The Washington PostDemocracy Dies in Darkness

Where are the bok choy or the plantains? Why U.S. dietitians should be more culturally aware.

(Joey Guidone/for The Washington Post)

Imagine this scenario: A 72-year-old Colombian-born woman living in Washington attends a diabetes education class at a hospital. She’s given an English-language diabetes meal plan to follow, which includes foods she’s never tried before, such as kale, edamame and flaxseed. Spanish is her first language, which makes the English advice difficult to understand. Because this nutrition plan doesn’t take her culture, language or food preferences into account, it’s not likely to be successful for her.

Sadly, it’s common practice for patients to receive one-size-fits-all nutrition information. The content is usually Eurocentric, with resources featuring “healthy” foods and visual images of slim, fit white people. Because 76 percent of U.S. dietitians identify as white, it’s not surprising that nutrition advice has this tone. But in the 2010 census, only 60 percent of the U.S. population identified as “white alone, not Hispanic or Latino,” so there’s a gap.

Despite this blind spot in patient care, there are also many innovative, culturally sensitive dietitians offering individualized advice based on their clients’ needs. I spoke with five of them, each of whom explained how they offer nutritional guidance to clients who aren’t from the majority culture.

Though these dietitians see clients from different cultural backgrounds, their approach is strikingly similar: All said that their job is to listen to the clients’ preferences, never make assumptions and ably meet their clients’ personalized needs.

“People come from diverse backgrounds, and starting a diet that doesn’t mesh with one’s culture ends up being a short-term solution that can make people feel restricted,” says Nazima Qureshi, a Toronto-based dietitian who works with South Asian and Middle Eastern Muslim women. “It almost puts shame on their own cultural foods, because they feel like they have to give up foods they love just so they can be healthy.”

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Jessica Jones, a dietitian who practices “inclusive wellness” with a multicultural population in San Francisco, agrees. “Someone from a different ethnic background needs to be able to pursue wellness in a way that works for them,” she says. “Sometimes the dominant wellness ideal can strip that from people and make them feel like they must have one exact smoothie or grain bowl, which may not include any healthy foods from their own culture.”

These dietitians all said they take the time to shop for, prepare and eat the ingredients their clients talk about so that they can tweak recipes and make some traditional foods a bit healthier. Bronx-based dietitian Sandra Arévalo sees mostly Latino and African American clients and says, “I take the time to go to different supermarkets and restaurants and try different foods so I’m well-educated about what my clients eat.”

Arévalo also says her clients don’t identify with the images they see in health marketing, so she creates her own custom resources, complete with culturally appropriate recipes and photos. “It takes hours for me to find photos of ethnic families in image searches, but it’s important to do,” Arévalo says. “People look at the picture before they read. If my clients see a picture they don’t identify with, they won’t read the resource.”

Speaking a common language is another way to ably care for patients. Hazel Ng’s clinic in Los Angeles mostly serves Asian and Latino clients, so she offers dietitians who speak Spanish and several Chinese dialects. “I can use interpreters, but if the dietitians actually speak their clients’ language, the client reacts totally differently. They light up and talk more,” says Ng. Fellow L.A.-based dietitian Vandana Sheth notes that her practice attracts people with an Indian heritage because she speaks Tamil, Gujarai, Hindi and English. “Clients are excited to find a dietitian who understands their language, foods and traditions,” she says.

These dietitians have also learned — and teach others — not to make assumptions about people based on their race, religion or cultural background. As a patient, Jones once had a physician deny her request for a vitamin B12 test for herself because he falsely assumed that a black woman wouldn’t be vegetarian (vitamin B12 sometimes falls short in vegetarian diets, which can lead to anemia if left undetected). She reminds health professionals to ask questions before giving any recommendations.

Ng reminds clients why assumptions can be harmful. “Some of the non-Asian patients come into my office and say, ‘Why are there so many petite Asians in your waiting room? Why would they need to see a dietitian?’ ” Ng says. She explains that thin doesn’t always mean healthy, and that genetic markers can increase the risk of chronic illnesses regardless of weight. “I teach them that wellness is not tied to how people look,” Ng says.

In a perfect world, every client would be matched with a dietitian who is familiar with their culture and foods. When that’s not possible, it’s vital to find a dietitian who practices culturally sensitive care, listens to your needs and doesn’t impose their own viewpoints on you. They do not need to be from the same culture, as long as they take time to understand yours.

“Regardless of size or ethnic background, we all have the right to pursue wellness from wherever we are starting at, in a way that makes us feel best,” Jones says. “And that doesn’t look the same for everybody.”

Registered dietitian Cara Rosenbloom is president of Words to Eat By, a nutrition communications company specializing in writing, nutrition education and recipe development. She is the co-author of “Nourish: Whole Food Recipes Featuring Seeds, Nuts and Beans.”

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