The Academy’s Military Roots Visualized
2014; Elsevier BV; Volume: 114; Issue: 12 Linguagem: Inglês
10.1016/j.jand.2014.10.009
ISSN2212-2680
Autores Tópico(s)Dietetics, Nutrition, and Education
ResumoContinuing Professional Education (CPE) InformationTo 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar∗Before 2012 the Academy of Nutrition and Dietetics was called the American Dietetic Association. Throughout this article, it will be called the Academy. 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. 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 status1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar, 3Hodges P.M. Perspectives on history: Military dietetics in Europe during World War I.J Am Diet Assoc. 1993; 93: 897-900Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 4Vogel EE, Manchester KE, Gearin HB, West, WL. Training in World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chaptervi.html. Accessed August 4, 2014.Google Scholar—resulting in 2,000 Academy members (out of 7,562) holding commissions by the war’s end in 1945.5Hodges P.M. Perspectives on history: Army dietitians in the European, North African, and Mediterranean theaters of operation in World War II.J Am Diet Assoc. 1996; 96: 598-601Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar 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. 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar, 6Manchester KE, Gearin HB. Dietitians before World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chapterII.html. Accessed August 5, 2014.Google Scholar 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 3Hodges P.M. Perspectives on history: Military dietetics in Europe during World War I.J Am Diet Assoc. 1993; 93: 897-900Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 7Mullins WS, ed. Chapter V: Dietitians, physical therapists, and occupational therapists. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/booksdocs/wwii/medtrain/ch5.htm. Accessed August 25, 2014.Google ScholarThe chief dietitian supervises French civilian personnel washing vegetables during World War II.(Photo courtesy of US Army Medical Department Center of History and Heritage Research Collection.)View Large Image Figure ViewerDownload (PPT) 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,2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar 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.6Manchester KE, Gearin HB. Dietitians before World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chapterII.html. Accessed August 5, 2014.Google Scholar Thus, many of their commanding officers were not sure what to ask dietitians to do.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar 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.”2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar, 6Manchester KE, Gearin HB. Dietitians before World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chapterII.html. Accessed August 5, 2014.Google ScholarComing Up Through the Ranks: Esther MyersEsther 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. 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 1938.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar became the first dietitian on staff of the US Public Health Service.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar 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.”6Manchester KE, Gearin HB. Dietitians before World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chapterII.html. Accessed August 5, 2014.Google Scholar 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.”6Manchester KE, Gearin HB. Dietitians before World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chapterII.html. Accessed August 5, 2014.Google Scholar 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 6Manchester KE, Gearin HB. Dietitians before World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chapterII.html. Accessed August 5, 2014.Google Scholar Graduates of this program were most frequently the dietitians assigned to US Army hospitals. 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.2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar 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.7Mullins WS, ed. Chapter V: Dietitians, physical therapists, and occupational therapists. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/booksdocs/wwii/medtrain/ch5.htm. Accessed August 25, 2014.Google Scholar Efforts continued for years to attain military status for dietitians, a role that by now was more fully understood stateside and among allies. ‡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.2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar Editorials published in the Journal advocated for granting of military service and encouraged dietitians to serve.2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar 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 meeting1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar 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.”8Goldsmith GA. Russell M. Wilder—A biographical sketch. http://jn.nutrition.org/content/74/1/1.full.pdf. Accessed August 20, 2014.Google Scholar Wilder also offered his assistance in working toward obtaining military designation for dietitians when entry into WWII seemed certain (see Figure 2, Figure 3).1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 7Mullins WS, ed. Chapter V: Dietitians, physical therapists, and occupational therapists. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/booksdocs/wwii/medtrain/ch5.htm. Accessed August 25, 2014.Google ScholarFigure 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.View Large Image Figure ViewerDownload (PPT) 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.2Hodges P.M. From Home Sister to Second Lieutenant: Army Dietitians in World Wars I and II. Catawba Publishing, Charlotte, NC2007: 40-41Google Scholar 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google ScholarA dietitian, a first lieutenant, checks one of the dishes to be served at the noon meal with the chef.(Photo courtesy of US Army Medical Department Center of History and Heritage Research Collection.)View Large Image Figure ViewerDownload (PPT) Dietitians were granted relative rank §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.5Hodges P.M. Perspectives on history: Army dietitians in the European, North African, and Mediterranean theaters of operation in World War II.J Am Diet Assoc. 1996; 96: 598-601Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar in 1943 and full commissioned status in 1944.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 9Harman TA. Professional services of dietitians, World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chaptervii.html. Accessed September 2, 2014.Google Scholar, 10Baylor University. History of military dietitians. http://www.baylor.edu/graduate/nutrition/index.php?id=68073. Accessed September 9, 2014.Google Scholar 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 1943.4Vogel EE, Manchester KE, Gearin HB, West, WL. Training in World War II. US Army Medical Department, Office of Medical History website. http://history.amedd.army.mil/corps/medical_spec/chaptervi.html. Accessed August 4, 2014.Google Scholar 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.1Cassell J.A. Carry the Flame: The History of the American Dietetic Association. American Dietetic Association, Chicago, IL1990Google Scholar, 10Baylor University. History of military dietitians. http://www.baylor.edu/graduate/nutrition/index.php?id=68073. Accessed September 9, 2014.Google ScholarA Career in the Reserves and Research: Joyce GilbertJoyce 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.” 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
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