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


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

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,

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

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.

Disparities in Health Status
  • The demographic statistics are significant ,
    because minority groups often suffer a
    disproportionate burden of disease and other
    health care problems

  • 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

  • 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

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

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

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 ?

  • 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

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

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 ?

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 ?

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

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 )

  • 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
  • The return is a reduced morbidity and mortality

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

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
  • Check blood glucose if gt13.9mmol, check for
  • If ketones are present, do not exercise
  • Frequent monitoring

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

Integrating TherapiesPhysical Activity
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

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
  • Influence of which foods are considered hot and
  • Use of folk remedies

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
  • Involve family members in the counseling session

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

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

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

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

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

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

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

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

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

Chinese Americans Culturally Appropriate
  • 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

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
  • Point out mistakes in a way that will not cause
    the client to lose his or her self - respect

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

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
  • Increased intake of convenience foods
  • Reduced use of traditional foods and cease to be

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

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