Research dietitian nutritionist perspectives

Significant changes in financial policies under the CTSA impacted how or if RDNs provided nutrition services for investigators. One RDN commented, “We’re in the midst of a pendulum shift towards very little support for the kind of work that we have all been trained to do.” In addition to varying levels of institutional support, centers moved to cost recovery models where investigators paid for nutrition services previously provided at no cost. Nutrition staff salary costs were not fully recovered, leading to RDN and nutrition support staff reductions and, in some cases, closure of nutrition units. Facility changes varied, including loss of metabolic kitchens and location changes. Reported benefits included new kitchens, offices, equipment, and networking opportunities. Two RDNs described “champions” among their administration who advocated for continued nutrition research resources.

NARN members navigated the transition with flexibility and agility. Some expanded their role to include administrative tasks associated with a fee-for-service model, marketing their services, or working with the Community Engagement Program. Others began offering services such as exercise testing.

Due to funding cuts, some RDNs used convenience foods instead of whole foods for feeding studies, and when metabolic kitchens were eliminated, food was often procured from affiliated hospital kitchens. This reduced costs but sacrificed quality, accuracy, and reproducibility. Furthermore, RDNs assisted with food preparation when staffing reductions were necessary. When inpatient facilities were lost, RDNs supervised feeding studies at hotels and other locations.

Some RDNs expressed concerns, while others felt optimistic about the future and the institutional support for their services; “the opportunity is that we get to start over and do things a little bit different….” RDNs observed reduced requests for services, especially complex long-term feeding studies, which they attributed to the loss of inpatient facilities and investigator’s inability to cover the costs; “when what we did was free, everybody talked about…how important nutrition was…to public health challenges….” If disease prevention and treatment through nutrition research are not prioritized, the next generation of investigators may be unable to conduct complex nutrition studies. A quality concern noted was “outsourcing” of services such as dietary recalls and body composition measurements to untrained study coordinators to reduce costs. This outsourcing may further constrain nutrition staffing and has implications for the rigor and reproducibility of nutrition research.

RDNs were also concerned about the lack of time, funding, and studies needed to train the next generation of research RDNs. As one RDN considered retirement, she wondered, “Will they replace me with another dietitian, and will this dietitian have any research experience?”

Regret was expressed about the loss of the annual GCRC meeting where RDNs kept abreast of NIH research changes, shared best practices, and networked with peers. NARN helps fill this gap with webinars and member forums.