Is a Registered Dietitian’s Help Really Worth Paying For?

Adapted from article published in Sacromentor Bee May 20, 1990: Professional help for losing pounds; you lose necessary weight without losing unnecessarily in pocketbook.

Have you ever wanted something for nothing? Or next to nothing? Do you want a ‘magical’ solution to a big-time problem?

The recent concerns that have been raised about the weight loss industry support buyer beware.

As a registered dietitian (one of 60,000+ nationwide), I am a trained health care professional and my job is to translate the science of nutrition into practical suggestions for the public.

Why then does John Q. Citizen select the highly advertised commercial business as his source for weight loss expertise?

I call it “health care mentality” although consumers are beginning to recognize the R.D. (registered dietitian) as a trained professional, John Q. says to himself “my doctor referred me to the R.D. for cholesterol, high blood pressure, diabetes, obesity, etc.; therefore this expense/service should be covered by my health insurance policy.”

Although recently recognized as a disease, obesity treatment is frequently denied coverage by most insurance companies. Coverage for nutrition services for other health-related problems is variable. Since R.D. services are not covered frequently, out citizen does not want to pay out of pocket. Yet he will go to a commercial weight loss program and pay without question.

For example, let’s look at a scenario of a 35-year old woman who has hypertension and is 40 lb overweight and who consults with an R.D. and compare this to a commercial business.

When consulting with an R.D., and appropriate history and nutritional assessment will be completed at the first visit. This session typically lasts one hour. At the end of this time, our patient will leave with an eating pattern based on her likes and dislikes and her usual way of eating. It will be designed to produce a weight loss of 1-2 pounds per week, including information on avoiding high sodium foods, and recommendations for exercise. The cost for this service is $40 to $50 (costs vary across the country).

Regular follow-up is planned with her individual needs (financial, counseling, support) in mind. Assuming compliance with the plan and follow-up appointments (30 minutes) every three weeks, the program will last approximately 25 weeks (assuming a loss of 3 pounds the first week and 1.5 pounds thereafter). The cost of eight follow-up appointments is $160 to $200 ($20 to $25 each; costs vary across the country). Most importantly, changes in behavior are taught gradually over time using “real” food purchased at regular outlets.

In contrast, at a typical commercial program, the fee is frequently promoted as “lose all the weight you need for $49 to $195.” What is not obvious is that weekly food costs can run $40 to $50 (not including fresh produce, etc.). Weekly or daily weights are encouraged and/or required. Sessions are with “counselors” who have variable training; the pay scale will screen out those most qualified. For example, I interviewed with a major company and was offered $5 per hour to start—this with a bachelors and masters degree and 20-plus years of experience.

Our same woman can spend $49 to $195 initially. Let’s assume a special low rate of $49 and a promised weight loss of 2 pounds per week. Assuming a loss of 4 pounds the first week, it will take her 18 weeks to lose the 40 pounds. The 18 weeks will cost nothing for the “counseling”, but food costs at $40 per week equals $720 or a total of $770.

The same woman would not think to question health insurance coverage for this program.

Is she learning how to maintain her weight loss? Is she able to eat meals with her family? Can she eat out? Travel? Can she buy food at regular outlets? Should she beware?

This woman spent over three times at a commercial program than a one-on-one sessions with a trained health professional in food and nutrition expert. More importantly, if she met with the R.D. she would learn how to keep the weight off for the rest of her life - traveling, eating out, at meetings, at home - whever her life took her.

Investigation by appropriate agencies and media coverage will do much to bring these issues to light. Each of us needs to take responsibility to modify our health risks. The R.D. is the most appropriately trained professional to educate regarding food and nutrition issues. R.D.s do not have large advertising budgets and are less inclined—ethically and professionally—to offer magic easy solutions.

According to Nancy Wellman, Phd, RD, former American Dietetic Association president: “Balance, variety and moderation are still the keys. Changing eating habits is a gradual process which requires individualization, ongoing monitoring, and reinforcement. Dietitians play a vital role in helping people make permanent adjustments. We’re a dieter’s personal cheerleader.”

So may the consumer beware.