TAMARA MELTON, MS, RDN, is the cofounder and executive director of Diversify Dietetics and founder of the nutrition education platform Tamara's Table.
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.
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.
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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 her 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.
This article originally appeared in the October 2021 issue of Health Magazine. Click here to subscribe today!
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