Have you ever had a healthcare provider disregard your traditional diet and proceed to recommend foods that you don’t particularly like to eat or are not familiar with?
If so, you are not alone. I have experienced it first-hand. I also had clients, friends, and family discuss their frustrations with me on multiple occasions. As a Global Public Health Nutritionist and a woman of African descent, it is my duty to address some of it.
The Traditional (African) dietary pattern
Traditional (African) dietary patterns generally involve eating whole foods, mainly of plant-based variety, fresh fruits and vegetables and are packed with flavour from the abundance of herbs and spices used while preparing and cooking. Cultural foods are minimally processed, often prepared at home from scratch, and structured around fixed meal times with minimal snacking in between. However, although numerous studies have found these attributes to be key in promoting overall health and longevity, mainstream guidelines continue to show minimal interest in understanding the eating patterns of diverse cultural groups.
The reality is people of different cultures are often made to feel ashamed of their cultural food choices and eating patterns, all because it doesn’t fit the mainstream idea of what ‘healthy eating’ should look like.
Advocates for diversity in health and nutrition care have been sounding the alarm on this issue for a while now. However, it is still the case that the majority of dieticians/nutritionists in the UK lack the appropriate training in delivering optimal care for people from non-white backgrounds. Of course, this is, mostly, through no fault of their own. Lack of widespread coverage, minimal interest in the scientific investigation of cultural foods, and its absence in dietetic training all play a part in the lack of mainstream representation.
So, why is mainstream nutrition advice problematic?
1. It can be discriminatory
Conventional nutrition advice largely reflects the mainstream (Western) perspective and tends to promote the idea of ‘healthy eating’ through Eurocentric lens. This one-size-fits-all approach to health and nutrition is consequential to minority groups whose cultural foods are often left out of the wider considerations. Most importantly, it disregards centuries-old culinary history and culture that minority groups have enjoyed since birth and discounts the values they place on eating the way they have been accustomed to.
Ultimately, the continuous absence of cultural foods in the health and nutrition conversation and professional advice leads immigrant communities into believing their food choice is a bad choice.
Not only is this wrong but also discriminatory. Firstly, it stands to overlook the importance (and adequacy) of cultural foods in meeting the nutritional needs of minority groups. It also takes away the immense social and psychological benefits of being able to enjoy heritage foods.
The value of cultural foods is not just about nutrients, it makes up a huge part of immigrant communities’ identity, bring a sense of home far away from home, it is essentially a source of joy. All of these components are significant if a person is to achieve optimal overall health and well-being.
What can be done? Dieticians and nutritionists working with ethnic minorities need to recognise that the value of cultural foods extends far beyond the nutritional composition of foods. Practitioners need to therefore be sensitive to these extra values that cultural food choices bring to the lives of their clients.
2. It's culturally-uninformed
A huge chunk of the problem also stems from the fact that most of the scientific evidence centres around Western dietary patterns. For example, the Mediterranean diet is often represented as the gold standard of what ‘healthy eating’ should look like. Of course, there is nothing wrong with this particular pattern of eating, if that is what you like. The problem arises when it is implied that other traditional diets are somehow less than.
If the research community paid enough attention to eating patterns from other cultures, this perceived diet hierarchy would not have been a point of discussion. In reality, however,
Other cultural dietary patterns are seldom researched, unless of course the ‘wellness’ industry stands to profit off of it. Then it is suddenly repurposed as a ‘super food’. Moringa, Spirulina, Teff are just a few examples.
What can be done? Dietitians should take time to research cultural foods other than their own and tailor recommendations based on the preferences of their patients/clients. If not, Nutrition practitioners should provide resources and signpost clients to other professionals who may be better suited to guide them.
3. It's unsustainable
The primary goal of nutrition professionals should be to support their patients/clients make changes that they can stick to long-term. For minority groups, having to follow a nutritional strategy that excludes familiar cuisine can be perceived as highly restrictive. The evidence is crystal clear on restrictive diets, they simply do not work long-term, and people will, sooner than later, return to their customary regimen.
Nutrition advice that does not take into account the importance of cultural food choices and instead force the widely prescribed Western method is, to say the least, an unsustainable approach.
What can be done: To improve dietary adherence, it is essential to tailor advice to the individual, work with them to build on their customary diet, and educate them on how they can build on their current eating patterns. This is a sustainable strategy than attempting to convert them into eating what is, essentially, alien to them.
What you can do as a patient/client?
1. Approach with confidence
Talking about our cultural food preferences often carries a sense of guilt and shame mainly because we simply don’t see them represented enough. The first step is to acknowledge the fact that your food choices matter and your assigned dietician should respect that. Do not be afraid to openly discuss the foods that are important to you and those you do not particularly enjoy. The health professional should then tailor your nutritional plan according to your preferences and educate you on how to add more nutrition where it lacks.
2. Be your own advocate
Know your rights as a service user and take time to understand the basics of your nutritional care and the scope of your relationship with your provider. If, for any reason, the recommended nutritional plan is not working for you, raise it with your assigned dietician/nutritionist and ask for the plan to be revised. It is also important to speak up if you feel you are not getting enough support from your current practitioner as you may be able to switch to another provider who may understand your concerns better.
3. Be clear about barriers and challenges
Not all of us can afford to have lean meat multiple times a week, or have access to health food stores locally. However, these barriers should not be the reason you cannot attain the goals you or your medical professional has set for you. If you feel the type of foods recommended by your dietitian/nutritionist would put a financial strain on you or doesn’t account for other challenges you may have, let him/her know. Your care provider should be able to offer you challenge-proof alternatives to achieve similar nutrition goals.
4. Do not tolerate discriminatory attitudes
Cultural competency within the dietetic profession is now a required skill and there is no place within the healthcare system where your cultural foods are dismissed or frowned upon. Do not hold back if you feel your dietician/nutritionist is discriminating against you both as a person or your cultural food choices. Voice your concern and the relevant personnel should be able to investigate the matter.
5. Find your community
Be proactive in your journey to better health and nutrition. Luckily, the amount of culturally-informed dieticians/nutritionists providing evidence-based information in the digital space is progressively increasing. Start by looking for accredited nutrition practitioners and connecting with those providing information relevant to you and your specific culture. Heritage Nutrition also endeavours to produce culture-focused nutrition resources which may be of interest to you, so keep an eye out.
Disclaimer: This article is not a substitute to the advice of your medical care. You should follow the treatment and recommendations of your doctor and specific dietician at all times. Please check out our full disclaimer on our website here
Hanna Haile is a Registered Associate Nutritionist with specialty in global public health nutrition and health promotion. Hanna is the Founder of Heritage Nutrition and provides culturally-inclusive guidance to people from diverse backgrounds. Her work revolves around helping clients realise their nutritional and health goals through a set of evidence-based dietary and lifestyle strategies. Hanna is also a health & Nutrition writer and Published Author in Journal of World Public Health Nutrition.