Aetna considers nutritional counseling medically necessary for chronic disease states in which dietary adjustment has a therapeutic role, when it is prescribed by a physician and furnished by a provider (e.g., licensed nutritionist, registered dietician, or other qualified licensed health professionals such as nurses who are trained in nutrition) recognized under the plan.

Aetna considers nutritional counseling of unproven value for conditions that have not been shown to be nutritionally related, including but not limited to asthma, attention-deficit hyperactivity disorder and chronic fatigue syndrome. 

Note: In all circumstances, the intent of this policy is to permit the nutritional counselor to function as a consultant to evaluate the member and coordinate ongoing care with the referring physician.

Medical nutrition therapy provided by a registered dietitian involves the assessment of the person’s overall nutritional status followed by the assignment of individualized diet, counseling, and/or specialized nutrition therapies to treat a chronic illness or condition.  Medical nutrition therapy has been integrated into the treatment guidelines for a number of chronic diseases, including (i) cardiovascular disease, (ii) diabetes mellitus, (iii) hypertension, (iv) kidney disease, (v) eating disorders, (vi) gastrointestinal disorders, (vii) seizures (i.e., ketogenic diet), and other conditions (e.g., chronic obstructive pulmonary disease) based on the efficacy of diet and lifestyle on the treatment of these diseased states.  Registered dietitians, working in a coordinated, multi-disciplinary team effort with the primary care physician, take into account a person’s food intake, physical activity, course of any medical therapy including medications and other treatments, individual preferences, and other factors.

De Luis et al (2009) assessed the utility of a hypo-caloric diet with Optisource versus nutritional counseling in obese patients with an indication of replacement surgery for degenerative osteoarthritis.  A total of 36 patients were randomized into 2 groups: (i) diet I with lunch and dinner substituted by 2 Optisource [1,109.3 kcal/day, 166.4 g of carbohydrates (60 %), 63 g of proteins (23 %), 21.3 g of lipids (17 %)] and (ii) diet II with nutritional counseling with a decrease of 500 cal/day from the previous dietary intake.  Before and 3 months after treatment, a nutritional and biochemical study was performed.  A total of 19 patients were randomized in group (i) and 17 patients in group (ii).  All patients in group (i) and 14 patients in group (ii) finished the study.  Weight loss was higher in group (i) than group (ii) (7.7 [4.7] versus 3.92 [3.32] kg; p = 0.05), with a significant decrease of homeostasis model assessment (HOMA) and diastolic blood pressure in group (i).  Decreases of body mass index (-2.9 [1.8] versus -1.4 [0.9]; p = 0.05), fat mass (-3.8 [3.4] versus -2.3 [1.7] kg; p = 0.005) and HOMA (-2.0 [2.2] versus -0.4 [1.82]; p = 0.05) were higher in group (i) than group (ii).  The authors concluded that obese patients with chronic osteoarthritis treated with a mixed diet supplemented with a commercial hypo-caloric formula improved weight, fat mass and HOMA in a better way than patients treated with a dietary counseling alone.

There is a lack of reliable evidence for nutritional interventions as a treatment for asthma.  Ahnert and colleagues (2010) employed relevant data bases to collect and evaluate guidelines, meta-analyses, and reviews as well as primary studies dealing with asthma therapy for children and adolescents.  Treatment approaches whose effectiveness with regard to bronchial asthma was empirically verified (i.e., evidence-based) were identified (medical and diagnostic procedures as well as drug trials were excluded from the analysis).  A total of 152 methodically sound studies referring to asthma treatment of children and adolescents were selected.  Strong evidence was found for patient education, parent education, exercise therapy, inhalation, and tobacco withdrawal.  Nutritional counseling and avoidance of allergens showed limited evidence.  Breathing exercises, climate therapy, clinical social work (legal and social counseling services, vocational re-integration counseling, aftercare), integration counseling, psychotherapy, and relaxation techniques showed inconsistent evidence.  No evidence was found for alternative medicine.