Greater Cultural Competency (and Better Patient Outcomes) in Nutrition Starts With More Diverse RDs

Designed by Natalie Carroll

As it stands today, only about 16 percent of professionals in the field of dietetics identify as a person of color; of those, only 3 percent are Black or African American. And I’m one of them.

I’ll never forget the moment when I fully comprehended that the lack of diversity within the field of dietetics was much more than a statistic. It was 2016, at the annual Food & Nutrition Conference & Expo in Boston, when I descended the escalator onto the conference floor, I saw it was flooded with a sea of similar-looking women: Nearly all were white; practically no one looked like me.

At the time, less than 12 percent of those in nutrition and dietetics identified as being a person of color. Nearly 10 years later, that number hasn’t shown much growth—especially amongst Black Americans. (Black student enrollment in nutrition programs has not exceeded 2,000 over the last 30 years, and it's been steadily declining since 2012.) As it stands today, only about 16 percent of professionals in the field of dietetics identify as a person of color; of those, only three percent are Black or African American. And I’m one of them.

When you consider how deeply personal food is—it’s tied to your culture, roots, livelihood—it’s easy to see why this statistic is so deeply disconcerting. The overwhelming lack of diversity in dietetics causes the strongly-held connections many have to their cultural foods to be underrepresented, excluded, or even “othered” unintentionally (or, at times, intentionally) by many of those in the field. Few nutrition professionals are equipped to address these racially-charged biases or understand the unique ways that different cultures choose to nourish themselves.

When the public face of nutrition is white, the foods mainstream wellness culture presents as the “healthy ideal” are cast through a very white lens. (Simply stated, kale salads with poached salmon did not abound in everyone’s home growing up.)
What’s more, people of color who have a background in nutrition science are few and far between due to long-standing societal and structural issues. BIPOC practitioners entering the field of dietetics face a wide set of barriers even before their first day of work, including the financial burden of pursuing a costly degree, stigmas associated with careers in dietetics, a lack of community for folks of color in the industry, and limited education addressing cultural sensitivities in dietetics programs.

But here’s the cold, hard truth: Greater diversity in health care has been associated with better patient outcomes and satisfaction rates. (And isn’t that the goal?)

As such, these are just a few of the factors that inspired me—and my co-founder Tamara Melton, RD—to start Diversify Dietetics, a 501(c)(3) nonprofit organization dedicated to increasing racial and ethnic diversity in the field of nutrition and dietetics by empowering nutrition leaders of color.

The barriers people of color face in order to pursue a career in dietetics

Pursuing a career in dietetics is far from an affordable or easy undertaking, which makes it even harder for people of color—who are already being underpaid—to enter the field.

For starters, you must obtain an undergraduate degree from an accredited university or take post-baccalaureate courses. Then, you have to complete supervised practice hours, often referred to as a dietetic internship—that is, if you can get one. For the past few years, the Dietetics Inclusive Centralized Application Service (DICAS), which coordinates placements for dietetic internships, has only matched 60 percent of applicants to internships.

Most internship programs are unpaid; many actually entail lofty out-of-pocket expenses for students ranging anywhere from $8,000 to $10,000. (Some of my colleagues have racked up six-figure debt coming out of the program.) For context, the mean annual wage for dietitians in the U.S. was roughly $65,000 in 2021—and that same year, the average monthly expenses for a family of four was about $93,000. It’s also important to note that these programs require working full days for upwards of 40 hours a week, and that just 3 percent of programs offer a stipend to help cover student costs.

The only way to provide effective and truly supportive nutrition care to all communities is by hiring registered dietitians that represent the people they serve.

There’s also the fact that people of color are so underrepresented in nutrition-related careers that many folks with a non-white background are unfamiliar with the dietetics industry in the first place. Speaking from personal experience, I can assuredly say that the first time I met a Black dietitian was the first day of my dietetic internship, when I saw that my professor was a person of color. This was especially shocking considering I attended the University of Houston, a highly diverse institution in one of the most diverse cities of the country. While a couple of the nutrition courses I took integrated pre-med students from other fields (and thus presented as a slightly more diverse group), the racial and cultural silos were apparent in my dietetic internship program. The group consisted of 11 students; one was Latinx, and I was the sole Black intern.

The lack of diversity in dietetics is made even more apparent when you take a look at the heterogeneity among educators in the field. In my experience, it was virtually nonexistent—and as a result, Eurocentric diets were held as the gold standard. Understanding and honoring the nutritional benefits of your own culture’s foods can feel nearly impossible in this setting; instead, it further instills the idea that non-Western foods are not a representation of “healthy food.”

This can lead nutrition students of color, as well as their patients, to harbor feelings of otherness or shame around their cultural foods. For instance, do I think other dietitians are aware of the fact that eating black-eyed peas on New Year’s—an African American tradition—is the norm in my culture? I’d reckon it’s unlikely. It’s also worth noting that research has shown that patients are more likely to withhold critical information from health professionals if they perceive ethnic or social differences with health-care providers.

The only way to provide effective and truly supportive nutrition care to all communities is by hiring registered dietitians that represent the people they serve. It’s so important that providers are equipped with the knowledge they need to meet their patients’ unique needs, especially when it comes to something as profoundly personal as food and nutrition.

How Diversify Dietetics is pushing for progress

Tamara and I started Diversify Dietetics (DD) in 2018 with the mission of forming a community that supports racial and ethnic diversity in the field of nutrition and dietetics. The organization formally consists of around 400 members, but we consider anyone dedicated to our mission who identifies as a person of color to be a part of the DD community.

At Diversify Dietetics, we have three main program buckets—student, professional, and educator—and we consider community building to be our core value and foundational block. The community connection really comes to life in the networking meetups we host around the country, as well as in DD’s mentorship program, which pairs dietitians from various backgrounds with students and young professionals of color. We’ve worked with over 350 total matches thus far, and have many more forming as we speak.

DD also recognizes the significant challenges of completing a dietetic internship, which is why we started the Dietetic Internship Application Support (DAS) Program. Our team of skilled providers supports aspiring dietitians of color through their entire application process, helping with everything from writing personal statements to actually enrolling in dietetic programs. We’re also proud to offer scholarships, thanks to relationships with some like-minded brands and generous donations from the Diversify Dietetics community.

For professionals already in the field, Diversify Dietetics hosts webinars, workshops, and a yearly summit focused on ways to provide the best care for communities of color. We also love to highlight the work of our fellow peers by way of our RDN spotlight, which further increases representation within the field of nutrition. And as for educators, we provide workshops for recruiting, retaining, and supporting diverse students in their programs in a culturally sensitive matter.

In 2023, I am so excited for Diversify Dietetics to roll out its own dietetic internship program, which will kick off this fall. My goal for this program is to alleviate some of the financial burden (read: sky-high out-of-pocket costs) of getting a degree in dietetics. By supporting first-generation students, folks of color, and caregivers—to name a few—I hope we can break down some of these structural barriers-to-entry in our field.

Additionally, Diversify Dietetics will be hosting its first-ever communications workshop this year. Diverse representation for RDs in mainstream media is particularly sparse—again, it’s predominantly led by white voices—and I think it’s pivotal that we encourage and spotlight more nutrition-related discussion around cultural foods. The workshop aims to sharpen skills related to pitching content ideas for the media, working with brands, and contributing to print or digital nutrition stories. My objective with this project is to ensure that the perspectives of communities of color are front and center when we consider how we approach health and wellness—as is Diversify Dietetics’ mission overall.

As told to Maki Yazawa.