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Diversify Your Practice: the Need of the Time for RDN and RDN to Be 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. Food 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. cooking) and time ● Social determinants such as culture, family, peers and meal 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 chef 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 meals 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/cuisine https://www.eatright.org/food/resources/national-nutrition-month/toolkit American Cuisine 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 cuisines: 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 beef, 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, potato 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 Uganda. 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 banana leaves and while it’s cooking it is mashed into a large dumpling. Matooke is served with peanut sauce. On the left side of the plate is Katogo, it is plantain, meat and vegetables cooked in banana leaves. It’s a delicacy enjoyed for breakfast. 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 Italian Cuisine by Anna De Nicolais Italian people love to use fresh ingredients for their meals. They cook for breakfast, lunch and dinner and meals are part of family life. Eating well is part of the Italian culture
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