Systemic Racism and Implicit Bias in Nutrition and Dietetics

Systemic Racism and Implicit Bias in Nutrition and Dietetics - Food & Nutrition Magazine - Stone Soup
Photo Courtesy of Stephanie Carter

On a New York winter day, I came to the realization that my life needed to change. An aspiring actor at the time, I had grown weary of auditioning for shows that I just wasn’t quite right for — or, should I say, just wasn’t quite “white” for. I knew I was ready for a change, so I took a break from acting to figure out how I could find a career that I was equally passionate about, but that had far less variability and more financial stability.

It didn’t take me long to decide to get my master’s degree in nutrition. I called home and explained to my mother that I was leaving my dream job as an actor/dancer to pursue a career as a registered dietitian nutritionist. She was proud of me and gave me her blessing. Six months later, my mother passed away suddenly and unexpectedly from heart failure as a complication of Type 2 diabetes.

After my mother passed away, I thought long and hard about what I could’ve done to help her. I knew she had diabetes, but she didn’t let on that her heart was failing. Looking back now, I see the signs: shortness of breath, edema and fatigue. I wondered why her physician hadn’t pushed her more and how the health care system failed her. Why did my mother die of a preventable disease? I can’t know for sure, but based on the town I grew up in ⁠— the town where my mother still lived — systemic racism and implicit bias played a factor in why my mother was underserved by the health care community.

If there was any doubt about being an RDN, it was cleared up pretty quickly as I tried to wrap my head around my mother’s death. My immediate thought was, “Why is it that so many in our community die of a preventable disease?” I was instantly mad that my mother became a statistic, adding to the number of African Americans who lose their battle with heart disease. I made a commitment that one of my goals as an RDN would be to provide prevention education and nutrition counseling to the Black community to help put an end to this public health crisis.

Once I began graduate school, I found that most of my peers didn’t share my viewpoints on nutrition. Overall, the school I went to was very diverse, but I was the only Black person in my coordinated dietetics program. Not only were my experience-driven, racially sensitive comments met with resistance during class discussions, I also was dismissed as a peer by my classmates who were predominately white. I found myself frequently questioning if I made the right decision to head into this field. Even as I write this, I’m honestly not sure if I made the right choice.Systemic Racism and Implicit Bias in Nutrition and Dietetics -

Throughout my education, I felt a disconnect with what I was learning in school and the practical application of dietetics in various socioeconomic and cultural populations. I can name several instances in school in which my experiences as a Black person were very apparent. One instance from my advanced concepts in research class stands out: A group was presenting on the best way to provide nutrition for children who are picky eaters. The predominate viewpoint of the class was to raise children to become intuitive eaters. This eating style encourages the parent or caregiver to choose what food to serve at meal and snack times but allows the child to decide how much to eat of the foods offered.

In my opinion, many low-income families cannot raise intuitive eaters because, given their financial restraints, they simply need to make sure their children are fed. I’ve worked with families who aren’t sure when they will have their next meal. In fact, many low-income families rely on school breakfast and lunch programs to feed their children. I responded during the discussion that I believe intuitive eating is a very privileged way of thinking about food, and I was quickly met with backlash from the white majority. I let it drop, since I was the only one holding this sentiment.

That wasn’t the only time this clique of girls went out of their way to exclude me. I would frequently arrive early to sit outside of the classroom and wait for the current class to let out. This same group of girls would walk past me and sit down at the other end of the hallway like I didn’t exist. They couldn’t even bother to say hello. I literally called my father one day and cried when they did this to me. My father responded, “Suck it up. Later for these white girls who won’t accept you. You’re there to get an education, not make friends.” I stopped showing up for class early.

My entire education was fraught with instances such as these, both from a select few professors and groups of my peers. Despite all of it, I stayed focused, graduated and subsequently passed my registration examination. Now, instead of classmates, I’m dealing with interviewers and hiring managers who may or may not harbor unconscious bias toward African Americans.

One day, after receiving a string of rejection letters, I was granted an in-person interview at a prestigious hospital here in California. I was elated, but I knew the interview, which was scheduled to last two hours, would be difficult. I prepared by brushing up on my medical nutrition therapy, reviewing tube feed calculations and testing myself with several case studies. I was ready for this interview.

I showed up to the interview 30 minutes early and checked in. The senior administrative assistant greeted me and led me into my first interview with the associate director. This woman was a petite blonde who looked at me with apprehension. I shook her hand, sat down and confidently began to answer her interview questions. About five minutes into the 30-minute interview, she told me that I didn’t have enough experience and that she would be seeing other candidates who were more experienced than I was. I sat there thinking to myself, “You called me in for this interview. I applied and my resume made it through the hiring software, through human resources, through the administrative assistant who placed me in this chair. You had my resume before I walked in. If I didn’t have enough experience, why bring me in to interview?”

For the next 25 minutes, she continued to question why I would be a good fit for the job given my lack of experience. I almost cried. Instead, I explained that my work ethic and dedication to the job would prove why I was the right candidate for the position. However, sitting there, I already felt as though she had written me off. And as I waited for my next interview, I saw her leaving the hospital laughing with a friend as if my interview hadn’t even happened.

I was upset that there are people who can go through life, not even having a second thought about a moment like the one that just occurred. For me, that 30-minute time span played over and over in my head, and unfortunately, it was like so many other moments I experienced while interviewing to become a clinical dietitian. Should I have taken the time to take down my long, gorgeous braids to style my hair into a more “acceptable” hair style for the workplace? Did she have an implicit, unconscious bias against Black people? I don’t know, but studies suggest that when faced with equally qualified African American and white applicants, employers tend to favor one.

With approximately 2.6 percent of RDNs and less than 6 percent of physicians and surgeons in the U.S. identifying as Black, it is interesting to me that a qualified candidate like myself would have such a difficult time trying to enter the health care field. These percentages are problematic at least for the Black population because, historically, there is a level of mistrust between Black communities and health care institutions and professionals. Research suggests that, put simply, people of color often receive less care — and often worse care — than white Americans. Reasons include lower rates of health coverage, communication barriers and racial stereotyping.

Eliminating systemic racism and implicit bias in health care will require increased representation of people of color as health care providers and more education about racial bias. Without starting here, the cycle of disparity is perpetuated.

Interestingly enough, as I’m writing this, I still haven’t been offered a clinical dietitian job even with my master’s degree and after completing 1,200 hours of supervised practice. I still question which is worse: the implicit bias I faced as an actor or the implicit bias I continue to face as an RDN.

The team behind Food & Nutrition Magazine® aims to amplify the voices of people of color and other underrepresented individuals in nutrition and dietetics and highlight the experiences of RDNs, NDTRs, dietetic interns and nutrition and dietetics students. Our goal is not only to stand in solidarity, but also help inform our readers and increase awareness about the importance of diversity in the field of nutrition and dietetics. We know it’s not enough, but we hope it’s a step in the right direction that will support meaningful conversations and a positive change in the profession. 

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Stephanie Carter
In addition to counseling as dietitian, Stephanie Carter, MS, RDN, is a well-known fitness professional who creates dynamic and challenging programs for group fitness and personal training clients. Stephanie also is a professional actor/dancer and a member of the Actors Equity Association. In her 20-year career, she has appeared in numerous musical theatre productions across the country and continues to act today.

Stephanie's brand and private practice, Carter Hall Lifestyle, provides evidence-based content, services and products to balance life within the area of nutrition, fitness, and general well-being. She is set to launch a much-anticipated membership program through Carter Hall Lifestyle, focusing on metabolic health.

Through her private practice, Stephanie is also a preceptor and mentor. Stephanie is passionate about supporting long term healthy lifestyle behaviors and helping clients to live their best life ever! Her philosophy is simple: #LiveNourished. Connect with her on Instagram, Facebook, LinkedIn and Carter Hall Lifestyle.