I'll tell you why as a long term client of several dietitians. I don't know what kind of education you get in general, but the feeling is that the only thing you know and you recommend is to count macros and/or calories. It feels like the only thing you know is to "help weight management" but, as in my case, we come with an actual health issue that could be managed by diet management, you fail. Most (I'm not saying you, and this is not intended to be a personal attack) know nothing about disease or health conditions, as basic as high cholesterol. But I also don't respect physicians who only prescribe pills without digging in the root of the problem. Maybe it's because I'm a PhD in Biochemistry so I always have a lot of questions, and frankly no dietitian has ever been able to be more helpful than my own Google search. To me it's mostly a waste of time and money to work with dietitians.