Study Shows Lack of Diversity in Nutrition Profession

The number of people with obesity in the U.S. continues to rise. While its prevalence impacts people from all walks of life, Black and Hispanic adults have a higher prevalence of obesity than their non-Hispanic white counterparts.

A recent study in the American Journal of Clinical Nutrition found not only a lack of racial diversity among healthcare professionals who treat people with obesity but also a lack of systemized tracking of the racial makeup of the field. Here is how and why better representation may help improve health outcomes for more Americans.

Representation Matters

Whatever the disease state or concern in question, the ability of a practitioner to build rapport with a patient can have a positive impact on health outcomes. In terms of treating BIPOC communities, experts say representation, and mirroring of cultures is especially important given the history of treatment of some communities by the medical field at large, and the perceived risks of seeking medical attention in the first place.

“Being treated by someone who shares the same ethnic, cultural, and racial background allows a patient to feel seen and understood,” says Alice Figueroa, MPH, RDN, chef, and author. “Historically, many BIPOC communities have a distrust of the healthcare system establishment. Although our population is becoming more diverse, most doctors, dietitians, nurses, physical therapists identify as white, and BIPOC health professionals are underrepresented in every sector of the healthcare industry.”

Figueroa adds that it is important for the healthcare system to train health professionals to provide culturally-humble healthcare, while at the same time making efforts to support current and future BIPOC health professionals. Ashley Carter, RD, LDN, and Jasmine Westbrooks, MS, RD, LDN of Eatwell Exchange, Inc. echos this sentiment. 

“There’s a different dialogue that occurs when your healthcare provider is able to relate to you and that opens the door for effective problem-solving,” Carter says. “Equitable healthcare will provide a higher retention rate amongst minorities thus reducing health disparities in the long run.”

One Size Does Not Fit All

Beyond the issues of equitable, competent treatment, both Figueroa and the dietitians of EatWell Exchange Inc. express concerns not only with the lack of diversity among healthcare professionals who are treating people with obesity but also with the parameters and tools by which obesity itself is defined.

“With regards to obesity treatment, I believe that our current medical system uses poor or insufficient tools to assess a person’s health,” Figueroa says. “BMI is a measure that was developed using a white, male population and was not initially intended to become a health marker.”

She indicates that the current BMI equation was not created using a representative sample of the global population that includes women and BIPOC. As a result, she indicates that it may not be the most appropriate measure to base health assessments on.

“l firmly believe that a person can be healthy at any size, regardless of their BMI and weight,” Figueroa says. 

Both Carter and Westbrook believe taking a weight loss approach to patients is dismissive and does not address or validate the primary reason they are seeking help. Interventions for obesity should not be treated as a one-size-fits-all concept. Every person is unique, they say.

Culturally competent care for obese patients means that healthcare professionals have taken into account that race/ethnicity, socioeconomic status, food insecurity, cultural practices, and lifestyles during the treatment process, Carter and Westbrook add.

“Specifically for patients diagnosed with obesity, healthcare professionals should educate themselves on obesity as it relates to an individual culture to accurately assess that patient’s health needs,” Carter says. “If a patient enters your office with health concerns that aren’t directly related to their weight status, the first response shouldn’t be discussing their BMI and recommending they lose weight.”

Why It Matters

The study in the American Journal of Clinical Nutrition also highlights the need for a more diverse healthcare profession (including researchers), stating that this will result in more studies focused on generally underrepresented racial groups. But Figueroa notes that the task is not as simple as hiring a more diverse workforce in the healthcare setting.

“It is key for RDs to construct partnerships with BIPOC people and groups that champion antiracism initiatives and provide representation, support, and space that champions empowerment for people from diverse backgrounds,” she says. “Ignoring the existence of systemic racism within health organizations only worsens the problem, stunts organizational growth, and delays progress, justice, and equity.”

It’s also important to nurture the development of BIPOC dietetic students, dietetic interns, and new professionals through mentorship and funding of scholarships and training programs that make dietetics education more accessible and affordable, Figueroa says.

“Equitable healthcare will provide a higher retention rate amongst minorities thus reducing health disparities in the long run,” Carter and Westbrook say. “How do we increase diversity in the healthcare system? We challenge the discrimination, lack of promotion and job opportunities, and other obstacles minorities face in the healthcare workforce. As a result, we will begin to see increased engagement and more satisfying interactions between minorities and their healthcare providers.”