实践与思考

目的:旨在为成都初步建成环境优美、保障健全、文化繁荣、人群健康的国家“健康城市示范市”提供参考建议。方法:采用“SPIRIT”框架,主要从政治承诺与政策、场所手段与基础设施、社区参与与跨部门合作、健康资源与科学研究、可持续性发展与培训等5个维度进行研究。结果:成都近年健康城市建设在政治承诺与政策、场所手段与基础设施、社区参与与跨部门合作、健康资源与科学研究、可持续性发展与培训等5个维度指标数据不断优化,人群健康水平不断提高。结论:把健康融入所有政策,以社区为平台整合各类健康资源,以可持续性发展理念培育健康人群,运用互联网+新技术等有利于成都健康城市建设,促进人群整体健康水平的提高。     

Window of opportunity--positioning food and nutrition policy within a sustainability agenda.

Public health professionals have an opportunity to refocus national attention on food and nutrition policy, within a sustainability agenda. A broadly based national Food and Nutrition Policy was developed in 1992. However, its implementation has been selective and primarily based within the health sector. Other major policy areas, for example; industry, agriculture and trade, have dominated Australian nutrition and health policy. A broad, whole-of-government commitment to a comprehensive food and nutrition policy that engages with the community is required to achieve outcomes in terms of public health, a sustainable environment and viable food production for future generations.     

Taste the difference, make the difference: the role of a public health nutritionist in the UK food retail industry and a rural community in Zambia

Summary  Nutritionists and Dietitians have an important role to play in enabling populations to improve their health. Using examples from a UK food retailer and rural community in Zambia, this article highlights the importance of developing strong partnerships which support sustainable community-based activities that promote healthier practices at the individual, family and community levels.     

Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control

The predictors of sustainability of community-directed treatment with ivermectin (CDTI) at four implementation levels were evaluated in 41 African Programme for Onchocerciasis Control (APOC) projects, encompassing 492 communities in 10 countries. A model protocol provided information on indicators corresponding to nine aspects of a project that is likely to be sustainable at community level after the cessation of external support. Six of the nine aspects had components of community ownership as predictors of project sustainability. Quantitative and qualitative assessments were used to obtain individual community scores and an overall sustainability score for each project graded on a scale of 0-4. Of the 41 projects evaluated, 70% scored "satisfactorily" to "highly sustainable" at the community level. We found variations among countries and that health system weaknesses could hamper community efforts in sustaining a project, such as when ivermectin was delivered late. Community ownership was of primary importance to the community score, and the community-level scores correlated with overall project sustainability. The therapeutic coverage achieved in each project correlated with the ratio of volunteer ivermectin distributors per population served. Surprisingly, the performance of these distributors was not affected by the direct incentives offered, and coverage appeared to be highest when cash or in-kind compensation was not given at all. Although further research is required, anecdotal evidence pointed to diverse indirect benefits for distributors-political goodwill, personal satisfaction and altruistic fulfillment. The results demonstrate that community ownership is among the important determining factors of sustainability of community-based programmes.     

Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues in Feeding and Hydration

It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians (RDs) should work collaboratively as part of the interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. RDs have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When individuals choose to forgo any type of nutrition and hydration (natural or artificial), or when individuals lack decision-making capacity and others must decide whether or not to provide artificial nutrition and hydration, RDs have a professional role in the ethical deliberation around those decisions. Across the life span, there are multiple instances when nutrition and hydration issues create ethical dilemmas. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the individual and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision requires ethical deliberation. RDs' understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provide an essential basis for ethical deliberation. RDs, as health care team members, have the responsibility to promote use of advanced directives. RDs promote the rights of the individual and help the health care team implement appropriate therapy. This paper supports the “Practice Paper of the Academy of Nutrition and Dietetics: Ethical and Legal Issues of Feeding and Hydration” published on the Academy website at: www.eatright.org/positions.     

American Dietetic Association: scope of dietetics practice framework

As a whole, the Framework provides a structure for our profession by describing the full range of resources available to us all, at every stage of development. At the broadest end of the spectrum, the Framework emphasizes the dietetics practitioner’s professional accountability and places decisions about boundaries of practice in the hands of the individual practitioner. It is intended to be used throughout the profession by students and educators, individual RDs and DTRs, people who have just entered the profession, people who have progressed to advanced or specialty practice, retired dietetics professionals who maintain the active RD or DTR credential, hiring managers, certification and licensure boards, national committee members, researchers, and anyone encountering new challenges at work. It serves as a tool for everyone who engages in the profession of dietetics. And, as we individually and collectively change to respond to new developments in the health care environment, so too will our Framework evolve over time to reflect this.     

Developing and implementing health and sustainability guidelines for institutional food service

Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.     

Environment and gender issues: need to revisit SAP

It is now recognized that environmental degradation, gender inequality, access to and control over resources, gender-based division of labor in survival and management tasks related to the environment, and the feminization of poverty are all interconnected and must be approached with an interdisciplinary, gender perspective. Because women play a vital role in managing biodiversity and socioecological systems, measures that reinforce women's lack of control over resources threaten biodiversity as well as women's position. Creation of truly sustainable and equitable development policies and practices will require a transformation in economic, social, and gender relations that will result in a proper valuing of women's roles as managers of their environments and providers to their families. Policies designed to promote environmental sustainability would also result in desirable population changes. Instead, structural adjustment programs (SAPs) have had a disastrous effect on the environment because they favor large-scale projects over energy-saving projects, are export-driven and stimulate over-exploitation of natural resources, and serve a private market that fails to reimburse environmental costs. Kutznets' Curve explains that environmental pollution is inevitable in the early stages of economic development, prolonged by SAPs, and can only be mitigated when development generates enough money. Until this happens, vulnerable women are experiencing deterioration in their living conditions, and state policies are required to improve this situation.     

Making space for belonging: Critical reflections on the implementation of personalised adult social care under the veil of meaningful inclusion

This paper critically reflects on the way in which recent adult social care reform has been evolving beneath the alleged policy goal of prioritising the cultivation of meaningful inclusion and ‘belonging’ in the community. With this goal, there has been a focus away from ‘services’ for persons with intellectual disabilities, to supporting natural connections within the community. This paper draws on a grounded theory study of the perspectives of those responsible for overseeing community living arrangements for persons with disabilities, drawing on interviews and focus groups with service providers and relevant government officials. It examines the socio-spatial implications of the gradual shift towards ‘belonging’ as a disability policy goal, as it has evolved in two discrete settings – British Columbia, Canada and Ireland. The findings identify the complexities involved in facilitating active community connection for persons with intellectual disabilities and reveal important cautionary lessons for other jurisdictions where community living policy has arguably been moving away from communal services towards self-managed supports in ‘real’ communities through personal budgets in an effort to remove barriers to participation. The paper thus critically reflects on the rapid pursuit for transformation in personalised adult social care in government policy, arguing that the process of fostering meaningful community inclusion will and should take time.     

Nutrition concerns in discharge planning for older adults: a need for multidisciplinary collaboration

This survey of 84 case managers (CMs) (88% response rate) in 11 south Florida hospitals, in one for-profit health care system, sought to identify their discharge planning concerns regarding the food and nutrition needs of older patients, how they addressed these concerns, and the degree to which registered dietitians (RDs) were involved. Most CMs were female (82 of 84, 98%), older than age 40 (59 of 84, 70%), and were registered nurses (51 of 84, 61%). Almost all (82 of 84, 98%) reported job barriers, including excessive patient loads and responsibilities and limited community services. Almost all said that nutrition-related diseases and factors (eg, chewing/swallowing problems, poor appetite, modified diets, poor dentition) strongly influenced discharge planning. Many perceived community nutrition resources (eg, congregate meals, food stamps, shopping assistance, outpatient dietitians) as not readily available. While physicians, nurses, social workers, and physical therapists were identified as very important in discharge planning, RDs were not; almost half of CMs consulted them infrequently, if at all. Strategies for the six nutrition-related case scenarios were inconsistent. Home-health agencies were chosen most often and outpatient RDs least often. Comprehensive discharge planning must include more attention to nutrition with greater input from clinical, outpatient, home health, and community RDs through, for example, attendance at hospital discharge planning rounds, inservices for CMs, and better marketing of RD services. More RDs can and should become CMs to help serve the number of older adults with nutrition-related chronic conditions.