Dietary advice and nutritional therapy services

Dietary advice is usually intended to prevent illnesses and the effects they cause. It is mainly aimed at people who are healthy. It can help answer questions about the right diet in certain circumstances or phases of life, such as childhood and adolescence, old age, pregnancy or shift work. The goal is to make sure people eat a healthy diet and have a healthy body weight.

In Germany, dietary advice services are available on a one-on-one basis, in prevention courses or as part of workplace health promotion schemes.

Nutritional therapy is aimed at people with an illness. It is intended to support the treatment of diet-related illnesses and relieve illness-related diet problems. It can be useful for people who are obese ( BMI of over 30 kg/m2) or have diabetes, very high levels of fat in their blood (blood lipids), a food allergy or intolerance, an irritable bowel, kidney disease or cancer.

The aim of the therapy is to have a positive effect on the underlying illness and to stop or delay it worsening. It is also intended to help relieve the symptoms or allow you to use less medication. Nutritional therapy helps people change their eating habits and stick to their new diet.

In Germany, nutritional therapy is offered in the form of individual sessions or group sessions with a maximum of five people.

People with certain types of metabolic disorder (like phenylketonuria or cystic fibrosis) need nutritional therapy to help prevent developmental disorders and serious brain damage. Children who have phenylketonuria need a special diet because they’re not allowed to eat foods that contain protein. By contrast, people with cystic fibrosis have to eat lots of fatty and high-calorie food because their body needs more energy than other people.

The dietitian or therapist starts by asking you about your personal situation. Then they will work with you to define an objective for your sessions with them. Depending on what you need, they’ll talk to you about what diet changes would make sense or are necessary.

For instance, if your body is unable to absorb certain nutrients properly, it’s important that your diet can compensate for those missing nutrients. If your goal is to lose weight, you can reduce your calorie intake and make long-term changes to your diet.

Dietary advice and nutritional therapy may involve things like ways to

• cut out or cut down problematic foods in your diet,
• find suitable foods and eat the right amounts of them,
• ensure you’re getting enough vitamins and minerals and
• support you as you make changes to your diet and help you integrate your new eating/drinking habits into your routine.

In Germany, dietary advice is offered in dietary advice clinics, doctors’ practices, gyms and some businesses.

Nutritional therapy is mainly available at nutritional therapy clinics, doctor’s practices and hospitals.

In Germany, anyone can call themselves a “dietitian” or “nutritional therapist” but statutory health insurers can’t pay anything toward the costs if the practitioner doesn’t have a recognized qualification. The following are considered to have recognized qualifications:

• Dietitian pracitioners (Diätassistent) with a qualification from a vocational school (Fachschule)
• Ecotrophologists and nutritional scientists with appropriate additional training
• Graduates of related study programs who have appropriate additional training
• Doctors who have additional training in nutritional medicine

Generally speaking, anyone can use dietary advice services. But your health insurer will only pay toward the costs if the advice services are clearly intended to prevent illness and the provider holds a recognized qualification. You don’t have to have a recommendation from a doctor to use dietary advice services. The health insurers decide how much they will pay towards the cost. It is not always the same amount at every insurer. To apply to your insurer to have the costs paid, you have to send them the invoice and a letter confirming you have attended the sessions (Teilnahmebescheinigung).

The rules for nutritional therapy services are different. Generally speaking, health insurers don’t cover these costs. But there are exceptions for cystic fibrosis, phenylketonuria and other rare metabolic disorders already present at birth.

If the therapy is for a different illness, the health insurer reviews the application and decides whether to pay toward the costs. It makes sense to ask your insurer about the rules for reimbursements. The amount differs greatly from insurer to insurer.

To apply to have the costs covered, you’ll need:

• a letter from your doctor confirming that you have a diet-related illness that needs treatment (Notwendigkeitsbescheinigung),
• a cost estimate for the nutritional therapy, and
• the details of the nutritional therapist’s qualification. The insurer will only pay if the practitioner has a recognized qualification.