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Our series,Good Food for All, examines the barriers to putting healthy food on the table and what is being done to help.
Growing up, my parents never policed my food and I never had an issue with my weight. In college, I discovered the power of Sbarro pizza, unlimited chicken nuggets and Pepsi. My college roommates often quip that I should be sure to tell the world I used to drink a six-pack of Pepsi every three days and didn’t know what a vegetable really was. And, yet, here I am, writing to you about the importance of cultural competency and how making nutrition and wellness accessible to all is the only way to move forward and reframe how we see the field of nutrition and dietetics (and health care in general) as a whole.
I left Fordham University with a history degree, along with 40 additional pounds, skin that was riddled with acne, and a digestive system that was in turmoil. I wasn’t taking care of my body and I simply didn’t feel well. I tried to change my habits on my own. Since this was the year 2000, there were no Instagram influencers to help me (or dole out bad advice, as is sometimes the case). My doctor was unwilling or ill-equipped to help me. He blew off my recent weight gain as normal and told me to cut outcarbs. No instruction as to how to do this, just don’t eat them. He didn’t think to tell me what a carb actually was, where to find them and most importantly how this avoidance was going to go. He did tell me, though, not to eat any rice—which had basically been a staple for most of my little 22-year-old life.
The truth is, even though my parents didn’t police my food when I was growing up, my mother made most of our meals from scratch. She cooked with root vegetables and added minimal salt and oil. Because healthy food was available to me, I never had any issues throughout childhood.My mother’s rice and beans weren’t actually the problem, but rather the ultra-processed items I collected on my walks from the D train to campus.
I had lost a fair amount of weight, but I didn’t know really how I did it. I wanted to know how my body worked and what I could do to continue on this trajectory. I didn’t feel good with those extra 40 pounds, and so I wanted to ensure I could maintain this weight loss without having to overly restrict or count calories. I decided to meet with a dietitian. I knew that their job was to help with weight loss and meal planning, but I was pleasantly surprised when she also spoke to me in terms I could understand—unlike my doctor just a few months earlier. She taught me the importance of carbs in my diet (energy, fiber, B vitamins, minerals—to name a few) and how my beloved rice and beans had its place as part of a healthy diet. I was lucky she was culturally competent and willing to make the foods I loved fit in my diet. Rice and beans were good, she told me, and considered a complete protein, but I would have to be mindful of the portions I was taking in—so instead of 1 or 2 cups, we would scale it back to ½ cup of each.
Fast-forward a few years: I am currently counseling a couple: we’ll call them Harold and Jess (because those are their actual names and they’ve given me permission to share their story). Harold has type 2 diabetes, and Jess wants to support her husband as they try to navigate his illness. Harold and Jess are Black and had been working with their primary care physician (who was white) for the better part of four years without success.
Harold and Jess told me that they had sought me out as a Black practitioner because they wanted to be seen and heard. I want them to be seen and heard—everyone deserves that. But it should make us all feel sad that they felt the need to seek out a Black practitioner to get this most basic level of support. After years of going from practitioner to practitioner, they thought it important to find someone who could work with them and give them actionable tools that they would be able to implement into their daily lives.
I often wonder why is it that kale seems to be the gold standard for a healthy leafy green, when collards are just as good for you? If I makemacaroni and cheesefrom scratch, can’t it live on my plate in an appropriate amount? What about rice and beans—that together are a complete protein—can’t this be part of a healthy diet? I recently took part in a webinar about race, and the moderator discussed internalized racism, the idea that “white is right” and anything else isn’t seen as such. I applied it to the above thoughts about food and nutrition. We have grown up in a society that idolizes “white foods” and doesn’t always allow for other cultures and their cuisines to be considered as healthy. Takebok choy, for example: native to Asia, it’s a cruciferous vegetable that’s loaded with nutrients. However, when we talk about these kinds of vegetables, normally we hear about broccoli, cauliflower and cabbage. What about the macaroni and cheese I wondered about earlier? Growing up I never had a blue box of mac and cheese until my college roommate made it for me.I will tell you though, that on Sundays my mother would make macaroni and cheese from scratch with a béchamel sauce that was simply divine. I would have that with some sort of protein and a salad for a balanced—albeit slightly indulgent—meal.
We need to come from a place of inclusivity, while providing our patients with sound advice and care. We want them to see us working with them to achieve their goals rather than dismissing the foods they grew up with and love.
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