While nutrition is a science, food is personal, and healthy eating is a little bit different for everyone. There are so many factors that shape the way we eat—taste preferences, goals, schedules, food availability—and a person’s cultural background has a huge impact on their relationship with food. The role of a registered dietitian is to counsel others on nutrition, so it’s important that R.D.s be sensitive both to individual preferences and cultural differences when giving nutrition advice.
The thing is, when it comes to diversity, the nutrition field is lacking: Seventy-eight percent of all dietitians in the U.S. identify as white, according to the Commission of Dietetic Registration. There’s also a lack of culturally diverse nutrition advice, both in official nutrition resources and in the media. Because of this, it’s especially important that dietitians work to understand their clients’ backgrounds and values around food, and that they give nutrition advice that’s culturally sensitive and relevant.
To shed a little more light on a topic that’s complicated and has so many implications, SELF asked seven registered dietitians from various cultural and ethnic backgrounds about the intersection of food and culture, why diversity in the nutrition field is so important, and how they work to give culturally sensitive nutrition advice in their own practices.
Jessica Jones, M.S., R.D., C.D.E., cofounder of Food Heaven Made Easy
Although we have seen more people of color enter the field since I started practicing dietetics five years ago, the diversity rates are still abysmal and the inclusion needs to be happening at a faster pace. People often think of diversity as obligatory checkboxes without realizing that it actually enhances our organizations and makes us better providers. When more cultures are represented, we’re able to connect with patients on a more meaningful level.
Because of the lack of diversity in the field, health and nutrition resources are not always inclusive. For example, at one clinic I worked in, I had so many patients who recently immigrated to the United States from Guatemala, and contrary to the assumption of many health care providers, Spanish was not their first language, so providing wordy handouts in Spanish was useless to them. Because of this, we later created many handouts that were primarily photo-based instead of focusing so heavily on text. We need to be sensitive not only to language barriers but also to literacy levels in the materials we provide.
I think that when it comes to food and nutrition media, the problem is worse. Wellness is typically equated to a naturally thin, able-bodied, blonde woman striking yoga poses or drinking a green smoothie in a remodeled white kitchen. This is unfortunate because it excludes so many people who don’t identify with that narrative. We need to do a better job of including practitioners of color in the healthcare conversation by being inclusive when deciding who to invite to speak on panels or who to feature on our platforms.
I’ve worked in hospitals, private practice, community nutrition, and outpatient clinic settings and on average, about 60 to 75 percent of my clients have been women of color. So many of my patients are very appreciative to see a dietitian that looks like them and makes an attempt to understand their culture, food preferences and barriers to behavior changes. For example, many of my patients have an extremely limited income, and healthy foods like salmon and avocados may be too expensive for them to eat on a weekly basis. Likewise, it’s common practice to recommend an outdoor walk as physical activity, but many providers don’t realize that some people don’t feel safe walking around their neighborhoods after work.
I try to start every session by asking what the patient wants to get out of the visit, so that they drive the conversation. I also make sure to ask them about what they eat in a typical day, what their food preferences and dislikes are, their financial limitations when it comes to a food budget, where they shop, and what are their time constraints. This way I can work with them to create a plan that fits into their budget, time constraints, preferences, and cultural norms. I also love knowing where they shop so I can make specific recommendations based on proximity, especially for those with limited mobility.
Miho Hatanaka, R.D.N, mindful eating coach at Coach Viva, founder of Zen Integrative Nutrition
When I immigrated to the U.S from Japan at age 11, the culture shock I experienced with the food offered at school was more jarring to me than not being able to communicate with my classmates due to the language barrier. In fact, this experience is what first made me want to become a dietitian.
A person’s ethnic and cultural background has a huge impact on their relationship with food. Food is what builds our bodies, but it also shapes our culture. It plays a role in many aspects of our lives: physically, mentally, and spiritually. We eat to nourish and comfort ourselves, we share food with friends and family, and we offer foods to our God(s). As a dietitian, it’s important to know not only what you clients eat, but also to understand the role that food plays in their culture, as this often shapes their beliefs about health and medicine, as well. In Japan, for example, many of us believe that certain foods have medicinal properties, and we look at food as the first line of defense against disease.
I keep in contact with R.D.s from diverse backgrounds, and I’m the diversity chair for Dietitians in Integrative and Functional Medicine. When I see clients from different backgrounds, it can be helpful to consult other R.D.s for professional advice on how to best help and relate to them. I make a point to listen to my clients’ specific questions and concerns, because it’s my experience that not many healthcare professionals have time to do this. I’m also very aware that both being sick and maintaining health can be difficult in a country where you’re in the minority, so I always acknowledge this struggle. I’d like to see more R.D.s and other healthcare professionals collaborating with a diverse network of peers, as I believe this is an important part of helping patients establish healthy habits that align with their values and traditions.
Nour Zibdeh, M.S., R.D.N., C.L.T
I have my own private practice in Northern Virginia (the D.C. area), which is very diverse, and my clientele is not predominantly Muslim. I focus primarily on helping patients who suffer from specific digestive conditions, poor thyroid health, autoimmune conditions, food sensitivities, and few others problems that span all races, religions, and genders.
My Muslim female clients definitely feel a level of comfort when working with me, but I feel women in general identify with each other, as we all face many of the same challenges, regardless of our race or religion. The physical stress of childbirth, family values, juggling work and life, and prioritizing others before our health are all conversations I have with most of my female clients. I focus on how similar we are, not how different, and I have had amazing relationships with clients of all ethnic and religious backgrounds.
When I do presentations and talks, or when I create content for my website and social media, I make sure that I include images of people from different ethnic backgrounds. During my private patient sessions, I try to learn about each patient’s culture, food preferences, and what matters most to them. People like to share and talk about these things, and just being receptive to hearing their stories and their foods improves rapport and trust, both which are important in any coaching relationship. I do feel a connection with my patients who grew up in other parts of the world, whether in Asian, African, European, or South American countries—there’s always something we miss about home! I’ve also learned recipes from patients and taught them to others, like a savory breakfast pancake recipe from a South Asian patient. She makes a batter from eggs and chickpea flour, adds vegetables, and eats it for breakfast. That’s a creative new meal idea!
Wendy Lopez, M.S., R.D., C.D.E., cofounder of Food Heaven Made Easy
It’s been incredibly frustrating to not have more people of color within the field of nutrition. Thinking back on my days as a student, I felt isolated within the program and felt like I couldn’t really connect with most of the students or staff. I envisioned graduate school being this enriching experience, where I would develop strong bonds with future colleagues. Sadly, this wasn’t the case, mostly because I felt really uncomfortable being one of the only students of color on a campus in Harlem, New York (the irony). Now that I’m a registered dietitian, some of those frustrations remain, but I feel more supported because I’ve been intentional about seeking connections with a diverse network of dietitians.
Ninety-nine percent of my clients are people of color, and about 70 percent of those clients are women. In my clinical practice, I work mainly with Latino immigrants, many of whom are undocumented. I try to be as present as possible when listening to clients’ experiences and stories, and use that to inform our counseling sessions. This acknowledgement goes a long way in developing a strong relationship. Being able to speak their language and empathize with their experiences is an incredibly valuable tool during sessions. This adds to the connection and comfort they have with me as their provider, which in turn leads to better health outcomes.
Culture and ethnicity are intertwined with food. Food connects people to their childhood, family, and cultural traditions. With that being said, it’s incredibly important that people of color understand that sacrificing their food and culture is not necessary for achieving good health. Oftentimes, I get clients who feel defeated because they don’t want to leave behind the tortillas or plantains, but think it’s something they have to do in the name of good health. I use this as an opportunity to shift the conversation, and provide education on all the amazing foods they can enjoy, that not only benefit their health, but are also culturally relevant. Also, I aim to develop recipes and nutrition content that are accessible to people who may not have a specialty market in their neighborhood. I stick with simple, basic, whole foods you can typically find in any local supermarket and try to stay away from using overpriced ingredients. I make it a point to ask clients what cultural foods they enjoy, and work with them to incorporate these foods in ways that are balanced and satisfying.
Sobia Khan, M.Sc., R.D., professor of food and nutrition at George Brown College, author of 150 Best Indian, Asian, Caribbean and More Diabetes Recipes
Living in Toronto, I’ve always worked with a diverse group of dietitians, and I’m constantly learning from people of different cultural backgrounds, whether they’re fellow R.D.s, clients, chefs, or my culinary students. If you work with food, whether it’s as a chef or an R.D., your own cultural background is significant. In a way, it’s an area of expertise, and having a unique background can help you stand out and really engage with clients from similar backgrounds. In my experience, my South Asian students and clients are appreciative that I understand their language and cultural cuisine. My parents migrated to Canada from Pakistan, so I can also relate to the challenges that come along with this, as well, especially as it pertains to changes in lifestyle.
As a health-care provider in Toronto, I feel we have come a long way and are really trying to cater to high-risk cultural populations that are more prone to certain chronic diseases, like diabetes. But, I think more can be done to translate health and nutrition resources into other languages, and to incorporate into them a more culturally diverse range of foods. For example, Health Canada’s current food guide doesn’t include many diverse ethnic foods in its examples of healthy eating patterns, even though we have such a large multicultural population. I feel that it’s important to change this, especially since new migrants from around the world may not realize how incorporating a more westernized lifestyle can really effect health outcomes.
Because I have worked with such a multicultural population—as a dietitian and professor of nutrition—I’m always trying to learn as much as I can about the traditions, foods, and health practices of different cultures. I try and provide as much research-based information on the benefits and potential harms of foods that are significant in a client’s cultural cuisine so that they can modify these foods to make them healthier, instead of suggesting that they stop eating them. For example, when I’m working with clients in the South Asian community, I emphasize the health benefits of the spices such as turmeric used in traditional curries, but recommend cooking these curries with less oil or ghee.
Ha Nguyen, R.D., L.D.N., founder of Yummy Body Nutrition
I live in Philadelphia, which to me is truly the city of brotherly love. Most people here are progressive and cultured—they embrace different cuisines no matter what their ethnicity, and love the booming food scene here. I think it’s important for dietitians to understand the foundations of different ethnic food cultures, especially in diverse areas like this. At Drexel University, where I studied nutrition, learning how how to be a culturally sensitive dietitian was strongly emphasized in our curriculum. All students in the nutrition program had to take a cultural diversity class and a food course called Foods and Nutrition of World Cultures. Each week a different person was assigned a country and tasked to research the country’s cuisine, develop a menu, and cook for the class.
My Asian background has led to some great business opportunities, as well. I have had Asian clients call me saying how delighted they were to find me, because they knew I would be able to relate to their food preferences. I’ve had physicians refer their older Asian patients who may have been otherwise been reluctant to see a dietitian. I’ve even had a company who was seeking out dietitians of different ethnicities to counsel their diverse population of employees offer me a contract for their corporate wellness program. I do believe that people who work in the health and wellness industry understand the importance of making their service relatable to a diverse group of people.
My consultations include a full intake of my client’s food history and lifestyle. What kinds of food are they eating? How do they prepare it? Who do they live with? Who are they eating dinner with? Where do they go grocery shopping? Who is doing the cooking? Giving someone effective nutrition advice is about figuring out healthy habits that align with their lifestyle and their values.
Nazima Qureshi, M.P.H., R.D., founder of Nutrition by Nazima
Over the past couple of years, I have looked at being a Muslim woman and a dietitian as an opportunity for engagement and discussion with other dietitians about the importance of developing and delivering culturally sensitive nutrition information. Although there is a lot of fantastic evidence-based nutrition information out there, there is a lack of consideration when it comes to cultural, religious, and other personal factors. Working exclusively with Muslim women has allowed me to develop and deliver nutrition content in a variety of ways that is more specific to this audience, which I think makes the information more useful and applicable to real life. Specifically, many Muslims fast in the month of Ramadan for 30 days from sunrise to sunset, and it can be difficult to provide generic nutrition advice in this situation without fully understanding the scope of fasting. Every year, I share a lot of content related to Ramadan, including a 30-day meal plan that incorporates factors such as eating during limited hours and how to fast safely while breastfeeding.
I also find that many Muslim women come to me because they see someone that looks like them, and that makes them feel more comfortable. Almost every single client tells me that they want to work with me because I’m Muslim and “I get it.” It can be frustrating for a Muslim woman to have multiple interactions with health professionals that don’t take into account cultural and religious factors. My goal is to help Muslim women live healthier and happier lives, and in order to do that, I think it’s important to provide evidence-based nutrition information, but also to incorporate my lived experience so that the interactions and information are more valuable to the client.
A person’s ethnic and cultural background plays a large role on their relationship with food. Each culture not only brings specific flavors, but also certain practices. However, it is important to not make generalizations when it comes to a certain ethnicity or culture. Even within my Muslim clientele, multiple cultures and ethnicities are represented. This is where building rapport, asking questions, and a willingness to learn about a client or culture goes a long way. During individual consultations, I ask a lot of questions in order to get an understanding of what my client’s day-to-day life looks like and avoid making assumptions. Then, I can provide personalized information based on the various factors that influence my client’s food intake.