Changing the Face of Dietetics
Today's dietitian
By Sharon Palmer, RD
Vol. 6 No. 2 p. 28

As I peered around the grand ballroom at the opening session of the American Dietetic Association (ADA) Food & Nutrition Conference & Expo in San Antonio last October, I allowed an air of pride to wash over me and flow into the room. Thousands of professionals sat erectly in conference room chairs, neatly dressed in the latest fashions after recent flights from far-away cities. These well-coifed women dripping with self-confidence and intelligence were my sisters in career. They practiced in hospitals and clinics in every city of our country and managed kitchens bustling with legions of foodservice workers in places as far away as Alaska and Hawaii. These capable dietitians tended the nutritional micromanagement of neonates and the critically ill without breaking a sweat. But, as my chest swelled with pride for my fellow dietitians, a slow realization dawned on me as I scanned the crowds in the hushed room. Most of these faces looked all too familiar. They looked too much like the face I greeted in the mirror each morning. These dietitians represented the never-changing face of dietetics, a predominantly female Caucasian profession.

Since the birth of dietetics, when Lenna F. Cooper and Lulu C. Graves formed the ADA to battle public health and nutrition woes during World War I, the profession has primarily attracted white women. According to the ADA 1999 membership database, 89.9% of dietitians are Caucasian, with 5.4% Asian/Pacific Islander, 2.4% African American, 2.0% Hispanic, and 0.2% Native American dietitians. These numbers grow more significant when compared with our current population, which is comprised of approximately 25% minorities. According to the U.S. Census Bureau, by 2050, we should expect more than one-third of our population to be minority (African American, Hispanic, Native American, and Asian/Pacific Islander). But, dietitians aren’t the only ones with a diversity crisis on their hands. It seems that the entire healthcare workforce does not echo the country’s demographics, as only 10% of all healthcare workers are minorities. Meanwhile, the overall demand for dietitians is predicted to grow, while the culturally diverse are attracted to other careers.

But, having a poor representation of minorities in the dietetics field poses more problems than merely contributing to a diagram for supply and demand in a given workforce. It has become painfully obvious in this culturally rich country of ours that minorities do not receive the same level of healthcare as do their white counterparts. Research from the Institute of Medicine, The Kaiser Foundation, and the Commonwealth Fund suggests that there are differences in treatment and healthcare outcomes that exist and persist based on race and ethnicity. These disparities are caused by many factors such as differences in socioeconomic status (education level and income), differences in the health behaviors of those seeking care and adhering to treatments, the lack of multicultural tools and sensitivity in part of the healthcare provider, language barriers, payment and coverage, outright discrimination and stereotyping by healthcare practitioners, and the lack of diversity in the healthcare workforce. The ADA 2002 Environmental Scan shows that new opportunities exist for the dietetics profession in part because of the increasing ethnicity of our country’s population and the accompanying supposition that there will be significant numbers of underserved.

The recognition that we have a problem in this area has prompted the country to create a bold national goal to virtually wipe out racial and ethnic disparities. Addressed in the Healthy People 2010 initiative, our nation established a mission to eliminate health disparities among racial and ethnic minority groups by 2010, with specific emphasis on cultural competency in healthcare providers.

With a more diverse population of dietitians walking down corridors in clinics and hospitals across America, we can do our part to ensure that the issue of healthcare disparity is resolved. By increasing minority dietitians in our workforce, underserved populations might get a break, as studies have shown that minority health professionals are more likely to provide care to minority and uninsured patients than are nonminority healthcare providers. A culturally diverse dietetics workforce can more effectively care for a culturally diverse population, as people prefer to discuss their health concerns with someone from a familiar background.

“Most people feel more comfortable discussing issues like food, body image, and weight with people of a similar ethnic background. Who could better understand their plight than someone from their racial/ethnic group?” says Terry Brown, RD, LD, vice president of the North Texas Chapter of the National Organization for Blacks in Dietetics and Nutrition (NOBIDAN). Diversity in dietetics takes on even more weight when we consider the statistics on nutrition-related health issues in minorities. Fifty-two percent of non-Hispanic African American women, 50% of Mexican American women, and 54% to 80% of American Indians are overweight. African Americans experience higher rates of at least three of the serious complications of diabetes (blindness, amputation, and end-stage renal disease). The prevalence of type 2 diabetes is twice as high in Hispanics/Latinos. African American women have coronary heart disease and mortality rates 35.3% and stroke rates 71.4% higher than do white women.

According to the Journal of the American Dietetic Association, diversity will more than likely challenge the dietetics field, which was mainly built on one set of cultural values. Thus, it is a necessity for our profession to evolve into a more diverse group, with a resulting bonus that nonminority dietitians will become more aware and sensitive to their ethnic patients. Dietitians can learn to embrace traditions, beliefs, and things as simple and important to the profession as food preferences. Adhering to individuals’ ethnic food preferences has been a hot topic for years in dietetics. The Joint Commission on Accreditation of Healthcare Organizations jumped on the cultural bandwagon by requiring that the racial and ethnic sensitivities of patients be addressed in foodservices, patient communications, and patient education.

“A more culturally diverse dietetic population would benefit healthcare because there would be RDs for each culture and race represented on the healthcare team,” says Jeanette Jordan, a Charleston, S.C.-based RD and spokesperson for the ADA, who is a health disparity scholar trained through Morehouse University. “These RDs could make the other team members aware of their culture and help them to communicate effectively with people of their culture. They could aid in the development of culturally sensitive educational materials.”

Most of us agree that the whole country would benefit from a more diverse group of dietitians plying our trade throughout the land, but how do we get them there? This is the question that has attracted attention in ADA headquarters for the past two decades. The ADA has created a Diversity Philosophy Statement that addresses the goal to seek an increase in participation of underrepresented groups in dietetics education programs, the association, affiliate dietetic associations, dietetic practice groups, leadership, and ADA staff. In addition, the ADA 2000-2003 Strategic Plan includes goals, objectives, and tactics focused on underrepresented groups. The ADA recognizes the need to try new methods for addressing the diversity issue and began the Diversity Mentoring Project with funding from other organizations.

A number of networking groups have also been formed to support minority dietitians, such as Chinese American Dietetic Association (CADA), Filipino American Dietetic Association (FADA), Hispanics in Dietetics and Nutrition, Indian American Dietetic Association (IADA), the Korean American Dietetic Association (KADA), and NOBIDAN. With unrelenting enthusiasm, many of these networking groups seek to promote the dietetics field in their culture through a number of strategies.

“We mentor students around the world and focus on promoting RDs to MDs through public media, health expos, and promoting our cultural materials,” says Rita Batheja, MS, RD, CDN, founder of IADA. “We are guest speakers on radio, we give talks in local communities, and we participate in Chinese American practices,” says Karen Tso, MS, RD, president of CADA, of strategies used to promote dietetics among Chinese Americans.

Visibility of the dietetics profession among the culturally diverse is an essential element of increasing diversity into our fold. “To Koreans, dietetics is not a well-known profession compared with teachers, nurses, and accountants,” says Younghee Kim, PhD, RD, LD, associate professor of food and nutrition at Bowling Green State University in Ohio and president of KADA.

Brown says, “Low pay prevents some minorities from entering this profession. It is not one of the glamorized professions like medicine and law.”

Betty Dykes, PhD, RD, LD, president of FADA, says, “Filipinos born in the United States do not usually take dietetics since it does not pay as much as other professions such as computer science, nursing, OT, and PT. Considering that one needs four years at the bachelor’s level and another year or so for internship, it does not seem right that entry-level dietitians do not get as much as the other medical professions.”

“Many Chinese students start to get a BS in nutrition and end up going into public health or research. They feel that an advanced degree gives them better opportunities. We need to work on our RD image,” says Tso. Getting culturally diverse dietitians on television and in magazines, speaking about our profession, and dispensing nutrition information is a definite priority in promoting our career to a diverse population. But, possibly our biggest opportunity for advancing dietetics is in reaching out to kids across America.

In a country that finds minority kids underrepresented in college to begin with, organizations such as the American Hospital Association are focusing on kids in kindergarten through 12th grade by developing a Commission on Workforce for Hospitals and Health Systems. The Robert Wood Johnson Foundation and W. K. Kellogg Foundation, in conjunction with the Health Professions Partnership Inititiative, awarded six grants to increase minority participation in health professions with a requirement that efforts must be focused on middle and high school curricula.

Kids need to see dietetics as a fulfilling career choice possibility early on, boning up on their math and science skills to land them in a dietetics education program. Jordan feels that apprehension about the difficulty of required courses is another factor keeping African American students out of the field. “A strategy that might be effective is more active recruitment of minorities at the high school level,” she says. A study on minority dietetic interns published in the Journal of the American Dietetic Association concluded that increasing minority dietitians’ visibility at career days and early recruitment of students were ways to increase diversity within the profession.

“Members, affiliates, DPGs [dietetic practice groups], and other groups do not have mentoring and outreach as a priority,” says Yolanda Gale Pearson, chairperson of the ADA Diversity Committee. With input from experts in cultural diversity, a Building Our Future Mentor Program Toolkit was developed by the ADA to provide models for mentoring culturally diverse groups. The toolkit, which may be downloaded from the ADA Web site, is effective for community-based mentoring programs for kindergarten through eighth grade and high school that will raise awareness of dietetics.

Even though the numbers of minority dietitians have not significantly increased over the past decade, didactic programs in dietetics are seeing a rise in minority enrollment from 19% in 1996 to 24% in 2002, according to the ADA’s Commission on Accreditation for Dietetics Education. The percentage of minority students enrolled in coordinated programs and postbaccalaureate dietetic internships increased from 13% in 1997 to 18% in 2002. But, these data suggest that there is a gap between the number of students who are interested in the career and who actually obtain the RD to practice.

Other issues are keeping minority students out of dietetic education programs. Lack of knowledge about the number of career opportunities dietitians hold, apprehension of acceptance into a profession with few ethnic role models, fear of or difficulty being accepted into an internship, the lack of access to dietetics programs (most historically African American schools lack a dietetics program), poor recruitment in disadvantaged schools, or lack of funds to attend a dietetic education program are some valid concerns that may keep kids out of the dietetics field altogether.

It’s going to take a concerted effort among the dietitian fold to change the visage of dietetics. Minority dietitians face the added challenge of not only supporting their chosen career but also attempting to pass it along to their cultural community. We can all make a difference, and mentoring is the most readily available option. Let your voice be heard in support of our profession, and hopefully in another decade, the ADA Food & Nutrition Conference & Expo will better reflect the changing face of America.

— Sharon Palmer, RD, is a freelance writer who delights in the cultural milieu of southern California.

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