FOOD IS ABOUT SO MUCH MORE THAN NUTRITION:
It's culture and family and history and comfort. However, the recommendations on eating healthily don't always encompass a wide range of foods, recipes, and traditions. That's part of what drove Tamara Melton, MS, RDN, to found Diversify Dietetics, a nonprofit organization devoted to increasing racial and ethnic diversity in the field of nutrition. We asked her about the importance of culturally competent care, what can be done to promote equity, and why this push is so essential.
When I was a clinical instructor at Georgia State University, which has a very diverse student body, there were a lot of BIPOC students in my Nutrition 101 course. But the students in the actual nutrition program were still overwhelmingly white, and not representative of the university's student body. This really bothered me, and I knew that the explanation I heard from other nutrition professionals—that students of color just weren't interested in the field or didn't "have what it takes" to complete the science-heavy curriculum—simply wasn't true. That's when I realized there was a need for an organization to address this issue head-on. Young people of color may not be aware of the career as an option for them and may need help navigating the somewhat confusing education pathway. They may also need help affording school, and especially the dietetic internship, which is a required, often unpaid, 9-to-24 month training program. Our team at Diversify Dietetics, which I started with my cofounder Deanna Belleny Lewis, MPH, RDN, provides resources such as mentorship programs, application preparation, academic course remediation, scholarships, and more to BIPOC dietetics students, interns, and young professionals. We also lead training programs for nutrition educators to build the strategies and skills needed to support diverse students.
HOW DOES THE LACK OF DIVERSITY AMONG NUTRITION
PROFESSIONALS IMPACT PUBLIC-HEALTH MESSAGING AND THE QUALITY OF CARE THAT
PEOPLE FROM DIVERSE BACKGROUNDS RECEIVE?
Registered
dietitians (RDs) work in many different settings, including schools, hospitals,
multinational food companies, public health agencies, and private practices
where they provide group or one-on-one counseling. They influence the nutrition
recommendations given to the general public and to individuals. Currently, less
than 15 percent of registered dietitians are people of color, less than 3
percent are Black, and the number of Black nutrition students has dropped more
than 15 percent since 1998. Food is so closely tied to people's cultures, and
if we do not have enough RDs from various backgrounds creating nutrition
education and counseling people, we have a major blind spot. For example, the
Dietary Guidelines for Americans, 2020–2025, which provides advice about what
to eat and drink to stay healthy and serves as the foundation for federal food
and nutrition policies and programs, encourages customizing the framework to
different cultural traditions. But it defers to the "expertise of
professionals in nutrition and in specific cultural foodways." Since
there's not much diversity in this group, the guideline is likely to fall short
in execution.
All of this makes it even more important that all dietitians
practice cultural competency, which is an ongoing effort to understand a
patient's culture and how it influences their values and beliefs related to
health. In the U.S., there is still a narrow view of what is considered
"healthy" eating. When patients don't see their culture's foods
included in representations of what's healthy, they may feel that their food
isn't good for them or that they can't eat healthily while still enjoying
traditional cuisines. And they can! All patients deserve care and advice
that is adjusted for their unique needs. For example, telling a patient who is
from the Caribbean and who needs help managing a new diabetes diagnosis to
avoid eating mangoes or plantains because they are high in carbohydrates isn't
going to be helpful. A culturally competent dietitian would tweak her advice to
include these foods, teaching the patient about how to incorporate them into
meals in a way that will keep their blood sugar balanced. This approach allows
patients to continue to eat foods that are healthy, accessible, and
familiar.
WHAT CAN SCHOOLS DO TO ENCOURAGE MORE EQUITY IN THE FIELD
OF NUTRITION?
In order for dietitians to serve diverse communities with the
highest level of care, we need more students from diverse backgrounds to
become RDs. Universities and colleges should consider if they are seeking
out diverse students and exposing them to the profession. And this exposure
needs to happen early (even as early as high school), since the pathway to
become an RD is pretty rigid. It's hard to pivot and change your major to
nutrition as a junior or a senior. Also, some nutrition programs have standards
to include only students who are at or very close to a 4.0 GPA, which can
exclude those who may need to work to support themselves. I know from
experience that a student with a B here or there has all the potential to be an
excellent RD! Representation is also important. If there are faculty members or
alumni who are BIPOC, asking them to help in student recruitment can make a big
impact. Once nutrition programs become committed to shaking up the status quo,
I believe we will start to see meaningful changes.
WHERE CAN PEOPLE
TURN FOR DIETARY ADVICE THAT FITS IN WITH THEIR CULTURAL BACKGROUNDS?
All RDs should be practicing cultural competency; it's part of
our code of ethics. Your dietitian should absolutely respect your beliefs and
traditions and tailor their recommendations to the foods that you prefer, can
access, and are familiar with eating. If you do not get that kind of care,
remind your RD that your cultural foods are important and ask for them to be
included in her recommendations. If she doesn't listen, seek out an RD who can
provide you with more appropriate care, if you can. We have a directory of
diverse RDs on our Diversify Dietetics website, as well as a blog series
featuring RDs who work in many different practice areas.
BY: Tamara Melton, Health Magazine, September
22, 2021, TAMARA MELTON, MS, RDN, is
the cofounder and executive director of Diversify Dietetics and founder of the
nutrition education platform Tamara's Table.
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