People from Black African, African Caribbean and South Asian backgrounds living in the UK are more likely to develop type 2 diabetes, cardiovascular disease and stroke compared to the rest of the UK population [1-3 – see references below]. Even though the cause is complex and multifaceted, there are some risk factors that are widely known to contribute to the development of chronic conditions. Some risk factors are classified as modifiable, because they can be changed like diet and lifestyle to lower or increase the risk of a disease. Whereas, other factors are non-modifiable because they cannot be changed, for example, genetics, ethnic background and family history [4].
From a dietary perspective, we know that healthy eating, which consists of plenty of fruits and vegetables, whole grains, moderate amounts of unsaturated fats, protein and dairy and dairy alternatives, can play a significant role in the prevention and management of some diseases [5]. However, foods that constitute a healthy diet will look different from one person to another. Therefore, it is important for dietitians to take time to understand the driving factors that influence clients’ and patients’ food choices and overcome any barriers to change in order to provide tailored healthy eating advice.
There are various factors that may influence a person’s food choice, such as, but not limited to: food availability and access, socio-economic status, taste preferences, appetite, mood, cooking skills, beliefs and knowledge about food. Having said this, a person’s cultural background may influence their food preferences and food intake [6]. Therefore, dietitians should always take a holistic approach and consider all these factors during dietary counselling with patients or clients.
Identity, culture and tradition
For some people, food is more than just about nutrition or a necessity for a healthy, balanced diet. It can be an expression of identity and a way of embracing culture and tradition. Thus, when providing healthy eating advice, dietitians should try to ensure that it reflects their clients’ and patients’ background, perceptions and beliefs with food so that it doesn’t only meet their health and nutritional needs but their cultural needs too. With that being said, it is important that dietitians to not make assumptions as some people do not always consume their cultural and ethnic foods.
Asking relevant and culturally sensitive questions during consultations is key to ascertain what an individual eats on a typical day and what their food likes and dislikes are. Knowing this information can help inform their dietary plan and ensure it is individualised. In my professional experience, clients, patients, their carers and relatives, especially those from a different ethnic background to me, feel satisfied and appreciate it when I take time to understand and learn more about their culture and food preferences.
Gaining understanding
To ensure cultural diversity and inclusivity in dietary advice, dietitians should be open to gaining more understanding of the traditional diets of different ethnic communities. It may also be worth knowing some healthier food alternatives that are similar to individuals’ traditional foods too. Where possible, dietitians should consider providing written resources, diet plans and menus in appropriate languages and examples of different cultural foods.
Some dietitians may be required to do outreach in the community and engage different ethnic groups. It may be worth collaborating with another health professional or recognised community worker from a similar ethnic background if possible, this may be very important if there is a language barrier.
As the UK population becomes more ethnically diverse, our approach and advice related to diet and nutrition should be ethnically diverse too. There are currently some great organisations, groups and individuals that have acknowledged this and have adapted dietary advice to individuals from different ethnic minority groups.
It would be great to have some examples shared so that it can be shared on the BDA website. If you or your organisation have made culturally adapted healthy eating resources, please tell us about them using the form below.
References:
[1] British Heart Foundation. (n.d). Ethnicity. [online] Available at: www.bhf.org.uk/informationsupport/risk-factors/ethnicity [Accessed 18 December 2020].
[2] Pham, T., Carpenter, J., Morris, T., Sharma, M and Petersen, I. (2019) Ethnic Differences in the Prevalence of Type 2 Diabetes Diagnoses in the UK: Cross-Sectional Analysis of the Health Improvement Network Primary Care Database. Clinical Epidemiology 11 (1) pp.1081-1088
[3] Gulli, G., Rutten-Jacobs, L., Kalra, L., Rudd, A., Wolfe, C. and Markus, H. (2016). Differences in the distribution of stroke subtypes in a UK black stroke population – final results from the South London Ethnicity and Stroke Study. BMC Medicine, 14(77)
[4] Adams, M., Grandpre, J., Katz, D. and Shenson, D. (2019) The impact of key modifiable risk factors on leading chronic conditions. Preventive Medicine 120, pp.113-118.
[5] World Health Organisation (2003). Diet, nutrition and the prevention of chronic diseases. Geneva: Joint WHO/FAO Expert Consultation.
[6] European Food Information Council (2006). The Factors That Influence Our Food Choices [online] Available at: www.eufic.org/en/healthy-living/article/the-determinants-of-food-choice [Accessed 18 December 2020].