Written By: Fatema Jivanjee- Shakir, LMSW & Brianna Theus, RD, CDN

A Registered Dietitian (RD) is, quite literally, an expert on nutrition. But have you ever thought about how a dietitian has been trained? Where does their expertise come from?

If you’ve ever visited a dietitian, you may have noticed that many create nutrition plans for their clients. In these nutrition plans, they provide recommendations about how much of each food category (i.e., protein, carbohydrates, fats, dairy, fruits, and vegetables) someone should consume in a day. 

But how are they coming up with these recommendations?

Registered dietitians go through four years of schooling, a minimum 1,200 hour accredited internship program, and continuing education units (CEUs) to obtain and maintain their license. Dietetics education includes chemistry, biology, anatomy & physiology, and food education. The food education provided in these courses is based on nutrition guidelines from the United States Department of Agriculture (USDA).

How are current nutrition guidelines developed by the USDA?

Presently, the USDA utilizes the MyPlate method when developing nutrition guidelines (U.S. Department of Agriculture, 2020). This methodology prioritizes weight management as the main goal and accounts for factors such as age, sex, weight, height, and activity level to calculate an individual’s total recommended daily caloric intake. This total is then divided into 5 categories so that a percentage of an individual’s daily calories come from 5 food groups: fruits, vegetables, grains, protein foods, and dairy. These recommendations may then be turned into meal plans or used as a basis for nutrition goals by dietitians.

What are some of the flaws in current nutrition guidelines?

Current nutrition guidelines are not culturally-inclusive.

The current USDA guidelines are based on Western* ideas of what makes up an ideal meal. Other cultures may have different ideas about what food groups and how much of each of these food groups makes up a typical meal. For example, many South Asian diets tend to be high in carbohydrates and low in protein (Gullapalli, 2022; Wulan et. al., 2021). This is because vegetarian diets are more prominent in many South Asian countries, in part due to religious and cultural practices as well as the high cost of meat (Holmboe-Ottesen & Wandel, 2012). Similar dietary practices exist in many other cultures as well, including Caribbean, Latin American, and African cultures, to name a few.

Because of how nutrition guidelines are rooted in Western ideas of what an ideal diet consists of, many Black, Brown, Indigenous, Persons of Color (BBIPOC) individuals are often judged and reprimanded by medical providers for their diets. We are often told to abandon our cultural practices of eating to follow the USDA’s guidelines for food intake. Being told to change your diet to follow a Western standard of nutrition can make someone feel as though their cultural diets and foods are bad, and furthermore, can send the message that they are bad for eating them. This moralization of food, and by extension, culture, can perpetuate diet culture and place individuals at risk for developing an eating disorder.

Some individuals may seek to map their cultural foods onto the USDA’s guidelines to “improve” their diet while continuing to eat their cultural foods. However, many providers are often unsure of the dietary makeup of foods outside of mainstream cultures. In fact, according to the Commission on Dietetic Registration from a 2020 survey, 80% of dietitians identify as Caucasian and have limited exposure to the foods of other cultures (Commission on Dietetic Registration, 2020). Furthermore, dietitians are typically taught that the cultural foods of BBIPOC are “unhealthy” and should be avoided. They may thus struggle to guide individuals on how to incorporate their cultural foods into their daily diet, and may instead encourage their clients to adopt an American standard of a “healthy” diet or to eat Americanized versions of their cultural foods. Clients may then leave behind their own cultural foods as they alter their diets to assimilate into the American ideal. When this happens, it reinforces the marginalization and racism many BBIPOC individuals already face. It suggests that we are different, which often leads to feelings of not belonging. We as BBIPOC have been taught to erase our identity in order to conform, including through food. This feeling of disconnection can negatively impact one’s mental health and trigger disordered eating or eating disorders. 

Current nutrition guidelines do not account for unequal access to food 

Oftentimes, when healthcare professionals provide nutrition recommendations, their recommendations are based on how much of each food group a person should eat at breakfast, lunch, or dinner. Snacks are often not included in these meal plans, which can send the message that snacking is “bad,” “unhealthy,” and undeserving of space in one’s nutrition landscape.

Why is this problematic? BBIPOC individuals are more likely than Caucasian individuals to have hourly, low-paying, non-benefits jobs (U.S. Equal Employment Opportunity Commission, 2006). This type of employment is associated with unprotected lunch breaks, as the individual may be hired for less than the allotted work time legally required for a lunch break in that state. Furthermore, the individual may work multiple jobs to financially support their family. It can therefore be difficult for them to take time out to eat a meal, have time for meal prep, or have the financial capacity to purchase a meal. Snacking may allow them to nourish themselves in ways that are financially and time-wise accessible to them. When snacking is villainized by diet culture, it can lead to individuals restricting themselves, and therefore, lacking proper nutrients to get them through the day.

Furthermore, the standardized USDA meal plans do not account for how race and socioeconomic status impacts access to foods. Many BBIPOC live in food apartheids where access to fresh fruits, vegetables, and meats may be limited (Union of Concerned Scientists, 2016). They may therefore utilize more pre-packaged options, like frozen meals, canned foods, and what are considered to be ultra-processed foods. These foods are often labeled by diet culture as being “unhealthy.” Many providers recommend that individuals refrain from eating these foods, which can subsequently trigger restriction and fuel disordered eating. 

Conclusion

The USDA MyPlate’s guidelines have a priority in managing weight. Because of this, the guidelines do not appear to take food as anything other than fuel into consideration. For example, for many, food can be a sense of community. It can be love, connection, comfort, and joy. If the only thing that providers focus on is making sure meals are balanced and prevent weight gain, we are missing out on so much more that food can do for us.

When nutrition recommendations do not account for the unique cultural identities and experiences of different individuals, they stigmatize and alienate those they intend to support. This can lead BBIPOC individuals to feel the need to assimilate to Western standards by altering their food intake and eating patterns. Doing so can further lead to feelings of isolation, lack of belonging, and washing of culture. One-size fits all approaches are rarely beneficial – especially when food has historically been racialized. We have seen time and time again, that when there’s the convenience of fun or profit involved, the food and culture of BBIPOC is celebrated (ex:. Cinco de Mayo in the U.S.), but when those are gone, we shame BBIPOC for embracing their culture and identities. 

Recommendations for Providers

In acknowledging how current nutrition practices can negatively BBIPOC individuals, we also have a call to do better by our clients. If you are a provider looking to approach clients from a place of cultural humility and inclusivity, we encourage you to consider the following in your practice:

1.  Ask clients what their family’s food culture looks like. What meals and snacks were consumed? What times were those consumed? What were those meals and snacks composed of? Where did the family eat? Was eating an individual or communal experience?

2. Discuss what it means for your client to eat their cultural foods. Note that not everyone wants to incorporate their culture into their diet and that’s okay. Don’t assume that your client wants to do this.

3. Consider how to ask questions about identity and culture with nuance and individualization. For example, if a client names a food that you know nothing about, how you become educated on that food is going to vary based on your client. Some clients may not want you to ask about a dish they’ve mentioned because they don’t want to be responsible for educating you about it. Some may want you to ask and might feel that the session is more inclusive of their culture if you do ask. As you continue to build rapport with your clients, you can develop a sense of how to practice cultural humility in a way that is inclusive of their individualized needs. As always, consider supervision from a BBIPOC provider for more support.

4. Critically consider the nutrition information you are being educated on. Who has been included in the research studies that are informing the education you’re receiving? What was the main goal or purpose of these studies? Who is funding the research that this information is being based on?

5. Recognize and name power differentials that can exist in the client-clinician relationship. Caucasian individuals have historically been in positions of power as compared to BBIPOC individuals. Additionally, many BBIPOC cultures believe that it is disrespectful to disagree with authority figures. It is important to consider how this dynamic can impact the clinical relationship and your client’s willingness to advocate for their needs and share disagreements with you. 

Acknowledgement: We acknowledge that this article focuses on one specific area in which the USDA guidelines are not inclusive. We recognize that the USDA guidelines also do not account for how hormone therapy, medications, disability, and diseases can impact nutrition needs. 

*In the context of this article, we utilize the term Western to reflect the dominant culture that has developed as a result of European colonization. Some may articulate that the term Western is interchangeable with the term White. We hold, however, that using this term can marginalize and mislabel others because of how conditional whiteness impacts definitions of what racial and ethnic groups are considered part of white supremacy and perpetuating discrimination in nutrition care. Race is a social construct and whiteness is vague. According to California’s Ethnic Studies Model Curriculum, individuals and societies often decide the identities of other individuals and groups based on what serves their interests – a term labeled conditional whiteness (California State Board of Education, 2021). For example, light-skinned Jewish, Middle Eastern, and North African individuals may be considered white in certain contexts and BBIPOC in others. We aim to not label the identities of others, and instead utilize the term Western to reflect the dominant culture that has developed as a result of European colonization.

About The Authors

References

California State Board of Education (2021). Ethnic studies model curriculum. 1-437.

Commission on Dietetic Registration (2020). Academy/commission on dietetic registration demographics.https://www.cdrnet.org/academy-commission-on-dietetic-registration-demographics

Gullapalli, A. (2022). South Asian diets and diabetes. The Johns Hopkins patient guide to diabetes. https://hopkinsdiabetesinfo.org/south-asian-diets/

Holmboe-Ottesen, G., & Wandel, M. (2012). Changes in dietary habits after migration and consequences for health: a focus on South Asians in Europe. Food & nutrition research, 56(1), 18891.

Union of Concerned Scientists  (2016, Apr. 12). The devastating consequences of unequal food access: the role of race and income in diabetes. https://www.ucsusa.org/resources/devastating-consequences-unequal-food-access#ucs-report-downloads

U.S. Department of Agriculture (2020). MyPlate. https://www.myplate.gov

U.S. Equal Employment Opportunity Commission (2006). Section 15 race and color discrimination.https://www.eeoc.gov/laws/guidance/section-15-race-and-color-discrimination

Wulan, S. N., Raza, Q., Prasmita, H. S., Martati, E., Maligan, J. M., Mageshwari, U., … & Plasqui, G. (2021). Energy metabolism in relation to diet and physical activity: A South Asian perspective. Nutrients, 13(11), 3776