How to Work in the U.S. As a Foreign-Educated Dietitian or Nutritionist

If you’re a dietitian or nutritionist who was educated outside the United States and you’re thinking about moving here and starting your career, you might be wondering how to get started.

Even though the process might seem complicated, the good news is that many states welcome internationally educated dietitians and nutritionists, as long as they follow the proper steps.

That usually means having your education and experience evaluated, passing a national exam, and completing a supervised internship. It might sound like a lot, but with the right guidance, it’s possible. Once licensed, you should be able to work in hospitals, clinics, schools, private practice, research, and more, depending on where your skills lead you.

In this guide, we’ll walk you through each step so you know what to expect. We’ll also point you to helpful resources like credentialing agencies, licensing boards, and exam prep tools. Now, let’s get started.

Why Become a Dietitian or Nutritionist in the U.S.?

Job Outlook and Earning Potential

You may be asking yourself if becoming a licensed dietitian or nutritionist in the U.S. is worth the effort. So, let’s take a closer look at the job market.

Dietitians and nutritionists play a vital role in helping people live healthier lives. Whether you’re working in a hospital, supporting athletes, helping manage chronic illnesses, or guiding patients through better food choices, your expertise can make a real impact.

Plus, according to the U.S. Bureau of Labor Statistics, jobs for dietitians and nutritionists are expected to grow by 7 percent between 2023 and 2033. That’s faster than the average for most occupations in the U.S., which means there’s a good chance you’ll find employment.

It’s also a career with strong earning potential. The median annual wage is $73,850, and with more experience or a specialized focus, you could earn even more.

Now that we’ve seen that there are rewarding job opportunities in this field, let’s review the steps you’ll need to take to get licensed and start working as a dietitian or nutritionist in the U.S.

Understanding Licensing Authorities

National vs. State Oversight

To become a licensed dietitian or nutritionist in the U.S., it’s important to know which organization handles licensing in the state where you hope to work.

Two main organizations help oversee the field of dietetics nationally. The Academy of Nutrition and Dietetics promotes nutrition science, education, and public health, and the Commission on Dietetic Registration, or CDR, sets certification standards and administers the Registration Examination for Dietitians (RD Exam).

However, to get licensed, you’ll have to communicate with your state board. For example, in Texas, dietitians are licensed through the Texas Department of Licensing and Regulation, while in New York, licensing is handled by the New York State Education Department.

You can use the CDR’s interactive map to help you find your licensing board. However, we’ll also share the contact details for California, Florida, Illinois, Massachusetts, New Jersey, New York, and Texas since these are the seven most popular states where internationally trained professionals choose to relocate to the United States.

How to Contact Your State Licensing Board

Now, let’s discuss the best way to contact your state’s licensing board.

Because nutrition is still an evolving profession in many places, not every state has a dedicated licensing board for the field yet.

In the meantime, the responsibility may fall to a state-level agency, such as the Department of Health or the Department of Consumer Affairs. So be sure to identify the correct agency in your state, as they’ll be responsible for reviewing your qualifications and issuing your license.

If English isn’t your first language, you might want to write your message in your native language and then translate it carefully to sound clear and professional. We can help with a translation if needed.

When you email or send a letter, include your full name, phone number, mailing address, and email address so the department can easily contact you.

If you’d rather call, keep in mind that most government offices are open Monday through Friday, from 9 a.m. to 5 p.m. Because the U.S. spans several time zones, be sure to check the local time before you make the call.

Nutritionist vs. Dietitian: What’s the Difference?

Definitions and Scope of Practice

Before going much further, we need to establish the difference between nutritionists and dietitians.

A dietitian is a licensed healthcare professional who completes a degree, supervised training, and a national exam to work in clinical settings. On the other hand, a nutritionist has fewer requirements, and in some states, a person without a degree can legally use the title.

Even though the two roles are not exactly the same, their work often overlaps. Nutritionists might provide general nutrition counseling, wellness advice, or support for healthy eating habits. However, there are limits. In most states, only licensed professionals like dietitians can offer services such as Medical Nutrition Therapy.

Because the rules for nutritionists are looser, internationally trained professionals may be able to work as nutritionists while they complete U.S. requirements to become licensed dietitians. Others may choose to stay in the nutritionist role if it fits their long-term career goals.

Certified Nutrition Specialist (CNS) Option

If you’re seeking a formal title as a nutritionist, you might want to consider becoming a Certified Nutrition Specialist or CNS, which the American Nutrition Association regulates. To earn this credential, you need an advanced degree in nutrition or a related field, at least 1,000 hours of supervised practice, and you have to pass the CNS exam.

According to the American Nutrition Association, Certified Nutrition Specialists can legally offer some level of personalized nutrition counseling in nearly every state. In many states, CNS professionals are even eligible for state licensure or certification if their qualifications meet or exceed the local standards.

Nutritionist Licensing by State

Now, let’s take a quick look at how this plays out in the seven most popular states for immigrants.

In New York, Illinois, Florida, and Massachusetts, you must be licensed to work legally as a nutritionist. New Jersey is in the process of setting up licensing rules, but the regulations are not finalized yet.

In California and Texas, there is no state licensing requirement specifically for using the title “nutritionist.” However, many employers still prefer to hire candidates who hold recognized certifications or degrees in the field. Additionally, insurance companies may only reimburse services provided by licensed or certified professionals, which can impact where and how a nutritionist can work.

If you’re interested in becoming a Certified Nutrition Specialist, you can find more details on the American Nutrition Association’s website, including a state-by-state list of practice rights.

However, although you may be able to find work as a nutritionist, this guide will focus on what it takes to become a Registered Dietitian.

We’re focusing on this path because the RD credential is widely recognized across the U.S. and is often required for roles in hospitals, clinical settings, and jobs that involve complex health needs. While nutritionists play an essential role in many areas of health and wellness, the RD credential can open up a broader range of work opportunities and give you more options for where and how you practice.

How to Become a Registered Dietitian

Credential Overview and State Licensing

So, let’s look at what it takes to become a dietitian in the U.S.

Registered dietitians are certified by the CDR. You might hear people use the acronyms RD or RDN. These two terms are used interchangeably and mean the same thing.

To become a dietitian in the United States, you need a degree from a program approved by the Accreditation Council for Education in Nutrition and Dietetics, or ACEND. You must also complete a supervised internship, pass the RD exam, and obtain state licensure.

Most states require dietitians to hold this license. These requirements help ensure dietitians are qualified to give safe, evidence-based nutrition guidance. These credentials allow dietitians to work in hospitals, clinical settings, and other regulated healthcare environments.

As for the seven states we mentioned earlier, New York, Illinois, Florida, Massachusetts, and Texas all require a license to practice as a dietitian. New Jersey is still setting up its licensing system, but the rules haven’t been finalized yet. In California, no state license is required, but many employers still expect national certification, and insurance companies often look for it, too. Later, we’ll discuss how to become a registered dietitian in each of these states in more detail.

All things considered, if your goal is to work in hospitals or clinical care, becoming a registered dietitian is likely your best path. If you’re more interested in wellness coaching, private practice, or nutrition research, the Certified Nutrition Specialist credential or another type of certification might be a faster way to get started.

Whichever path you choose, be sure to look up the laws in your state. Each state sets its own rules, and knowing those requirements early on will help you make the right decisions for your career.

Education Requirements for Foreign-Trained Professionals

So, let’s go over the education and degree requirements for dietitians who were educated abroad.

Nearly everywhere in the U.S., hopeful dietitians must hold a master’s degree or higher from an ACEND-accredited program to take the RD exam. While this might seem like a lot of extra schooling, a foreign degree evaluation may certify and apply some of your coursework from your prior studies, so you’re not starting from zero. We’ll discuss the degree evaluation process in more detail shortly.

Whenever possible, you may want to prioritize finding a program that allows postgraduate students to transfer coursework from a degree they have already earned. As you search for an ACEND-accredited program that fits your needs, the CDR recommends reaching out directly to the program director. They can review your foreign degree evaluation, determine which courses may transfer into their program, and guide you on the next steps.

Though this process may feel like a step backward, it ensures that all dietitians and nutritionists in the U.S. meet the same high standards. After completing the necessary coursework and earning your graduate degree, you will receive a “verification statement” from the director of your ACEND-accredited program. This statement confirms that you’ve met the educational requirements and are eligible to apply for the CDR exam.

If you’re looking for online ACEND-accredited programs that might accept some of the coursework you’ve already completed, check out the Academy of Nutrition and Dietetics, program directory page. There, you’ll find two helpful filter boxes: ‘Course Credit Transfer Agreements’ and ‘Distance Education,’ which can make your search easier.

Let’s take a closer look at how your internship fits into your degree requirements.

Understanding Supervised Internships

According to the Academy of Nutrition and Dietetics, there are four types of programs, and each one handles internships differently. You can check out their online flowchart for an illustration of these pathways, but here is the basic information:

1. Coordinated Program in Dietetics (CP)

• Available at the bachelor’s, master’s, and doctoral levels
• Combines academic coursework with 1,000 hours of supervised practice
• Qualifies you to take the RD exam upon completion

2. Graduate Program in Nutrition and Dietetics (GP)

• Offered only at the master’s or doctoral level
• Integrates coursework with supervised practice, similar to the CP

3. Didactic Program in Dietetics (DPD)

• Available at the bachelor’s and master’s levels
• Includes academic coursework only—no internship
• Requires you to apply separately for a dietetic internship afterward

4. Dietetic Internship (DI)

• Requires completion of a bachelor’s or master’s degree
• You must also have a verification statement from your program director
• Focuses solely on completing the supervised practice requirement

Keep in mind that you must complete both a degree program and an internship before you’re eligible to sit for the RD exam.

These internships typically require around 1,000 hours of supervised practice in a range of settings like hospitals, community clinics, long-term care facilities, public health departments, schools, and even food service operations. The goal is to give you a comprehensive understanding of what dietitians do in the United States and ensure you’re fully prepared to handle the work as soon as you’re licensed.

To help you explore your options, the Accreditation Council for Education in Nutrition and Dietetics maintains a comprehensive list of approved internships on its website. The directory is organized by each of the program types mentioned above and by location, making it a valuable tool for finding a path that fits your background and goals. But remember, one of the most important things you can do is reach out to program directors for guidance.

Now, let’s take a more detailed look at the foreign credential evaluation you’ll need.

Foreign Credential Evaluation

As we mentioned earlier, your degree and experience will need to be reviewed. This evaluation will determine how your foreign education aligns with the requirements of the college or university you hope to attend in the U.S.

When ordering a credential evaluation, you’ll see different levels of detail, ranging from basic to highly detailed. According to the Academy of Nutrition and Dietetics, a ‘detailed course-by-course evaluation‘ will be the most helpful for making the process smoother. This evaluation gives program directors at ACEND-accredited programs a thorough idea of your studies, helping them figure out which of your completed courses may count toward their program.

Fortunately, the CDR has put together a list of approved credential evaluation agencies, so you know exactly which organizations to use, but keep in mind that some universities only accept evaluations from specific agencies. If you have a particular program in mind or aren’t flexible about relocating, it’s a good idea to check with the school first to see which credential evaluation agencies they accept.

These evaluations typically cost between $200 and $400, with processing times ranging from a few days to about 4 weeks. If you’re in a hurry, many credential evaluation companies also offer expedited processing for an extra fee, which is usually between $80 and $150.

Once the evaluation is complete, the agency will send the results to you. Then, you’ll provide the report to the program director of the ACEND-accredited school where you’re applying.

To use a credential evaluation service, you’ll need a few key documents, including your original degree certificate or diploma, transcripts, and mark sheets. And if your documents aren’t in English, you’ll need a certified English translation. This will help the program director and admissions team process your application more quickly.

Certified Translations

Why Certified Translations Are Required

If your documents aren’t in English, they must be translated by a certified professional. It’s important to understand that, even if you are fluent in English, you are not permitted to translate your own documents. In most cases, evaluation agencies will provide you with various options depending on whether you are going to have your documents translated in the U.S. or abroad. So, be sure to check with the evaluation agency because they may have certain requirements.

What Certified Translations Do—and Don’t Do

Certified translations provide an accurate English version of your academic or professional records so that U.S. evaluators can assess them. These translations do not determine equivalency or adjust the value of a grade—for example, a grade of “10” in your system will be listed as “10,” not converted into a letter grade like “A+.”

Now we’ll discuss how to demonstrate your level of English proficiency.

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English Proficiency

Importance of English in Training and Practice

Having strong English skills is also important if you plan to become a dietitian or nutritionist in the United States.

While there are no specific English language requirements listed for international students who want to sit for the RD exam, the reality is that every step of the process will be in English. The RD exam is only offered in English. ACEND-accredited degree programs are taught in English. And your supervised internship will also be conducted entirely in English.

Beyond that, strong communication skills are a big part of the job. As a dietitian, you’ll write notes, give advice, and talk with patients, families, and coworkers. In most settings, all of that will be done in English.

After you’re licensed, English will continue to play a role in your daily life. You’ll take part in continuing education programs, read scientific research, and may even be asked to write reports or present your findings. Having a solid understanding of the language makes it easier to succeed in all these situations.

Voluntary Language Exams

Some internationally educated dietitians choose to take a language proficiency test to demonstrate their English skills to program directors, licensing boards, or potential employers. Two of the most popular exams are the TOEFL, which stands for “Test of English as a Foreign Language,” and the IELTS, which stands for “International English Language Testing System.”

The CDR doesn’t require these tests, but they can show that you’re ready to succeed in an English-speaking academic or clinical setting. In many cases, submitting your test results can strengthen your application and show program directors or employers that your language skills are strong enough for the job.

The RD Exam

Registration Process and Fees

To become a Registered Dietitian, you must pass the Registration Examination for Dietitians.

This is the national test for all dietitians and is commonly called the RD Exam but sometimes also called the RDN Exam. The CDR developed and oversees the exam, and you can check out their online PDF: RD Handbook for Candidates for a detailed look. But for now, we will go over the most important things you need to know.

While the CDR oversees the RD Exam, it’s administered by a separate company, Pearson VUE. To schedule your exam, the first step is to log into Pearson VUE’s online portal and create a candidate profile.

Once you’ve created your profile on Pearson VUE’s website, you’ll find step-by-step instructions for scheduling and paying for your exam. The full exam fee is $225, and payment must be made by credit card when you register for your appointment. After you’ve paid, you’ll receive a confirmation email, and it’s important to check for that email to ensure your exam was successfully scheduled.

If you need to reschedule or cancel your exam, you must do so through the Pearson VUE web portal at least 48 hours before your chosen date and time.

The RD Exam is offered at more than 250 Pearson VUE professional test centers across the United States. To find a location nearest to your address, you can use the “Find a Test Center” tool on the Pearson VUE website.

When you arrive for your exam, you must present a valid, government-issued ID that matches the name on your Pearson VUE profile. If you don’t have a current ID from the United States, you’ll need to show a passport from your country of citizenship.

Exam Format and Content Areas

The RD Exam is computer-based and designed to adapt to your performance. It includes both scored questions and unscored pretest questions, which are mixed together, so it’s important to answer every question, even if you’re unsure.

Once the first question appears, you’ll have 3 hours to complete the exam. Before the test begins, you’ll also have 20 minutes for an introductory tutorial, and at the end, 10 minutes for a short survey. So, plan for about 3 ½ hours to finish your test.

The exam includes four main content areas:

• Principles of Dietetics: 21%
• Nutrition Care for Individuals and Groups: 45%
• Management of Food and Nutrition Programs and Services: 21%
• And Foodservice Systems: 13%

All of the questions are designed to match real work situations. Questions from any of the 4 content areas can appear at any time and do not follow a set order.

Scoring and Retake Policies

You’ll receive between 125 and 145 questions in total. Of those, at least 100 will be scored, and up to 25 will be pretest questions. All the questions are in multiple-choice format, with four answer options each. To receive a pass or fail score, you must answer at least 125 questions. If the exam ends before you reach 125 questions, that means you didn’t pass the exam on that attempt.

When you finish the exam, you will receive a printed score report before you leave the test center. If you do not receive a score report, you can log into your Pearson VUE online account to download a copy and contact Pearson VUE directly. The report will show your total scaled score with detailed scores for each content area.

The exam is scored on a scale from 1 to 50 using computer adaptive testing. This type of scoring helps ensure that the exam is fair for every person who takes it. Each exam has a different set of questions, and every candidate is scored based on the difficulty of the exam version they receive.

Some exams might include questions that are a little easier. Other exams might include questions that are a bit more difficult. If your exam includes more difficult questions, you will need fewer correct answers to pass. If your exam includes easier questions, you will need more correct answers to pass.

To pass the exam, you need a minimum scaled score of 25. The number of correct answers you need to reach that score can vary slightly depending on the test version.

If you do not pass, you will need to request reauthorization before you can schedule another attempt. This process is not automatic. You must submit a new request through your candidate profile on Pearson VUE. You can retake the exam after 46 days, and the standard fee to retake it is $225.

However, the CDR offers an optional test bundle that can save you money if you’re concerned about needing a second try. For $325 total, you can pay for your initial attempt and receive a discounted retake voucher. This bundle is only available when you register for your first exam. It cannot be added later. If you choose the bundle, your retake voucher brings the cost of a 2nd attempt down to $100 instead of the full $225.

Study Materials and Online Communities

To help avoid taking the exam a second time, there’s a broad range of study resources available. For starters, let’s look at the materials provided by the CDR. These are completely free and can be found on their website. If you go to the section called “Registration Examination for Dietitians,” you’ll find a detailed content outline for each part of the exam, a 13-page study guide, a list of recommended references you can review, and 30 practice questions followed by correct answers and explanations for each one.

Many aspiring dietitians desire additional study help so let’s take a look at some other RD exam prep materials.

One of the most popular study guides comes from the Academy of Nutrition and Dietetics, and it’s called eatrightPREP for the RDN exam. When you sign up, you’ll get access to a fully online learning platform created by the Academy. It includes flashcards, 3 practice tests, and 2 simulated exams timed for 2 ½ hours, which is slightly shorter than the actual exam and helps you build speed and confidence.

Each flashcard and question includes a clear explanation of the correct answer, along with a cited reference, so you know exactly why it’s right. The platform also tracks your performance and shows you where you’re doing well and where you need improvement.

There are two pricing options. 90-day access is available for $200. Or, you can choose one 180 access for $300. And if you want to try it out before you commit, there’s a free demo. Just go to the eatrightPREP website and click on “RDN Course Demo” to start your 7-day trial.

Another popular study guide among aspiring dietitians is Inman’s Review Course. It’s available as a live virtual class or as recorded lectures on a USB drive. The course costs $385 and includes a comprehensive Study Manual that follows the official CDR guidelines and covers all four exam domains.

You’ll also receive more than 1,000 sample test questions, along with tips on how to study and navigate the computer-based format of the exam.

If you have questions while you’re studying, you can contact Jean Inman, the creator of the study guide. She’s also the Director of the New England Center for Nutrition Education and offers individual support.

If you choose the virtual class, make sure to register ahead of time and include the date you plan to attend from the options listed on the website.

In addition to study guides and other resources, you might want to connect with fellow dietitians who are also working toward licensure. A great place to start is the r/dietetics subreddit, which has over 31,000 members. People post there daily, and responses often come within a few hours. It’s a helpful space to find advice, encouragement, and tips from others who are either going through the same process or have already completed it.

There’s also a private Facebook group called RD Exam Prep, with over 5,000 members and new posts every month. It’s a great place to find community or get advice about things like pricing, scheduling, or choosing the right study materials. Since the group is private and focused specifically on exam prep, you might also receive more detailed or up-to-date answers to your questions.

State Requirements for Licensure

Internship Hours, Fees, and Certification by State

Though the national exam is the same for nearly every state, the process to become a dietitian or nutritionist can vary depending on the state you’re hoping to work in.

So now, let’s look at what it takes to become a dietitian in seven of the most popular states, including the number of internship hours you’ll need, the application fees, and what kind of license or certification each state issues.

As we mentioned earlier, California doesn’t currently issue a license for registered dietitians. But according to California’s state law, anyone claiming to be a dietitian or nutritionist should be at least 18, hold a bachelor’s degree or higher in nutrition or a related field, complete 900 hours of supervised practice, and keep up with continuing education. You can contact the California Department of Human Resources if you have more questions.

As for Florida, the process for dietitians and nutritionists generally follows the nationwide standard. In Florida, both professions are licensed under one official title, which is Licensed Dietitian Nutritionist, often called ‘LDN’ for short. To earn this license, you’ll need to complete 900 hours of supervised practice and apply for licensure by paying the $165 fee.

Illinois is similar to Florida, where dietitians and nutritionists share one title of LDN. To earn this license, you’ll need to complete at least 900 hours of supervised practice, pass the RD exam, and pay the $100 application fee.

In Massachusetts, dietitians and nutritionists also share the title of LDN. To earn this license, you must complete at least 900 hours of supervised practice through a Board-approved internship, pass the RD exam, and pay the $196 application fee.

As mentioned earlier, licensure for dietitians and nutritionists in New Jersey is currently unavailable. However, the state is actively working to create a licensing process. The smartest thing to do is to check online and contact the New Jersey Division of Consumer Affairs for the latest updates.

In New York, anyone who wants to use the title of Certified Dietitian, Certified Nutritionist, or Certified Dietitian-Nutritionist must first earn state certification, which requires completing at least 800 hours of work experience and paying a $294 application fee.

Lastly, in Texas, you’ll need to take an extra test called the Texas Jurisprudence Exam, which covers the state and federal laws, rules, and regulations for Licensed Dietitians. The test costs $34, takes about 2 hours to complete, and it’s open-book. You’ll also need to complete a 900-hour internship, and pay the $108 application fee.

The table below summarizes the above information, providing a helpful visual reference alongside the full details.

License Renewal Requirements

Continuing Education and Renewal Fees by State

After you get your license, you’ll still need to maintain it every 2 or 3 years.

Let’s take a look at what you’ll need to keep your credentials up to date in the same seven states we just covered.

California doesn’t offer its own license for dietitians, so the best way to stay current is to maintain your registration with the CDR by completing 75 continuing professional education units every five years.

In Florida, dietitians are required to complete 30 hours of approved continuing education in dietetics and nutrition every 2 years, with a $100 fee. The state even provides a list of acceptable courses to make it easier.

Dietitians in Illinois must complete 30 hours of continuing education every 2 years from an approved sponsor and pay a $100 renewal fee. The sponsors must follow specific guidelines, including submitting an application and providing certificates with details like course content and hours attended.

As for Massachusetts, there’s a $130 license renewal fee every 2 years, plus 30 continuing education units required per renewal cycle.

Since New Jersey doesn’t have an official licensing process, it’s similar to California. The best way to stay current is to maintain your CDR registration by completing 75 continuing professional education units every 5 years.

New York doesn’t require continuing education for dietitians and nutritionists, but you’ll still need to renew your license every 3 years, which costs $179.

Finally, in Texas, renewing your dietitian license requires completing at least 12 hours of continuing education every two years and paying a $90 renewal fee.

Final Thoughts

That brings us to the end of our overview of the licensure and renewal requirements for dietitians and nutritionists across some of the most popular states among immigrants moving to the U.S. Even though each state has its own rules, most states follow similar patterns, so this guide should give you a solid understanding of what to expect wherever you choose to practice.

As you prepare for your move, it’s encouraging to know that no matter where you choose to settle, you’ll be making a positive impact. Whether you’re aiming for clinical roles, community health initiatives, private practice, or research, your work as a nutrition professional can make a real difference in people’s lives.

Starting a new chapter in the U.S. as a dietitian or nutritionist brings a lot of exciting opportunities, but it also comes with its fair share of paperwork. Beyond the professional requirements like certified translations of transcripts and degree certificates, you may also be asked to provide translations of personal documents, such as birth or marriage certificates, depending on your situation and the state you’re moving to.

That’s where we come in. Navigating these steps can feel overwhelming, but you don’t have to do it alone. If you’re unsure about what documents need translation or how to get started, contact us. We’re here to support you and help make sure you’re ready to take the next step in your career.

Author: Aaron Randolph | LinkedIn