History of Military Dietitians
As a specific occupation, dietitians were actively recruited to serve in World War I. Initial qualifications included two years of college study majoring in home economics and four months of practical experience in hospital dietetics. These qualifications were established by the National Committee on Dietitian Service of the Red Cross in 1916. Dietitians initially served overseas as members of hospital units organized through the American Red Cross and deployed in support of the British Armed Forces. The first military dietitian to serve overseas deployed in May, 1917.
Miss Lena Cooper was appointed to represent the dietitians at the Office of the Surgeon General (OTSG) in 1918. (Miss Cooper later served as the first vice president of the American Dietetic Association.) Miss Cooper initiated the first training course for student dietitians approved by the Army Surgeon General. The first class was taught at Camp Custer Base Hospital, Michigan, and the first class graduated in 1919. Uniforms were provided through the Red Cross because they were serving with Red Cross sponsored hospitals. At this time dietitians were not entitled to protective wartime benefits equal to those of Army medical personnel with whom they served, such as war risk insurance, war bonuses or hospitalization in military hospitals following completion of their tours of duty. Serving within these discrepancies, several American dietitians were decorated by the British and French governments and four died while on duty overseas.
Following World War I some dietitians remained in service with the Army while the profession as a whole continued to grow. On 2 October 1922, as part of the Medical Department Professional Service Schools at Walter Reed General Hospital, the first training program for dietitians was established. This program met the requirements of the American Dietetic Association and was the only training course for dietitians conducted by the Army from 1922 to 1942.
As the United States entered World War II, dietitians were again there to serve their country despite inequitable compensation and recognition as health care providers in comparison with their commissioned counterparts. During the Japanese occupation of the Philippines three dietitians of the Army Medical Department at Sternberg Army Hospital in Manila were captured as prisoners of war. (They were eventually liberated in Manila by American forces in February 1945.) Dietitians served in every theatre of war- European, Pacific, Mediterranean and China-Burma-India theatres. In June, 1944 Congress passed Public Law 78-530 which provided commissioned status for dietitians in the Army, granting them the same allowances, rights, benefits and privileges as other commissioned officers. By August 1945, at the twilight of World War II, dietitians on active duty numbered 1,580. (In comparison, today's combined number of Army and Air Force active duty dietitians hovers at approximately 200.) In 1947, President Truman signed Public Law 80-36, which established the Women's Medical Specialist Corps as part of the Regular Army. Permanent military status was thereby granted to the dietitian.
Although the National Security Act of 1947 created the United States Air Force (USAF), the Army continued to support the USAF until July 1949. The USAF Medical Service was created in 1949 with the Women's Medical Specialist Corps (WMSpC) as one of its six components. Thirty-eight Army dietitians transferred to the Air Force, including Maj Miriam Perry who was appointed as the first Chief of the WMSpC.
In 1947, the WMSpC began accepting qualified males in its reserve component and the Women's designation was dropped from the WMSpC name. In 1965, the Medical Specialist Corps was retired by the USAF. Dietitians, occupational therapists, and physical therapists that comprised the corps were transferred to the newly established Biomedical Sciences Corps (BSC) in the United States Air Force. Meanwhile, Army dietitians served under the Women's Medical Specialist Corps until 1955 when it was also retitled to reflect the inclusion of men. The Army Medical Specialist Corps was created by Public Law in 1955. The Corps insignia changed to remove the black "W" from the silver caduceus and established a black "S" on a gold caduceus that was uniform with the other corps.
The role of the dietitian started to expand during the Korean conflict to include not only therapeutic dietetics, but also the supervision and operation of the entire hospital food service system. Dietitians in the USAF and the USA completed nutrition surveys in Africa, South America, and the Middle East. Later they were assigned to combat areas during the Vietnam conflict and played a key role in determining the nutritional status of repatriated prisoners of war and recovery of troops. To aid in the nutritional care of patients transported via the Aeromedical Evacuation System, Air Force dietitians developed a system to order, prepare, and serve cooked therapeutic inflight meals (CTIMs). Air Force dietitians also worked on the project to develop foods used on early manned space flights.
To support the numerous Army hospitals feeding operation throughout the Vietnam conflict, dietitians were assigned as consultants to medical groups supporting each of the four combat tactical zones. These dietitians, along with warrant officers and senior food service personnel, advised food service management personnel, consulted with medical staffs regarding patient care, and trained enlisted personnel in aspects of patient feeding, and inspecting food service operations.
The diversity of roles and military unique responsibilities of the dietitian in the Air Force led to the establishment of the USAF Dietetic Internship. One hundred ninety-nine dietitians have graduated from the program since 1972. The dietetic internship is regarded throughout the United States as one of the premier dietetic education programs and has attracted the top college graduates. The internship graduates continue to contribute significantly to expanding and advancing the role of USAF dietitians and enabled the USAF to assign junior officers to small operations where they could function independently as privileged healthcare providers and managers.
During Operation DESERT SHIELD/STORM, USAF dietitians were deployed to several contingency hospitals in Europe as well as to the desert. Many USAF Reserve dietitians were recalled to active duty to backfill stateside positions of dietitians who deployed. Dietitians were mobilized to serve in Rwanda and in the "circuit rider" program in Europe.
Army dietitians were also deploying in support of DESERT SHIELD/STORM as forty-four Army hospitals deployed to Southwest Asia. Dietitians were heavily represented by activated reservists in particular. Primary responsibilities included patient nutrition support, ration preparation for patients and hospital staff and representation on troop menu boards.
By this time the work of the pioneer dietitians in current previous conflicts had paved the way for areas of increased responsibility and visibility outside of direct patient care areas. The introduction of the Objective Medical Group (OMG) in 1994 led to expanded leadership opportunities for AF dietitians. Examples of exciting roles USAF Dietitians have embraced outside of Nutritional Medicine include BSC Corps Director, Chief of Officer Accessions, Chief of Health Promotion Operations, Director of Staff, MAJCOM Health Promotion Director, Flight Commander, Squadron Commander, Deputy Group Commander, Nutritional Medicine Squadron Operations Officer, International Health Specialists, Nutrition Program Managers in Health and Wellness Centers, Air Force Assignments Officer, Air Force Academy Instructor, Human Effectiveness Biotechnology Program Manager, Chief, Population Health Support, Course Supervisor, Military Liaison Team member to Romania, Wing Inspector General, and Chief of Medical Training Systems, among others.
Meanwhile Army dietitians had established permanent research positions in military nutrition and exercise physiology at the United States Army Research Institute of Environmental Medicine, and a position at the Clinical Investigation and Research Service at Walter Reed Army Medical Center. Additional positions particular the Army's mission include combat development staff support, FORSCOM staff officer to facilitate training and Corps interaction in combat readiness. Dietitians were now attending Command and General Staff College and Army War College courses in residency with combat officers.
In 1998, the separately accredited U.S. Army and U.S. Air Force Dietetic Internship Programs joined resources and created the first "Dietetic Internship Consortium" in the nation, hence the name U.S. Military Dietetic Internship Consortium. The U.S. Navy is also a member of the Consortium although they do not currently have an active training program.
Support from both USAF and Army dietitians in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been critical in terms of both combat support as well as humanitarian and detainee operations. Over 20 reserve and active duty dietitians have deployed with the USAF in assignments including protocol officer, senior Air Force officer on the USNS Comfort, Expeditionary Aerospace Medicine Squadron Commander and Nutritional Medicine Flight Commander. More than sixty active and reserve Army dietitians have deployed in a number of assignments supporting OEF and OIF. Beginning in the fall of 2006, the Army expanded its initial entry level dietetics program to a 20 month combined Masters Degree and Internship program. The USAF and Army continued to share a number of training resources as part of the U.S. Military Dietetic Consortium that has its roots in a shared history of service and scholarship. For the first time in 2010, USAF dietetic interns and Army dietetic interns jointly trained in the U.S. Military-Baylor Master's Program in Nutrition at Fort Sam Houston, Texas, yet another milestone in the history of military dietetics where dietitians can continue to serve America's finest.
Commemorating Our 60th Anniversary
US Air Force Nutrition and Dietetics
Col Paula Tsufis (Expanding original material by Colonel Esther F. Myers for 50th History Update)
The Army Medical Specialist Corps, 45th Commemorative Publication Army Medical Specialist Corps
Army Medical Department Center and School