The Nutrition Field Is Incredibly White — Here’s Why That’s Harmful for BIPOC Communities
Plus, here's what drives the lack of representation in nutrition in the first place.
From your daily smoothie to whether you opt for brown rice or white rice, nutrition impacts everything from your energy levels to your ability to score quality sleep, as well as any exercise goals and recovery efforts. On the flip side, deficiencies in important nutrients can lead to chronic health issues, such as heart disease, stroke, diabetes, and cancer.
However, once you drill down past the basic principles of eating more fruits and veggies, nutrition advice today can be incredibly convoluted, especially since the breadth of the $946 billion industry makes it difficult to keep up with the latest research and expert-backed recommendations. From the latest trendy diet to an influencer pushing a new brand of probiotics, many people find it difficult to wade through the marketing and make science-backed nutritional choices. And while consumers can theoretically turn to experts, such as registered dietitians, to get nutrition recommendations, this expert advice often ignores the unique perspective and needs of Black, Indigenous, People of Color (BIPOC). Part of that marginalization is because 80 percent of registered dietitian nutritionists (R.D.N.) self-identify as white, according to a 2020 study commissioned by the Academy of Nutrition and Dietetics.
So, why are BIPOC so underrepresented in dietetics, and why is diversity especially important in the nutrition field? Here’s what you need to know about the widespread whiteness of nutrition.
How BIPOC Have Historically Been Marginalized By Public Health Care
Before exploring how BIPOC communities have slipped between the cracks when it comes to nutritional health care, it’s important to understand how these groups became marginalized in the first place.
There’s a long history of suspicion between BIPOC communities and the health care industry. From the 1932 syphilis study at Tuskegee University in Alabama (in which nearly 400 Black men were deliberately infected with syphilis without informed consent) to the COVID-19 pandemic, when BIPOC communities experienced death and hospitalization at rates disproportionate to those of their white counterparts, evidence suggests medical communities are at worst biased and at best uninformed when treating BIPOC communities.
Once in the doctor’s office, BIPOC patients experience a lower quality of care than white patients. In 2002, the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care found that people who are perceived as ethnic minorities by providers (regardless of their actual race) receive lower quality of care and worse health outcomes. For example, studies have shown that Black people are prescribed less pain medication, receive less aggressive heart attack treatments, and rate their quality of care lower than white patients.
Finally, there’s a correlation between income level and nutritional health that also disproportionately impacts BIPOC, says Erika Villalobos-Morsink, R.D., a clinical sports dietitian who works with low-income communities in the Bronx borough of New York City. For example, a 2015 study found that low-income children were less likely to meet the recommended energy and nutrient intakes in their diet than their middle- and high-income counterparts. Similarly, a 2008 review from the American Journal of Clinical Nutrition found that whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher socioeconomic status. On the other hand, a diet high in refined grains and added fats was associated with lower socioeconomic status groups. FYI, refined grains and added fats are contributors to cardiovascular disease, type 2 diabetes, and stroke, among other poor health outcomes.
Why There’s a Lack of Representation Among Nutrition Experts
As an overwhelmingly white profession, current dietitians worry that a lack of representation translates to inadequate care for communities of color. And representation matters: When BIPOC patients are exposed to BIPOC health care providers, such as dietitians or doctors, patients experience benefits such as increased time spent with providers, improved medication adherence, and mutual decision-making. Without representation, however, patients might not believe that wellness and a healthy lifestyle are even possible, says Vanessa Rissetto, M.S., R.D., C.D.N.,CEO and co-founder of Culina Health. This diversity deficit also impacts the pipeline of potential R.D.N.s and nutrition experts among the BIPOC community. "If [BIPOC] don't see someone who looks like them in this field, they may be less likely to choose it," says Tamara S. Melton, M.S., R.D.N., co-founder and executive director of Diversify Dietetics.
So, what’s to blame for a lack of BIPOC nutrition experts in the field? Plenty of factors, as it turns out — starting with schooling and the associated costs. For many BIPOC, navigating the educational requirements of a career in dietetics is riddled with obstacles such as competitive programs, biased faculty, culturally insensitive advisors, and figuring out how to pay for the expensive degree, says Melton. As with many fields, to become an R.D.N., you need years of rigorous academics and practical study before taking an exam (which, if you pass, will require continuing education credits and an annual registration fee). And that’s not even the end of it: Beginning in 2024, a graduate degree will now also be required to sit for the registration exam for dietitians.
"The cost of education in this country, in addition to 1,000 unpaid hours in a dietetic internship, are both barriers to entry," says Maggie Moon, M.S., R.D., a Korean-American dietitian based in Los Angeles and best-selling author of The MIND Diet. Even once in the field, dietitians have low entry-level salaries compared to other professions with similar educational requirements (especially once you factor in that Black and Hispanic workers make about 75 percent of what white workers make.) “The return on investment is not as high as in other fields,” echoes Mia Ramdon, M.C.N, R.D., L.D., a Texas-based dietitian and founder of Koinonia Nutrition LLC. “This is sad because this work is very important."
The curriculum being taught in these dietetic programs is also a major issue. Alice Figueroa, M.P.H., R.D.N., founder of Alice In Foodieland, says she did have professors who wove cultural sensitivity into the curriculum. However, she thinks there was a greater need for cultural humility, which goes a little deeper than cultural sensitivity. "Cultural humility goes beyond just a surface understanding of the fact that there are different cultures and cultural traditions, but actually learning from those cultures and embracing them," she says. For example, cultural humility would intentionally incorporate different food traditions into nutrition education while acknowledging that these traditions are valid and can be part of a healthy lifestyle. In this way, you both embrace the food and the experience behind the food, rather than vilifying these foods and cultures, says Figueroa. Including non-white cultures in nutrition education also gives BIPOC a seat at the table to discuss nutrition education and policy.
Why Diversity In Nutrition Matters
Like any other profession, diversity in thinking, ideas, experiences, and cultures leads to better outcomes for patients of any color in dietetics and nutrition. And science confirms this: With diversity comes a growth in creativity and innovation as well as higher quality decisions in communities and organizations, according to research in the journal Perspectives on Psychological Science. Additionally, “both majority and minority individuals in diverse groups consider more information and process that information more deeply and accurately.”
With more diversity in the nutrition field, specifically, you could expect that "there would be more research on different cultures' foodways [eating habits and culinary practices of people], and therefore more resources for us as R.D.s to provide recommendations that are both culturally-sensitive and evidenced-based that also support the prevention of chronic diseases," explains Melton. "And that would mean that more people would see their cultures' foods represented as ‘healthy’ by the scientific and medical community." Plus, R.D.s of diverse backgrounds would bring their unique knowledge of particular cultural foods, allowing for more effective interpersonal care, which, in the long run, may lead to greater adherence to nutritional advice.
"Greater BIPOC representation in the industry will improve whole-person care, and that's what it's all about — helping people," adds Moon. Not to mention, "without it, we end up answering questions they didn't ask and possibly doing harm." Or perhaps not even asking the right questions, as Moon knows from personal experience. "My grandmother didn't speak English; if she'd had a Korean-speaking dietitian who understood her — literally and culturally — maybe her late-life diabetes would have been diagnosed and managed earlier."
Plus, receiving care from providers who look like you can go a long way toward establishing trust in the patient-doctor relationship. "The familiarity of receiving help from people who look like yourself creates a higher level of trust and receptiveness to public health information," explains Ramdon. In fact, studies have found that there’s a decrease in implicit bias in physicians when physicians and patients share the same race.
Finally, it’s time to recognize that the idea of a singular “right” or “correct” diet is a narrow view centered around a predominately white culture. “We sit around here and talk about diet culture, negating or forgetting that this very diet culture is part of the system that leaves BIPOC out of the wellness space,” says Rissetto. “We as dietitians should be more concerned with lack of representation and how that impacts the world at large before we care that Gwenyth Paltrow is touting a fasting book.”
“More diversity in the profession will bring about more diversity in what healthy eating and healthy bodies look like,” adds Melton. And this is the real key to making wellness-related information more accessible to all communities. Diverse representation will teach people that nutritious food choices can include a wide variety of flavors and that there's not one "right" way to eat.
The bottom line is that "the only way we will make significant progress in the field of nutrition is by making our field more diverse and representative of our nation," says Figueroa. Doing so will give everyone an opportunity to be seen and heard, and, ultimately, a chance at reducing their risk for chronic disease.
