Cultural Competency in Nutrition and Diabetes: Food Choices, Physical Activity and Obesity among Ethnic and Cultural Groups in the United States - PowerPoint PPT Presentation

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Cultural Competency in Nutrition and Diabetes: Food Choices, Physical Activity and Obesity among Ethnic and Cultural Groups in the United States

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Title: Cultural Competency in Nutrition and Diabetes: Food Choices, Physical Activity and Obesity among Ethnic and Cultural Groups in the United States


1
Cultural 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

2
U. 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

3
Population 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.

4
Disparities 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

6
Culture
  • 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

7
Cultural 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

8
Cultural Differences
  • Race and ethnicity
  • Gender
  • Religion
  • Age
  • Physical disability
  • National origin
  • Sexual orientation

9
Your 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 ?

10
Stereotypes
  • 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

11
Different 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

12
Exploring 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 ?

13
Exploring 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 ?

14
Quality of Healthcare
  • Influenced by socioeconomic status
  • Level of education
  • Income

15
Current 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 )

16
N 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

17
Integrating 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


18
Integrating 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

19
Integrating 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

20
Integrating TherapiesPhysical Activity
21
Type 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

22
Nutrition 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

23
Nutrition 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

24
Meal 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

25
Meal 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

26
African 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

27
Meal 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

28
Meal 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

29
Navajo 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

30
Navajo 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

31
Meal 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

32
Meal 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

33
Chinese 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

34
Chinese 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

35
Meal 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

36
Indian / 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

37
Meal 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

38
Margaret Mead
  • I rather change a mans religion
  • than his food habits.
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