Nutrition Recommendations Need To Be More Culturally Relevant—Here's Why It Matters
Respecting cultural foods and personal preferences is important. Bok choy and collard greens are as healthy as kale—so why don't we hear about them as much? Here's why we need to do better when we're giving nutrition advice.
Our series, Good Food for All, examines the barriers to putting healthy food on the table and what is being done to help.
Growing up, my parents never policed my food and I never had an issue with my weight. In college, I discovered the power of Sbarro pizza, unlimited chicken nuggets and Pepsi. My college roommates often quip that I should be sure to tell the world I used to drink a six-pack of Pepsi every three days and didn't know what a vegetable really was. And, yet, here I am, writing to you about the importance of cultural competency and how making nutrition and wellness accessible to all is the only way to move forward and reframe how we see the field of nutrition and dietetics (and health care in general) as a whole.
I left Fordham University with a history degree, along with 40 additional pounds, skin that was riddled with acne, and a digestive system that was in turmoil. I wasn't taking care of my body and I simply didn't feel well. I tried to change my habits on my own. Since this was the year 2000, there were no Instagram influencers to help me (or dole out bad advice, as is sometimes the case). My doctor was unwilling or ill-equipped to help me. He blew off my recent weight gain as normal and told me to cut out carbs. No instruction as to how to do this, just don't eat them. He didn't think to tell me what a carb actually was, where to find them and most importantly how this avoidance was going to go. He did tell me, though, not to eat any rice—which had basically been a staple for most of my little 22-year-old life.
How was this going to work? What would I eat? I decided to give it a go on my own, cutting out all the things that I loved: rice and beans, plantains, pizza, Pepsi. And of course, you might have guessed, I lost 40 pounds in about six months. Not too hard, right? I'm 22, with a fast metabolism, and I was no longer drinking cheap beer five nights a week with my friends or grabbing White Castle from across campus twice weekly. Plus, I drastically reduced my calorie and carb intake by cutting so much out of my diet.
The truth is, even though my parents didn't police my food when I was growing up, my mother made most of our meals from scratch. She cooked with root vegetables and added minimal salt and oil. Because healthy food was available to me, I never had any issues throughout childhood. My mother's rice and beans weren't actually the problem, but rather the ultra-processed items I collected on my walks from the D train to campus.
I had lost a fair amount of weight, but I didn't know really how I did it. I wanted to know how my body worked and what I could do to continue on this trajectory. I didn't feel good with those extra 40 pounds, and so I wanted to ensure I could maintain this weight loss without having to overly restrict or count calories. I decided to meet with a dietitian. I knew that their job was to help with weight loss and meal planning, but I was pleasantly surprised when she also spoke to me in terms I could understand—unlike my doctor just a few months earlier. She taught me the importance of carbs in my diet (energy, fiber, B vitamins, minerals—to name a few) and how my beloved rice and beans had its place as part of a healthy diet. I was lucky she was culturally competent and willing to make the foods I loved fit in my diet. Rice and beans were good, she told me, and considered a complete protein, but I would have to be mindful of the portions I was taking in—so instead of 1 or 2 cups, we would scale it back to ½ cup of each.
She also encouraged me to think about positive changes I could make to my diet, instead of only focusing on what I had to cut out. We talked about having leafy greens at every meal and to make sure I was eating adequate amounts of protein in the forms of chicken, fish, pork and beef. I didn't have to give up the griot (Haitian pork) my mom made me on Sundays? Of course not, I just had to remember that the pork was fried and having smaller amounts as part of dinner was OK. She didn't speak to me in absolutes but rather worked with me to fit in the foods I was used to and enjoyed eating. It actually helped to strengthen my affinity for my culture and my relationship with food in general. Meeting with that dietitian also sparked my interest in nutrition. I loved how this person was able to encourage and support me to meet my goals, by providing me with actionable tools to achieve success. I wanted to do that for others. I wanted people to feel seen and understood and also that their practitioner was willing to meet them where they are.
Fast-forward a few years: I am currently counseling a couple: we'll call them Harold and Jess (because those are their actual names and they've given me permission to share their story). Harold has type 2 diabetes, and Jess wants to support her husband as they try to navigate his illness. Harold and Jess are Black and had been working with their primary care physician (who was white) for the better part of four years without success.
Upon meeting Harold and Jess, I was struck by their determination to change, their optimism and their eagerness to learn. As I worked on a nutrition plan with them, it became clear to me that I was giving them information they had not been given before. Harold and Jess had been trying to follow a vegan diet in an attempt to control their weight because that is what they heard was the best way to lose weight. And though a plant-based diet might work for some people, it isn't the best choice for everyone.
I instead started the conversation by asking them what a typical day was like for them. Then I helped them see how all foods actually do fit, and how to still enjoy their staples and favorite foods while losing weight, improving their health and keeping Harold's blood sugar in a healthy range. Of note, Harold and Jess cooked all their meals at home—why had no one given them guidance on portions and how that affected Harold's blood sugar? It had been years since his initial diagnosis, and he still wasn't getting key information he needed to stay healthy. Why was this couple led to believe that the only way to achieve success was to be restrictive and adopt a food belief that didn't entirely resonate with them? Harold has since lost 20 pounds and dropped his A1c (a number that measures blood sugar over time) from a risky 13 to an ideal 6.3, and Jess has lost 10 pounds herself. They are happily meal-prepping foods they enjoy and are confident that their food choices are the right ones for them.
Harold and Jess told me that they had sought me out as a Black practitioner because they wanted to be seen and heard. I want them to be seen and heard—everyone deserves that. But it should make us all feel sad that they felt the need to seek out a Black practitioner to get this most basic level of support. After years of going from practitioner to practitioner, they thought it important to find someone who could work with them and give them actionable tools that they would be able to implement into their daily lives.
I often wonder why is it that kale seems to be the gold standard for a healthy leafy green, when collards are just as good for you? If I make macaroni and cheese from scratch, can't it live on my plate in an appropriate amount? What about rice and beans—that together are a complete protein—can't this be part of a healthy diet? I recently took part in a webinar about race, and the moderator discussed internalized racism, the idea that "white is right" and anything else isn't seen as such. I applied it to the above thoughts about food and nutrition. We have grown up in a society that idolizes "white foods" and doesn't always allow for other cultures and their cuisines to be considered as healthy. Take bok choy, for example: native to Asia, it's a cruciferous vegetable that's loaded with nutrients. However, when we talk about these kinds of vegetables, normally we hear about broccoli, cauliflower and cabbage. What about the macaroni and cheese I wondered about earlier? Growing up I never had a blue box of mac and cheese until my college roommate made it for me. I will tell you though, that on Sundays my mother would make macaroni and cheese from scratch with a béchamel sauce that was simply divine. I would have that with some sort of protein and a salad for a balanced—albeit slightly indulgent—meal.
How can dietitians, and others in the health care and wellness world, not just theorize about helping populations that have different experiences than our own, but actually help their practice be more inclusive? Recently I had my nutrition students take an eight-week course on cuisines from around the world. Led by registered dietitians, the course brought the students into their kitchens via Zoom, where they learned about foods that were native to different areas and how foods were prepared. This is valuable on so many levels, but mainly, when someone from the Dominican Republic comes to sit across from you and talks about plantains, you now have a point of reference for that food, how it fits into their culture and different ways it's prepared and enjoyed. That puts you in a better place to work with people to help them succeed and achieve their goals as they pertain to food and nutrition.
We need to come from a place of inclusivity, while providing our patients with sound advice and care. We want them to see us working with them to achieve their goals rather than dismissing the foods they grew up with and love.