All Americans Deserve a Healthy Diet. Here’s One Way to Help Make That Happen

All Americans Deserve a Healthy Diet. Here’s One Way to Help Make That Happen

For National Nutrition Month, a BU dietitian argues that promoting diversity among healthcare providers is as important as advocating for a diverse diet

Photo by Charday Penn/iStock

Since its inception, dietetics—the scientific study of how nutrition and diet affects people’s health—has been shaped by societal forces that have made it a feminized, white profession. Dietetics emerged in the early 1900s as a subspecialty of home economics, which was then one of the only acceptable majors for white women of higher socioeconomic status who attended college. And history records that over the course of the advancement of the dietetics profession, white students were encouraged to move on to practice clinical dietetics in hospital settings, whereas Black students were often encouraged into food service or out of the profession entirely. This explicit racism is one of several factors that contributed to the lack of racial and ethnic diversity in dietetics today.

For dietitians to address the problems we face today—particularly the health disparities found in marginalized communities across the United States—this must change. Dietitians are uniquely qualified to support the health and well-being of individuals and groups through counseling on healthy diet patterns and development of public policy. Yet, even as the dietetics field has evolved, the racist societal forces that shaped it persist.

Today, registered dietitian nutritionists (or RDNs) are credentialed professionals who complete a rigorous education, including a master’s degree, and at least 1,000 hours of experiential learning. RDNs work in myriad settings, including hospitals, food service, business, industry, private practice, and with community organizations. I entered the ranks of RDNs in 1989 after completing a master’s degree and supervised practice. Unfortunately, I have witnessed little change in the demographic makeup of students and professionals in the field since I entered it, prompting me to focus my research on diversity, equity, inclusion, and social justice among healthcare professionals in the field. A recent paper that I coauthored centered the experiences of Black dietitians who found the profession to be neither diverse nor inclusive. Shannon Peters, a Boston University Sargent College of Health & Rehabilitation Sciences lecturer in health sciences, and I also conducted an analysis of dress codes written for dietetics education programs and found evidence that they are discriminatory, and privilege select societal groups (white, thin, cisgender) over others.

My research and the research of many others have shown the myriad reasons why a lack of diversity is problematic, not only for the profession, but also for all healthcare professions and the people we seek to serve. Professional diversity better equips all healthcare practitioners to provide inclusive, culturally humble care to diverse patients. A recent review of the literature focused on the effects of race concordance (when providers and patients share a common racial/ethnic identity) on patient-physician communication suggests that when healthcare providers are better able to bridge the social and cultural divide when communicating and providing services, better healthcare outcomes may be realized. Additionally, some studies have shown that receptivity to healthcare provider recommendations may be improved with patient-provider race concordance. Better healthcare outcomes and patient adherence to therapeutic recommendations are essential to meeting the healthcare needs of our diverse nation.

Over the last few decades, the Academy of Nutrition and Dietetics, the largest organization of nutrition and dietetics practitioners, has invested money and energy into actions designed to increase diversity in the field, though those actions have yet to be effective. Many Black-identified dietitians continue to relate stories of racism, microaggressions, and other oppressions. The recent requirement of a master’s degree to take the national registration exam also adds additional expense on to a process that already includes an unpaid internship. These (and other issues) make realizing a diverse profession near impossible. Demographic data collected by the academy show that, in 2022, the number of Black or African American credentialed professionals was just 3 percent; in 2021, about 14 percent of the US population identified as Black. In fact, the percentage of Black-identified professionals in dietetics has remained static since 1990.

It’s long past time that we, as dietitians, act differently to ensure that the demographic makeup of dietetics professionals reflects the depth and breadth of diversity that we see in our world. Scholars in this area have published evidence-based approaches to make dietetics more diverse, such as a holistic application process for dietetics programs and financial stipends to support dietetics students in their supervised practice programs. As dietitians, we know that the best way to health and well-being for all people is a diverse diet of whole foods. It’s time that the demographic makeup of the profession be similarly diverse. 

Michele A. “Shelly” DeBiasse (CAMED’16) is a BU Sargent clinical associate professor of nutrition and has been a registered dietitian nutritionist for 35 years. DeBiasse’s current research focuses on issues related to equity, diversity, inclusion, and social justice in healthcare and healthcare professions, particularly dietetics, and how gender may contribute to challenges often associated with female-dominated healthcare professions.

“Expert Take” is a research-led opinion page that provides commentaries from BU researchers on a variety of issues—local, national, or international—related to their work. Anyone interested in submitting a piece should contact thebrink@bu.edu. The Brink reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.

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