Ch 2 : Scope of Practice for a Nutrition Coach
Nutrition Coaches are responsible for facilitating an action plan for the client. In order to do this, it is very important for them to perform a thorough assessment.
Lesson 2
The Process : Assess, Educate, Implement
Step One of the Process : Assess the Client
- Assessing the client can look like a questionnaire, a verbal interview or a body composition assessment
- A thorough assessment can help rule out any issues that might be beyond my scope of practice. For example, health issues like diabetes, pregnancy, cancer, etc.,
- If the client has a weight loss goal, follow up the assessment with a 3 to 5 day food journal. This will give some insight into the client’s current intake. This can be done manually or using a tracker like MyFitnessPal,
Step Two of the Process : Educate the Client
- It is the responsibility of the Nutrition Coach to educate the client on acceptable nutrition practices and behaviours.
- Provide information that is highly relevant, based on their prior experiences, practical and perceived to be important
Step Three of the Process : Implement a plan
- It is important to keep track of the client’s emotions though the process. Many extreme diets and workouts are not practical in the longterm. If a client is very preoccupied by their physique and is willing to take extreme measures, refer the client to a RDN who specialised in disordered eating.
Lesson Three
Beyond the Scope of the Nutrition Coach
- If a client is not making progress toward their established goals, a referral to a registered dietician or other licensed healthcare professional is warranted.
- Warning signs : Unexpected decline in performance, unexplained fatigue, client becomes pregnant, postpartum
Disordered Eating
- Disordered eating not within the scope of a nutrition coach
- For a quick assessment of an eating disorder, perform the scoff questionnaire. This can be performed formally or informally.
- THE SCOFF QUESTIONNAIRE : Basic yet reliable set of five questions that help assess whether an eating disorder exists.
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry that you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 lbs) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
- A score of two or more on the Scoff Questionnaire indicates a likelihood of anorexia nervosa or bulimia.
Chronic Diseases
- Nutrition coaches can use public information provided by reputable organisations to reduce the risk of certain diseases
- However, if the client has pre-existing conditions like heart disease, cancer or diabetes, it is not within the scope of the practice to provide specific dietary guidelines.
- Hypoglycaemia : A condition of an abnormally low blood glucose (blood sugar) level in the blood.
Psychological Disorders
- After working with a nutrition coach for an extended period of time, a client could potentially develop a very close relationship. If the client provides information on psychological problems, alcohol dependence, panic attacks, etc., make sure to refer the client to a specialist.
- In the case a client mentions thoughts of suicide, an immediate call to emergency services is warranted. Call emergency services and do not allow the client to leave the premises, if possible.
| Reason for Referral | Referral Specialist |
|---|---|
| Lack of progress toward weight loss or weight gain goals | RDN or personal physician |
| Decline in athletic performance | RDN who specializes in sports dietetics (CSSD credential) or personal physician |
| Change in health status: onset of CAD signs/symptoms, trouble regulating blood glucose levels, issues with shortness of breath, chronic pain or fatigue, etc. | Personal physician or Emergency Services (911) if life-threatening |
| Pregnancy or lactating mother | Personal physician and/or obstetrician |
| Extreme preoccupation with weight loss or weight gain | Psychiatrist, psychologist, eating disorder specialist, or RDN |
| Signs or symptoms of depression, anxiety, panic attacks, or more extreme mental health issues | Psychiatrist, psychologist, or Emergency Services (911) if life-threatening |
| Client with well-regulated chronic condition now wants to participate in athletic competition or extreme sports (i.e., a person with diabetes who wants to do an Ironman triathlon) | RDN, CSSD, or physician specialist (i.e., endocrinologist for the triathlete with diabetes) |
| Change in gastrointestinal status (i.e., frequent diarrhea, constipation, gastric reflux, or irritable bowel) | Personal physician or gastroenterologist |
| Client with a chronic condition considering adding supplements to existing medications (i.e., herbs, homeopathy, etc.) | Personal pharmacist, physician, RDN, or alternative health practitioner (licensed by the region) |
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Quiz Questions
The Nutrition Coach can provide specific meal plans for their client. FALSE
The Nutrition Coach can recommend specific supplements for their client. FALSE
The Nutrition Coach can offer advice on eating behaviours and/or macronutrients that are known to reduce the risk of disease or slow disease progression. TRUE
A thorough assessment can help rule out any client who has issues that are beyond the scope of practice for the Nutrition Coach. TRUE
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