Good Nutrition for all Is Impossible When Most Dietitians Are White

Nutrition isn’t just a health issue; it is a social justice issue, compounded by systemic racism. Black, Hispanic and Latinx, and Native American communities in the U.S. are more likely to experience food insecurity compared to their white counterparts. Additionally, food and eating are deeply entrenched in cultural norms and practices. The road to “good nutrition” for ethnic minority groups is nuanced. To reach as many as possible, people within these minority groups need to inform nutrition practices.

However, the public face of nutrition is a white one, especially in the dietetics community. Registered dietitians and registered dietitian nutritionists (RDs and RDNs, respectively) are often called upon as nutrition experts to work with individual clients as well with companies and in the media. This is a good thing—they have extensive training on nutrition that other health experts (including medical doctors) do not share. But in the United States, 77.8 percent of RDs are white. Meanwhile, 2.6 percent of dietitians are Black, 3.9 percent are Asian, 3.3 percent Hispanic or Latinx, and even less are Native American, Native Hawaiians, Pacific Islanders, and people of mixed race—yet these communities collectively make up 42.1 percent of the population.

In light of the current protests for racial justice sweeping the country, many dietitians have publicly criticized the Academy for what they feel was an inadequate response to the systemic racism in nutrition in light of nationwide protests for racial justice. But as indicated by the statistics above, the diversity problem in dietetics has been present long before the past month.

Becoming a dietitian is an uphill battle for many BIPOC

Systemic racism means the education currently required to become a dietitian is inequitable, says Teresa Turner, MS, RD, a Maryland-based dietitian who served as chair of the Diversity and Inclusion Committee at the Academy of Nutrition and Dietetics (an organization that represents registered dietetic professionals in the U.S.) from 2018 to 2020. The long-standing wealth gap between BIPOC (especially Black people) and white people due to systemic racism makes higher education harder to access and pay for. Besides having to take out student loans for the undergraduate and soon-to-be required masters degree, students themselves bear the cost of the mandatory internship required for RD and RDN certification. “I worked as a full-time RD during my internship; the only thing that was different was that somebody was monitoring my work, but instead of getting paid for the work, I had to pay to do this internship,” says Alice Figueroa, MPH, RDN, nutrition researcher and founder of Alice In Foodieland.

Averaging around $8,000 to $10,000, the internship (which involves 1200 hours of supervised clinical practice) is no small expense, and there are no means to take out student loans for it—putting students of lower incomes at a massive disadvantage. “I worked 35 hours a week at night because I couldn’t afford to live in New York while working for free at my internship [program], which lasted a year and a half,” says Figueroa. “I would go to my internship really early, leave by three or four. At night, I would work as a babysitter to make ends meet and I would get home at midnight.” Dalina Soto, RD, LDN, who runs a Philadelphia-based practice serving Latinx women, felt that by having a second job to make ends meet, she needed to prove to interviewers that she would still give 100 percent to the internship and study.

Besides the cost barrier, most professors and internship preceptors are white, which impacts how people are educated and trained. In the curriculum, “cultural” foods are taught separately, giving the impression that it is other. “It has psychological implications, to always feel like I have to do something different and whatever was natural for me and my family and my culture is ‘other’. It causes anxiety among other things,” says Turner.

White instructors also often are not well-versed in said “cultural” foods and practices.  When a professor did not accurately portray African-American food culture, as the only Black student in the class, Cordialis Msora-Kasago, RD, regional nutrition manager at Sodexo and founder of The African Pot Nutrition, felt she “was not always able to challenge the teacher.”

“It has psychological implications to always feel like I have to do something different and whatever was natural for me and my family and my culture is ‘other,'” —Teresa Turner, MS, RD

Additionally, standard dietitian course material often presents the “ideal” picture of health through a very white lens—which often means being physically slim and eating certain kinds of foods. Even nutrition research perpetuates the white-centric focus of healthy eating. “A lot of this research is conducted mostly in a white population and doesn’t necessarily reflect the health needs of minority communities,” Figueroa says. For example, the data that informs Body Mass Index (BMI) rankings was gathered from white Europeans in the 19th century—and yet is still used as a metric of health for all races and ethnicities to this day.

The inequities, of course, don’t stop once training is completed. Upon entering the workforce, wellness media is dominated by white voices, Figueroa says, as are many other “mainstream” nutrition spaces. Health issues that matter to many communities of color, like lack of food access and microaggressions in nutrition, are rarely spoken about—and can even be dismissed outright. Mearaph Barnes, RD, an LA-based dietitian, recalls wanting to list herb alternatives instead of stating “add salt to taste” in an online recipe she was writing with a white colleague. “Culturally, as Black people, we are initially inclined to add more salt to our food, which further increases our risk for heart disease,” she says, which is why she wanted to add alternatives. She was told that “the people they targeted for the site” would not find that helpful. “As a person of color, I felt very unseen,” she says.

“If our issues are front and center just like the issues of white communities, more people of color would be worried about these justice issues and become passionate about working in the dietetics field,” argues Figueroa.

Additionally, since the field of dietetics is largely white, that means leadership is largely white, too—making top-down change difficult to implement effectively. “When you lack diversity for so long and in so many different ways, there is a major disconnect in knowing how to change that demographic and a lack of agency to do so. We need more representation in the field but especially in leadership positions,” says Deanna Belleny, MPH, RD.

The importance of including and supporting BIPOC in nutrition

Changing dietetics to be truly diverse isn’t just about creating opportunities for BIPOC who want to be dietitians—it’s also about better-serving a wider range of people with unique nutrition needs and perspectives. “Professionals tend to go and work in the areas that they grew up in or are socialized in,” says Msora-Kasago. “Some underserved areas don’t have a lot of dietitians because we’re not graduating dietitians that come from those particular areas.”

These underserved areas see, for example, large travel distances to grocery stores, lack of fresh produce, or high saturation of fast food restaurants that impact their ability to eat healthfully. Having grown up in this kind of an environment, Soto makes sure to include questions in her client intake forms that address social factors that impact someone’s food consumption, such as a functional kitchen, clean water, and steady income. She also helps clients apply for services like food stamps and grocery delivery. “I remember having these conversations with my colleagues and them not grasping it because they didn’t have that lived experience like I did. And that’s the kind of experience that I bring to my practice and letting my clients know, hey listen, I understand,” she says.

“When a person of color tells me these challenges they face, like racism or being an immigrant, I feel connected to them because I have experienced it. And I understand how it can cause trauma, stress, and anxiety, and affect the way they feel overall.” —Alice Figueroa, MPH, RDN

“When a person of color tells me these challenges they face, like racism or being an immigrant, I feel connected to them because I have experienced it,” says Figueroa. “And I understand how it can cause trauma, stress, and anxiety, and affect the way they feel overall, their health and mental well-being, and even affect their appetite or their ability to be able to cook.”

Dietitians of color are also often able to identify gaps in information. Barnes observes that after dietitians of color started to contribute to the cultural dishes section of the Nutrition Care Manual (the clinical resource manual used by dietitians), portrayal of international foods over the years has improved in accuracy. However, there is always room for growth. Soto (who is of Dominican descent), notes that “when information is put out to the [Latinx] community from the Academy or any nutrition source, they gear it to South American cuisine because that is the majority. They forget that different countries have different dishes.”

Plus, having more RDs of a wider range of backgrounds and experiences will help erode the white-centric picture of health that has dominated the wellness industry for so long. “I am in what is considered a straight-sized body; I’m also not super thin. I can tell my clients how diverse in body types my family is, how we all eat the same but we all look different. And my clients feel comforted,” says Soto.

How we start to achieve true diversity in dietetics

For its part, the Academy launched a Diversity Strategic Plan in 2015, which is still in effect. It encompasses grants and awards, a number of member interest groups that focus on minority communities, and a Diversity and Inclusion Committee. Turner, who was part of the committee, says the main goal in the last five years was to distribute grant money to retain and recruit underrepresented groups. However, though the committee pushed hard, the percentage of dietitians of color has not significantly increased.

“I think the main thing that’s not being looked at, similar to when one decides to give money to a charitable organization, is we don’t know the people that are receiving the grant money outside of their application. If that group of people has not committed themselves to properly do diversity work, if they have not had implicit bias training or do not understand systemic racism, then how well is the money going to be used?” Turner says. “It is a systemic problem that needs to be addressed on a higher level.”

Dietitians are also doing what they can on an individual level to support students and new RDs. Together with colleague Tamara Melton, Belleny co-founded Diversify Dietetics in 2018, a not-for-profit organization “to increase the racial and ethnic diversity in the field of nutrition by empowering nutrition leaders of color.” Diversify Dietetics’ Mentor Program requires mentors to understand the systemic barriers that impact students and professionals of color. They also run a free internship application support program to help people navigate higher ed applications, interviews, and more.

There is still a lot of work to be done to address racism and diversity in dietetics. But thanks to the hard work and advocacy of professionals like Figueroa, Soto, Turner, Msora-Kasago, Barnes, and Belleny, the field seems to be starting a better, more inclusive chapter.