What to Expect from a Reproductive Health Dietitian

Working with a dietitian who has experience in reproductive health care can be an incredible way to prioritize your well-being and unlearn diet culture messages about food and the body. However, if you’re not sure what to expect from their care and you forgot to ask in a discovery call (or forgot to book one!), this is a quick guide to some common expectations you can have going in!

As a debrief, Registered Dietitians (RDs) are regulated health care providers, just like doctors, nurses, physiotherapists and pharmacists. There are specific educational and practical requirements to become a dietitian, and legal guidelines to follow that aim to keep the public safe. RDs have to renew their license every year, and may be audited by their regulatory body.

RDs are trained in medical nutrition therapy - this is the application of nutrition recommendations to specific conditions and symptoms, over and above general guidelines you might find on a public health or government website. RDs don’t practice medicine, but they collaborate with doctors to support whole-person care.

Because of their scope, a reproductive health RD will not be able to conduct pelvic exams or imaging, but they may help advocate for you with your family doctor or health care team. This might look like calling your doctor or writing notes and letters to share their assessment notes and seek additional opinions.

RDs may or may not be able to order bloodwork testing as this can depend on their location and if they have a directive in place. As an example, some Family Health Teams may allow RDs to request blood sugar panels, and some Intensive Care Units allow RDs to request indirect calorimetry to determine energy expenditure. Most RDs can help you make a list of potential testing to talk to your doctor about, and look at the results from testing. As an FYI, RDs cannot make a diagnosis of anything off of your bloodwork results (even if they know the diagnostic criteria for things like diabetes or kidney disease).

RDs cannot write prescriptions for you, in most cases (in the past, I was certified to write prescriptions for nicotine replacement therapy but I no longer do this). They can provide you with support around taking medications if you find it hard to remember to take them, or if you have multiple medications and supplements that might interact with each other. And most RDs are required to have some baseline knowledge of how different classes of medications work, so they may be able to review what your doctor or pharmacist has told you if you’ve forgotten.

RDs may provide very specific food recommendations to address symptoms such as constipation or nutrient deficiencies, or they may use a counselling approach to talk about the way you think about food and make food choices. They can talk to you about supplements that may be helpful, and how to choose a safe supplement that has been third-party tested. You can ask them what approach they take to care so you know what kind of resources you will be given in sessions. You’re not ever required to follow these recommendations without your consent to participate, and you are allowed to decline services and request a second opinion - just like any health care situation.

RDs should be able to have conversations with you about a healthy relationship with food and your body without body or weight shame. Many RDs still practice from a weight-centric approach (focusing on weight and weight loss as a marker of health), and this contributes to medical weight stigma and systemic fatphobia. Talking about the social determinants of health and non-weight markers of health should be a component of your care.

Like any other health care provider, RDs should disclose any financial relationships, conflicts of interest or commissions they make in selling services or products. If they don’t, you are allowed to ask. While there isn’t anything inherently wrong with making commissions or having brand partnerships, these need to be appropriately disclosed and they should not impact the use of evidence to provide care.

This last one may vary by region - RDs shouldn’t use client testimonials to support their clinical work. In Ontario and Newfoundland (two provinces where I am currently licensed), guidelines states that RDs should refrain from the use of client testimonials as these may skew perceptions of their work and may inadvertently disclose private information of a patient or client (like their name or location). An RD may use testimonials or reviews for non-clinical work they do, such as presentations to workplaces or public handouts - these might help people make informed purchasing decisions and don’t necessarily influence their ability to access health care.

Having strong expectations going into a dietitian appointment is important to help you get the care you deserve and invest in your health the way that makes sense to you!