We all need to eat in order to survive, but there isn’t just one way to do that. How you eat depends on where you live and what food is available. It can also depend on your heritage and your racial, ethnic, and religious background.
Dietitians from diverse backgrounds can support culturally appropriate nutrition counseling and guidelines. But finding a professional who shares your background can be difficult since 80% of dietitians are White.
Why does racial and ethnic diversity matter in the nutrition and dietetics profession? Tamara Melton, MS, a registered dietitian nutritionist and founder and executive director of Diversify Dietetics, shares her views on the current state of diversity in the field and why increased representation matters for nutrition counseling.
This interview was edited for length and clarity.
WebMD: Why does diversity matter when it comes to nutrition counseling?
Melton: It's critical that we have more diversity if we want to stay relevant and make sure we’re listening to the communities we serve. If we don’t have diverse colleagues across the field, we’re left with a huge blind spot.
As dietitians, we can look at a food and break it down to its chemical components and know how it supports or negatively impacts health. It’s our superpower. But people don’t eat nutrients. They eat food, and food is tied to culture. They choose what they eat based on taste, then price and what’s available. Taste goes with your preferences and what you grew up with and what you know. Nutrition is down the list.
WebMD: With less diversity, what are the blind spots?
Melton: In our field, we promote and share what’s considered healthy, which is based on scientific evidence. That, in turn, informs major governmental programs like SNAP [the Supplemental Nutrition Assistance Program] and the [National] School Lunch Program. It’s also what goes into textbooks that are used to train future dietitians. It’s what’s used for graphics shown to the general public and in public health campaigns and individual counseling sessions. It informs what food brands decide to invest in and put out into the market.
But you can’t be evidence-based if you’re not researched. What foodways are the academic community researching to see if they support health? As humans, we tend to focus on what we know and what we’re exposed to. Not having all cultures represented can lead to a major blind spot or bias that leaves out diverse cultures and ways of eating.
WebMD: Why does culturally relevant care matter from a patient’s perspective?
Melton: We’ve seen improved outcomes for patients of color and improved compliance if they receive care from a diverse care team. We know that health inequities – perceived or actual – decline.
Many times, especially in an acute care setting and even in an outpatient setting, patients aren’t there because they want to be there. They’ve probably been sent to a dietitian because there’s a chronic or acute condition. If you have someone who understands where you’re coming from and you don’t have to explain your culture, it takes that burden off of the patient when you’re already in a stressed state.
It’s not just understanding food in terms of cultural values, race, or ethnicity, but also religion. It’s important to patients in their ability to follow the recommendations given to support their health and the health of their loved ones.
WebMD: What’s the current state of diversity in the field?
Melton: According to the Commission on Dietetic Registration, in the United States, only 16% of registered dietitian nutritionists identify as a person of color. On the surface, it might not look that bad, but when you start to drill down and look at different cities, you start to see the disparities.
For example, less than 3% of dietitians are Black, or approximately 2,700 Black dietitians in the country. Yet in Atlanta, where I live, 40% of the population is Black. In the San Francisco Bay Area, there’s a higher population of people of Asian ethnicity, but only 5% of dietitians are Asian. Asia is a huge continent, and all the different ways of eating aren’t the same.
People are always retiring too, and we’ve seen the number of students going into the profession drop.
WebMD: Have these numbers changed?
Melton: Over the last 5 years, the number of Hispanic/Latino students has risen. What’s alarming is that among Blacks, the number of students and professionals has continued to decline. There’s a small number of Indigenous dietitians, and that number also continues to decline.
WebMD: Why have the numbers continued to decline within these populations?
Melton: It's a confusing career pathway to figure out, not only academically but financially.
Many Black students don’t complete the whole pathway. They may not know about the field. By the time they get to their junior year of college and need to declare a major, it may feel too late because they don’t have the prerequisites and have to go back and take them.
After graduating, they must complete an internship or supervised practice. Not only are these often unpaid, but you pay to do the program. To practice in the field, you need a master’s degree and have to pass a credentialing exam. We’ve seen an increase in the number of students who can’t pass. This happens to students of other groups as well, but we’ve definitely seen it with the Black students in particular.
If they do get into the field, mentorship is a challenge because there’s little representation. They’re also trying to fit into largely White spaces. Some students have said they feel like there's a secret society that they don't know how to break into. They have to navigate microaggressions at every turn, either implicit or explicit biases, that are baked into our profession. For them, it's like a death by a thousand cuts.
WebMD: Has diversity in the field improved?
Melton: There’s more awareness among colleagues as to why we need more people of color in the profession. I’ve seen more niche, professional development opportunities and sharing of best practices and resources, especially on social media. Diversify Dietetics puts on a conference. Our colleagues put on BIPOC eating disorder conferences. We’re starting to see these sort of things at large conferences like the Academy of Nutrition and Dietetics and more conversations in the media. And consumers are demanding it. They want to work with a dietitian who looks like them.
What we need is the number of dietitians and students to meet that demand. Otherwise, people are going to turn to other sources who may not have our training. I tell my colleagues in academia that every single course should include culture. It shouldn’t be an afterthought or a single course.
WebMD: How do we continue to build and support the pipeline of diverse students?
Melton: At all levels of our profession, we need to take a step back and say, let's try something different to be able to recruit, support, and retain young professionals and help them thrive. There needs to be more marketing of the profession. There needs to be an expansion of the career pathways that dietitians can go into beyond just the clinical setting. That’s not the only space that foods sit in and often not where younger people want to work.
We also need to look at our credentialing exam and understand why we have such a low passing rate, compared to our colleagues in nursing, physical therapy, speech, and occupational therapy, who have a passing rate of over 85%. We’re sitting around 71% for first-time pass rate.
WebMD: What can people do to support diversity efforts?
Melton: If you see yourself missing, it doesn't mean that your foodways and your culture are not healthy. They're just not there, and they should be.
It's important for consumers to continue to ask for providers and for resources that support them. Demand is going to influence supply. That will let the programs know that diversity is important to people, their health, and their family's health, and that our whole profession would benefit from having more diversity.
