As MAHA champions nutrition, it’s ignoring the experts, dietitians say

WASHINGTON — Changing Americans’ nutrition has been among the Trump administration’s most prominent health policies since Robert F. Kennedy Jr. became health secretary. Officials have flipped the food pyramid to emphasize the role of protein in the diet, encouraged the public to cut back on highly processed foods, and started overhauling meals served at schools, on military bases, and in hospitals. Some of the administration’s ambitious food goals, however — including expanding nutrition coaching in primary care and helping chronically ill people eat more fresh produce — may be harder to achieve, as they require an atrophying workforce: dietitians. Long-standing problems and new barriers are combining to make a career in dietetics less appealing and less financially feasible, just as the nation is increasing its appetite for nutrition in health care. So far, even the secretary’s Make America Healthy Again movement — which emphasizes poor diet as a main driver of chronic disease — has done little to assuage dietitians’ deeply rooted troubles. “I would predict that 20 years from now, unless something seriously changes, the role of a dietitian will not really exist,” said Jo-Ann Heslin, a registered dietitian, now in her 70s, who has written dozens of popular nutrition books. For decades, America’s dietitians have struggled against low salaries, the product of a system in which preventive care, including nutrition, is undervalued. That is true in a literal sense: For the most part, unless someone has a diagnosis of diabetes, kidney disease, or has recently received a kidney transplant, Medicare and Medicaid won’t cover a dietitian’s services. Private insurers have tended to follow that lead, and many cover only a handful of visits, often after a person has developed a chronic condition. Even though commercially insured patients have more access to dietitians, they often face copays that can quickly add up. Those issues persist, even as the field has tried to further professionalize and legitimize itself. As of 2024, aspiring dietitians need to get a master’s degree and complete a 1,000-hour internship before they can sit for the certification exam. JaKyra Allen, 22, was in the first cohort of students to need a master’s degree before entering the dietetics workforce. She wanted to become a dietitian because she grew up with congenital heart disease, and felt that her cardiologist never had satisfying answers about her symptoms, or how diet could affect them. Several of her family members died young of heart disease. During the Covid-19 pandemic, Allen started planting squash, watermelon, okra, and peppers at her family home in Louisiana, and learning how to prepare the food she grew. Her family started eating better, and her chest pain and shortness of breath decreased. But Allen’s interest in helping her community be well-fed quickly ran up against the practicalities of becoming a registered dietitian. Her family had to come up with an extra $10,000 — on top of nearly $50,000 for her undergraduate studies at Louisiana Tech University — to fund the master’s degree. She is nearly done with her 18-month internship at Southern University and looking at job prospects. The pay in Louisiana is bad, Allen said, sitting around $55,000 annually for a clinical dietitian job in a hospital. She’s looking in Texas instead, where the hourly wage is “more attractive.” But if she had known about all the challenges dietitians face, Allen “absolutely” would’ve chosen to go into medical technology or a different field. “I was just more passionate about nutrition. I know so many people that are affected by it,” she said. New policies create more problems As of last May, the mean wage for a registered dietitian was $77,000, according to the Bureau of Labor Statistics — almost $40,000 less, on average, than physician assistants, nurse practitioners, speech-language pathologists, and physical therapists. The One Big Beautiful Bill Act passed by Congress last year only magnified those financial pressures. The law capped federal graduate loans at $100,000 for dietetics, leaving many aspiring RDs to figure out the finances by themselves, or take on personal loans to complete their training. The loan cap policy comes as the dietetics pipeline is already in decline. Enrollment across accredited dietetics programs fell 39% in the past decade, and undergraduate degrees in the field peaked in 2014. In 2023 and 2024, more internship slots were empty than not. The money issue is driving people into higher-paying dietitian jobs in private practice or outpatient clinics, or into other fields, like nursing, said Jason Fee. As a result, fewer dietitians in the U.S. are working in clinical settings, leaving hospitals understaffed to care for the sickest patients. “That is where the highest need for the credential is,” said Fee, who before starting a private practice in central Florida, was for months the lone dietitian at his hospital. He predicts the loss of skilled hospital dietitians will become a major issue as the U.S. population ages. It could also become a barrier in the near future, as the Trump administration tries to use its biggest levers — Medicare and Medicaid — to implement nutrition reform. As of 2028, the Centers for Medicare and Medicaid Services will require more reporting on nutrition for patients hospitalized for more than a day. Advocates, including at the Academy of Nutrition and Dietetics — the largest nonprofit organization for dietitians in the U.S. — hope the change will make identifying and treating malnutrition a more consistent practice. However, the policy doesn’t carry any new dietetics funding or staffing requirements, meaning it won’t explicitly require hospitals to hire more RDs. Mandating malnutrition reporting could increase the need for dietitians in already understaffed hospitals, or create overwhelming caseloads that could endanger patients and heighten the risk of RD burnout. STAT reached out to CMS for comment. Trump officials are also trying to expand the reach of Food is Medicine programs, which provide chronically ill people with medically tailored meals and produce prescriptions, by letting states seek Medicaid coverage for the service. Food is Medicine often relies on dietitians to assess people’s nutrition needs and build a responsive meal plan. Tammie S. Brown, an Alabama dietitian who runs her own clinic, said she has had to turn away Medicare and Medicaid patients because of the reimbursement problem. She has built a financially viable business over time by taking only patients with private insurance, and building relationships with physicians who can refer patients to her, she said. While she has no problem with other medical professionals learning about nutrition (something Kennedy has pushed for), the health care system will still need a specialized workforce, Brown said. Doctors and nurses usually don’t have time to do the in-depth screenings and counseling a dietitian does. “Everybody thinks they can do our job, and they can’t,” she said. To boost payment for dietetics, she and many others are advocating for federal legislation to expand the population that’s eligible for covered nutrition counseling. The bipartisan Medical Nutrition Therapy Act, reintroduced by Sen. Susan Collins (R-Maine) in February, would give more Medicare patients access to dietetics. People with prediabetes, high cholesterol, eating disorders, and celiac disease, among other conditions, would be able to receive nutrition care under Part B. However, the fate of that bill is uncertain. It has not moved since the spring. STAT reached out to Collins for comment. Left out of food-first prevention Politicians in Washington recognize and appreciate the work of dietitians, said Alison Steiber, chief impact officer of the Academy of Nutrition and Dietetics. Academy members regularly talk to the Trump administration and lawmakers about policies, including Collins’ MNT Act, Steiber said. In Alabama, Brown said lawmakers have started asking about Food is Medicine — a promising sign in a deep-red state. However, that friendly political dynamic isn’t registering for many in the field. Sara Cardenas, a California-based dietitian working in school nutrition, said she became doubtful after watching Trump officials use fearmongering to promote their nutrition agenda. She recalls in one instance, the Department of Agriculture posted on social media about new school meal goals, including serving more whole grains and limiting ultra-processed foods, all of which were already in place or being implemented. “It’s like, this information is not new. It’s just being portrayed as a new thing, which I think makes the population worried and fearful,” she told STAT. Others wondered why there hadn’t been more collaboration or visible interaction between Kennedy and registered dietitians. The secretary has publicized his meetings with everyone from health technology CEOs and regenerative farmers to addiction recovery specialists, fast-food executives, and beyond. HHS did not respond to STAT’s request for comment. On the whole, dietetics has not appeared to be a priority for the administration, with much of the conversation focusing on bolstering nutrition education for medical doctors, or elevating non-credentialed roles, like wellness coaches. Some dietitians have additionally felt thrown off by new dietary advice that goes against the nutritional consensus, including an emphasis on meat, and the maligning of seed oils. Others have felt personally attacked by Kennedy’s anti-establishment rhetoric. “It kind of feels like we’ve ‘had our time’ to make America healthy, and we’ve failed,” said Jennifer White, an RD who works with pregnant women at a northern California federally qualified health center. Dietitians see themselves as an antidote to the mixed bag of nutrition information people are getting online, in conversation with AI chatbots, or even in official government documents. They can manage everything from daily eating advice to keeping gravely ill people alive. They can tailor nutrition plans to treat and prevent illnesses like type 2 diabetes and kidney disease, and teach patients about healthy food preparation. They work in schools, long-term care facilities, supermarkets, and food companies, providing nutritional guidance for products and menu items. In hospitals, they make recommendations for IV nutrition, tube feeding, or other nutrition supports. All this makes them an ideal group of professionals to combat chronic disease. While lamenting MAHA’s underuse of their expertise, some dietitians suggested that their field should be doing more to own the MAHA moment, and set the profession apart from the hordes of minimally trained nutrition influencers pushing various diets. “The dietitians should’ve gone in there with guns blazing and said, ‘You believe in prevention? We’re it,’” said Heslin, the dietitian-author. As of August, there are about 116,000 RDs working in the U.S. — a small army equipped with the knowledge to change Americans’ nutrition for the better. “And it has not been explored fully enough,” Heslin said. “It’s like having a pantry full of food and you forgot to open the door.” STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.