Is It Possible To Provide Equitable Nutritional Care for Diabetes and Obesity?

Is It Possible To Provide Equitable Nutritional Care for Diabetes and Obesity?
Is It Possible To Provide Equitable Nutritional Care for Diabetes and Obesity?

I’ve been a registered dietitian for over a decade and have endorsed the Mediterranean Eating Pattern for nearly as long. The science behind it is strong and it does a wonderful job of incorporating plant-forward staples like whole grains, colorful vegetables and fruit, and other nutrient-rich food that research shows may prevent heart disease, type 2 diabetes, and some cancers.

But I also know that certain cultural foods that don’t typically fit into the Mediterranean eating pattern — like white rice, plantains, corn tortillas, and jicama — can be just as health-promoting as standard Mediterranean-based foods like hummus and olive oil. It’s not the exact food but the overall eating pattern that counts.

The fact is that many of the food suggestions and nutritional guidelines dietitians give their patients come from Western ideas of the ideal diet. And often Black, Brown, Indigenous, and Persons of Color (BBIPOC) feel alienated, misunderstood, and even fat-shamed when their food choices and traditions look different.

Turning people off to discussions about eating patterns is the last thing we need when we’re facing an epidemic of obesity, diabetes, and other cardiometabolic conditions in this country — especially among communities of color. Diabetes is growing at an exponential rate across all demographics, but markedly among Black and Hispanic Americans with rates around 60-70% more than non-Hispanic Whites.

If we hope to build a more equitable healthcare system that truly addresses the unequal rates of disease in the US, we need to do a better job of considering people’s cultural identities and lived experiences. That’s especially true when counseling on something so central to identity as a person’s eating pattern and cultural food choices.

We all know there’s much more to food than calories and macronutrients. Food is integral to any culture. It’s often the focal point of holidays and celebrations. It can be a conduit for love, community, and connection. And it can also be hard to come by.

An estimated 54 million people, over 17% of the US population, live in food deserts. They don’t have easy access to an affordable grocery store. And many more people work shifts or back-to-back jobs that make it hard to plan for three healthy home-cooked meals a day. They may only have the time and means to grab snacks on the go.

So how can we work toward more equitable care when it comes to diet-related conditions like obesity, diabetes, and heart disease?

First, we need to offer more access to registered dietitians. Decades of exploitive convenience food marketing and limited exposure to where our food comes from have all done a lot of damage to the eating habits of the average American. We need a lot more education to counteract these challenges — especially for people grappling with complicated conditions like diabetes that demand constant dietary vigilance.

More employers and health plans understand this and are partnering with digital solutions that offer evidence-based nutritional guidance to their people. The best kind of solutions don’t just rely solely on AI and chatbots, but rather, invest in on-staff registered dietitians to deliver face-to-face nutritional counseling to members. Outcomes show that the power of human connection can’t be beat.

Second, we need to attract more BBIPOC people to the dietetics profession. Nearly 70% of registered dietitians in the US identify as Non-Hispanic White and 85% are women. (I’m one of them.) Research bares out that many people would prefer to work with providers who look like them and share their same background and cultural values.

Third, we need to offer more culturally-sensitive nutritional training to dietitians. While I’m all for championing more diversity in the dietetics profession, we can’t wait for provider demographics to catch up to the need all around us.

We should arm our dietitians with more nuanced information about different cultural food traditions — including nutritional information about customary eating times, regional dishes, favored grains, vegetables, and other carb sources, holidays, and more. The more information we can give dietitians, the better they’ll be able to help people make easy swaps and healthier food choices in their daily routines.

Ultimately, people want to feel seen and understood by their healthcare providers, including registered dietitians. Building trust is essential in any provider-patient relationship, but especially in ones where a provider needs to partner with a patient to change eating patterns. More healthcare companies are employing registered dietitians to serve diverse populations. I just hope they’re also providing culturally-sensitive training to those dietitians so they can give people the support they need.

With obesity, diabetes, and heart disease rapidly growing among communities of color, we need to do everything we can to help people sustain healthy eating habits. It’ll take more nuance than a Westernized one-size-fits-all diet. But with the right resources, training, and emphasis on personalized nutrition, we can make a real difference.

Photo: Drazen Zigic, Getty Images

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