Although the racial and ethnic composition of the nutrition and dietetics profession has become somewhat more diverse over the past two decades, similar to other health care professions, it does not resemble the communities it serves. According to a 2017 survey about heritage, 5 percent of nutrition and dietetics professionals indicated Hispanic, 5 percent Asian, 3 percent black/African-American and 2 percent other. The field also continues to be dominated by women, with 94 percent of professionals identifying as female.
Nutrition and dietetics is not the only health-related profession challenged with building a more diverse workforce. According to 2016 Census Bureau data on demographics, 68 percent of physicians and surgeons identified as white, 23 percent Asian, 6 percent black/ African-American and 3 percent other. Among nursing professionals, 24 percent reported minority backgrounds and 11 percent identified as male.
Definitions of diversity can vary. Some descriptions refer to differences in ethnicity, gender, sexual orientation, socioeconomic status, age, physical abilities and personal beliefs. Other definitions focus less on highlighting differences and more on learning to respect and understand those differences in a shared space. The Academy of Nutrition and Dietetics does both: “Diversity recognizes and respects differences in culture, ethnicity, age, gender, race, creed, religion, sexual orientation, physical ability, politics and socioeconomic characteristics.”
While definitions may vary, the importance of diversity is certain. Beyond 2030, the United States population is projected to grow slowly, age considerably and become more racially and ethnically diverse. These shifts in population size, age, race and ethnicity will have a significant impact on the type of care provided and the resources needed by clients and patients.
Putting It into Practice
Trained health care providers should be able to relate to patients in a fair and equal manner, but this is not always the case. Studies suggest that a provider of the same ethnicity as his or her minority patients tends to provide more effective interpersonal care than a practitioner from a different background. Additionally, health care providers from underrepresented groups are more likely to serve medically underserved communities and minority patients. Furthermore, non- English-speaking patients typically receive better interpersonal care and demonstrate improved compliance when visiting language-concordant practitioners. To address this, the 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.”
If the mission is to accelerate improvements in global health and well-being through food and nutrition, then dietetics must find innovative ways to improve diversity. “We have a very narrow view of what healthy eating looks like; it’s not inclusive of other cultures,” says Tamara Melton, MS, RDN, CPHIMS, co-founder of Diversify Dietetics, a group dedicated to increasing ethnic and racial diversity in the profession.
Rahaf Al Bochi, RDN, LDN, spokesperson for the Academy of Nutrition and Dietetics, explains how the traditional view of healthy eating also can exclude religious practices. “Ramadan is a holy month in which Muslims abstain from food and drink from dawn to sunset; it comes with specific nutritional recommendations,” Al Bochi says. “There are people with chronic conditions, such as diabetes, who decide to fast for Ramadan. A Muslim health professional will have a better understanding of the intricacies involved in Ramadan and will be able to advise the individual better.”
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.”
Nutrition and dietetics literature traditionally frames differences in gender-specific nutrient recommendations as occurring between cisgender, heterosexual males and cisgender, heterosexual females. However, emerging research suggests distinct nutrition-related considerations for sexual minorities of the lesbian, gay, bisexual and transgender population. Adopting culturally competent, gender-affirming practices can enhance patient care from nutrition and dietetics practitioners and improve inclusivity within the profession.
The importance of increasing diversity in the nutrition and dietetics profession has been a topic of interest for the Academy since the early 1980s, when the first diversity/affirmative action plan was created. Unveiled in 2015, the Diversity Strategic Plan includes a variety of initiatives to increase diversity and improve cultural competence. Academy resources aimed at diversifying the profession include grants and awards, a Diversity Mentoring Toolkit and other efforts by dietetic practice groups and member interest groups. In addition, the Academy’s Diversity Committee sponsors programs and establishes diversity liaisons.
Diversify Dietetics uses social media to reach underrepresented nutrition students. An RDN spotlight and Meet My Mentor series help to increase awareness of opportunities for diverse individuals within the field while stressing the importance of mentorship throughout the career journey. The group also offers cross-cultural training and access to evidenced-based resources and tools for nutrition professionals and educators.
Next Steps to a More Diverse Field
Since most studies examine diversity in the U.S. workforce in terms of ethnicity and gender, diversity initiatives commonly target those demographics. However, racial and ethnic categorizations can overlook differences within groups. “Asian-American is a very heterogeneous, diverse community,” says Karen Lau, MS, RD, LDN, CDE. “With a broader view, there are East Asians, South Asians and Southeast Asians and, within that, there are different countries and, within a different country, there still is more diversity such as language, culture or potentially physiology.” Narrowing the discussion of diversity to ethnicity and gender also may discount differences in sexual orientation, socioeconomic status, physical ability and other types of diversity.
One way to build a more diverse field is by reaching students sooner. “Education programs are the gatekeepers to the profession,” says Jill White, EdD, RD, LDN, associate professor of nutrition science at Dominican University. “There needs to be a thorough examination of what the obstacles are and how they can be addressed.”
Increasing the number of nutrition students from underrepresented groups may lead to an increase in diversity among nutrition practitioners. A supportive and inclusive educational pipeline to the dietetics field is needed to recruit and retain a diverse pool of students. “Of nine preceptors during my dietetic internship, eight were non-diverse,” says Teresa Turner, MS, RD, LDN, the vice-chair of the Academy’s Diversity Committee. “That lack of visibility is a deterrent for those who do not wish to take on the pressure of being the ‘odd man out.’ It is very difficult for some people to become part of a group when they feel like no one in that group will understand their perspective.”
As the U.S. population becomes progressively diverse, nutrition professionals must match the trend. The campaign for a more representative profession should include wide-ranging initiatives to ensure no group gets lost in the larger push for diversity. The Academy, cognizant of this important issue, has addressed this in its strategic plan: “Increase the diversity and cultural competence of the workforce to reflect the communities they serve.”
What You Can Do
Recognize. Some level of bias is nearly always present and it is important to recognize how that may impact decision-making. “We all have formed an opinion about someone based on their looks, language, culture, et cetera,” says Joseph Quinlan, MSH, RD, CNSC, LD/N, chair of the Academy’s Diversity Committee. “It’s going to happen and, as professionals, we must realize we are judging people not on fact but on bias and opinion. We preach evidenced-based nutrition — sometimes we need to form evidence-based impressions.”
Learn. After recognizing personal biases, place yourself in a position to grow. Attend trainings on cultural competence, review inclusion resources and tools, and be intentional about encouraging diverse spaces both personally and professionally. Joining a member interest group with a focus on another culture could be beneficial.
Connect. Mentorship is an effective strategy to recruit and retain students and professionals from underrepresented groups. If you do not have the capacity to serve as a mentor, connect interested students with helpful resources or colleagues.
Share. If you create or implement an effective approach to the problem, share the solution with other nutrition professionals. Working together to address lack of diversity is more resourceful than attempting to tackle the issue alone.
Ask. If an organization does not offer a statement on how diversity is handled, then inquire. As a student, find out how your education program helps students of diverse backgrounds overcome barriers and how you can get involved. Health care practitioners can ask similar questions in the workplace to spark conversation about cross-cultural competence, diversity and inclusion.