Learning By Doing

Nutrition Students Travel the World to Learn Impact of Culture on Diet

Photos courtesy of Mary Willis

Many people grow up hearing the adage, “You are what you eat,” as a warning against consuming too much junk food and making unhealthy choices. But in fact, we are the foods that we eat: our cultures have been shaped by food. The foods that different groups have traditionally consumed were defined by the places they lived; in turn, their unique eating habits and customs changed their biological makeups and influenced other aspects of culture.   

Maggie Dawson, nutrition major at the University of Nebraska-Lincoln, in Ethiopia.
Maggie Dawson, nutrition major at the University of Nebraska-Lincoln, in Ethiopia.

“Culture is a biological adaptation,” says Mary Willis, professor in the department of Nutrition and Health Sciences at the University of Nebraska-Lincoln. “People use the food that is nearby. And because food intersects with every aspect of life, what people eat and how they prepare it helps create their culture. Dietitians may make big mistakes by not taking into account cultural differences.”

In a rapidly diversifying country, where lifestyle-related diseases are increasing, the need for skilled, culturally-sensitive dietitians who understand these physical and cultural differences has never been greater.

For example, the Centers for Disease Control and Prevention reports there are more than 29 million Americans with diabetes, and nearly 87 million Americans over the age of 20 are at risk of becoming diabetic if they do not make lifestyle changes. Minority and low-income populations have been disproportionately affected.

Access to nutritious food is a huge issue, especially among minority and low-income neighborhoods.

“Socioeconomic status affects what people can purchase, whether they can access certain foods, and how they learn about food,” says Willis. “Let’s face it, processed foods are cheaper, so we have to be sensitive when we give nutrition counseling to low-income groups. Just because they know which foods they should be eating doesn’t mean they’re going to be able to afford or acquire fresh foods or organic fruits and vegetables.”

Willis, whose educational background is in anthropology, teaches nutrition students in her Cultural Aspects class how geographic location influences how we access and prepare meals, what types of foods we consume, when we eat, and how much.

Consider regional variations in cuisines throughout the U.S.: In the Northeast, shellfish from the Atlantic Ocean abounds. Among states in the South, corn is a mainstay of the diet, and meat is traditionally fried for quicker cooking, a benefit in hotter temperatures. Southwestern cuisine, often called Tex-Mex, is a hybrid of Mexican and European tastes.

Willis prepares her students to be sensitive to these differences by mixing active, hands-on instruction with in-class teaching. Her students prepare different ethnic cuisines and eat what they make. She says many of them are surprised by how different the food tastes when they prepare it themselves.

“It’s a very ‘ground up’ approach. They don’t just buy tortillas from the grocery store; they actually make the tortillas themselves,” she says.

Maggie Dawson observes an Ethiopian family’s eldest daughter prepare food for the evening meal during Ramadan. Throughout the annual, month-long religious observance of Ramadan, adult Muslims fast during the day, eating only between sunset and dawn.
Maggie Dawson observes an Ethiopian family’s eldest daughter prepare food for the evening meal during Ramadan. Throughout the annual, month-long religious observance of Ramadan, adult Muslims fast during the day, eating only between sunset and dawn.

It may come as a surprise to some, but Lincoln, Neb. — where beef is a plentiful, Midwestern mainstay — has a diverse population, with immigrants and refugees from Myanmar, South Sudan, Micronesia, and Central and South America.

“Populations are moving all over the world and have to adjust to food physiologically; their tastes change, and so does what they eat,” Willis says. “We have to ask, why do some cultures have no problem digesting wheat while others are more prone to Celiac disease? It’s because their bodies are not used to foods they didn’t grow up eating.”

She also says that religion plays a large role in the dynamics of food and culture.

“Religion affects preparation and who prepares the food, taboos surrounding what foods can be eaten or not, and kitchen set-up. Dietitians have to get to know the client by asking: ‘Who prepared the food when you were growing up? Did you eat in or go out for meals? Did you have someone else preparing food for your family?’ All of these things must be taken into account.”

Willis also encourages students that study abroad to see firsthand how different cultures access and prepare food. Each year, she takes a group of 10 to 15 students to Ethiopia to study how the local culture ties into the cuisine of its residents.

She says people in Ethiopia know the importance of getting adequate amounts of protein to sustain health, but they don’t have access to large supplies of meat. Her students learn to appreciate the different protein sources available nearby, such as teff, a tiny grain common in the Ethiopian diet.

Other sources may seem less palatable.

“A lot of my students cringe when I tell them this, but the World Health Organization is actually recommending insects as a viable protein source,” says Willis. “Insects have a tiny carbon footprint, they pack a nutritional punch, and they’re easily replicated.”

Shahla Wunderlich, registered dietitian and professor in the department of Health and Nutrition Sciences at Montclair State University in New Jersey, says race and economic status must be viewed together to better inform treatment programs.

“It used to be in the old days of nutrition that one size fit all, but as the population becomes more global, students have to understand worldwide eating habits,” says Wunderlich. “Nutrition counseling for a middle-class African American is not going to look the same as it would for a low-income Muslim American. The economic situation is different as well as the culture and traditions.”

Along with Willis, Wunderlich stresses how important it is for students to keep religion in mind when working with diverse populations, since many faith practices include unique dietary restrictions.

At Montclair State, nutrition and dietitian students undergo rigorous training so that they are culturally sensitive to different health situations and beliefs. They learn to understand disparities, to be aware of different health needs related to life stages, and to recognize their own limitations and where they need to be more culturally responsive.

Wunderlich says one of the biggest challenges for dietitians is that people often don’t want to change their habits.

“It can be really hard to get people to comply with counseling advice, especially if you’re suggesting a big change,” she says. “The most important thing we tell students is to sit down and listen to what the client is telling you, then tailor treatment to that person’s unique makeup and recommend small modifications that will result in more lasting change.”

In a guest post on Indian Country Today Media Network in November, Catherine Keene, healthcare specialist and former facility director at the Indian Health Service, wrote of efforts to improve the health of the Eastern Shoshone and Northern Arapaho tribes on the Wind River Indian Reservation in Wyoming.

According to the CDC, 15.9 percent of American Indians and Alaskan Natives have been diagnosed with diabetes, the highest percentage of any ethnic group in the U.S. Research suggests that when American settlers began farming near native land, Native Americans had to rely on government-issued sugar, lard, and white flour to survive. Increased contact with Western lifestyles during and after World War II caused greater disruptions for Native Americans; decreased physical activity and weight gain led to higher rates of diabetes.

At Wind River, where 12 percent of adults have diabetes, a collaboration of health professionals and lay educators partnered with the community to encourage healthier lifestyles.

Keene wrote that the classes offering advice on healthy eating and exercise implemented the culture of the tribes while also introducing lifestyle changes.

“To me, one of the great attractions of this training framework was the two-way nature of the instruction,” she wrote. “Consultants shared technical and practical expertise relating to diabetes. And the tribal participants helped integrate cultural and traditional themes into the curriculum. Exercise routines were enriched with traditional music and games; menus were improved by adding traditional foods and cooking techniques.”

Every nutrition program should be teaching their students how to diagnose and treat diverse populations — they need to think globally and act locally.●

Rebecca Prinster is a staff writer for INSIGHT Into Diversity.