Kulkarni Cultural Competency in Nutrition and Diab

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, BC-ADM, CDE

U. S. Population : Year 2000: 

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: 

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: 

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

Slide5: 

“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

Culture: 

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

Cultural Competence: 

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 one’s 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: 

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

Your Culture: 

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 ?

Stereotypes: 

Stereotypes We are often influenced by our perception of a person’s cultural back ground , socioeconomic status, gender , or age. These perceptions are influenced by our stereotypes of certain groups or individuals. Examples : Elderly people can’t hear well and talk too much People who talk slowly are ignorant

Different Ways of Thinking : 

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

Exploring Patients’ Health Beliefs: 

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: 

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 : 

Quality of Healthcare Influenced by socioeconomic status Level of education Income

Current Healthy People 2010 : 

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 )

N D E P: 

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

Integrating Therapies:Physical Activity: 

Integrating Therapies: 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 Benefits of regular physical activity

Integrating Therapies:Physical Activity: 

Integrating Therapies: Physical 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 >13.9mmol, check for ketones If ketones are present, do not exercise Frequent monitoring

Integrating Therapies:Physical Activity: 

Integrating Therapies: Physical Activity Type 2 Consider safety, obtain medical clearance If over 35, consider EKG stress test Determine best time to exercise If BG > 16.7mmol, do not exercise Monitor BG, if >13.9mmol, check for ketones Additional food usually not necessary

Integrating Therapies:Physical Activity: 

Integrating Therapies: Physical Activity

Type 2 Diabetes in Minority Populations: 

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 : 

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

Nutrition Counseling : Mexican Americans: 

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

Meal Pattern for Mexican American Client with Type 2 Diabetes: 

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: 

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: 

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: 

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: 

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: 

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 : 

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: 

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: 

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 Counseling : 

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’

Chinese Americans’ Con’t : 

Chinese Americans’ Con’t 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

Meal Pattern for Chinese American Clients: 

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: 

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

Meal Pattern for Indian and Pakistani Clients : 

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: 

Margaret Mead “I rather change a man’s religion than his food habits.”