Education is the most powerful weapon which you can use to change the world. If you are reading this editorial as an Accredited Practising Dietitian (APD), or as a current student, you will have experienced a dietetics degree at university. Whether you loved or loathed the process of obtaining your degree, there is no question that it will have provided you with much more than a pathway to your chosen profession. Obtaining a university education is a transformative experience, with far-reaching consequences on life outcomes. Graduating with a university degree positively influences your earning potential, how fully you will be employed, your status in society,1 how healthy you will be2 and even how long you will live.3 Higher education also impacts your contribution to society through influencing your values and civic participation.1 This was illustrated in the 2023 Voice referendum in Australia, with degree-qualified people voting yes two and a half times more frequently than those who did not complete the final year of high school.4 Your university credential thus not only enables you to work as a dietitian but continues to influence you throughout your life. My own university education inspired me to spend more than three decades working as an academic dietitian to help to transform the lives of others. This editorial draws on the literature and reflections on my personal experience to highlight the development of university-based credentialing of dietitians in Australia, the emergence of academic dietitians as an influential sub-group of the dietetics profession and considers the role of this sub-group in dealing with challenges facing the university sector and the dietetics profession. The term ‘profession’ represents a high-status level of occupation. Like other allied health professions, dietetics has largely followed medicine by adopting their professionalising criteria or traits, namely: a university-level credential, an independent body of knowledge and expertise, ethical decision-making and having professional status recognised by the state.5 To maintain these traits, and therefore our professional status, we need to defend our scope of practice against encroachment by other groups. We also need to maintain a strong system of self-regulation while advocating to be included in the Australian Health Practitioner Registration Agency scheme for recognition by the state. Fortunately, the university degree criterion is now well established, although this was not always the standard credential for dietitians. Dietetics was established in Australia in the 1920s following trends in the United Kingdom and United States of America where educated women were seeking independent careers.6 While many pioneering dietitians held university science degrees, they completed their dietetics credential in the hospital setting.7 It was not until the late 1970s that growth in the number of tertiary dietetics programs prompted the professional body to endorse a tertiary credential as standard in the ‘Recommended Minimum Guidelines for the Professional Training of Dietitians in Australia’.8 This was a significant structural change, and the new standards were used to accredit these five post-graduate programs. By 1991, there were seven universities with dietetics programs, including the first undergraduate dietetics credential in Australia.9 Notably, all seven dietetics programs were led by a male Professor who was either a medical doctor or a biochemist, rather than by a dietitian. This could be considered a disadvantage of adopting medicine's trait approach to profession. Medical dominance, synonymous with male dominance characteristic of universities at the time, was a system that did not readily afford the female-dominated profession of dietetics a share of its power.5 While each university program employed a few dietitians, they tended to be employed at Lecturer Level B (Step 2 of 5 levels) and there were less than 20 academic dietitians in the national workforce. These academic dietitians were not only responsible for delivering content, but also for the labour-intensive tasks of organising work integrated learning placements, pastoral care of students and liaising with the professional association to comply with accreditation standards. In addition to these roles, most academic dietitians were also undertaking their doctoral research. While this research was initially conducted in laboratory and hospital settings, exposure to interdisciplinary teams in universities allowed dietitians to broaden research into the social sciences and to conduct qualitative research enquiry.10 Despite these challenging workloads, the number of academic dietitians completing PhDs and embracing research increased, and they began to progress through the academic levels. By the end of the 1990s there were 10 university programs, and the number of enrolled students more than doubled through the period 1996–2002.11 This resulted in a decade of dramatic growth for the dietetics profession, with the numbers of practising dietitians increasing by 54.5% between 1991 and 2001.11 The new millennium brought the next significant structural change to academic dietetics with the appointment of dietitians as Professors (Level E), an academic level commensurate with having an impact on university systems and outcomes. Twenty-five years after the establishment of a university degree credential, curricular and teams were finally being led by dietitians. These changes were initiated by individuals determined to lead, and the field greatly benefitted from the leadership and mentoring of these early role models. Growing groups of academic dietitians built research capacity by supervising the next generation of PhD dietitians, and made a leading contribution to the evidence base for the dietetics profession through their research outputs.6 By the 2010s, the number of universities establishing dietetics degrees had again increased.12 The professional body responded with another major structural change by specifying in in the accreditation manual for pre-registration programs (Version 1.02010) that the staff of at least four APDs should be led by a dietitian with an appointment Level of D (Associate Professor) or above. This brought about a ‘second wave’ of dietitians appointed to the Professoriate, and in 2011, I was the 14th dietitian to be appointed at Level E in Australia. The effects of these changes were captured in a 2014 study that used publicly available information to identify the location and level of the Australian academic dietetics workforce.12 The findings revealed ‘a small but influential sector’ (p. 281) with 18 universities with programs seeking or possessing accreditation for dietetics programs, employing around 147 academic dietitians. Eleven dietitians (7%) were appointed at Level E (the study excluded research-only Professors), which was consistent with the proportion of Level E positions in the Australian university sector.12 However, the proportion of dietitian academics at Level B (Lecturer) of 41% was much higher than the sector average of 25%.12 A research track record benchmarking study used a similar technique to the earlier study12 to identify Australian academic dietitians in late 2018.13 While their workforce results were similar in size (n = 148) and in the proportion of Level B academic dietitians (43%), they found 18 (12%) dietitians at Level E (excluding research-only Professors). This strengthened professoriate allowed the formation of a new structure: the Council of Deans of Nutrition and Dietetics Australia New Zealand in 2015. Positioning itself as a peak body in nutrition and dietetics education and research, this group comprises the most senior academics from universities with dietetics programs. The Council leads advocacy to government and other bodies and commissioned an evidence-based project resulting in the report ‘Towards 2030: Reimagining the future of Nutrition and Dietetics in Australia and New Zealand’.14 Perhaps the most striking development between the 2014 study12 and the 2018 study13 was the dramatic increase in research capacity with the proportion of PhD-qualified academic dietitians increasing from 54% to 76%. By 2018, academic dietitians at the professorial level had a stronger research track record than other professional groups.13 The research sophistication of the dietetics profession is reflected in the collection of papers in this edition of the journal, all of which are syntheses of the literature in the form of scoping reviews15-18 or systematic reviews alone,19 or with meta-analyses.20, 21 So after these decades of development, where is academic dietetics positioned as we enter 2024? In the absence of updated published data, a check of Dietitians Australia and university websites shows that the profile of the academic workforce continues to strengthen and develop. There are now 20 universities with at least one dietetics program with full (n = 16) or provisional accreditation (n = 1) or seeking accreditation (n = 3).22 All but one of those programs are led by Level E (n = 12) or Level D (n = 7) academic dietitians, and there are several other dietitians at Level E with research or executive leadership roles within universities. While there are no updated figures on the size of the academic dietetic workforce, the continued increase in program numbers means that figure is likely to be more than the 150 observed last decade.12, 13 New studies are needed to continue to track the development of the academic dietetics workforce as they respond to challenges faced by the sector. While academic dietitians have led research in nutrition and dietetics, surprisingly few have focused their research on curricular development and education theory. In a 2016 editorial, I noted a small but growing number of academic dietitians presenting their educational research at conferences and in journal articles.10 Rather than relying solely on these education researchers, all academic dietitians need to participate in strengthening the educational evidence base in dietetics curriculum design through scholarly publications and presentations. Innovative, research-based approaches are needed to respond to the many challenges facing the education sector. One such challenge is that posed by the sudden and dramatic emergence of generative artificial intelligence.23 A key concern for dietitians, as for all academics, is the ability to assess authentic learning in students who might use programs such as ChatGPT to complete assignments. Considering we are educating future health professionals, use of artificial intelligence not only poses ethical issues but raises concerns for safe practice. Responding to the artificial intelligence challenge will require academic dietitians to draw on their research skills and knowledge to develop solutions, and to find ways to embrace the potential positive benefits of this rapidly emerging technology. Another challenge for academic dietitians is the composition of the dietetics workforce. One of the criticisms of a trait approach to profession is that it limits alternative perspectives. The Futures Report identified the need to increase the diversity of the students that enter our programs beyond the White, privileged females that traditionally comprise our student body and the broader profession.14 I acknowledge my own White privilege in supporting the call for more diverse role models throughout the profession.24, 25 Broadening the curricular, particularly through Indigenisation of content, is another key strategy needed to develop diversity in the dietetics workforce. Arguably the most imminent challenge facing the world is the climate crisis and its effect on planetary health. The editorial published in this issue, and simultaneously in multiple journals around the world, argues that health professionals need to advocate for the restoration of biodiversity and tackling climate change together to respond to the global health emergency.26 As dietitians educated in the biological sciences, we are well placed to add our voices to this advocacy effort and to incorporate planetary health into our core mission. Despite these and other challenges, the academic dietetics workforce of 2024 has achieved a strong position through a combination of structural change and leadership advocacy. A strong academic sector is important for all dietitians, who benefit from receiving a quality education, the strong evidence base for nutrition and dietetics practice, and from academic dietitians advocating for the role of dietitians in addressing population needs. It has been an honour to be part of the development of academic dietetics over three decades of my career. I am excited for the future of academic dietetics and the broader dietetics profession. While this is all my own work, I appreciate the discussions I had with colleagues who informed the content. It was written on the lands of the Arakwal people of the Bundjalung nation. Lauren Williams has not received any funding to write this editorial. Lauren Williams is an academic dietitian and has been since early 1992. She retired from full-time work in July of 2023 but remains a proud academic dietitian, with honorary Professorial appointments at Griffith University and the University of Newcastle.
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