Diversify Your Practice: The Need of the Time for RDN and RDN to be

Sangeeta Shrivastava PhD, RDN, FAND Registered Dietitian Nutritionist, Faculty, Leader, Speaker & owner of Dr Sangeeta Nutrition

Website: https://drsangeetanutrition.com/ Email: [email protected] Session Summary

The United States is very diverse country. There are various health disparities among specific population and their needs vary. RDNs are uniquely trained to provide evidence based nutritional services. is such a personal thing and if we RDN do not personalized our services to meet the needs of our diverse population we won’t be successful in true manner. I believe solution exists within us, we RDNs need to open our minds and extend our hands for collaboration to serve our patient/ client better. It’s time that we identify those tools and equip ourselves to go beyond our comfortable boundaries and put our patient’s unique needs first. Disclaimer

● Volunteer leader with IND:MIG, DIFM/DPG, IAAND, CAND ● Owner of a private practice ● Part time Faculty Cal Poly pomona ● Part time clinical dietitian at Sub Acute: Orange Coast Post Acute ● No Financial disclosure to be made Learning Objectives

Understand Attendees will be able to understand health disparities and unique nutritional needs of diverse patients/clients. Locate Attendees will be able to locate diverse professional sources to serve diverse patient/client population. Learn Attendees will learn patient centered care in understanding food choices among diverse group of population and sample personalized plates from various cultures. Today’s America:

Population Estimates, July, 1 , 2019-328,239,523

Race and Hispanic Origin Percent

White alone 76.3

Black or african American Alone 13.4

American Indian and Alaska Native alone 1.3

Asian alone 5.9%

Native Hawaiian and Pacific Islander alone 0.2

Two or more races 2.8

Hispanic or Latino 18.5

White alone, not Hispanic or Latino 60.1 https://www.census.gov/quickfacts/fact/table/US Today’s Nutrition & Dietetics

Today 100.000+ Dietitians Nutritionists

Race/ethnicity Percent

White 78.4

Asian 4

Latinos 3.3

Black 2.5

Native Hawaiian or Pacific Islander 1

American Indian or Alaskan Native 0.6

Other 1.1 https://www.researchdpg.org/docs/Diversity%20Papers/Reatna_Taylor_2018.pdf Health Disparities

“Communities of color are amongst the wide variety of populations for which dietitians provide services.

Chronic diseases such as obesity, diabetes, and heart disease disproportionately affect people of color who are often also at increased nutritional risk. The prevalence of obesity (body mass index ≥30 kg/m2) was 47% in Latino/a adults and 46.8% in non-Latino Black adults compared to 37.9% in non-Latino white adults. Whereas with diabetes, there is a 77% and 66% higher risk of being diagnosed with diabetes for African-American and Latino/a populations, respectively, when compared to white populations. Compared to the general population, the risk of developing diabetes is twice as high for Asian Americans, Native Hawaiians, and Pacific Islanders. Heart disease is one of the leading causes of death in the U.S, accounting for 1 in 4 deaths. However, disparities exist with the prevalence of cardiovascular risk factors, hospitalization rates, and life expectancy - where the risks are higher for non-Hispanic black populations than for non-Hispanic white populations. These chronic health conditions have nutritional implications and can be prevented and/or managed through lifestyle modifications that include nutritional intake.”

https://www.researchdpg.org/docs/Diversity%20Papers/Reatna_Taylor_2018.pdf

Key is the culturally sensitive/personalized care Social Determinants of Health

According to CDC SDOH are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.

One of Healthy People 2030’s five overarching goals is specifically related to SDOH: Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.

https://www.cdc.gov/publichealthgateway/sdoh/index.html Determinant of food Choices

● Biological determinants such as hunger, appetite, and taste ● Economic determinants such as cost, income, availability ● Physical determinants such as access, education, skills (e.g. ) and time ● Social determinants such as culture, family, peers and patterns ● Psychological determinants such as mood, stress and guilt ● Attitudes, beliefs and knowledge about food

https://www.eufic.org/en/healthy-living/article/the-determinants-of-food-choice

Determinants of Food Choices: Why do we eat?

Food is our common ground, a universal experience.

-James Beard (1903-1985) – an American and food writer

Taste still remains the top determinant Why it is the need of the time?

2018 Code of Ethics for the Nutrition and Dietetics Profession includes the following standard: “Acting in a caring and respectful manner, mindful of individual differences, cultural, and ethnic diversity.” Define Diversity

Google gave About 2,110,000,000 results

The practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different genders, sexual orientations, etc.: Dictionary

Academy Diversity and Inclusion Statement

“The Academy encourages diversity and inclusion by striving to recognize, respect and include differences in ability, age, creed, culture, ethnicity, gender, gender identity, political affiliation, race, religion, sexual orientation, size, and socioeconomic characteristics in the nutrition and dietetics profession.”

Cultural Competency

Capacity to function effectively within the context of the cultural beliefs, behavior and needs presented by consumers. Humbling Humility

Take a pause! Identify our own bias!

“Cultural humility is one construct for understanding and developing a process-oriented approach to competency. Hook, Davis, Owen, Worthington and Utsey (2013) conceptualize cultural humility as the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person]” When we change I to We !!The Illness becomes wellness!! Cultural Humility is a journey not an outcome-so listen, learn amplify “ Beyond cultural and religious practices, the general perspective on acceptable eating patterns must widen to accommodate factors such as gender and sexual orientation. “The profession should represent the people it serves,” says Academy Foundation chair Marty Yadrick, MBI, MS, RDN, FAND. “For example, a male RDN might be able to relate more to the problems of a single dad in preparing healthy for his family.” Sources within our reach

Diversity and Inclusion https://www.eatrightpro.org/practice/practice-resources/diversity-and-inclusion Member Interest groups of the Academy

Asian Americans and Pacific Islanders (AAPI): https://www.aapimig.org/home Cultures of Gender and Age (COGA): https://coga.eatrightpro.org/about-coga

Global MIG (GMIG): https://gmig.eatrightpro.org/home Indians in Nutrition and Dietetics (IND): https://ind.webauthor.com/ Latinos and Hispanics in Dietetics and Nutrition (LAHIDAN): https://www.eatrightlahidan.org/home National Organization of Blacks in Dietetics and Nutrition (NOBIDAN): https://www.nobidan.org/home

Religion MIG (RMIG): https://rmig.eatrightpro.org/about-us Other Resources

1. https://www.todaysdietitian.com/newarchives/AS20p40.shtml 2. https://foodandnutrition.org/from-the-magazine/doubling-down-on-diversity-t he-journey-to-a-more-diverse-field/ 3. https://www.researchdpg.org/docs/Diversity%20Papers/Reatna_Taylor_2018 .pdf Personalize Your Plate: A National Effort https://www.eatright.org/food/resources/national-nutrition-month/toolkit Explore different cultures/

https://www.eatright.org/food/resources/national-nutrition-month/toolkit by Linda Gigliotti MS, RDN, CDECS, CSOWM, FAND

• Culinary melting pot of cultures reflecting immigrants from around the globe • Adapted to create new versions of an old : Italian-American, Tex-Mex • Regional differences reflect local ingredients: New England seafood, Iowa corn, Wisconsin cheese • Hearty, simple meals reflect passion for meat and potatoes: large cuts of meat, especially , served with a side of potatoes • The All-American Cookout- fire up the grills for a cookout, with traditional American favorites like hamburgers, hot dogs, salad, and coleslaw. • “American as apple pie”- deep connotation for mom, home, warmth and family love. Ugandan Cuisine by Susan Nyanzi DrPH, MCHES, FRSPH, ACSM

The food is from the Baganda tribe in . The Baganda are the largest tribe in Uganda. Kampala, Uganda’s largest city and capital is in Buganda. Starting on the right of the plate, is the stable matooke (Young plantain). It is steamed in leaves and while it’s cooking it is mashed into a large dumpling. Matooke is served with . On the left side of the plate is , it is plantain, meat and cooked in banana leaves. It’s a delicacy enjoyed for . Although Katogo was a poor man’s breakfast, over the years changes were made to the recipe that now Katogo is enjoyed in all parts of Uganda, homes and restaurants and all over Africa by Anna De Nicolais

Italian people love to use fresh ingredients for their meals. They cook for breakfast, and dinner and meals are part of family life. Eating well is part of the Italian culture as well. Different dishes are used for different occasions or holidays. Favorite ingredients are fresh vegetables, olive oil, cheese and locally sourced meats. Pizza and are the most popular Italian dishes around the world but they are very differently when made in Italy. Pasta is usually served alone and are made of a few ingredients like tomatoes sauce (olive oil, little onions and garlic, salt, basil and a sprinkle of Parmesan cheese), pesto (basil, cheese, pine nuts, salt and pepper) and a simple aglio olio e peperoncino sauce (olive oil, garlic, chili pepper and a sprinkle of grated Parmesan). Hispanic Cuisine by Rachel Flores MS, RD

First photo is milanesas which are thin pieces of beef, pounded flat then breaded and fried. In my family we serve them with refried beans, fried potatoes, and a lite salad. And salsa! This is a labor intensive dish so we typically only make it a few times a year, always on my father-in-law’s birthday. Second photo is carne asada tacos topped with pico de Gallo, served with beans and a salad. by Shraddha Chaubey MS, RDN, LDN

“Atithi devo bhavo” is a sanskrit phrase Hilary Chia Wu MS, RD

Various traditional dishes eaten during Lunar New Year. Dishes will vary among household but there will always be dish of whole fish as the sound fish is similar to “left over, signify the wealth and fortune will carry over to the new year. Another common dish is called “Buddy Jump Bridge” to be the word to word translation. Inside this dish, there is taro, mushroom, bamboo, rib, dried scallop and some will even put in dry sea cucumber. This dish symbolize wealth and prosperity.

Another common dish in the Taiwanese lunar New is caviar paired with radish and/or green onion. In this household there is a side dish called the five different vegetables, which is quite simple to do but the preparation required a lot of times since it requires a lot of finely chopped vegetables. This dish is only prepared during Lunar New Year because when all of the family members came back home, there is enough help chopping ingredients. There is one dish that is not present in the picture, which is a soup dish. That will make 10 dishes for the Lunar New Year since the number 10 symbolize good luck. Persian Cuisine By Golie Khayef DrPH, RDN CEDRD

Name: Tahdig and Ghormeh Sabzi Origin: Persian/Iranian Food

Description:

Tahdig: In Persian cuisine, is blanched to an al dente texture and then transferred to an oiled pan to finish cooking by steaming, during which time the oil at the bottom of the pan helps form the golden crispy tahdig. Different variations of tahdig is made by adding saffron, yogurt and egg to create a more perfect golden color and crispy texture.

Ghormeh Sabzi: Labeled as Iran’s , this has four essential elements: fenugreek leaves along with a collection of finely minced herbs, Omani limes or dried Persian limes, Kidney bean and chunks of fresh lamb. The herbs are sauteed and cooked down until they are dark and dry at which point they are added to the already sauteed meat, dried lemon, and the kidney beans and cooked for a few hours. In Farsi, Ghormeh sabzi means braised meat with herbs.

RUSSIAN CUISINE by BY MARINA, SAVELYEVA, RD, CNSC

• A TYPICAL RUSSIAN MEAL CONSISTS OF MORE THAN ONE DISH: SOUP IS FREQUENTLY SERVED WITH LUNCH AND DINNER. A FAMOUS RUSSIAN SOUP IS "SCHI" (PICTURED BOTTOM LEFT). AND SOURCE OF PROTEIN (MEAT OR FISH) ARE USUALLY OFFERED WITH THE SOUP.

• PICKLED VEGETABLES AND MARINATED WILD MUSHROOMS ARE OFTEN SERVED AS WELL.

• IN THIS PICTURE, PICKLED HERRING (TOP RIGHT) IS SERVED WITH BOILED POTATOES AND DARK BREAD.

• "" (PICTURED CENTER) ARE RUSSIAN DUMPLINGS STUFFED WITH PORK OR BEEF). Call to Action

Understand, Locate, Leran Create diverse work culture Be self aware-Humility Be a good listener Go beyond your comfortable boundaries. Be support and seek support Look solution within you, your workplace, community We are RDNs and we are here to support and lift each other up

Final Thought

Personalize

Not

Standardize

There is no love sincerer than the love of food.

-George Bernard Shaw (1856 – 1950) — an Irish playwright who is the only person to be awarded both a Nobel Prize for Literature and an Oscar Questions and Conversation-Let’s talk

Stay connected..

Facebook: Sangeeta Srivastava PhD, RDN, FAND Twitter: SangeetShriva4 Instagram: rdn-drsangeeta LinkedIn-https://www.linkedin.com/in/sangeeta-shrivastava-phd-rdn-fand-3a5aa611 Sources

https://foodandnutrition.org/from-the-magazine/doubling-down-on-diversity-the-journey-to-a-more-diverse-field/ https://www.self.com/story/culturally-sensitive-nutrition-advice https://www.eatrightpro.org/news-center/member-updates/diversity-and-inclusion-updates

Hook, J. N., Davis, D. E., Owen, J., Worthington Jr., E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology®. doi:10.1037/a0032595 https://www.researchdpg.org/docs/Diversity%20Papers/Reatna_Taylor_2018.pdf https://www.eufic.org/en/healthy-living/article/the-determinants-of-food-choice https://www.cdc.gov/publichealthgateway/sdoh/index.html https://www.researchdpg.org/docs/Diversity%20Papers/Reatna_Taylor_2018.pdf 1.