Facing Down Food Deserts
One of the major barriers that patients face when they attempt to eat a healthy diet is that of access. A significant number of individuals, particularly low-income patients who may also rely on SNAP, is that these patients live in food deserts, which means that there are no full-service grocery stores in their area, only convenience stores, bodegas, and fast food restaurants.
Care providers need to talk to patients about where they shop and what options are available in their community. Telling patients that they need to eat lean protein and fresh fruits and vegetables when all that they have access to are high-sodium canned vegetables and processed meats isn’t productive for either party and will just lead to frustration and accusations of non-compliance.
Explore Culinary Traditions
In addition to a lack of knowledge about what foods are available and affordable for patients, another reason that nutrition education fails is because it doesn’t take into account cultural traditions. While many Western foods are loaded with fat and sugar, a lot of traditional cuisines from elsewhere in the world are actually quite healthy, hence why obesity follows Westernization and dietary changes.
Despite the established link between Western diets and obesity-related health problems, many medical practices provide nutritional guidelines that reflect a stripped back, bland “American” diet. Encouraging patients to eat foods that reflect their background, such as high protein pigeon peas that are popular in many African, South Asian, and Latin American countries, or probiotic kimchi from Japan, can make dietary advice more relevant and infuse them with flavor.
Focus On Listening
When doctors and nutritionists offer dietary advice that doesn’t reflect their patients’ cultural backgrounds or sounds entirely unrealistic for their social situation, patients may try to say something but feel too intimidated – or their provider may not listen. This is especially the case if there’s some kind of language barrier. While all medical providers need to be trained to listen carefully to their patients and to watch for signs of uncertainty or hesitation, this is especially important for medical assistants, who often take patient histories to know what types of questions to ask to draw out useful information about patients’ food preferences, knowledge, and access.
Know Who Is At Risk
As noted above, some patients are far more likely to face serious nutritional risk factors for disease, and one of the most powerful things that doctors can do is to identify those risk factors and offer concrete solutions. This might include offering community outreach and diabetes screenings, providing interpreter services to patients, and hiring a diverse medical team that can better connect with the patient population.
Ultimately, when it comes to encouraging patients to make health-focused dietary changes, clinicians need to act as partners who can support their patients and guide them, but they can’t force the process. What constitutes a normal dinner for an upper-class white doctor with a high level of access and disposable income is, unsurprisingly, very different from what’s normal for an immigrant family living paycheck-to-paycheck. We can’t override those differences, but we can work with patients to help them lead healthier lives despite social and economic limitations.
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