Photos by Ashley Barnas March 28, 2022
Several years ago, while University of Delaware Behavioral Health and Nutrition Department professor Kelebogile Setiloane was teaching, she asked her students about their heritage. To her astonishment, several students had no idea whether their roots traced back to Ireland, Italy, or Germany. She recalled her students saying:
“‘I don’t have a heritage. I’m just American.’”
It was in that moment that Setiloane, who’s also the director of the African Studies Program at UD, realized just how important her “Cultural Perspectives on Food and Nutrition” class really was — as she confronted the impossible task of asking the next generation of dietitians and nutritionists to understand others before they even understand themselves.
“All of us came here from somewhere. We all have a heritage,” she said. “One of the things that I’ve initiated in my class is to think about us all as being immigrants — that’s a part of history that has been shied away from.”
She encouraged her students to dig into their own heritage and come back with a story or a recipe. While recognizing heritage illustrates our differences, it also reveals a commonality.
“Hearing that history of ourselves helps us have a better understanding of other people. You see your commonalities and respect your differences,” she said. “If dietitians get in touch with who they are as people, I think it enables them to better relate to other people. It makes them better health professionals.”
That commonality also comes out in cuisine perhaps more than many realize.
In Kristin Wiens’ “Food Concepts” class this semester, the cultural theme for students’ Recipe Testing and Evaluation Project is Filipino cuisine. This semester, Wiens sought the expertise of the Filipino Student Association, which provided students with a lecture on Filipino culture and food and helped them select recipes.
In addition to preparing tasty cultural dishes like pancit, a Filipino stir-fried noodle dish, Wiens ensures students have a historical and cultural understanding of the origins of each dish.
“It’s really important for students to understand the influence that colonization, immigration, conflict, and oppression have had on the origins of cuisine,” she said.
Students are also challenged to use lesser-known ingredients in line with this year’s cultural theme.
“Students are going to be using cassava; it’s a starchy vegetable that’s a common staple in lots of different parts of the world, and they’re actually going to be using it to make a dessert — a cassava cake,” said Wiens.
March marks National Nutrition Month, and this year’s theme is Celebrate a World of Flavors. For consumers, the message is: Try new foods at the comfort of your kitchen table or at a local restaurant without a pricey plane ticket or a passport. For registered dietitian nutritionists, the message resonates much deeper.
“There’s finally been a big push for more widespread cultural competence and cultural appreciation and better ways to integrate that within practice. For dietitians, this means we need to get better at recognizing and understanding how different cultures might eat so we can better counsel our clients and our patients and be culturally appropriate,” said Wiens, who’s also the coordinator of UD’s Food and Nutrition Education Lab.
Adriana Verdezoto Alvarado is getting her doctorate in nutrition sciences and serves as vice president of the Hispanic/Latino Graduate Student Association, which organizes the Taste of Latin America series.
“Culture plays such a huge role in food. Being Hispanic myself, food is part of who we are and almost how you define yourself,” said Verdezoto Alvarado.
On March 22, as part of the Taste of Latin America series, the association featured Mexico and planned to make chilaquiles — a traditional Mexican breakfast dish — inside Willard Hall.
“I’m not from Mexico, so I asked: ‘Can we make fajitas or burritos?’ And the guy from Mexico, Ricardo, said, ‘That’s Tex-Mex, that’s not Mexican,’” said Verdezoto Alvarado in what was a learning moment for her.
The association is also hosting Taste of Latin America events on April 12 and 26.
“We all cook together, and there’s laughs, and having that sense of community,” said Verdezoto Alvarado.
Setiloane said food and events like the Taste of Latin America series should be used to help understand other cultures.
“When we’re all coming from different cultures, particularly nowadays with racial tensions going on, it becomes very difficult to talk about race, to talk about different cultures, and food is something that’s common to all of us in different cultures,” Setiloane said. “Once we learn about the food, where it comes from, who eats it…it becomes an easier segue to talk about ourselves.”
Wiens said developing a healthy eating plan for others must recognize a variety of food preparation techniques as well as new-to-you ingredients. She points to turnips, a root vegetable high in phytochemicals and antioxidants.
“Turnips can be really, really delicious,” she said. “They’re cheap and usually pretty easy to find, so sometimes it’s looking at what’s in the grocery store that people might view as being ‘old-fashioned’.” she said.
Verdezoto Alvarado said respect for other cultures in this field is paramount.
“Nutrition and dietetics are mostly a white female-dominated field,” she said. “You’re telling people to eat kale and quinoa and don’t take into account whether they eat peppers or jalapenos. It’s about how you can help somebody through nutrition without losing their identity.”
Work is underway in UD’s Nutrition Clinic to build on cultural competence. For example, oatmeal isn’t the key to a healthy breakfast for all, and a turkey sandwich isn’t everyone’s idea of a healthy lunch. Some cultures don’t even eat sandwiches.
“We don’t need to remove culture from the equation and wash everything over with these bland, across-the-board suggestions for everybody,” said Wiens.
Registered dietitian and instructor Sharon Collison takes that duty seriously.
“I love food and creating recipes — it’s a passion of mine,” said Collison. “I just love developing healthier ways of making traditional recipes.”
When people of other ethnicities come to her clinic, she asks them to share their favorite foods and recipes, and she jumps right into altering them.
“I recently had a student who is Pakistani. She isn’t much of a foodie, but her mom is, so we got some of her mom’s recipes and made them more heart-healthy,” she said.
She pointed to using fat-free Greek yogurt over full-fat yogurt, canola oil instead of vegetable oil, and fat-free half and half instead of heavy cream in chicken biryani to cut saturated fat.
“My recommendations depend on the recipe and my gut feeling on how much it’s going to impact the flavor and the texture,” she said. “This recipe was 250 calories and five grams of saturated fat less than the original, so that’s pretty significant.”
But Collison admitted, this may not be common among practitioners.
“I don’t think people come to a dietitian thinking they’re going to work with them on recipe modification. I don’t think they expect that,” she said. “It might show them that it’s not all or nothing. It’s not either they don’t eat foods they love, or they stay where they are. Try to get them to see they can modify something even slightly, and it can really have a positive impact on their health.”
Setiloane said too often, nutrition practitioners take food at face value.
“It’s just food, and they don’t understand where that food comes from or the history behind why people are eating that food,” Setiloane said.
Her class aims to help students change their perspective — going from “ew” to a place of understanding.
“There may be a whole history behind why people eat the foods they do,” Setiloane said. “For instance, enslaved Africans in America may have had to make do with the leftover foods they were given — foods like pigs feet, chitlins or intestines.
“I hope students get to understand the stories of people different from themselves so they can recognize why people eat the foods that they do.”
Elizabeth Donovan, a junior nutrition and dietetics major in the College of Health Sciences, recently returned from a winter session study abroad opportunity in Hawaii, where she took a class called “Cultural Awareness for Health and Healthcare.”
Data from the U.S. Department of Health and Human Services shows native Hawaiians are three times more likely to be obese than the overall Asian American population in the United States and its territories.
"But being bigger is seen as a sign of beauty and power in their culture,” Donovan said. “Maybe they don’t want to change, but it might be seen differently in the eyes of medical doctors, so they feel like they don’t want to seek treatment or conform. I learned how to make patients feel understood, so they’ll be able to get the healthcare they need.”
Being thin also doesn’t always equate to optimal health.
“When nutritionists see someone who looks healthy, and they don’t look past that — because they ‘look good,’ — they’re not given the time of day,” she said. “This cookie cutter approach has deterred so many potential patients from seeking out help and has resulted in people of color and people of bigger body sizes from just not seeking out help altogether.”
Experts say a lack of understanding of other cultures has also stopped people from different ethnicities from seeking out dietary advice.
Rebecca Metellus, a junior nutrition and dietetics major, who’s currently enrolled in Setiloane’s class, sees this first-hand in her mother, who’s Haitian.
“Healthy for her might be tropical fruits, but the types of fruits she grew up eating aren’t available where we are now,” said Metellus. “Recommending the Americanized version of healthy to someone who’s not used to the type of diet, it will be hard for them to adapt.”
Ngozi Ikpeama, a junior nutrition and medical sciences major, stressed being open-minded and receptive to other cultures.
“It’s important to plant the seed and show respect — that’s how you build rapport and trust with health care providers,” said Ikpeama. “I feel that disconnect leads a lot of people to not getting adequate care, and that is what leads to disparities.”
Natalie Raab, a sophomore nutrition and dietetics major with a minor in Spanish for Healthcare, recognizes the importance of being a global citizen. She said the Cultural Awareness for Health and Healthcare class, led by Setiloane and now required for all three nutrition majors, taught her not only that every person is different, but how to recognize the reasons behind those differences, resulting in individualized treatment plans.
“The class showed me the importance of looking at a patient through not just their current symptoms, but the factors of their environment, culture, availability, access — all those factors play into making them who they are and how their diet may be impacted by that is kind of what that class solidified for me,” she said.
Raab, who also plans to get her master’s degree, hopes future coursework continues to push her outside her comfort zone.
“Our healthcare system has dropped the ball time and time again,” Raab said. “We see it in how different races are treated and in their healthcare statistics, and their lifespan, and their overall health is so negatively impacted by our healthcare system and a lack of knowledge. This new generation wants to become educated on other cultures and other people’s day-to-day lives that are different than their own.”
When she becomes a dietitian, Donovan said, she’ll approach the job with understanding and empathy thanks to her UD education and experiences.
“Don’t just assume everybody has everything to meet the goals they want to be healthy,” Donovan said. “Acknowledge that it’s hard to change your diet, but also try to make recommendations that work for them and fit into their culture, their needs, and their lifestyle.”
But even with increased cultural competence, nutritionists and dietitians can’t be expected to be experts in every type of culture and cuisine. In those instances, Setiloane recommends being both inquisitive and humble.
“As health professionals, very often, we feel as though we know everything about food and nutrition,” Setiloane said. “Allow the people to be the experts in what it is that they eat. Have the humility to say, ‘Oh what is that you eat? Why do you eat that?’ You should be aware that this person may be different and may eat different food, and you should be humble enough to ask the person what you need to know to help them.”
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Photos by Ashley Barnas March 28, 2022