FROM THE ACADEMY Practice Roles and Characteristics of Integrative and Functional Nutrition Registered Dietitian Nutritionists Emily M. Goodman, MS, RDN, LD; Jessica Redmond, MS, RDN, FAND; Dana Elia, MS, RDN, LDN, FAND; Stephanie R. Harris, PhD, RDN, LD; Mary Beth Augustine, RDN, CDN, FAND; Rosa K. Hand, MS, RDN, LD, FAND Figure 2 is available at www. jandonline.org. T HE FIELD OF INTEGRATIVE AND functional medicine has expe- rienced significant growth in US health care settings. Ac- cording to the National Institutes of Health National Center for Comple- mentary and Integrative Health, inte- grative approaches to health and healing are used across a variety of populations and conditions, from wellness for the aging to pain and symptom management for military veterans and cancer patients, respec- tively. 1 Although the terminology is evolving, integrative and functional medicine combines therapies from within and outside of conventional medical care 1,2 ; that is, therapies outside of conventional medical care are generally considered complemen- tary approaches. 3 These complemen- tary approaches are divided into two major categories: nonvitamin, nonmin- eral dietary supplements such as fish oil, prebiotics, probiotics, and herbs and mindebody practices, including yoga, chiropractic/osteopathic manipu- lation, and meditation. 1,2 Use of integrative and functional medicine approaches, particularly di- etary supplements, is high among Americans. According to the 2012 Na- tional Health Interview Survey, 34% of American adults used a complemen- tary health approach during the past 12 months, a rate that has been relatively stable over the past decade. 4 This translates to approximately $28.2 billion in out-of-pocket spending on complementary health approaches, or 8.6% of total out-of-pocket health care expenditures. 5 In addition, 2012 Na- tional Health Interview Survey data found that nonvitamin nonmineral di- etary supplements were the most-used complementary health approach among those surveyed (17.7%). 4 Like- wise, recent data from the National Health and Nutrition Examination Survey revealed 52% of US adults 6 and 31% of US children 7 used vitamins, minerals, or other dietary supplements during the 30-day period before the National Health and Nutrition Exami- nation Survey survey date. In 2012, The Bravewell Collaborative 2 conducted an integrative medicine mapping survey of clinical centers across the United States. Of the 29 centers surveyed, 68% employed di- etitians/nutritionists. Food/nutrition and dietary supplements were the top two of 34 interventions for the treat- ment of twenty different conditions. There is a clear consumer interest in these complementary health ap- proaches 8 ; and because many of these approaches involve nutrition and diet, registered dietitian nutritionists (RDNs) are among the most qualified professionals to assess and recommend such approaches. In 2014, Dietitians in Integrative and Functional Medicine (DIFM), a practice group of The Academy of Nutrition and Dietetics (Academy), in collaboration with the Dietetics Practice-Based Research Network, surveyed Academy members to identify their education, perceived knowledge, attitudes, and practice regarding integrative and functional nutrition (IFN). 9 Results showed RDNs’ interest in IFN; 72% of respondents were interested in continuing professional education (CPE) in IFN and 87% were interested in CPE in dietary supplements. In response to RDN interest and suggested gaps in ed- ucation, DIFM and the Academy Center for Lifelong Learning developed a cer- tificate of training program in IFN to provide CPE opportunities in this area of nutrition and dietetics. 10 The Academy has published Stan- dards of Practice/Standards of Pro- fessional Performance (SOP/SOPP) for RDNs (Competent, Proficient, and Expert) in Integrative and Functional Medicine (now expired and under revision), a theoretical framework for RDN self-evaluation at their current practice level and areas for future professional development. 11 Although approximately half of 2014 survey respondents reported always/usually using these standards, approximately one-third were not aware of these SOP/SOPP. 9 Even so, neither the SOP/ SOPP nor current research define an RDNs’ practical role in managing IFN approaches or the decision-making process for recommending such ap- proaches. evidence-based practice guidelines pertaining to IFN therapies are limited. 11 Based on RDNs’ re- ported interest in and practice of IFN approaches, it is important to more clearly define RDNs’ role in over- seeing therapeutic IFN approaches and measuring the resulting outcomes. PURPOSE As part of a larger, mixed-methods study on experienced IFN RDN roles and critical thinking, this article de- scribes the roles and practice charac- teristics of experienced IFN RDNs based on data collected via a semistructured interview and online survey. METHODS Study Protocol The study protocol addressed two objectives: to describe the roles, 2212-2672/Copyright ª 2018 by the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2018.03.027 ª 2018 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1