“All foods fit” is a common approach to a healthy and balanced eating pattern. However, due to a lack of representation of diverse foods as examples of healthy eating, and a gap in culturally sensitive nutrition guidance, many can be left feeling like their foods don’t exactly fit. In the nutrition field, there is a growing awareness of the importance of addressing this; in fact, the recently updated 2020-2025 Dietary Guidelines for Americans put an emphasis on meeting dietary recommendations while keeping cultural preferences in mind.

We asked Registered Dietitians (RD) Nazima Qureshi, Carlie Saint-Laurent Beaucejour, Sarika Shah and Michelle Jaelin to share their expertise for culturally sensitive approaches to nutrition in our Diversifying MyPlate Series. This series highlights how healthy eating can take on many different forms outside of the typical Western diet; it also emphasizes how diets from other cultures can align with nutrition recommendations in resources such as USDA’s MyPlate. This Q&A concludes our series on diversifying MyPlate and offers advice for how registered dietitians can integrate culturally sensitive approaches into their own practices.

Q: How do you define a culturally sensitive approach to nutrition and dietetics, and why is this important? How do you integrate this into the work that you do?

Nazima Qureshi, RD: A culturally sensitive approach to nutrition and dietetics is one that includes the client’s food preferences, traditions, and current cultural context. It is important to incorporate an understanding of their culture in order to provide recommendations that are relevant and sustainable. Culture isn’t just limited to ethnicity but also includes a person’s family traditions, as well as their lived experience; understanding this makes nutrition recommendations more personalized. I integrate this approach into the work I do by asking a lot of questions in my initial nutrition assessment and tailoring recommendations to include foods that are familiar to the client.

Q: What are some of the challenges that you or your clients/patients have encountered using resources like MyPlate, and how have you navigated those?

Carlie Saint-Laurent Beaucejour, RD: A challenge my clients and patients have when using MyPlate to create meals is that they believe that they have to incorporate every food group at every meal all the time, which can be intimidating. Also, if a plate is not colorful, that does not mean that it doesn’t have a variety of nutrients. I point out to my clients how their dish already incorporates the different food groups and let them know that it’s okay if every meal or day does not have all the food groups. It’s important to focus on what you can add rather than what you have to eliminate.

Sarika Shah, RD: The MyPlate tool is a great visual, however it makes it difficult for clients to apply its suggestions to their cultural foods without explanation. Often, cultural foods fit more than one of the five MyPlate categories, which makes it confusing. I take the time to understand how my clients eat, what they eat and when they eat, and then I make suggestions on how to improve their health. It is usually encouraging them to add to their plate, not remove. I do not believe in removing cultural foods. Nutrition is individualized for all clients, and no two clients are ever the same.

Q: What assumptions or misconceptions about diets from other cultures do you think are important to address and challenge to work towards more culturally sensitive approaches in this field?

Carlie Saint-Laurent Beaucejour, RD: We need to stop making assumptions or misconceptions. We need to really understand who, what, how and where our audience is preparing and consuming their foods. You can never ask too many questions and we need to continue to investigate, no matter how long you work with that individual or audience.

Michelle Jaelin, RD: In dietetics, we have been trained to put certain diets on a hierarchy based on colonialist training and ideology. Western diets are often recommended as the healthiest for all clients, regardless of cultural background. There is strong evidence that the Mediterranean diet helps with heart disease, depression and other forms of chronic disease. Keep in mind, these studies are also done on mostly white populations. However, Japan has the highest number of people living past 100 years old; does that mean everyone should eat more tofu, purple yams, rice and seaweed? This is what it feels like when the Mediterranean diet is recommended all the time. Therefore, diet recommendations most often will only work for certain individuals or groups if it resonates with their cultural foods. We must unlearn our biases towards western science training and work more on cultivating dietetic practice with cultural safety; this is defined as delivering quality care through recognizing the power imbalances and creating an environment where clients feel safe.

Q: What guidance would you give to other dietitians about integrating a culturally sensitive approach within their own practices?

Carlie Saint-Laurent Beaucejour, RD: Listen and learn from their clients. Something I would like to do more for myself is try different cuisines. There’s so much to learn and so much food to taste.

Michelle Jaelin, RD: Internal reflection and constant learning are important for dietitians integrating a culturally sensitive approach. The dietetics curriculum is based on western, scientific, and Eurocentric ways of thinking and knowledge. Because of this, dietitians may find that they have certain biases towards certain ways of eating to be healthier than others (e.g., regarding MyPlate, many cultures do not eat food on individual dinner plates). Remember, clients are experts on their own food and health; dietitians help guide clients to make food choices that are culturally appropriate, accessible and healthy for them. Using listening skills and working with the client, their food preferences and daily eating patterns to come up with solutions, is the first step to cultural sensitivity.

Sarika Shah, RD: When working with clients of different cultural backgrounds, I believe the most important part of our approach as dietitians is to listen. Ask questions such as ‘what is your typical breakfast, lunch and dinner?’ and ‘what do you snack on?’. It is okay to not know about a client’s traditional foods but we can continue to learn and research. Find ways to incorporate traditional meals; sometimes it’s as simple as changing portion sizes, other times, it may be swapping some ingredients. Remember, do not encourage clients to eliminate traditional and cultural foods. Cultural foods are more than nutrients; they are memories, joy, tied to family and part of their identity.

Nazima Qureshi, RD: I often hear stories from frustrated clients who had a negative experience with a registered dietitian who was not using a culturally sensitive approach. It often ends with the dietitian providing general recommendations belonging to a specific culture without fully understanding the client’s needs. This can leave diverse clientele feeling frustrated and uninterested in adapting healthy choices. In order to avoid these situations, here are 3 things to keep in mind:

• You don’t need to be a part of a specific culture in order to be culturally sensitive.
• There are a lot of factors that impact what your client’s plate currently looks like, not just their ethnicity.
• Don’t make assumptions, instead ask questions.

We would like to thank RDs Michelle Jaelin, Carlie Saint-Laurent Beaucejour, Sarika Shah and Nazima Qureshi for their valuable contributions to this series.

Some responses were lightly edited for clarity.