Central Consideration for this Article: How can a consideration of someone’s cultural identity and the cultural meaning in food inform how health care professionals discuss dietary changes with patients?
Caroline Frier is a recent graduate of the George Washington University and is currently pursuing a Master of Science in Nutrition and Education at Teachers College at Columbia University to become a dietician.
Jen: Caroline, tell us about your background and what you’re currently up to?
Caroline: So right now, I am in NYC studying Nutrition Education at Teachers College, Columbia University. Like you, I went to GW. I was originally on the pre-medical track, and I decided to study abroad my junior year of college. I went to the South of France and immersed myself in all that is French cuisine, French culture, and French language and fell in love with learning about how people connect with and hold meaning in food. When I came back, having studied all the ways I could connect with people through food and food culture, I was less certain of the path I wanted to be on. Ironically enough, it was you who told me our senior year that if I didn’t want to forget about this part of my life, I should try to combine what I love to study with what I like to do when I’m not studying; and it seemed like a light bulb went off. Combining my passion for food and for people brought me to nutrition. I also decided to write my thesis at GW on French culinary literature and French culture and identity.
Jen: Identity – perfect. We’ll talk more about that today in “Bioethics and Identity”. Caroline, you talk about the meaning people hold in food, and it’s something that was apparent to you when you participated in another culture. What are different ways you would say people hold meaning in food?
Caroline: The French have the word terroir (pronounced tehr wahr) which is about connecting with food of the region it comes from. So there is a strong identification with where you come from and what you’re eating. This concept is not only for the French, and can be true for any country or community that has their own history of agricultural customs, provincial resources, or religious traditions related to food. These identifications have a deep-set history. Although people have been establishing food traditions for generations, people have been creating their own food identities from different paths.
Jen: And why is such knowledge relevant to dietitians when discussing diet changes with patients?
Caroline: As health care professionals (HCPs), we come across medical conditions impacted by the food people eat, so for example cardiovascular disease and diabetes. In treating patients who come from a variety of cultural backgrounds, we need to account for deep-set ties people have with their food. For example, you have a patient who is 80 years old and comes from Chinese descent, and he has been diagnosed with type 2 diabetes. He is advised to start a regimen to control blood sugar levels, such as by managing carbohydrate intake. The biggest source of carbohydrates and a central part of meals in Chinese cuisine would be rice, but you can’t just approach this patient and say, “eat less rice.” Rice has been an important staple, historically and culturally speaking, for the Chinese for millennia. So, to expect someone to severely limit or entirely stop putting this food on their table is to not acknowledge the reality of how people of a certain heritage relate to their food. HCPs need to have the training and cultural competence to understand and cross these barriers.
Jen: Beyond understanding the meaning people hold in food, what influences HCPs’ abilities to determine a diet that is right for their patient’s health?
Caroline: So, back to the patient in our example, for an HCP to recommend lifestyle changes, there are other factors that also need to be considered. For a patient of any background, it is important for HCPs to understand the following considerations: we need to be aware of where patients are living and if they is able to access healthier options. Does the patient live in a safe area where he could walk to get what he needs? If this patient lives in a food desert, an area in which it is difficult to buy affordable or fresh food, he may need a car to get groceries. If he needs a car, does he have one? If so, is this elderly patient be able to drive it? If not, would family members or friends be able to pick up food for him? In considering access, we also need to include financial considerations. White rice is relatively inexpensive, and if he does not have the financial means, it may be difficult for him to substitute it with something else. There are also linguistic barriers that could prevent HCPs from being able to have conversations with patients about their lifestyles.
Jen: Could genetics also play a role in answering the previous question?
Caroline: Yes, absolutely. Certain populations are epigenetically predisposed to being overweight. So, we all have a genetic component set in stone, which is the nucleotide sequence, but the expression of our genes can be impacted by environmental factors. This is an example of epigenetics. When people are in periods of stress, for example in times of famine, this can impact gene expression involved in metabolic signaling pathways for their children. Their bodies are expecting the same stressing environmental conditions at birth as experienced by their parents and ancestors. For example, the Pima tribe of Arizona has a history of experiencing times of extreme famine. So, people descended from the Pima tribe experience these epigenetic changes that expect an environment where their bodies need to conserve energy. However, when these same descendants are in an environment of abundant food, they are predisposed to being overweight, as their bodies are expecting famine and storing energy as fat. Genetic context and history can be used by HCPs to understand the causes and necessary dietary changes for patients to improve their health and well-being. Such epigenetic changes have been seen in populations in other parts of the globe, such as in Ireland with the potato famine, and in Sweden.
Jen: Thank you, Caroline. Is there any final message you would like to share with our viewers?
Caroline: Yes, I think everyone could benefit from exploring food of different cultures and learning about what the food culture is, its origin, and the meaning embedded in it. Going to France made me understand there is a deeper way we can connect with numerous cultures, people, and history – through food.