Diabetes care and education needs to diversify
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Susan Weiner, MS, RDN, CDCES, FADCES, talks with Diana Mesa, RD/LDN, CDCES, about barriers to entering the fields of nutrition and diabetes care and education confronted by people from historically marginalized groups.
Weiner: Only about 6% of dietitians identify as Latino/Hispanic. In fact, in 2017, only about 15% of diabetes care and education specialists identified as belonging to a minority group. Why do you think this is?
Mesa: The lack of representation in these fields speaks to a larger problem, which is the lack of equity in the U.S. According to data from the U.S. Department of Education, Black, Hispanic and Indigenous students graduate at lower rates than white students. Barriers are present right at the beginning of these students’ careers, as historically marginalized communities face a multitude of barriers, including financial, environmental and societal, among others.
Weiner: What are some barriers to accessing the field for people of color?
Mesa: Completing a bachelor’s degree for many students of color is difficult as is. The field of dietetics is now increasing the education level requirement to graduate level starting in 2024, while including a typically unpaid internship, which many must relocate for. Adding to the problem is that even after attaining a graduate degree in the field of dietetics, the average salary increases by only a few thousand dollars annually, if at all. The investment toward attaining the degree and credentials is high, but compensation is low. These things make the field even less accessible to members of already marginalized communities.
Another barrier people of color face in the fields of dietetics and diabetes care and education is a lack of representation within the field. According to 2020 data from the Commission on Dietetic Registration, 80% of registered dietitians are white, whereas data from zippia.com show that more than 64% of diabetes care and education specialists are white. It can be difficult to find mentors who share similar lived experiences and who can impart their wisdom to younger professionals. The gap is so evident that organizations like Diversify Dietetics exist to diversify the field and support student dietitians of color. They have created a community of likeminded professionals from all races and ethnicities where scholarships, mentorships and support are offered to people of color in the dietetics space from the beginning of their degree to well into their professional lives.
Wiener: How does the lack of representation in the field reflect the resources available to the people we work with?
Mesa: The lack of representation in the field leads to diabetes and nutrition education resources that are not always culturally responsive. As the country’s population of Asian, Hispanic and Black people continues to increase, diabetes care and education specialists and dietitians of color are finding they need to become trailblazers in the field to create culturally competent education material for the people they work with and provide lots of labor to educate some of their white colleagues on how to offer care with cultural humility.
While the existing depictions of the meals on a balanced plate may look appealing to people who were raised in the dominant culture, those from nondominant cultures may feel confused, may not relate to eating that way, or feel like their way of eating is wrong or unhealthy. There are also times when dishes from other cultures are appropriated and misconstrued into something they are not, which is insensitive and even offensive.
We need to show our communities that our foods also fit within what we depict as a balanced plate, and we need to do it in a way that captures the nuance within the Latin American community. We also need to be open to asking and learning about the way the people we work with live and eat so we can adapt existing resources to their personal and cultural preferences. This work needs to be shared among the profession and not just be the responsibility of professionals of color.
Weiner: What are the primary misconceptions surrounding Latin American cuisine and healthy eating for people with diabetes?
Mesa: One misconception is that people from Latin America all eat the same things. While there are many similarities in our foods because of our shared Indigenous, African and European colonial histories, there are also many differences and so much nuance in our eating patterns and foods. For example, a person from Cuba would not typically include a corn tortilla as part of their meal, whereas a person from Mexico or Guatemala may eat tortillas daily.
Another common misconception is that Latin American cuisine is inherently unhealthy, often associated with fried and starchy foods. In fact, non-starchy vegetables are present in many of our dishes as salsa or sofrito instead of as a side dish. While it is true that Latin American cuisines feature many starchy foods, such as beans, plantains, root vegetables and grains, these foods are nutrient-dense and an important part of a balanced plate. Beans, for example, are loaded with fiber, potassium, folate, iron and magnesium and are enjoyed in all Latin American countries in one way or another. Similarly, plantains and root vegetables, like potatoes and yams, are another great source of fiber, potassium, magnesium and other vitamins and minerals.
These foods fit into the U.S. Department of Agriculture MyPlate model or the Diabetes Plate Method as nutrient-dense fruits and vegetables and sources of carbohydrates that already have a place on our plates. Yet too often, we hear the recommendation to stop eating plantains and rice and beans, and we lack representations of a balanced plate using the foods we enjoy.
Regarding cooking preparations, Latin American dishes feature an array of cooking methods, like sauteing, stewing, braising, roasting and grilling. Frying is just one of many methods. Some examples of Latin American dishes using other preparations include Nicaraguan carne asada (grilled beef), Cuban ropa vieja (stewed beef), Peruvian pollo a la brasa (rotisserie-style chicken) and Panamanian arroz con pollo (rice and chicken cooked in the same pot in chicken broth). Yuca or plantain can be fried, but they are also commonly boiled.
As you can see, dismissing our foods as just “starchy” and “fried” is an uninformed oversimplification of our diverse and nourishing meals. There is nothing inherently unhealthy about our foods, and we can choose what foods we put on our plate and how we prepare them.
For more information:
Diana Mesa, RD/LDN, CDCES, is founder of En La Mesa Nutrition and author of Better Blood Sugars for Latinos: Building a Balanced Plate with Cultural Foods (Mejorando la glucemia en los latinos: Creando un plato equilibrado con nuestras comidas). She can be reached at diana@enlamesanutrition.com.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.
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