The processed food industry has infiltrated the Dietitians Association of Australia and the Dietitians Association – with its sugar and cereal lobby funding – has infiltrated public health policy, as documented on this website. Now, science journalist, Maryanne Demasi, reveals how the organisation targets its opponents. She also investigates claims the peak professional body for dietitians has been misleading its members over efforts to become an accredited profession.

WE HAVE conducted a series of investigations into how the food industry has infiltrated public health groups like the Dietitians Association of Australia, the peak body representing dietitians (here, here and here).

Revelations have now emerged that the DAA may have been misleading it’s 5000-plus membership base which pays the organisation over $3.1 million in membership fees annually.

The latest controversy surrounds the national regulation of dietitians.

Food for thought

Currently, the profession is not regulated by the Australian Health Practitioner Regulation Agency (AHPRA), which ensures independent oversight and accountability for quality of care and code of conduct of the profession.

The DAA has strongly indicated to its members that is has lodged an application so that dietitians could be nationally registered under AHPRA and that its application has been unsuccessful.

The DAA’s website said, “The DAA’s “exclusion” was based on an unsuccessful attempt at registration” and that “the Minister has not granted registration in response to a new submission”.

It went further to explain that its “exclusion from registration likely reflects the low risk of our profession to patient safety” and that “there has been no change to the Minister’s position on this issue”. Furthermore, the DAA says it is “continuing to campaign for registration”.

But there’s a problem. The DAA has never actually applied for national registration according to the COAG Health Secretariat, the office responsible for receiving applications.

We asked the DAA if it ever had lodged an application but the DAA was evasive. Instead, it said, “On behalf of the profession of dietetics and our members, DAA has been active in lobbying for national registration and regularly liaised with federal, state and members of parliament and departments, on the matter. Despite these efforts, dietitians remain a self-regulated profession”.

Shortly after we lodged this enquiry with the DAA, its webpage was taken down from public view, left only accessible to members, and a few statements disappeared from the website.

Dietitians revolt

The proposition that the DAA has misled its members about the profession’s national accreditation under AHPRA, has incensed some dietitians.

“I feel betrayed”, says Feng-Yuan Liu, a member of the DAA for ten years. “If my own accreditation body cannot be transparent and honest about something like this, how can I expect that they are transparent about other things?”

“I’m not impressed,” says Jessica Turton, a current member of the DAA. “The DAA are telling us that they are doing all that they can to push for registration so this is extremely disappointing and misleading to DAA members.”

Some dietitians did not want to go on record about their disapproval of the DAA. They feared retribution, especially in light of the harsh punishments of members and critics in the past, particularly the high-profile expulsion of Jennifer Elliott from the DAA in 2015.

The dietitians we spoke to felt the DAA lacked integrity and transparency and were increasingly troubled by the DAA’s relationship with the food industry.

DAA independence in question

Former member of the DAA, Melanie Voevodin points to the DAA’s own Partnership Report (dated 1 Jul 2015 to 31 Dec 2016) which says the Australian Breakfast Cereal Manufacturers Forum (ABCMF) “provides researched communication resources for DAA members, particularly on the benefits of breakfast, breakfast cereal, grains and fibre”.

“Many dietitians make decisions based on the information fed to them by the DAA, but in my view, the DAA is little more than a PR machine for the food industry,” says Ms Voevodin, who ran into problems with the DAA after she publicly announced her objection to its relationship with the food industry.

In the face of criticism, the DAA robustly argues these corporate partnerships do not affect its independence. “We have a number of protections in place to ensure that our corporate partners do not influence our decision making within DAA. These include binding legal contracts, robust and transparent policies and procedures and a risk assessment process before any partnership takes place,” states the DAA.

But eminent experts like Dr Marion Nestle doubt it.

“Statements like this strain credulity,” says Dr Nestle, Professor of nutrition, food studies, and public health at New York University. “Decades of research and thousands of studies demonstrate the influence of funding on the outcome of research and opinion”.

And while declaring financial ties is a good first step, the conflict remains. “Disclosure is not enough to prevent conflicts of interest. The influence is there, but funding recipients do not recognise it and typically deny it,” says Dr Nestle, author of the forthcoming book Unsavory Truth: How Food Companies Skew the Science of What We Eat.

DAA targets its opponents

Adding to concerns about the DAA misleading its members, we can also reveal that the DAA has been targeting its opposition, wielding its power over universities and hospital institutions. For example, in 2014, the DAA’s former CEO, Ms Claire Hewat tried to thwart an event on “low carbohydrate diets”, to be held at the University of Sydney.

In a letter to the executive, Ms Hewat said she was “astounded” that the university would consider giving the invited speakers “air time”. The letter impugned the reputations of the speakers, accusing them of “self promotion” and requested that the university reconsider allowing the event to take place.

“It was intimidation, definitely,” said Prof Kieron Rooney, the university researcher who organized the event. “The DAA thought it could muscle in on academic freedom”.

The DAA says it objected because one of its dietitians was not invited to talk, despite the fact that eminent US researcher Prof Stephen Phinney was there as an international expert in the field.

“We expressed concern for the potential implications the event might have on public health messaging. Therefore, we suggested to add additional speakers so that the audience were presented with a balanced view,” said the DAA.

In the interest of free speech, the university still went ahead with the event but some view the DAA’s interference as an act of censorship.

“They were trying to silence us,” says Prof Rooney. “If they were truly challenging misinformation then they would have come on the night and challenged the misinformation during the Q and A time. They didn’t.”

The Fettke Jihad

Similarly in 2014, the DAA launched an attack on a Tasmanian doctor for giving dietary advice to his patients. The DAA complained to Launceston General Hospital that an orthopaedic surgeon, Dr Gary Fettke, was advising his patients to reduce their sugar (fructose) intake.

The DAA was concerned that this “alternative nutritional view” was undermining other dietitians in the hospital. Furthermore, the DAA felt it was “beyond the scope of practice” for a surgeon to be giving dietary advice and not “based on current evidence-based practice”.

Despite strong evidence demonstrating the benefits of his dietary advice, Dr Fettke was subjected to a protracted “complaints process” which threatened his medical license and resulted in a ruling that does not allow him to give dietary advice to his patients. Now, Dr Fettke, wants to turn the spotlight back on the DAA.

“Deliberate targeting of a doctor who is practising preventative medicine, should be grounds for a full investigation into the DAA and the processed food industry influencing best practice in health,” says Dr Fettke.

The DAA has publicly denied that it tried to stop Dr Fettke “from telling his patients to cut their sugar intake”, stating on its website, “This is incorrect”. However, the written complaint about Dr Fettke, authored by the DAA clearly expresses its objection to Dr Fettke’s practice.

Should dietitians be regulated by AHPRA?

Despite failing to submit a formal application for national registration, the DAA maintains that it “continues to engage with the Council of Australian Governments (the Health Ministers) about the state of registration” for dietitians.

Currently, the DAA is “self-regulated”. It says, “We are members of the National Alliance of Self Regulating Health Professionals (NASRHP), which helps to provide assurance to the public that they are receiving quality, competent and ethical care from a certified health professional.”

This falls short however of the expectations of some dietitians. “I would love for dietitians to get accreditation with AHPRA,” says Ms Turton, University of Sydney. “I am yet to speak to a dietitian that disagrees with me or who does not want to be registered with AHPRA. I believe that dietitians are pushing for more answers from the DAA.”

The DAA claims that the lack of accreditation “most likely reflects the perceived ‘low risk’ of the dietetics profession to patient safety”. Again, the DAA would not be drawn into answering questions on whether it agreed with the characterisation, nor would it respond to questions about where its “low-risk” classification came from.

Whatever the DAA’s position, many dietitians reject the notion that the profession is ‘low risk’. “It is very irresponsible for the DAA to speculate dietetics is ‘low risk’,” says Ms Lui. “In the hospital setting, the wrong feed, at the wrong speed for a patient can have dangerous, even fatal outcomes.”

“Failing to provide appropriate education for an individual with Coeliac Disease is just one example of how a dietitian can increase the risk of harm to a patient,” says Turton.

In fact, the therapeutic value of diet should not be diminished. According to The Lancet’s Global Burden of Disease Study, poor diet accounts for a larger global burden of non-communicable disease than tobacco, alcohol, and physical inactivity combined.

Ms Voevodin says that the DAA contradicts itself. On the one hand, the DAA doesn’t object to being labeled a low-risk profession, yet it has made strong attacks on a doctor for giving dietary advice to his patients.

“Why is Dr Fettke attacked for giving nutrition advice if it was “low risk”? Why do dietitians have to pay the annual $700+ for the process of credentialing if anyone can do it? It’s hypocrisy,” says Ms Voevodin.

Questions remain about the credibility of the DAA.

As a “self-regulated” organisation, complaints about its conduct cannot be referred to an independent authority for assessment. Therefore, dietitians are unlikely to complaint because there is a threat they’ll lose their ‘accredited practicing dietitian (APD)’ title, which is essential if clients want to claim Medicare rebates.

These latest revelations may prove damaging to professional and public confidence in the DAA. Lack of transparency, misleading members about efforts to become an accredited profession, and the DAA’s financial relationships with the food industry, can only erode confidence.

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Disclosure: In 2014, I was invited as an unpaid speaker at the Low Carb event in 2014 at the University of Sydney. I accepted the invitation but then withdrew from the event at the request of my employer at the time, ABC TV.

DAA responses to questions:

QUESTION 1

Regarding national registration under AHPRA via National Registration and Accreditation Scheme (NRAS), the DAA has stated publicly that:

Our exclusion from registration likely reflects the low risk of our profession to patient safety. Unfortunately, there has been no change to the Health Minister’s position on this issue since that time. [DAA] wrote to CEO AHPRA calling for AHPRA to communicate to Australians why our profession has been denied registration, despite matching or exceeding AHPRA’s robust standards. We have yet to receive a response. Alongside continuing to campaign for registration under NRAS.

These statements strongly imply that the DAA has applied for registration using the due process. Did the DAA ever apply to the Health Ministers for “national registration” of dietitians by submitting an application on the agenda on the COAG Health Council meeting? (this does not include any appeal to AHPRA as it is not responsible for making the decision)?

QUESTION 2

Further statements on the DAA website state:

The DAA’s “exclusion” was based on an unsuccessful attempt at registration.

Can we please see evidence of the Health Minister’s decision to “exclude” the DAA from national registration?

QUESTION 3

Further statements on the DAA website state:

That the Minister has not granted registration in response to a new submission. We continue to advocate for AHPRA registration. And that the DAA is “continuing to campaign” for registration.

A “new submission” to the Minister indicates that the DAA attempted more than once at applying for national registration. How many times did the DAA submit an application for National Registration to the Minister, given that the DAA says it is “continuing to campaign” for registration?

QUESTION 4 (a) and (b) and (c)

The DAA’s website says:

Our exclusion from registration likely reflects the low risk of our profession to patient safety,

(a) Who came to the conclusion that the DAA was excluded from registration because its likely to be considered “low risk to patient safety”?

(b) Is there evidence and explanation of this assertion, documented somewhere?

(c) Does the DAA believe that its profession is “low risk” to patient safety?

DAA response to questions 1,2,3 & 4

On behalf of the profession of dietetics and our members, DAA has been active in lobbying for national registration and regularly liaised with federal, state and members of parliament and departments, on the matter. Despite these efforts, dietitians remain a self-regulated profession. We are members of the National Alliance of Self Regulating Health Professionals (NASRHP), which helps to provide assurance to the public that they are receiving quality, competent and ethical care from a certified health professional. NASRHP is the national peak body for self-regulating allied health professions and sets benchmark standards for regulation and accreditation of practitioners within each profession. The 11 NASRHP standards have been closely modelled on AHPRA standards.

QUESTION 5

In a Partnership Report detailing the DAA’s relationship with ABCMF, dating 1 July 2015–31 Decdember 2016, the DAA states:

Through this partnership, ABCMF provides researched communication resources for DAA members, particularly on the benefits of breakfast, breakfast cereal, grains and fibre. Through its partnership with DAA, ABCMF is committed to supporting the dietetics profession and works with Accredited Practising Dietitians (APD) to develop messages and resources for APDs, health professionals and consumers.

How can the DAA maintain that its advice, research, opinions and position on dietary advice is “independent” when the DAA’s own reports says the DAA receives “researched communication resources” for dietitians?

Response to Q5

DAA works together with a great number of stakeholders including Government, the food industry, public health advocates and media, because we care deeply about inspiring and supporting Australians to eat better, be healthier and live life to the full. Resources provided to our members are evidence-based. Information sources are disclosed, enabling members to evaluate and use at their own discretion.

QUESTION 6 (a) and (b) and (c)

(a) We have obtained a letter (dated 27 August 2014) authored by former DAA CEO Claire Hewat, to the Executive at the University of Sydney, expressing Ms Hewat’s disapproval of a “Low Carb” evening event and its speakers, which was to be held on the university grounds on 1 September, 2014. Ms Hewat said she was “astounded” that the university would consider allowing an event expressing opinions about “The Art and Science of Low Carb Lifestyle”. Why was the DAA offended by this community event, intended for the public discussion of “a low carb lifestyle” featuring a scientist, journalist and high profile low-carb adopters?

(b) Did the DAA send a spokesperson to attend the event and contribute to the public discussion after the presentations or submit questions to the organisers?

(c) According to internal documents from University of Sydney, the Executive allowed the event to go ahead in the interest of free speech . Some consider the DAA’s attempt to derail the event, an act of censorship and intimidation. Agree?

Response to Q6

Accredited Practising Dietitians (APDs) were not provided the opportunity to present at this forum. DAA expressed concern for the potential implications the event might have on public health messaging. Therefore, we suggested to add additional speakers so that the audience were presented with a balanced view.

Clarification

Is the DAA stating that while it “has been active in lobbying for national registration”, the DAA has not actually put in an application for registration with the Minister’s COAG Health Council? The website indicates that the DAA has already applied for national registration (under AHPRA) and been “excluded” or has made an “unsuccessful attempt at registration”.

(Source: The DAA’s “exclusion” was based on an unsuccessful attempt at registration”.)

Who decided (as stated by the website) that the DAA is a “low risk” profession? And does the DAA agree with this?

Clarification for Questions 1 and 2:

DAA continues to engage with the Council of Australian Governments (the Health Ministers) about the state of registration for our profession.

National registration under the Australian Health Practitioner Regulation Agency (AHPRA) has not been an option for dietitians. This is a decision of all state and territory governments, which most likely reflects the perceived low risk of the dietetics profession to patient safety and also that Accredited Practising Dietitians operate under similar or higher standards to those set under the National Registration and Accreditation Scheme.

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Dr Maryanne Demasi is an investigative medical reporter with a PhD in Rheumatology.

You can follow her on Twitter @MaryanneDemasi.