Title: Cultural Competency in Nutrition and Diabetes: Food Choices, Physical Activity and Obesity among Ethnic and Cultural Groups in the United States
1Cultural Competency in Nutrition and Diabetes
Food Choices, Physical Activity and Obesity among
Ethnic and Cultural Groups in the United States
- Karmeen Kulkarni, MS, RD,
- BC-ADM, CDE
2U. S. Population Year 2000
- White 75
- Hispanic or Latino 12.5
- African American 12.3
- Asian American 3.6
- American Indian 0.9
- Other 5.5
3Population Projections
- In percentage terms , Asians are the most rapidly
growing minority group. By 2020 , Asians will
compose 6.5 of the U.S. population. - In absolute numbers , Hispanics are the most
rapidly growing group. By 2020 , Hispanics will
compose 16 of the U.S. population.
4Disparities in Health Status
- The demographic statistics are significant ,
because minority groups often suffer a
disproportionate burden of disease and other
health care problems
5- It is much more important to know what sort of
a patient has a disease , than what sort of
disease a patient has . - - William Osler
- Dubos RJ. Mirage of Health Utopias, Progress
and Biological Change. New Brunswick , NJ.
Rutgers Univ Press 1997
6Culture
- Implies patterns of human behavior including
thoughts , actions, customs, values, and beliefs
that can bind a racial, ethnic, religious, or
social group within a society
7Cultural Competence
- A complex integration of knowledge , attitudes,
and skills that enhances cross cultural
communication and appropriate interactions with
others. It includes at least 3 perspectives - Knowledge of the effects of culture on others
beliefs and behavior - Awareness of ones own cultural attributes and
biases and their impact on others and - Understanding the impact of the sociopolitical ,
environmental, and economic context on the
specific situation
8Cultural Differences
- Race and ethnicity
- Gender
- Religion
- Age
- Physical disability
- National origin
- Sexual orientation
9Your Culture
- Where were you born
- Where were your parents born
- Where is your sense of belonging in terms of
culture ? - What positive and negative experiences have you
had with other cultural groups ?
10Stereotypes
- We are often influenced by our perception of a
persons cultural back ground , socioeconomic
status, gender , or age. These perceptions are
influenced by our stereotypes of certain groups
or individuals. - Examples
- Elderly people cant hear well and talk too much
- People who talk slowly are ignorant
11Different Ways of Thinking
- Patients may be unwilling to share health beliefs
until a safe environment has been created and a
trusting relationship has been established - Example evidence that patients do not tell
their physicians about their use of alternative
therapies
12Exploring Patients Health Beliefs
- Etiology What or who caused this illness, and
why ? - Symptoms What are your symptoms ? When did they
occur ? Why do you think they began ? - Pathophysiology How has your body ( or mind )
been affected by this illness ? - Diagnosis What do you know about this illness ?
What have people told you ? What do you believe
about this diagnosis ?
13Exploring Patients Health Beliefs
- Treatment What should be done about this illness
? Who should do it? What have you tried already ?
Did it work ? How do you feel about taking
medications ? - Prognosis How long will you be ill ? Will
anything that you do help to control or cure this
illness ? - Coping What or whom do you need to help cope
with this illness? - Meaning What does this illness mean to you ?
14Quality of Healthcare
- Influenced by socioeconomic status
- Level of education
- Income
15Current Healthy People 2010
- Goals for Hispanics include
- _ Increase quality and years of healthy life
(including life expectancy and quality of - life )
- _ Eliminate racial and ethnic disparities in
health ( U.S. Department of Health and Human
Services, 2000 )
16N D E P
- Diabetes education and prevention are objectives
that have been set forth as ways to achieve the
health goals - NDEP , is designed to improve treatments and
outcomes for people with diabetes , promote early
diagnosis, and ultimately prevent the onset of
diabetes - The return is a reduced morbidity and mortality
17Integrating TherapiesPhysical Activity
Benefits of regular physical activity
- Improve fitness
- Helps in weight management
- Increases insulin sensitivity
- Improves risk factors for
- Cardiovascular disease
- Blood pressure
- Lipid profile
- Maintain bone health
- Increases
- Energy
- Muscle strength
- Endurance
- Flexibility
- Sense of well being
18Integrating TherapiesPhysical Activity
- Type 1
- Consider the timing of the exercise
- Increase in food?
- Decrease in insulin?
- Both, an increase in food and decrease in
insulin? - Check blood glucose if gt13.9mmol, check for
ketones - If ketones are present, do not exercise
- Frequent monitoring
19Integrating TherapiesPhysical Activity
- Type 2
- Consider safety, obtain medical clearance
- If over 35, consider EKG stress test
- Determine best time to exercise
- If BG gt 16.7mmol, do not exercise
- Monitor BG, if gt13.9mmol, check for ketones
- Additional food usually not necessary
20Integrating TherapiesPhysical Activity
21Type 2 Diabetes in Minority Populations
- African Americans
- Hispanics
- Asian Americans
- Native Americans
- Disproportionate burden due to genetic
predisposition, family history, food choices,
limited physical activity, and a complex
interplay between these factors
22Nutrition Counseling Mexican Americans
- Assess level of acculturation to mainstream
American dietary practices - Determine the primary language at home
- Use food models, pictures, actual food during the
session - Influence of which foods are considered hot and
cold - Use of folk remedies
23Nutrition Counseling Mexican Americans
- Emphasize positive food practices, related to
traditional health beliefs and dietary customs - Traditional Mexican diet is low in total fat and
high in fiber - Encourage consumption of healthy foods that are
familiar and culturally acceptable - Dispel myths and misconceptions about dietary
recommendations - Involve family members in the counseling session
24Meal Pattern for Mexican American Client with
Type 2 Diabetes
- Breakfast typical ¾ cup refried beans with
chorizo( Mexican sausage ), 2-3 corn tortillas, 8
oz coffee with 3 oz milk. - Breakfast modified 1/3 cup boiled beans with
chili sauce, 2 corn tortillas, 8 oz coffee with 3
oz low fat milk, 1 small banana
25Meal pattern for Mexican American Client with
Type 2 Diabetes
- Lunch typical 2 cups chicken soup with
assorted vegetables and 3 oz of chicken, 2-4
tortillas, 1 cup Mexican rice or pasta, fried in
1 tbsp. of oil, 8 oz sweetened carbonated or
uncarbonated drink. - Lunch items modified 2 corn tortillas, 1/3
cup Mexican rice or pasta , fried in ½ tsp. oil
8 oz of diet soda or non caloric beverage or water
26African Americans
- A study at Grady Memorial Hospital in Atlanta
found that clients primary reasons for not using
meal patterns were , that the information was
alien to their lifestyle and contained
unaccustomed foods - Positive aspects of the traditional food
practices should be affirmed - Emphasis on vegetables and complex carbohydrates
from traditional recipes , is of benefit
27Meal Pattern for African American Client
- Breakfast typical ½ cup grits, 2 fried eggs, 2
sausage patties, 2 buttermilk biscuits, coffee
with sugar, 1 tbsp. margarine - Breakfast items modified ¼ cup egg
substitute, 1 homemade sausage, 2 slices whole
wheat toast, 1 cup cubed cantaloupe, coffee with
sugar substitute , 1 tsp. margarine
28Meal Pattern for African American Clients
- Lunch typical 1 fried chicken leg quarter, ½
cup mashed potatoes, ½ cup green beans seasoned
with ham, 1 medium tomato, 1 hot roll, 1 tbsp.
margarine, ½ cup blackberry cobbler, iced tea
with lemon and sugar - Lunch items modified 1 skinless baked chicken
quarter, green beans seasoned with fat free , low
sodium broth , 1 tsp. margarine, 1 ¼ cup
strawberries with sugar sub, iced tea with lemon
and sugar sub
29Navajo Current Food Practices
- Frying is a common method of food preparation
- 15-46 of the macronutrients are derived from
the following foods Navajo tortillas, fry
bread, home fried potatoes, mutton, processed
meats ( bacon, sausage, lunch meats, and canned
meat products ), soft drinks, coffee , and tea
30Navajo Traditional Foods
- Blue corn mush , Navajo cake , hominy , kneel
down bread, blue corn bread, and roasted and
steamed corn - Watermelon, pinon nuts, and Navajo tea
- Sumac berries, and a pudding is made from it
31Meal Pattern for Navajo Clients
- Breakfast typical 2 fried eggs, 3 slices
bacon, 1 flour tortilla, 1 cup orange drink, 2
cups coffee with 4 tsp. sugar - Breakfast Items modified 1 cup blue corn mush
, ½ cup low fat milk , 1 slice bacon, ½ tortilla(
part whole wheat) , ½ cup orange juice, 2 cups
coffee, with sugar sub
32Meal Pattern for Navajo Clients
- Lunch typical 2 slices white bread, 2 slices
canned lunchmeat, ¼ inch thick, 1 oz American
cheese , 1 tbsp. mayonnaise, 4 sandwich type
cookies,1cup non carbonated soft drink - Lunch modified 2 slices whole wheat bread, 1
slice lunchmeat, lettuce, 1 tbsp. reduced calorie
mayonnaise, 2 graham squares, 1 small banana , ¾
cup vegetable juice
33Chinese Americans Culturally Appropriate
Counseling
- Dispel myths and misconceptions
- Take advantage of the cultural concept that
certain foods are good for certain organs, to
teach food groups by their functions , rather
than their nutritional properties - Example instead of saying these foods are high
in fat and cholesterol , try these foods can
hurt your heart and arteries
34Chinese Americans Cont
- Encourage consumption of foods that are familiar
and culturally acceptable, for example , in
addition to recommending cheese and milk as food
for the bones, suggest tofu and green leafy
vegetables - Point out mistakes in a way that will not cause
the client to lose his or her self - respect
35Meal Pattern for Chinese American Clients
- Lunch typical 1 bowl pork broth with Chinese
herbs, stir fried beef with broccoli, 2tbsp
peanut oil, scrambled egg with barbecued pork, 2
bowls rice, 1large apple, and plain tea - Lunch modified 1 bowl pork broth with Chinese
herbs ( fat skimmed ), stir fried beef with
broccoli, steamed egg with minced pork, 1 cup
spinach with oyster sauce, 1 bowl rice , 1 small
apple , plain tea
36Indian / Pakistani Nutrition Implications of
Contemporary Food Habits
- From low fat and high fiber diets, have changed
to high saturated fat, animal protein, and low in
fiber - Increased intake of convenience foods
- Reduced use of traditional foods and cease to be
vegetarian
37Meal Pattern for Indian and Pakistani Clients
- Lunch typical 2 parathas , 1 cup spinach
curry, ½ cup potato curry, ½ cup raita, 1 banana,
3 tsp. oil used in cooking , 1tsp. Ghee - Lunch modified 2 sookhi roti, 1 cup spinach
curry, ½ cup tomato dhal, ½ cup low fat yogurt
raita, ½ banana , 2 tsp. oil used in cooking
38Margaret Mead
- I rather change a mans religion
- than his food habits.