Written By: Masuma Ali
Edited By: Nisha Rajoo
Illustrations by: Sneha Grace
The Nutrition and Dietetics community currently holds preconceived notions about the correct diet to follow and the perfect body image to have - both of which reflect dominant white cultural norms. This translates to an inadequate service being offered by many nutritionists that do not cater to ethnic and cultural nuances. Some arguments propose that the Nutrition and Dietetics field is underpinned by systemic racism. This is not to say that dietitians and nutritionists are racist, even though many may engage in overt and covert racist behaviour (see Figure 1 below). This is to say that the practice itself is fundamentally racist, which leads to faulting the overarching healthcare system and umbrella organisations.
It is also important to note that much of the research surrounding racism and discrimination within nutrition practice is largely American or Canadian-based and increasingly focuses on how this racism affects the African American population. While this research provides tremendous insight into the impact of this racism, there is a gap that needs to be filled. This gap represents a lack of research on a more global scale focusing on other parts of the world, as well as a lack of research focusing on other women of colour, for instance, Asian women.
Critical Race Theory (CRT) states that racism is seen as ‘ordinary, not aberrational’ when racism is so entrenched within a society that it seems natural and almost right by people. An aspect of CRT is interest convergence, which posits that advancements for subordinate groups are only allowed by those in power when it serves their self-interest. CRT can provide the nutrition field with an inclusive approach when studying where health inequalities originate from. Shahzadi Devje stresses the need to be mindful that not everyone has access to the same set of privileged opportunities and how ‘ethnic minorities across Canada lack access to many standard measures of quality of life: financial resources, adequate living space, sense of independence, health, education, and support’. Health-related disparities are suggested to be more a result of socio-economic differences, rather than race and ethnicity, even though cultural preferences can be a contributing factor. Assuming that all individuals require the same health needs can perpetuate many opportunities for racial inequality within nutrition. A comprehensive table displaying the contributors to diet related disparities can be viewed here.
The Journal of Critical Dietetics refers to a group of African American scholars from ten universities that formed the African American Collaborative Research Network (AACORN) in 2002. They examined 41 qualitative studies involving African American women. Findings displayed that many African American women who are or have been interested in a career in nutrition are often led towards food service management instead of clinical dietetics. There is a perceived hierarchy in dietetics putting those in ‘food service at the bottom and nutrition scientists at the top’. Those in food service are totally marginalised and of course, that is where the most black people are directed. Many participants spoke about their desire to show other black girls or girls of colour that the dietetics profession is one of diversity. It’s not ‘just your skinny, white, blond, celery eating profession’. Participants also addressed the significance of clients being able to identify and relate to their dietitian. With private matters such as food, having someone who looks like you to confide in makes all the difference. One participant said that many dietitians from a privileged background don’t understand why poor people who go through a stressful crisis would turn to food when it would just make a situation worse. If these dietitians understood why certain people turn to food, they could help their clients a lot better. But if you come from a background where food is in abundance and you haven’t experienced what people of colour experience, it becomes hard to relate to clients who have had the opposite experience and to be able to offer nutritional advice that might actually benefit them.
Many country specific food guides are also catered to a white European demographic and do not consider the cultural and ethnic nuances within different diets that can affect what a healthy diet looks like. First, ‘not all cultures and ethnicities eat using a plate model’. There is a lack of representation of food and ingredients from different cultures as well as any reference to food insecurity and how this might impact one’s accessibility to the foods suggested. It is a privilege to be able to afford to follow the guidance in Canada’s food guide and this is a factor that is simply left unaddressed.
Another aspect to discuss would be the use of the BMI (Body Mass Index) as an individual measure of health status. BMI is highly impacted by social determinants of health like racism, poverty and stress. For instance, experiencing racism increases cortisol (stress hormone) levels which contributes to increasing one’s allostatic load, leading to a higher BMI. Many conditions are left undiagnosed because of assumptions made related to BMI. A study on Asian Americans shows that ‘everyday racial discrimination was associated with obesity and increased BMI’. Furthermore, BMI does not take into account factors like muscle mass and ethnicity. Therefore, one’s health cannot be determined by a metric that was created from the data of white men.
How can we eliminate systemic racism in the larger healthcare system to ensure it then feeds into the nutrition practice? Stephanie Carter argues that there will need to be more people of colour represented within roles of health care providers along with more education surrounding racial bias. Shahzadi Devje agrees that there needs to be more representation but recognises that this is not happening organically. Therefore, there needs to be a ‘mechanism to hold organisations accountable’. While Canada’s food guide and the country prides itself on being multicultural, this does not translate into nutrition policy and education. Due to a lack of these seamless transitions, Devje believes that appointing a DIC (Diversity and Inclusion Chief) to take charge of keeping healthcare establishments and educational institutions accountable will ensure that race discrimination can be diminished.
Similarly, Anar Allidina, a registered dietitian specialising in Diabetes and based in Canada gives us her experience as a woman of colour in the field as well as touches on recommendations on how to further diversify the nutrition practice:
Focusing on a more dietetics lens, nutrition education and dietary counselling for those populations that experience the health inequalities need to be specifically tailored to factors like environmental contributors and demographic features. They also need to be adapted to understand the cultural preferences within target populations, and one way this can be done is to actually hire staff that these populations can relate to socio-culturally as well as on an ethnic and racial level. Currently, minority populations are underrepresented in clinical trials and prevention studies. Due to the disparities they face, it is essential that ethnic minority populations are sufficiently represented in research studies so that their inequalities can be studied and eradicated. Research studies involving ethnic minorities are also vital in order to collect information on behaviour patterns and environmental factors so that nutritional education programs can be accurately culturally informed. A table showing the various strategies that can be employed to reduce health disparities can be viewed here.
Current efforts to increase diversity within the nutrition field – Diversify Dietetics, a non-profit organisation working to increase racial and ethnic diversity within nutrition, provides mentoring and support to ethnic minorities that want to pursue nutrition. They also host a podcast called ‘Feed Me the Facts’, which focuses on diversifying dietetics. As the years progress and more people are educating themselves about diversity and inclusion, we may see a promising future for a more inclusive nutrition practice.