Personal Trainers Should Not Offer Nutrition Advice
Many personal trainers offer nutrition advice to their clients. However, they probably shouldn't.
What's wrong with that?, you ask. Personal trainers do this all the time, right? Certainly, diet and nutrition issues come into play if the exercise goal is to lose weight, or to perform well in a race, or to "get big muscles."
NUTRITION COUNSELING REQUIRES LICENSURE/CERTIFICATION
At least 40 states, plus the District of Columbia require licensure of nutrition/dietetics professionals. In most states, the licensing statutes explicitly define the scope of practice and state that performing as a nutrition/dietetics professional without first obtaining a license is illegal. In addition, many employers require dietetics professionals to be registered with the Commission on Dietetics Registration.
It is acceptable for healthcare professionals (ie., other than registered dieticians) to make nutrition recommendations, however no healthcare professional receives as much formal education on nutrition as do registered dieticians....including physicians. In fact, many medical schools do not provide formalized courses on nutrition.
It is very important for healthcare professionals to know when to refer patients to another clinician. For example, you probably wouldn't ask your dentist for advice on how to lower your cholesterol. Even though your dentist has the legal authority to prescribe drugs, and, may actually know quite a bit about how to manage cholesterol imbalances, it would be inappropriate for him/her to write a prescription for a cholesterol-lowering drug. Why? Because it's outside the scope of professional practice for a dentist.
On the other hand, personal trainers are (in general) not licensed healthcare professionals and yet we find it perfectly acceptable to listen to their nutrition advice when they offer it.
STANDARDS OF PRACTICE FOR PERSONAL TRAINERS
The American Council on Exercise (ACE) is one of the leading fitness organizations that certify personal trainers. Their Code of Ethics does not mention nutrition counseling specifically, however it does state that personal trainers should "refer clients to more qualified health or medical professionals when appropriate." In their training manual for personal trainers, they state: "if you are not a registered dietician or healthcare professional, you should avoid making specific recommendations and refer your client to a registered dietician or physician."
On the topic of recommending dietary supplements, ACE has adopted a firm stance. Their Position Statement on Nutritional Supplements states: "It is the position of the American Council on Exercise that it is outside the defined scope of practice of a fitness professional to recommend, prescribe, sell, or supply nutritional supplements to clients."
And the legal ramifications of inappropriate nutritional counseling can be staggering.
In the 1999 case Capati vs. Crunch Fitness, Anne Marie Capati, 37, died from a brain hemorrhage after a physical trainer gave her a list of herbal supplements to take despite knowing that she had high blood pressure that required medication. One product recommended and taken, Thermadrene, contained “20 mg of active ephedra, 150 mg guarana seed, 80 mg caffeine, 75 mg purple willow bark, 60 mg cayenne pepper, and 40 mg ginger root.”
Ephedra, particularly when used in combination with caffeine, has led to thousands of reports of adverse effects (see the related story "Ephedra: A Dangerous Supplement"). The use of these substances by someone with hypertension, particularly when they are taking medication for that condition, is extremely risky. In this case, it led to a death and a $320 million lawsuit.
But fines could be levied against a personal trainer who engages in nutrition counseling even if the conduct did not result in harm.
Actions (eg., behavior) can be just as important as titles and certifications: In one Ohio case (Ohio Board of Dietetics vs. Brown, 83 Ohio App; 3d 242, 1993.), the state issued a cease and desist notice based on this issue.
Thus, both criminal and civil penalties are possible when nutritional counseling is found to be inappropriate.
WHERE DO YOU DRAW THE LINE?
So, where do you draw the line? Personal trainers are frequently sought out by clients who want to lose weight. And, as mentioned above, proper nutrition is an important element of many fitness goals.
While it may seem pretty obvious that dentists should not be treating elevated cholesterol, where to draw the line when it comes to nutrition advice is much more blurry.
Here's an example of appropriate and inappropriate comments in a hypothetical conversation between a personal trainer and a client (from a presentation at ACSM, Orlando, FL, April 12, 2006):
- Acceptable: "Orange juice is a good source of vitamin C."
- Not Acceptable: "You should drink more orange juice."
The difference is subtle, but clear. The first comment is simply a statement of fact. The second statement is a recommendation...much different.
While it's true that many fitness goals cannot be addressed without also considering proper nutrition, that does not mean that personal trainers should be giving out that advice.
Unless your personal trainer is also a licensed and registered dietician, be highly suspicious if he or she suggests that you take supplements, or, makes specific nutritional recommendations. Not only are these behaviors inappropriate for personal trainers, but, some supplements can lead to very serious side effects.
Here are some guidelines:
• Work with a personal trainer who holds a certification from a reputable organization such as American Council on Exercise (ACE), the American College of Sports Medicine (ACSM), the National Strength and Conditioning Association (NSCA), or the National Athletic Trainers Association (NATA). Even better, find one who also has a college degree in a related exercise, fitness, or healthcare discipline.
• Talk to a qualified dietician before making any major change in your diet. Note that there are dieticians who specialize in "sports nutrition." They can be found by contacting the American Dietetic Association (see below).
• Don't take any nutritional supplements without first talking to a knowledgeable pharmacist or physician. Note that even many healthcare professionals -- including dieticians -- aren't aware of some of the concerns and risks associated with nutritional supplements. So, when in doubt, it's probably best to avoid taking any supplements until you know they are safe for you.