in some provinces. each province has an independent professional college (for example, the college of dietitians of ontario) which is responsible for protecting the public and regulating the profession. the colleges are entirely funded from licensing fees collected from dietitians. each college must have both public and professional members, and is empowered to investigate and censure (when malpractice/negligence is found) members of the profession who breach either their scope of practice or harm/endanger the health of a patient/client, and receive a complaint against them from a member of the public or another health care professional. to practice as a registered dietitian within a province, a dietitian must register with the college and obtain a license. the activities of the college are governed by legislation passed by the provincial government. it is the presence of this regulatory body which distinguishes registered dietitians from nutritionists in canada, the regulations for which vary by province (exceptions: alberta where "registered nutritionist" is a protected title that can only be used by dietitians. similarly in nova scotia and québec "nutritionist" is protected and can only be used by dietitians) the colleges also set the minimum entry requirements for admission into practice as a registered dietitian. requirements to entry into practice as a dietitian include a four-year undergraduate degree from an accredited university (which includes courses in science, foods, nutrition, management, communication and psychology/sociology, among others), a 10–12 month supervised practice period (called an internship), and successfully passing a board exam in nutrition and dietetics. the national professional association in canada is dietitians of canada. south africa in south africa, dietitians must be registered with the health professions council of south africa. the council regulates the following professional titles: dietitians, supplementary dietitians, and student dietitians, as well as nutritionists, supplementary nutritionists, and student nutritionists. requirements for eligibility for registration include a recognised bachelor's degree in dietetics or nutrition from an accredited educational institution. the undergraduate training should include the three practice areas of therapeutic nutrition, community nutrition, and food service management. against the backdrop of the hiv/aids epidemic in south africa, there remains high demand for greater numbers of practicing dietitians, along with other health care staff, in order to expand public sector health care services. academic programs, professional associations, and credentialing requirements do not exist for dietitians in most other african countries, where the number of professionals in dietetics is very low. united kingdom in the united kingdom, dietitians must be registered with the health and care professions council (hcpc, formerly the health professions council, hpc) in order to be able to work for the national health service. the education requirements include obtaining either a bsc in dietetics or a postgraduate qualification approved by the hcpc. united states in the united states, nutrition professionals include the dietitian or registered dietitian (rd), as well as "dietetic technician" or "dietetic technician, registered" (dtr) (see below). these terms are legally protected, regulated by the academy of nutrition and dietetics which registers and confers professional credentials. the academy also recognizes and certifies certain specialty areas, such as in gerontological nutrition. dietitians are registered with the commission on dietetic registration (the certifying agency of the academy) and are only able to use the label "registered dietitian" when they have met specific educational and professional prerequisites and passed a national registration examination. besides academic education, dietitians must complete at least 1200 hours of practical, supervised experience through an accredited program before they can sit for the registration examination. in a coordinated program, students acquire internship hours concurrently with their coursework. in a didactic program, these hours are obtained through a dietetic internship that is completed after obtaining a degree. in both programs the student is required to complete several areas of competency including rotations in clinical, community, long-term care nutrition as well as food service, public health and a variety of other worksites. once the degree is earned, the internship completed, and registration examination passed, the individual can use the nationally recognized legal title, "registered dietitian", and is able to work in a variety of professional settings. to maintain the rd credential, professionals must participate in and earn continuing education units (often 75 hours every five years). in addition, many states require specific licensure to work in most settings. for instance, the california business and professions code section 2585-2586.8, states that: any person representing himself or herself as a registered dietitian shall meet one of the following qualifications: been granted, prior to january 1, 1981, the right to use the term "registered dietitian" by a public or private agency or institution recognized by the state department of health services as qualified to grant the title, provided that person continues to meet all requirements and qualifications periodically prescribed by the agency or institution for the maintenance of that title. possess all of the following qualifications: (a) be 18 years of age or older. (b) satisfactory completion of appropriate academic requirements for the field of dietetics and related disciplines and receipt of a baccalaureate or higher degree from a college or university accredited by the western association of schools and colleges or other regional accreditation agency. (c) satisfactory completion of a program of supervised practice for a minimum of 1200 hours that is designed to prepare entry level practitioners through instruction and assignments in a clinical setting. supervisors of the program shall meet minimum qualifications established by public or private agencies or institutions recognized by the state department of health services to establish those qualifications. (d) satisfactory completion of an examination administered by a public or private agency or institution recognized by the state department of health services as qualified to administer the examinations. (e) satisfactory completion of continuing education requirements established by a public or private agency or institution recognized by the state department of health services to establish the requirements. in addition: it is a misdemeanor for any person not meeting the criteria... in connection with his or her name or place of business, the words "dietetic technician, registered", "dietitian", "dietician", "registered dietitian", "registered dietician", or the letters "rd", "dtr", or any other words, letters, abbreviations, or insignia indicating or implying that the person is a dietitian, or dietetic technician, registered or registered dietitian, or to represent, in any way, orally, in writing, in print or by sign, directly or by implication, that he or she is a dietitian or a dietetic technician, registered or a registered dietitian. as recent studies have shown the importance of diet in both disease prevention and management, many us states have moved towards covering medical nutrition therapy under the medicaid/medicare social insurance programs, making dietetics a much more lucrative profession due to insurance reimbursement. in the united states the governing body of dietetics practice is the academy of nutrition and dietetics (formerly the ada). this group is made up of approximately 72,000 members nationwide. international confederation of dietetic associations (icda) the international confederation of dietetic associations (icda) is a membership organization of over 40 national associations of dietitians and nutritionists. dietetics associations are professional societies whose members have education qualifications in food, nutrition and dietetics recognized by a national authority. the icda supports national dietetics associations and their members, beyond national and regional boundaries, by providing: an integrated communications system an enhanced image for the profession increased awareness of standards of education, training and practice in dietetics. other nutrition personnel these titles are general designations of nutrition personnel. specific titles may vary across countries, jurisdictions and employment settings. in particular the title nutritionist is, in some countries, unregulated so anyone may claim to be a nutritionist. dietetic technicians dietetic technicians are involved in planning, implementing and monitoring nutritional programs and services in facilities such as hospitals, nursing homes and schools. they assist in education and assessment of clients' dietary needs, and may specialize in nutritional care or foodservice management. dietetic technicians usually work with, and under the supervision of, a registered dietitian. the training requirements and professional regulation of dietetic technicians vary across countries, but usually include some formal (postsecondary) training in dietetics and nutrition care. in jurisdictions where the profession is regulated, such as in the united states, the title "dietetic technician, registered" (dtr) may be used. canada in canada, there are national standards for academic training and qualifications for dietetic technicians, according to csnm (the canadian society for nutrition management). in ontario, conestoga college offers a diploma program with a clinical focus for dietetic technicians. united states in the united states, the academy of nutrition and dietetics confers the "dietetic technician, registered" (dtr) credentials. qualified dtrs possess a specialized associate degree from community college programs which are accredited by the academy's accreditation council for education in nutrition and dietetics education (acend). they must complete a dietetic internship with a minimum of 450 supervised practice hours in the areas of foodservice theory and management, community dietetics, and clinical dietetics. they must also pass a national registration examination administered by the commission on dietetic registration (cdr) of the academy. the dtr is an academy-credentialed nutrition practitioner who works independently in many nutrition settings; however, when performing clinical dietetics, they must work under the supervision of a registered dietitian. some states have legislation specifying the scope of practice for the dtr in medical nutrition therapy settings. effective june 1, 2009, a new pathway to becoming a registered dietetic technician became available from the commission on dietetic registration. students may take the dtr examination without attending an internship after completion of a baccalaureate degree granted by a us regionally accredited college/university, or foreign equivalent, and completion of an acend didactic program in dietetics or coordinated program in dietetics. applicants must take and pass the cdr dietetic technician registration exam to qualify for the dtr credential. as for registered dietitians, in many cases the title "dietetic technician" is regulated by individual states. for instance, according to the california business and professions code section 2585-2586.8: any person representing himself or herself as a dietetic technician, registered shall possess all of the following qualifications: be 18 years of age or older. satisfactory completion of appropriate academic requirements and receipt of an associate's degree or higher from a college or university accredited by the western association of schools and colleges or other regional accreditation agency. satisfactory completion of the dietetic technician program requirements by an accredited public or private agency or institution recognized by the state department of health services including not less than 450 hours of supervised practice. satisfactory completion of an examination administered by a public or private agency or institution recognized by the state department of health services to administer the examination. satisfactory completion of continuing education requirements established by a public or private agency or institution recognized by the state department of health services to establish the requirements. dietary assistants dietary assistants, also known as "nutrition assistants" or "dietary aides", assist dietitians and other nutrition professionals to maintain nutritional care for patients and groups with special dietary needs. they assist in preparing food in hospitals, childcare centres, and aged care facilities. dietary aides in some countries might also carry out a simple initial health screening for newly admitted patients in medical facilities, and inform the dietitian if any screened patients requires a dietitian's expertise for further assessments or interventions. dietary clerks dietary clerks, also sometimes known as "medical diet clerks" or "dietary workers", prepare dietary information for use by kitchen personnel in preparation of foods for hospital patients following standards established by a dietitian. they examine diet orders, prepare meal trays, maintain the storage area for food supplies, and ensure practice of sanitary procedures. they may operate computers to enter and retrieve data on patients' caloric requirements and intake, or to track financial information. dietary workers are typically trained on the job. dietary managers dietary managers supervise the production and distribution of meals, as well as the budgeting and purchasing of food and the hiring, training and scheduling of support staff in various types of workplaces offering larger scale foodservices, such as hospitals, nursing homes, school and college cafeterias, restaurants, correction facilities and catering services. they assure their department is compliant with food safety regulations, and that the food served meets dietary requirements established by a dietitian. training requirements vary across jurisdictions and employment settings. dietary management is not usually subject to professional regulation, although