The Various Roles of an RD: WIC Nutritionist

I had the wonderful opportunity to do a rotation in the state WIC office at the Department of Public Health which included one week at a local WIC office. For those who might not be familiar, WIC stands for Women, Infants, and Children and is a nutrition program where pregnant women, moms, and children who meet income requirements are eligible for nutrition education, breastfeeding resources, and supplemental food coupons. Unlike SNAP or Food Stamps, WIC coupons are only good for very specific foods (these vary but the basics are: milk, whole grains, and fruit and vegetables) and the participants must attend nutrition counseling on a regular basis. WIC also highly encourages breastfeeding as it is the best nutrition for newborn babies by offering peer counselors, lactation consultants, and incentives for women who choose to breast feed exclusively.

The role of an RD at the state office differs greatly from that of an RD or nutritionist at a local WIC clinic. Obviously at the state level they are more focused on statewide programs, grants, and overseeing the local clinics, making sure that they are meeting the standards set forth by the state. At the local level, all WIC clinics employ nutritionists, and these may or may not be RDs. Some are LDNs (Licensed Dietary Nutritionists), some are DTRs (Diet Tech, Registered) and some have met other levels of education in order to qualify.

In the day-to-day role of a WIC nutritionist, they will see participants throughout the course of the day either from appointments or on a walk-in basis. These appointments range from pregnant mothers to mothers who have infants to children up until age 5 and they differ slightly based on the type of appointment (initial, low-risk follow-up, high-risk follow-up, etc). When a participant arrives they first have their height and weight taken. Then the nutritionist will sit with them to go over the child’s growth chart and where they fall on the weight for height chart. After that he or she will take a diet recall which might result in the number of ounces of formula per day a baby is drinking or what a toddler eats during the course of the day depending on the participant. Once the diet recall is complete the nutritionist will focus on any problems identified and methods for changing (for example if a child is not drinking the recommended amount of milk per day, they will work with the mom to identify where in the diet to include an extra serving). At the end of the appointment the nutritionist goes over the participant’s “package” which is what specific coupons they receive. Any changes are made based on a few factors such as whether the participant has decreased the amount that they are breastfeeding or whether the participant would rather get whole wheat tortillas instead of whole wheat bread. When the appointment is done the coupons are printed.

There are a wealth of handouts produced by WIC in several languages that are available for the nutritionists to distribute. At the local clinic where I spent the week many participants spoke Vietnamese or Spanish, so there are nutritionists on staff there who speak those languages. WIC also provides referrals to other organizations such as parenting groups, fitness classes, and community activities. WIC is a national program and employs many dietitians, making it a good career option for any RD or RD hopeful across the country.

The Various Roles of an RD: Community/Non-profit Dietitian

There are lots of opportunities for an RD to work in a community setting. Many non-profits employ RDs. This could range from someone working for an organization that delivers healthy meals to people who are chronically ill to someone who teaches urban or low-income teens how to grow vegetables in a city.

I was fortunate enough to be placed at the Greater Boston Food Bank (GBFB) for a rotation and got to see what it might be like to be an RD working under the hunger umbrella. There are actually a few RDs who work at this particular organization and they serve a variety of roles. They help to ensure that all of the food that goes out to pantries and organizations is safe (ie not expired), train people from pantries and organizations in food safety, and help to teach people at these organizations about healthy eating. This may sound a bit abstract so I'll focus mainly on what I did while I was there:

• Design and implement lesson plans about nutrition for kids at a Boys and Girls Club. The GBFB supports a program called Kids Cafe where kids get an evening meal served for free at the Boys and Girls Club. I taught the kids about sodium, calcium, and the importance of fruits and vegetables by playing games and making recipes.
• Create and cook a recipe for a School-based Pantry. These pantries, as well as Mobile Markets, are one way that the GBFB donates food directly to consumers. They set up in a school cafeteria in the community and parents can come and take a variety of foods such as vegetables, fruit, bread, hummus, and yogurt. The day that I went we found out that we'd be handing out acorn squash so I made an acorn squash pasta bake. I handed out samples as well as recipes so that they could make good use of their squash!
• Write nutrition newsletters for different audiences. A few other programs that GBFG implements are the Backpack and the Brown Bag program. Backpack ensures that kids have a bag of shelf-stable food to take home on the weekends and Brown Bag gives bags of groceries to seniors in a supermarket bag to remove any stigma associated with receiving donated foods. Within each bag of food is a nutrition newsletter geared at either the seniors or the kids. These feature a recipe, some cooking tips, and a game.

Working at the food bank is just one example of how an RD can make a difference by working within the community. While it is a very different role from a clinical or counseling position, it is important in the effort to make the community a healthier place!