If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
To take the Continuing Professional Education quiz for this article, log in to www.eatright.org, click the “myAcademy” link under your name at the top of the homepage, select “Journal Quiz” from the menu on your myAcademy page, click “Journal Article Quiz” on the next page, and then click the “Additional Journal CPE Articles” button to view a list of available quizzes, from which you may select the quiz for this article.
Early recognition of the contribution of dietitians to improving the nation’s health is owed largely to those who served in the military. Dietetics really began to take root as a profession during World War I (WWI). In 1917, a state of war between the United States and the Imperial German Government was declared, and dietitians met to discuss how they could assist the war effort. The result of that meeting was the founding of the Academy of Nutrition and Dietetics (Academy).
Before 2012 the Academy of Nutrition and Dietetics was called the American Dietetic Association. Throughout this article, it will be called the Academy.
∗Before 2012 the Academy of Nutrition and Dietetics was called the American Dietetic Association. Throughout this article, it will be called the Academy.
Dietitians rallied again when the United States entered World War II (WWII) in 1941, in response to the government’s notice of an urgent need for more dietitians to join the military ranks. WWII ultimately served as a major boost for the profession, as dietitians were joined by medical personnel beyond the profession in advocating for a greater import to be placed on the skills and training of dietetics practitioners for the US Army, yielding eventual increases in rank, pay, and status
The Academy’s 2017 centennial offers a moment to reflect on the profession’s history—including its military roots. The Academy and the US Army Medical Department’s Center of History and Heritage retained photographs and documents from the era, enabling the preservation of a crucial era in the formation of the profession. Current Academy members who have served in the military have also described their experiences—presented in sidebars throughout this article—to show how the role of military dietitians has evolved in recent decades.
WWI Service and Recognition in WWII
Serving as Civilian Employees in WWI
The American Red Cross (ARC) was charged with recruiting dietitians to the war effort and in 1916 formed a National Committee on Dietetic Service (see Figure 1). This committee established practice criteria for base hospitals, including age requirements (age 25 to 35 years), completion of a 2-year home economics course, 4 months’ practical experience, knowledge of appropriate dietary recommendations, and the ability to pass a physical fitness examination.
Dietitians were first included in the US Army medical program—along with physical and occupational therapists—beginning with WWI. Although some dietitians were deployed to perform duties in Europe, entering areas with hostile fire was not within their expected functions. Thus, they were regarded as temporary civilian employees at large, appointed by the Surgeon General, with no access to military training and no military pay, benefits, or privileges. Unlike other professionals granted military status, dietitians had to pay full price to travel by railroad and send mail home from war zones. Despite denial of military-level status, they were required to take an oath of service and meet the ARC criteria.
Though it is known that US Army dietitians stationed at home focused primarily on collaborating with government agencies in food rationing programs and food shortage prevention,
dietitians sent overseas were charged with feeding hospitalized soldiers and residents in war-torn cities. In fact, the term dietitian was not even part of the US Army regulations lexicon until 1918, after the war had ended.
Hospital foodservice management was overseen by a mess sergeant and a mess officer (often with a medical or veterinary science background) to whom the dietitian reported. As civilian employees with no clear-cut work orders or outcomes measures, dietitians learned to demonstrate their skills in this new “workplace.”
Esther Myers, PhD, RDN, FAND, Col (Ret), chief executive officer of Esther Myers Consulting and the former Chief Science Officer of the Academy of Nutrition and Dietetics, retired from the US Air Force in 2000, after more than 25 years of service. Her military interest began with a US Air Force dietetic internship. One of her first assignments post-internship was delivering nutrition lectures to fighter pilots after the first dietary guidelines were issued. There was no resistance from the pilots. “They will do anything to avoid being grounded, so when I explained, ‘If you eat a certain way, you could have a heart attack and be grounded,’ they paid attention.”
Myers also worked on a U2 pilot nutrition program for optimizing attention required to manually land planes. “There’s a huge burst of physical exertion after sitting 5 or 6 hours on the plane. We looked at their dietary routines for maximum landing and demonstrated a clear connection between nutrition and the success of their landing.”
One of two dietitians sent to the Middle East theater for Desert Storm, Myers recounts the intensity of deployment. “You train from the very moment you go in for what you will do in war, because that’s why you exist. Our building was in an airplane hangar and tent. We had to figure out what we needed for nutrition support, get products and services, figure out how to order food—these systems are not needed when there is not war, and all of a sudden this system springs to life and never works as planned. You’ve got to go, make it work, and put all training into practice. Deployment situations are defining moments.”
Desert Storm was an unusual conflict she adds, because after the rush to set up, there was a lot of waiting. “We realized that troops were sitting around and eating out of boredom, so we set to work on establishing healthy nutrition while waiting.”
During Desert Storm, after Myers came to learn that obtaining physician approval for prescribing diets was a self-imposed restriction—that physicians trusted the dietitians’ expertise and did not know why they would not order diets without permission—she helped to change military protocols so dietitians gained prescriptive authority.
Stateside, Myers worked on staffing issues, drafting a proposal for adding medical center dietitians to perform the newly developed nutrition assessment and conducting a manpower study showing the US Air Force was employing a regression formula with a standard error in determining its dietitian staffing needs based on meals served.
When the job functions of overseas US Army dietitians were first defined and published (in the American Expeditionary Forces Circular) in 1918, they were formally identified as civilian employees. This publication advised that dietitians were expertly qualified for upgrading the dietary balance, delivery of service, cleanliness, and monotony within the mess service and among its staff. The next year, 1919, Lenna Cooper
Lenna Cooper’s contributions to WWI and brief tenure as the first supervising dietitian in the Surgeon General’s office had a profound effect on the advancement of dietitians in the military. Furthermore, her planned business trip from the Battle Creek Sanitarium training school to Ohio in 1917 is what sparked the idea to call all dietitians of her and Lulu Graves’ acquaintance to Cleveland to discuss scientific research and how dietitians could assist in the war—and, in turn, found the Academy. That year, Cooper was elected the Academy’s first-ever vice president and later served as president from 1937 to 1938.
After Cooper’s inspection tour of 30 stateside US Army hospital dietary departments, she noted “there was an overlap of the responsibilities of the mess officer and the dietitian [and] worked hard to obtain standardization of the dietitians’ duties.”
Months later, another circular was published to clarify that regardless of dietitians’ lack of formal military status, they were professionals expected to work in cooperation with the nurses and their commanding officers and to be classified as neither cooks nor housekeeping staff, because doing so “…is an injustice to her and a disadvantage to the hospital in which she is working.”
A World War II hospital dietitian at the First General Hospital in France checks the food cart before the evening meal service is delivered to ensure there are enough trays with special diets for the surgical ward.
(Photo courtesy of US Army Medical Department Center of History and Heritage Research Collection.)
After the war, in 1922, the first US Army training school for dietitians was established at Walter Reed General Hospital through the Medical Department Professional Service Schools at the Army Medical Center. This program prepared qualified individuals for the particular requirements of working in US Army foodservice.
Graduates of this program were most frequently the dietitians assigned to US Army hospitals.
Greater Recognition Yields Military Status in WWII
Between the world wars, in 1921, the Academy began formally approaching the US Congress to seek an upgrade for dietitians from civilian to military status. By then the requirements for dietitians to serve had been modified and included US citizenship; marital status of married or single; graduation from an approved hospital program and Civil Service Commission certification; and an age of 48 years or younger, along with height, weight, and physical ability standards.
The rationale for continued classification of dietitians as civilians had included the theory that they weren’t expected to incur the same risks as other military personnel nor expected to enter hostile fire zones.
Understanding of the role of dietitians was not yet universal. When Lt Ruby Motley was captured during WWII by Japanese soldiers in the Philippines, her interrogators did not comprehend her title and considered her a nurse.
Although encouraged to continue to enroll in the ARC without waiting for and regardless of outcome, members were asked to write to their congressmen to petition their support.
Recognition from the medical community was exciting and celebrated. Russell Wilder, MD, PhD, DSc, for example—a Mayo Clinic physician and professor emeritus who had made extensive contributions to the body of knowledge surrounding nutrition and metabolism and had served as the first chairman of the Food and Nutrition Board of the National Research Council—was a key advocate for the profession. He frequently spoke about the importance of dietitians to health care teams, including presentations at the 1923 annual meeting
and a 1930 American Medical Association meeting where he called upon his colleagues to pay attention to “this important field of therapeutics,” to impose “greater intellectual application on the part of practitioners to quantitative features of dietetics.”
Wilder also offered his assistance in working toward obtaining military designation for dietitians when entry into WWII seemed certain (see Figure 2, Figure 3).
Figure 2A copy of a letter sent in 1940 from Mary Foley to Mary Pascoe Huddleson about support from a prominent figure in the medical community to secure military designation for dietitians when World War II seemed imminent. Foley served in World War I, the only dietitian in 1919 with full authority over a US Army hospital’s food and nutrition services.
Figure 3Mary Pascoe Huddleson’s response to a letter regarding support in the medical community for dietitians acquiring military designation. Huddleson, who served in US Army base hospitals in France during World War I, was the Journal’s editor at that time.
It wasn’t until 1941, the first year of the United States’ intervention in WWII, that the US Army took note that the risks to civilian employees deployed overseas were no less than for military staff and that these individuals were subjected to this risk with no protection of international law.
Representative Andrew Edmiston (D-WV) introduced a 1942 pay readjustment act to improve the pay of nurses and create a Women’s Auxiliary Corps, which granted classification according to the rank and pay of nurse and dietitian US Army officers from second lieutenant to colonel; Academy members rallied to participate in those congressional hearings. The bill passed just a few months later.
Relative rank denotes that these dietitians were granted military titles and had the right to wear uniforms and other insignia but had limited command authority over those under their operational control.
That same year, dietitians new to the US Army or those being sent overseas were required to participate in a basic training program—including drills and road marches; practice in pitching tents and using gas masks; and learning hospital procedures, caring for chemical casualties, and evacuating the sick and wounded—that had been established by the US Army Nurse Corps in 1943.
In 1947, 2 years after the WWII ceasefire, military status granted to dietitians was no longer at risk of being considered temporary when President Harry S. Truman signed into law the permanent creation of the Women’s Medical Specialist Corps.
Joyce Gilbert, PhD, RDN, LTC (Ret), president and chief executive officer of the Association of Nutrition & Foodservice Professionals, was commissioned in 1992 as a US Army reservist through the individual mobilization augmentation program, which was established to provide agencies with the ability to quickly augment their agency with select, qualified reservists in case of crisis, emergency, or mobilization. She would spend 2 weeks each year performing reservist activities wherever orders were given and spend the remainder of the year on special projects. During her 15-year military reservist career, her doctorate in nutritional biochemistry led her to work as a research dietitian, helping to prepare manuscripts and develop research protocols.
Gilbert was drawn to the US Army Reserves for a very specific reason. “I had always wanted to join the Peace Corps, as I believe it’s my life mission to serve country, family, and profession. But my adviser dissuaded me, concerned about the 3-year commitment, since I was on the cutting edge of research protocols. People suggested I instead join the Reserves.”
Gilbert believes that the Academy of Nutrition and Dietetics’ development of certified specialty areas of practice, starting with renal and pediatric nutrition, had a tremendous impact on military registered dietitian nutritionists (RDNs). “The ways to increase in rank in the military is through education and certification that directly relates to your position and the betterment of soldiers. It was important that military RDNs could take advantage of these advanced-level competencies, as many are now specialists.”
During her military reserve tenure, Gilbert worked on projects ranging from female iron status during basic training, increasing soldier strength before entering into any kind of conflict, ergogenic aids to get soldiers healthy more quickly, and improving the nutrient stability and taste of ready-to-eat meals.
Gilbert was mobilized for 1 year during the Iraq War (all reservists were mobilized between 2003 and 2005). Although she was supposed to go to Walter Reed Army Medical Center for a research assignment, the chief dietitian, knowing her background as a dietetics educator, intercepted her orders and sent her to Brooke Army Medical Center so the US Army could continue to matriculate RDNs during wartime.
From Brooke, Gilbert was assigned to the graduate school at Fort Sam Houston, TX, where all medical and science training is performed. Though she acknowledges the rigor of military dietetics—“You don’t have to be just academically prepared, you also have to be fit and pass all testing to become a military officer”—she calls the experience “One of the most fulfilling things I’ve ever done.”
Diet and Nutrition during the Wars
WWI
Although it had been firmly established that humans need to consume sufficient energy on a given day, the precision of the kilocalorie measurement was still being refined in 1917—dietitians worked tirelessly to calculate individual intakes to three or four decimals—and dietary means for consuming adequate vitamins and minerals was not yet established.
The Sippy diet for ulcers (a bland diet comprising mostly allotted amounts of milk and cream, farina, and egg consumed at regular hourly intervals within a prescribed time frame) was gaining popularity, whereas Fletcherism (a prescribed number of times to chew food before swallowing) was falling out of favor.
WWI dietitians were charged with feeding the troops on $0.50 a day ($0.60/day overseas and in stateside hospitals treating patients with tuberculosis). Overseas, butter would be rancid and inedible by the time it arrived at base hospitals, fresh milk was an unrealistic wish, and whenever eggs were available, they were nearly prohibitively expensive ($3/dozen, when the average price in the United States was $0.465 [1918] to $0.4925 [1919]).
There was an ample supply of flour, sugar, canned and powdered milk, turnips, and occasionally bacon and prunes, but during WWI, gelatin, broth, and cocoa were scarce. Because of insufficient means to refrigerate foods, any thawed beef had to be cooked immediately.
Although most dietitians were not in charge of planning menus or supervising food preparation for regular diets early in the war, this ultimately changed.
Because dietitian roles then were not standardized, overseas duties ranged from caretaking the nurses’ home, planning and serving patient diets, preparing food for the very ill, and managing the kitchen. Those specially trained stateside for military dietetics would observe the US Army procurement system, plan menus, calculate kilocalorie values of three meals each week, order supplies for regular and light diets, supervise food preparation for patients consuming special and regular diets, and act as ward supervisor of the nurses’ kitchen.
Char Norton, MS, RDN, LD, FAND, served in the military, although not to perform the duties of a clinical dietitian. Norton, the former director of Food and Nutrition at MD Anderson Cancer Center and president of The Norton Group for 28 years, began her 23-year military career at age 39, when the US Army’s chief dietitian asked her to join. Because of her educational background and management experience, Norton was accepted on a waiver after it went through an extensive approval process up the chains of command.
When she joined the US Army “there was a barrier between Reserves and Guard, and active component then,” she says, “but the barrier has since been broken. The military has now recognized that the Reserve and Guard component contributes a lot.”
As an officer, her typical duties included managing the weight control and foodservice programs; conducting inspections to ensure the criteria and guidelines were followed; and conducting audits to detect fraud, waste, and abuse. She also performed humanitarian missions and set up educational programs for the deployed medical staff to obtain continuing education credits.
Eventually, at age 60 years, she was deployed to Bosnia in 2001 (and closed her consulting firm). “If I had been younger, I may have been scared,” she says. There, Norton served as the executive officer of the Medical Task Force, acting in a capacity similar to that of the chief operating officer of a hospital. She oversaw the staff planning for seven subordinate units—including a level-III hospital, air and ground ambulances, preventive medicine, combat stress control, and veterinary teams—and supervised activities of the task force operational staff, comprising eight officers and 19 noncommissioned officers and soldiers.
However, because it was known she had a dietetics background, she was continually asked to fill dietitian roles in addition to running the hospital. That was not in the scope of her tasks, and she notes, “It was important that the assigned dietitians had the opportunity to learn and serve in that role.”
Although her ideas did not always follow regulations, she says it was gratifying that commanders considered her proposals for changes, such as using alternatives for liquid diets that avoided expensive rations and rethinking the policy that hospital patients cannot be fed ready-to-eat meals.
“It was the greatest thing I ever did,” says Norton. “My only regret is that I didn’t sign up sooner.”
WWII
Once the United States was engaged in WWII, dire reports surrounding the health of draftees—namely, that one-quarter of those drafted into military service showed signs of current or previous malnutrition—resulted in a surge in national nutrition programs, including issuance of the first Recommended Dietary Allowances in 1943 and an early iteration of the Food Guide to address nutritional adequacy of the wartime diet in the face of rationing in 1943.
A second lieutenant (a dietetic intern) and a private first class slice and size cutlets for foodservice at Brooke General Hospital in Fort Sam Houston, TX, in 1949.
(Photo courtesy of US Army Medical Department Center of History and Heritage Research Collection.)
Illustrative of the participation of dietitians in this boon in research to develop and disseminate to the nation is the January 1943 Journal table of contents. These groundbreaking and relevant articles populated the war years of publishing and beyond to the present:
•
Dietary Patterns and Food Habits, Margaret Mead, PhD
Mead was on “wartime appointment” to the National Research Council on Food Habits. This leave of absence took her temporarily from the American Museum of Natural history where she was the associate curator of anthropology and from which she achieved her renown.
‖Mead was on “wartime appointment” to the National Research Council on Food Habits. This leave of absence took her temporarily from the American Museum of Natural history where she was the associate curator of anthropology and from which she achieved her renown.
•
Developments in Dehydration, EM Mrak, PhD
•
The Nutritive Value of Dehydrated Vegetables, JC Moyer, PhD
•
Rationing in Theory and Practice, Albert Viton, PhD
•
Metal and Fiber Containers for Food During the Present Emergency, HL Sipple, PhD
Disseminating research to dietitians stationed abroad had been an essential theme woven through the tenure of Mary Pascoe Huddleson, the second-ever Journal editor (serving 19 years from 1927 to 1946). A public comment she had made about that seemingly endless supply of tomato shipments to her US Army base hospital post in France during WWI—Huddleson had been unaware of the series of papers that had been published on vitamin C benefits while she’d been stationed overseas—made clear that dietitians stationed abroad were in need of greater access to the latest in research developments.
By 1941, dietitians had official menu-planning responsibilities for feeding the majority of troops, and responsibility to ensure adequacy of diet, skill level of mess hall personnel, capability of the foodservice equipment, and food availability. Head and administrative dietitians wrote meal plans for various diet needs—soft, liquid, regular, and light—whereas therapeutic dietitians developed specialized meal plans and benefited from the guidance of a standardized hospital diet manual. This manual, a resource unavailable to WWI dietitians, was originally published in 1941; an updated manual was issued postwar (1945) to include lessons learned during the war, such as the health benefits of enriched flour and all types of milk as well as the benefits of using the liquids in canned fruit and vegetable products in preparing meals.
Because of limited food supplies, liberalized therapeutic diets were commonly medically approved, and they were often modifications of the regular diet to accommodate limitations in supplies, staffing, and equipment. Combat-induced exhaustion necessitated insulin therapy, but food limitations meant creativity was needed; in these cases, regular diets with larger portion sizes were supplemented with additional servings of breads, juices, and other items to increase the energy consumed. One of the most challenging diets of WWII was that for patients with hepatitis, which was at epidemic levels during and after the war, before its etiology and modes of transmission were fully understood and before it was fully appreciated that there could be more than one type of the virus.
Dietitians and dining hall personnel collaborated with medical professionals to experiment on determining the ideal diet—specifically, the tolerable amounts of fat, carbohydrate, and protein—for this growing patient population. The initial feeding regimen was generally inedible and nutritionally inadequate so that what little the patients could consume was not promoting or sustaining adequate weight gain.
Results from experiments showed that most patients could tolerate nonrancid fats like butter, which improved palatability, resulting in an increase in dietary fat allowance; despite its high cholesterol content, it was determined that one fresh egg daily—granted strictly for morale purposes—was acceptable.
Dietitians in the Veterans Administration diet therapy clinic, post World War II, provide patients and their families with diet prescription information before they were discharged from the hospital.
Overseas menu development proved challenging, as rationing depended on the limited availability of foods; conservation was essential; and personnel were less conversant in use of the processed, canned, and dehydrated foods that populated the menu. Because these items were becoming a tedious dietary routine for hospitalized troops, experimentation with these foods to make them more interesting and palatable was a common activity by dietitians and their cohorts in the mess halls and dietary departments. Some of the preparation techniques they tried out for Vienna sausage, corned beef, and the newly introduced Spam (Hormel Foods Corp) included baked, fried, dehydrated egg-battered, dough-rolled, pickled, frittered, and sandwiched. Meanwhile, the dietitians worked as best they could with what they had; for example, making soups with normally discarded items like turkey bones, celery tips and leaves, and leftover scrambled dried eggs, along with canned vegetables and the juices they were packed in. Because these experiments yielded as many misses as hits, special training in palatable use of these foods was developed.
After her first deployment to a US Army general hospital in Japan, Jessie Brewer, RD, was deployed to Vietnam in 1969. She served under the 67th Medical Group headquarters for nearly the entire year.
“At our unit, there were six frontline hospitals where soldiers stayed until they were evacuated to the United States or Japan,” she says. “I went to each hospital to consult on diets and supplies, but I had to hitchhike on helicopters to get to the hospital units, as ground transportation was not safe.”
When Brewer first arrived, there was only field equipment—portable equipment that required portable gasoline. Supply depots were beginning to close, so to get the ranges, refrigerators, blenders, and dishwashers she needed, she would visit these warehouses before equipment was moved back to Okinawa. “We had to physically look for pieces of foodservice equipment crated in wooden boxes. I had to learn the codes so I could figure out what was in the boxes and then I had to get them moved to our units.”
Once they had dishwashers, they found there was unsuitable running water at most units. “We hired local residents to wash dishes in the sink and supervised their work to achieve the best sterilization.”
Liquid diets, in particular, were a challenge in this region, especially without refrigerators and blenders. Preparing tube feeding was difficult without blenders or baby food. “When we did get blenders, the preparation in the hot kitchens would make the tube feedings too hot to save, therefore requiring them to be prepared throughout the day as needed. When we blended a meal, we couldn’t stash it in the fridge if we’d had one. We also had to calculate its shelf life, because it could get so thick that it wouldn’t pass through the tube.”
Brewer also helped to train the personnel inexperienced in working with the limitations of injured patients—for example, patients with an inability to use their arms and could not reach for nor hold knives and forks.
Because these hospitals focused on caring for the injured until they were airlifted out, a surgical/clear liquid regimen was the most commonly administered diet. “The gelatin desserts never stayed jelled because of the heat, and special food items were not always available. We had to make do with what we had.”
Brewer finds cause for celebration that there are currently so many more dietitians in the Reserves with greater responsibility. “When I was there, we were mostly stationed in hospitals. It is wonderful to see dietitians expanded into the units for helping educate, train, and work with troops. That is why they are there.”
Coffee, tea, sugar, meat, and canned and dried products were also limited stateside; the earliest rationing affected the supply of coffee, sugar, butter, cream, and potatoes. Planning meals had to account not only for food availability based on ability to receive deliveries (given the gasoline rations), but also war-related labor shortages.
Dietitians had to create menus based on forecasts of what would be available while “protecting [the US Army’s] forces and still not interfere with the supply of food for civilians.”
A captain (a physician) meets with first lieutenant dietitians to discuss the nutrition needs of a patient in the Walter Reed General Hospital renal ward.
(Photo courtesy of US Army Medical Department Center of History and Heritage Research Collection.)
The expertise of dietitians during WWII was recognized in many sectors. At his presentation at the 1942 annual meeting, a representative of the US Agricultural Marketing Administration noted that dietitians should lead the charge as citizens of the United States are encouraged to “eat more of what we need and less of what we like” for the duration of rationing.
Because WWI US Army dietitians were civilian employees and thus not automatically entitled to wear the uniform assigned to personnel of the US Army Nurse Corps, in the early years their uniforms were essentially “whatever was available,” especially for those serving overseas. Specifications drawn in summer 1917 called for indoor and outdoor uniforms for dietitians at home and abroad. Uniform combinations included a white dress, rolled white collar, white cap, and a caduceus symbol on a badge with the letter “D”; blue cotton dresses (when white was not a practical choice for outdoor wear) with a white cap and insignia; and an Oxford grey Norfolk suit with the caduceus and “U.S.” on the lapel, overcoat, black velour hat for winter, black or white straw sailor hat for summer months, black or white shoes, and a black ribbon tie.
In 1917, the ARC supplied uniforms to dietitians serving in ARC-sponsored hospitals. These uniforms consisted of a gray worsted dress, cape, ulster (a long and loose overcoat), and a velour hat. In April 1918, uniforms were redesigned to more closely resemble the uniform worn by the US Army Nurse Corps. White uniforms came with an ARC cape and badge that were only to be worn if enrolled in the ARC; dietitians were also expected to purchase gray travel uniforms upon assignment.
A military dietitian models the various WWII uniforms. Clockwise from top left: White dress uniform, taupe semidress uniform, alternative uniform with jacket, and semidress uniform with coat.
At the 1942 annual meeting in Boston, MA, life-sized mannequins displayed WWII US Army dietitians’ tailored winter, summer, and work uniforms in the procurement services booth in the exhibit hall. By now, dietitians were no longer considered civilian employees and had been granted military status; their street uniforms consisted of a medium-blue jacket and white or tan tailored skirt, and uniforms while on duty included a white cotton dress with a royal blue velvet band on the cap (with a wider band for the head dietitian).
Brenda Richardson, MA, RDN, LDN, CD, FAND, who works in business development and relations for Dietary Consultants Inc and Food Service Management Solutions—and is the chair of the Academy of Nutrition and Dietetics’ political action committee—first enlisted in the US Army as a music major playing in the US Army band. She left to attend college but returned in the mid-1980s—“Career-wise, there weren’t many opportunities in music. I took a college nutrition class and enjoyed it so much I got a degree in dietetics and food administration,” she says. “I was accepted to Walter Reed Army Medical Center for my internship and went back on active duty as an officer and registered dietitian [RD] in the Army Medical Specialist Corps.”
She began as a hospital dietitian, later promoted to chief of dietetics, and was responsible for clinical nutrition care, advising on nutrition support, and counseling inpatients and outpatients. “Even then, you had to request hospital privileges. RDs could prescribe diets and testing for percentage body fat… but we were able to do more in making nutrition recommendations than what usually happened [in civilian institutions] during the mid-1980s.”
Of her deployment to Grenada in 1983, Richardson says that her dietitian role changed dramatically. “Your role changes to more of a food safety officer—checking foodservice operations and troops’ meals, making sure the water supply and foods are safe. You also don’t do much preventive health care, as work becomes more focused on triage, dealing with complex nutrition issues, and administering enteral and parenteral nutrition.
During her military tenure, the medical community focused more on cholesterol, its associated risk factors, and determining the ratio between intake and high-density lipoprotein and low-density lipoprotein measurements. “It was on the cover of TIME
and got the attention of the military. I remember being called into a room full of generals interested in learning about how cholesterol affected troops and what they needed to do.”
There was also greater focus on body mass index then, and soldiers were sent to her for anthropometric measurements if they exceeded their weight recommendations. “Many soldiers I provided services to were Special Forces troops such as the Airborne Division,” explains Richardson, “and so they had more lean body mass and minimal body fat. The charts always flagged them as being overweight.”
Although budget cuts affect military RDs just as they do the private sector, Richardson notes that the Army Medical Specialist Corps has always worked to justify the value and need of military RDs. She also notes the camaraderie inherent in military dietetics. “You may not see some RDs for 5, 10 years, but there will always be that bond. We were always looking out for each other. The idea of ‘leave no one behind’ was a daily practice and culture.”
Meeting of military dress: Lenna F. Cooper (right), Academy president from 1937 to 1938 and supervisor of US Army dietitians in World War I, and Helen Burns, supervisor of US Army dietitians during World War II, donned their uniforms when they met at the Academy’s 1942 annual meeting in Detroit, MI.
Mary Pascoe Huddleson, who served in US Army base hospitals in France during World War I and was a Journal editor (1927-1946), poses in her off-duty American Red Cross uniform.
Mary Pascoe Huddleson, who served in US Army base hospitals in France during World War I and was a Journal editor (1927-1946), in the American Red Cross duty uniform.
With so many dietitians employed by the military in WWI and WWII, there was an inherent early interest in examining nutrition for the military population. The listed evening sessions for September 11, 1919, at the annual meeting in Cincinnati, OH, focused on military concerns and included the presentation of a film (then called “moving picture film”) about US Army food supervision (see Figure 4).
Figure 4A page from the 1919 annual meeting in Cincinnati, OH, demonstrates the Academy’s early interest in investigating nutrition as it related to the military.
Once the Treaty of Versailles to end WWI was signed in 1918, the slate of annual meeting presenters included several who had served in WWI, but the focus of the sessions shifted from war to clinical practice and academics. Once the United States entered WWII, sessions shifted back to focus on immediate war concerns.
Despite the government’s request that nonessential conventions be suspended until after the war, the 1942 annual meeting in Detroit, MI, convened as planned so war-related recruitment and training efforts could continue. The 1943 annual meeting in Pittsburgh, PA, was dubbed “The War Conference” (see Figure 5). Sessions focused on wartime matters, including military meal service on college campuses, effects of war on foodservice, rationing, and the request for more dietitians to heed the call to service.
Figure 5The cover of the program book from 1943 annual meeting—the “war conference”—which convened in Pittsburgh, PA.
so invitations to the 1945 annual meeting, held just 1 month after Japan surrendered in September, were exclusively issued to the executive board, staff, and state affiliate delegates. Only 200 individuals attended this abbreviated meeting (see Figure 6), whereas 2,000 attendees had been present in the previous year.
Figure 6The extremely abbreviated agenda for the Academy’s 1945 annual meeting in Chicago, IL. Because of war-related restrictions, members aside from the executive board, state affiliate delegates, and staff were asked to not attend.
Although the United States has not always been at war and the need for dietitians to join the military ranks has never been as urgent as it was in WWII, booths to promote a career path in military dietetics have often been a fixture in the exhibit hall at the annual meeting.
The Academy’s Awards and Military Dietitians
The Academy has named awards and honors after some trailblazing military dietitians.
The Marjorie Hulsizer Copher Award
The namesake for the Marjorie Hulsizer Copher Award, the Academy’s highest honor, was deployed to France in 1917. She was integral in introducing dietetics as a profession to England (nurses in WWI were called “nurse sisters,” and Copher was bestowed the title “home sister”). For her service, Copher was decorated by the French government and England’s King George V.
The Copher Award is given to an Academy member who demonstrates active and engaged participation at all levels of the Academy that helps to create opportunities for and inspire other members to become active in leadership.
The first-ever Copher Award was conferred in 1945 to First Lieutenant Ruby Motley, who had served in the US Army’s medical department in Manila. Motley had been recommended for a Bronze Star Medal and was given the Presidential Unit Citation Ribbon for caring for the sick and wounded with minimal equipment and minimal food while held as one of three prisoners of war after the fall of Corregidor in the Philippines.
Lenna Frances Cooper, along with Lulu Graves, planned that first 1917 meeting in Cleveland. Graves and Cooper had intended to discuss how dietitians could position themselves to become more integrated into the government program for food conservation at an American Home Economics Association meeting. When that meeting was canceled because of WWI, they seized the opportunity to call dietitians together. She was named first vice president at that meeting and, when the war ended, she was appointed to be staff dietitian in the Office of the US Army Surgeon General and was behind the formation of an Academy committee to advocate for military status for dietitians. She was elected president for the 1936-1937 term.
The Cooper Memorial Lecture is delivered at the annual Food & Nutrition Conference & Expo by an Academy member who is considered to be a role model in dietetics, has experience as an inspiring speaker, and shows noteworthy dedication to the Academy and the profession.
The Cooper Memorial Lecture was established in 1961, and the first lecture—delivered at the 1962 Food & Nutrition Conference & Expo (then called Annual Meeting)—was presented by Mary I. Barber, Academy president from 1940-1941 and an early Academy historian who wrote History of The American Dietetic Association: 1917-1959.
As a result of their expanding and diversified roles, dietitians became more integral to the US Armed Forces over the years. In fact, the US Air Force established a dietetic internship in 1972, which in 1998 evolved into a dietetic internship consortium in collaboration with the US Army and US Navy (although the US Navy does not have a dietetics training program). In 2006, the entry-level dietetics program was redesigned to be a combination internship and master’s degree program.
During her 25-year US Air Force career, Sharon Hunter, MS, RD, was not confined to typical registered dietitian (RD) roles. She came on as a staff clinical RD at a large military medical center, providing individual and group nutrition education in a classroom setting and dietary education for inpatients based on their diagnoses and diet orders.
Other roles included serving as department chief with responsibility for managing the entire nutrition department, including clinical and foodservice, with enlisted, officer, and civilian personnel; command consultant dietitian for two major commands, providing guidance to other medical centers, hospitals, and clinics within the command, particularly those that had no assigned dietitian; US Air Force dietetic internship staff; consultant to US Air Force Surgeon General and Associate Chief of Biomedical Sciences Corps, for Nutrition and Dietetics, providing guidance regarding nutrition policy topics for implementation across the US Air Force; squadron commander, deputy group commander, and group commander; and Aerospace Medicine Squadron Commander—a squadron encompassing public health, women’s health, bioenvironmental engineering, and a staging facility for airlifting patients out of the country—in Iraq.
To keep current on the ever-changing nutrition science, says Hunter, a committee of dietitians and representatives from base foodservice, commissaries, health promotion, and child-care services convened annually to discuss developments in nutrition outcomes monitoring, nutrition supplement use in the military, healthful food options in the commissaries and base/post dining halls, wellness initiatives, and nutrition research; representatives of the Department of Defense, Public Health Service, and Veterans Administration were invited to participate on this committee.
The expanded role of dietitians—that they are experts in food and nutrition generally but can specialize in a number of areas, while their skill sets are easily transferable into other domains, such as management—has been noticed by the military, Hunter says. Once the US Air Force began establishing health and wellness centers, dietitians were assigned to be staff or managers. Other US Air Force dietitians have served in recruiter, command staff quality improvement, case manager, executive officer, and commander roles.
When Hunter entered the military, these were nontraditional roles for dietitians; but since dietitians have capably demonstrated the adaptability of their skills to a variety of contexts in the military health care domain, such assignments are now no longer considered an unusual career path.
The modern trajectory of the dietitian has been documented.
Dietitians in subsequent military struggles beginning with the Korean War have emerged from these experiences—as the medical community does—with valuable outcomes to impart to the profession at large.
Military dietitians began as the core of the profession and now are a subset—but one that the Academy continues to celebrate. The contemporary registered dietitian nutritionists who served in the military, and whose stories appear in the sidebars of these pages, note the various ways the relationship between the US Armed Forces and Academy has evolved, from improved communication with the Army Medical Specialist Corps to recognition of servicemen and servicewomen asked to stand and be recognized at the annual Food & Nutrition Conference & Expo.
This US Navy booth at the 1963 annual meeting promoted the Medical Service Corps Women’s Specialists Section.
“I believe the Academy continues to hold military dietitians in the highest regard,” says Sharon Hunter, MS, RD, who served in the US Air Force. “Many current and former military dietitians are active through volunteer or elected positions in the Academy, the Commission on Dietetic Registration, and the Accreditation Council for Education in Nutrition and Dietetics, and former military have been employed by the Academy, which I think shows a respect for the talents and experiences of these dietitians.”
But, of course, that respect was earned by the dietitians serving in WWI who made do without the benefits of official military status, and those who advocated tirelessly until such status was granted during WWII—these individuals paved the way for those who followed. Their contributions to the military system’s hospital and mess operations proved invaluable, allowing dietitians today to begin their careers as commissioned officers, starting as second lieutenant and given opportunity to move up in the ranks.
“There is a long history of dynamic leadership within the corps,” says Brenda Richardson, MA, RDN, LDN, CD, FAND, the current chair of the Academy’s political action committee and a retired US Army clinical dietitian. “A lot of credit goes to the dietitians and other people over the years who were really progressive in working in the military. They had to make do with much less than what we have today, and I have such a respect for the leadership of [RDNs] in the military and the impact it’s had outside of the military.”
A booth at the annual meeting promotes a career in US Air Force dietetics.
The editors wish to acknowledge Carlos Alvarado, assistant archivist with the US Army Medical Department Center of History and Heritage in Fort Sam Houston, TX, for his assistance in providing photographs of military dietitians from the US Army Medical Department.
References
Cassell J.A.
Carry the Flame: The History of the American Dietetic Association.
This article was written by Karen Stein, MFA, a freelance writer based in Traverse City, MI, a consultant editor for the Nutrition Care Manual, and a former editor of the Journal.
01506-8&id=gr1.jpg){kind=link}
01506-8&id=fx7.jpg){kind=link}
01506-8&id=fx8.jpg){kind=link}
01506-8&id=fx1.jpg){kind=link}
01506-8&id=fx9.jpg){kind=link}
01506-8&id=gr2.jpg){kind=link}
01506-8&id=gr3.jpg){kind=link}
01506-8&id=fx10.jpg){kind=link}
01506-8&id=fx11.jpg){kind=link}
01506-8&id=fx2.jpg){kind=link}
01506-8&id=fx12.jpg){kind=link}
01506-8&id=fx13.jpg){kind=link}
01506-8&id=fx14.jpg){kind=link}
01506-8&id=fx3.jpg){kind=link}
01506-8&id=fx15.jpg){kind=link}
01506-8&id=fx16.jpg){kind=link}
01506-8&id=fx17.jpg){kind=link}
01506-8&id=fx18.jpg){kind=link}
01506-8&id=fx4.jpg){kind=link}
01506-8&id=fx19.jpg){kind=link}
01506-8&id=fx20.jpg){kind=link}
01506-8&id=fx21.jpg){kind=link}
01506-8&id=fx22.jpg){kind=link}
01506-8&id=fx23.jpg){kind=link}
01506-8&id=fx5.jpg){kind=link}
01506-8&id=fx24.jpg){kind=link}
01506-8&id=fx25.jpg){kind=link}
01506-8&id=fx26.jpg){kind=link}
01506-8&id=gr4.jpg){kind=link}
01506-8&id=gr5.jpg){kind=link}
01506-8&id=gr6.jpg){kind=link}
01506-8&id=fx29.jpg){kind=link}
01506-8&id=fx30.jpg){kind=link}
01506-8&id=fx6.jpg){kind=link}
01506-8&id=fx27.jpg){kind=link}
01506-8&id=fx28.jpg){kind=link}