Nutritional counseling and therapy

The food we eat has an effect on our health – this fact is the basic principle underlying both nutritional counseling and nutritional therapy. Both are concerned with providing support around the topic of nutrition. As the methods are similar, the terms are often used interchangeably. However, they are not the same and, in particular, are aimed at two different target groups.

Nutritional counseling

Nutritional counseling is a primary preventive measure, i.e., it seeks to prevent the occurrence of illnesses. Nutritional counseling guides healthy people to introduce health-promoting nutritional choices into their daily lives to suit their personal circumstances. The primary goals of nutritional counseling are

• to avoid inadequate or poor nutrition
• to promote healthy body weight
• to prevent diet-related diseases such as type 2 diabetes.

In principle, anyone can avail of nutritional counseling. It can be beneficial to healthy people depending on their personal circumstances or to those who are at an increased risk of health issues due to poor or inadequate nutrition. These include, for example, older people, pregnant women and those who are breastfeeding, as well as athletes and shift workers.

Nutritional therapy

In contrast to nutritional counseling, nutritional therapy is aimed at people who are already ill. Nutritional therapy may, for example, help

• to relieve symptoms
• to have a positive impact on the progression of the disease
• to reduce the need for medication
• to avoid complications
• to improve quality of life

Nutritional therapy can also help with the treatment of several diseases. These include diet-dependent diseases such as type 2 diabetes and obesity. 

On the other hand, there are also nutritional problems that are caused by a disease itself – such as cancer, for example – or by the treatment of the disease. While nutritional therapy cannot restore the patient’s health in such cases, it can improve their quality of life and help them to better withstand the effects of treatment. As a result, it may even improve their chances of survival.

For certain metabolic disorders, nutritional therapy even represents an important part of the treatment. This is the case, for example, with cystic fibrosis. With these disorders, nutritional therapy seeks, for example, to prevent the development of other physical and psychological complications and improve life expectancy.

The first step in nutritional therapy is to assess the current situation. All relevant circumstances of the person’s life are considered. These include their current health status, eating habits, preferences, culture and available shopping facilities. In the next step, personal goals are set based on individual needs. For example, a weight loss target may be set, to be achieved by reducing portion sizes or making different shopping choices.

Nutritional therapy also begins by assessing the current situation. Based on the person’s current health issues, individual nutritional plans are created to relieve symptoms or support the healing process.

Nutritional counseling or nutritional therapy may also include the following measures

• Choosing suitable foods and quantities and preparing them in the best way possible
• Food enrichment, e.g., if there is an increase in energy requirements or a loss of appetite
• Choosing foods containing certain vitamins or minerals, e.g., foods rich in calcium
• Calculating an individual’s energy requirements that need to be covered, e.g., during pregnancy
• Finding alternatives to foods that are best avoided
• Adapting diet to an individual’s disease, e.g., with disease-specific forms of nutrition – for example, during dialysis for kidney diseases
• Adapting the consistency of meals, e.g., for those with swallowing disorders or when “normal” eating is not possible and enteral nutrition (tube feeding) or parenteral nutrition (intravenous feeding) has to be used

Practical skills are also taught if needed. For example, the correct preparation of food items may be practiced in training kitchens or training in food shopping may be provided.

The nutritional consultant/therapist will also discuss with the patient how to implement the strategies learned on a daily basis way to ensure lasting success.

Nutritional therapy usually takes the form of one-to-one therapy sessions, but small groups are also possible.

Nutritional counseling and nutritional therapy are not standard benefits covered by health insurance providers. However, costs may be reimbursed to varying degrees subject to certain conditions.

In principle, anyone can avail of nutritional counseling. The costs may be reimbursed in part by health insurance providers. However, the counseling must represent a beneficial preventive measure and must be provided by a qualified provider. 

Nutritional counseling providers and courses are therefore inspected by a centralized inspecting body for disease prevention (“Zentrale Prüfstelle Prävention”) on behalf of the statutory health insurance funds. Offerings that have been certified by the inspecting authority are recognized and subsidized by health insurance providers. The value of the subsidies depends on the specific health insurance provider. Often, individuals must pay for the counseling themselves and apply for reimbursement from their insurance provider subject to proof of regular attendance. You should therefore find out in advance about your health insurance provider’s range of cover as well as terms and conditions.   

The medical conditions for which nutritional therapy is medically prescribed are defined in the Therapeutic Services Directive (“Heilmittel-Richtlinie”) of the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA). In accordance with this directive, health insurance providers are only obliged to reimburse the costs of nutritional therapy if it has been medically prescribed due to the patient having cystic fibrosis or other, rare congenital metabolic disorders. As a rule, the prescription must be issued by a doctor specializing in the disease.

As with other therapeutic services, adult patients are usually required to contribute co-payments. They are required to cover 10 percent of the costs themselves and to pay 10 euros per prescription. Children and adolescents under the age of 18 are exempt from co-payments.

For all other diet-related diseases and disease-related nutritional problems, nutritional therapy is considered a supplementary medical service. It requires a doctor’s recommendation and is not a standard benefit offered by statutory health insurance funds. Nevertheless, it is subsidized by many health insurance providers. In individual cases, it is advisable to ask your health insurance provider about the process involved and to apply for reimbursement where relevant.

Nutritional therapy may also form part of medical rehabilitation. In addition, training courses about nutrition are offered in the context of disease management programs (DMPs). These courses are free of charge for DMP participants.

Different rules apply to people with private health insurance. Whether and to what extent the costs of nutritional counseling and therapy are covered by private health insurance depends on the level of cover specified in the individual insurance policy. 

Further information about the precise conditions associated with nutritional therapy prescriptions can be found in our article on therapeutic services.

Watch our video for more information about disease management programs.

“Nutritional consultant” and “nutritional therapist” are not protected professional titles. However, health insurance providers only recognize providers who can furnish evidence of having certain qualifications.

These qualifications include:

• a state-recognized professional qualification as a dietitian
• a completed university degree in ecotrophology
• a completed university degree in nutritional science
• for nutritional therapy only – an additional qualification in nutritional medicine awarded to doctors (general practitioners)

Specific certificates are also required as proof of completion of relevant professional development and training courses.

Nutritional therapists who offer therapy for patients with cystic fibrosis or other rare, congenital metabolic disorders must also furnish proof of further qualifications.

Qualified nutritional professionals offer nutritional counseling and nutritional therapy in their own practices, general medical practices, rehabilitation centers and hospitals.

How can I find the right option for me?

When looking for courses, it’s advisable to begin by finding out about your own health insurance provider’s range of cover and which conditions apply. You can also ask your family doctor about suitable practices offering nutritional therapy. The following source of information will also help you find a qualified specialist:

An overview of quality-approved prevention courses provided exclusively by qualified professions is available on the portal of the centralized inspecting body for disease prevention (Zentrale Prüfstelle Prävention). 

You can use the website of the Platform for Qualified Nutritional Therapy and Nutritional Counseling (Plattform qualifizierte Ernährungstherapie und Ernährungsberatung e.V. – E-Zert) to find practices offering nutritional counseling and nutritional therapy in your area.

Nutritional therapy practices that treat patients with cystic fibrosis and rare, congenital metabolic disorders can also be found on the list of therapeutic providers published by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). The cost of the treatments provided by all of the practices listed can be covered by statutory health insurance providers. 

Professional associations can also help you find suitable practices offering nutritional therapy:

Professional Association for Ecotrophology (Berufsverband für Oecotrophologie e.V., VDOE)
German Nutrition Society (Deutsche Gesellschaft für Ernährung e.V., DGE)
German Society of Qualified Nutritional Therapists and Nutritional Advisors (Deutsche Gesellschaft der qualifizierten Ernährungstherapeuten und Ernährungsberater e.V., QUETHEB)
German Association of Dietitians (Deutscher Bundesverband e.V., VDD)
German Association for Nutrition and Dietetics (Verband für Ernährung und Diätetik e.V., VFED)