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abstract: Currently, there has been limited research on evaluating the social media use and competency level of registered dietitian/nutritionists (RD/N). With health information increasingly sought on social media, it is imperative to understand the social media competency of health professionals. The social media use, reach, and competency level of a nationwide RD/N sample was assessed utilizing an online survey. The sample (n=500) while mostly female (97%) was representative of RD/Ns compared to the nationwide statistics from the Commission on Dietetic Registration. The sample included RD/Ns from forty-six states with California (n=44), New York (n=42), and Texas (n=34) having the largest proportion of respondents. The majority of RD/Ns engage in social media for personal use (92.4%) and 39.2% engage for professional use. One hundred and twenty-five RD/Ns reported 777 ± 1063 (mean ± SD) social media followers. As compared to non-millennial RD/Ns, millennial RD/Ns engaged significantly more in social media for personal and professional use (+10% and +13.5% respectively, p<0.001) and scored significantly higher for social media competency (p<0.001). Additionally, food and nutrition management and consultant/private practice/industry RD/Ns had significantly higher competency scores than clinical RD/Ns (p=0.015 and p=0.046, respectively). RD/Ns who use social media personally and professionally had a significantly higher competency score than RD/Ns who did not (p<0.001). There were significant associations of Facebook, Twitter, total followers and total average followers with the social media competency score (r=0.265, 0.404, 0.338, & 0.320, respectively) in RD/Ns. Specifically, the social media competency score, was found to explain 16% of the variation in the number of Twitter followers and 10% of the variation in the average number of followers by platform. These data suggest an opportunity to increase RD/Ns’ social media reach (i.e. following) by improving competency level. / Dissertation/Thesis / Doctoral Dissertation Physical Activity, Nutrition and Wellness 2017

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Kentucky has a health crisis and most of the causes can be linked to diet, smoking and physical activity. Vegetarian and vegan diets have numerous benefits for many diet related health problems such as obesity, heart disease, Type 2 diabetes and certain cancers. There has been limited research on vegetarians and vegans in the United States and none in Kentucky. This study used an anonymous electronic survey to examine the different characteristics, behaviors, experiences and opinions of adult vegetarians and vegans in Kentucky. Results were compared to statistical data reported on the general population of Kentucky. Calculated body mass index (BMI) from self-reported height and weight showed 36% of vegetarians and 21% of vegans to be overweight or obese compared to 67% of the general Kentucky population being overweight or obese. The impact on BMI due to type of plant based diet (vegetarian or vegan) was found to be of greater significance (p=0.0030) than that of exercise. Reports from both groups indicated that they may be underserved by health care professionals. These findings have important implications for dietitians, dietetics education programs and health care providers concerned with high rates of obesity and chronic diseases.

The media has highlighted a proposed link between a gluten free diet (GFD) and weight loss. However, research related to weight gain and a GFD for persons with celiac disease (CD) has shown the opposite effect. A GFD is the only known treatment for persons with CD. If a patient with CD consumes a diet high in GF processed foods, weight management may be difficult to achieve. Participants with self-reported CD completed a modified GF food frequency questionnaire (FFQ) to assess typical dietary consumption of whole grains, sweets, fruits, vegetables and regular soda. Additionally, body mass index (BMI) and exercise were assessed. The results of this study found that whole grain, fruit and vegetable intakes were low among celiac patients. Additionally, BMI was on the high end of the normal weight range. The results of this study indicate that a greater emphasis should be placed on nutritional quality when counseling patients with CD. Registered dietitians should focus their diet counseling sessions with CD patients on a nutritious naturally GF diet in order to better manage weight.

Minimal educational requirements for Registered Dietitians (RDs) include a bachelor’s degree and practice program. Recently, a master’s degree was recommended. Studies have not established whether education affects employment. A secondary analysis of 2005 Dietetics Practice Audit data determined whether job responsibility, individuals supervised, and activities differed between 1,626 bachelor’s RDs (B-RDs) and 767 master’s (M-RDs) RDs, registered ≤5 years. Chi-square and ANOVA analyzed differences between B-RDs and M-RDs, at entry-level (0-3 years experience) and beyond-entry-level (3+-5 years experience). Beyond-entry-level B-RDs (31.8%) and entry-level M-RDs (31.9%) reported “supervisor/executive” responsibility more than entry-level B-RDs (26.5%; p=0.01). A higher percentage of M-RDs supervised (29.2%) than B-RDs (24.7%; p=0.02); however, B-RDs supervised more individuals (7.38 ± 4.89) than M-RDs (6.25 ± 4.87; t=2.32; p=0.021). A master’s degree has limited benefits; experience may affect responsibility, individuals supervised, and activities more than education.

Eating Disorder-Diabetes Mellitus Type 1 (ED-DMT1) refers to individuals who have type 1 diabetes and a co-occurring eating disorder. The aim of this study was to identify current treatment practices for individuals with ED-DMT1 in a residential eating disorder treatment setting. Clinical nutrition managers (CNMs) at 18 residential eating disorder treatment facilities were interviewed about treatment practices for patients with type 1 diabetes. Four themes were identified through qualitative case study analysis: 1) nutrition interventions for patients with diabetes, 2) medical diabetes management, 3) interdisciplinary diabetes team, and 4) CNM's assessment of diabetes care. The majority of CNMs interviewed reported utilizing an exchange- based meal plan, which is well suited for patients with type 1 diabetes. Dietitians described the use of diabetes technology (e.g., insulin pumps and continuous glucose monitors) and described a gradual advancement of responsibility and autonomy with portioning food at meals and snacks and managing diabetes care. The dietitian is heavily involved in providing diabetes education along with the medical and/or nursing team. The majority of CNMs interviewed demonstrated knowledge deficits related to diabetes management and expressed the need and desire for increased education for themselves and other staff members in order to provide the highest quality of care.