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We need to talk about how dietitians engage with cuisines of other cultures

By Seraphina Seow, APD

As dietitians, we understand the importance of tailoring our nutrition message to a client’s cultural background. Being able to maintain our cultural food practices is crucial to achieving wellness, especially if, in the case of migrants, it may be the last remaining tie for someone to their cultural heritage. However, the inclusion of cultural food practices in nutrition messaging still has some ways to go in dietetic practice.

The Australian Dietary Guidelines are proposed to be used as a guide for dietitians to adapt to their clients. Dietitians are expected to use their assessment of a client’s socio-cultural influences to inform how they practice. For example, we are taught that if someone does not eat dairy for a cultural reason, we replace it with another appropriate calcium-rich food.

This sounds simple theoretically. However, when dietitians enter the workforce and manage clients who are maintaining cultural food practices, they realise it requires more effort on their part to craft culturally acceptable nutrition recommendations. With the time constraints of consults, this is a challenge, says Krishanthi Shanmugathasan, APD, a clinical dietitian.  Nonetheless, it is a challenge that needs to be overcome.

Many university courses, while they do train dietitians to demonstrate cultural competence according to Dietitians Australia’s National Competency Standards, do not have the time to deepen students’ understanding of the eating practices of different cultures. “It is impossible to learn all about Indian food, for example, in university,” says Dr Tammie Choi, APD, PhD, lecturer & dietitian researcher, emphasising that dietitians need to leave university recognising that they need to do much more learning before they are able to provide nutrition messages that are culturally acceptable to the people they serve. “In university, we try to highlight that there are differences in foods and eating practices, but they are often generalised which is not ideal.”

Branavie Ranjithakumaran, APD, a dietitian working in private practice, says, “I’m aware that we are living in a western society and we may not engage with culturally diverse clients in the workforce. But I do feel like there was a lack of depth and breadth in my cultural development as a health professional. For starters, I don't know anything about the Indigenous way of eating. Our evidence-based learning was based on the colonising population, there was very little to connect us to the original people and roots of the land that we are practicing on.”

Inadequate emphasis on how to tailor foods of different cultures to manage clinical conditions means that the standard white Australian diet is mainly used when teaching students how to provide nutrition recommendations. This leads to nutrition advice that may not land with clients who are engaging in their culture’s eating practices. In Dr. Choi’s research among Chinese Australians, she found that dietitians try to tailor their healthy eating advice to fit within what they believe a Chinese diet looks like. Instead of recommending a salad sandwich, they would recommend more stir fries and weren’t able to recommend other culturally suitable nutrition advice apart from that. “We eat more than stir fries, so saying you’ll be fine eating stir fries is not really helpful,” Dr. Choi says. Besides this, simply telling them to have more vegetables in Chinese dishes may not be enough, because a major element of their cultural definition of healthy eating is not being discussed. “What type of vegetables, how to balance it, and whether it is a ‘heaty’ or ‘cold’ food, needs to be in the conversation,” says Dr. Choi.

When dietitians leave university without the awareness that what they have learnt about cultural foods is merely a drop in an ocean, it creates issues in their portrayal of these foods in relation to health. The nutrition media space is often the first introduction for the public to nutrition messaging. In Australia, these nutrition voices predominantly promote a westernised diet, which is understandable because most are of a white Australian background. It inadvertently creates a notion that good nutrition equates to eating in this westernised way and a diet that looks different to this is ‘othered’.

Because of a lack of people in the media who link health with eating foods of their cultural heritage, these do not cross the lay person’s mind when thinking about eating healthily, says Shanmugathasan. Ranjithakumaran recounts a client of Asian heritage who came to her clinic thinking he needed to stop eating his family’s cooking and have salad instead to be healthy. Celeste Ly, APD, a clinical dietitian, recognises that while healthy meal services provide meal plans that include a few culturally appropriate options, the meal plan remains, all in all, very westernised. “It’ll encourage clients of different cultural heritage to pursue good nutrition in the short term but I don’t think it’s sustainable,” says Ly. “If it’s only providing limiting options that's meant to be targeting their cultural group, people don’t eat the same thing every day.”

Besides this, judging whether a food is healthy based on its scientific merit alone while ignoring whether it is healthy from a socio-cultural perspective is where dietitians can miss the mark, says Professor Andre Renzaho, PhD, MPH, a professor of humanitarian and development studies at Western Sydney University. Ranjithakumaran agrees, “The danger is when someone takes a reductionist approach to what a cultural food is like by focusing primarily on its contributions to physical health.” We see this when online articles rank various Asian cuisines according to ‘healthiness’. When nutrition websites and social media accounts include culturally diverse foods, “it is a means to encourage people to incorporate particular nutrients into their diet, instead of including it for its flavors and from a place of cultural respect of why the food might be a source of comfort for someone,” says Ranjithakumaran.

Recipes for foods like dahl are proudly featured in a dietitian’s Instagram account, but key ingredients like ghee are replaced with olive oil, changing the texture and misrepresenting what the curry is truly like. For someone who may have immigrated to Australia, food may be one of the last things they have to tie them to their cultural roots, and stripping back what makes the food taste how it should isn’t going to help achieve wellbeing. This is why Dr. Renzaho believes that if a dietitian makes a clinical decision that a dish needs to be modified to achieve the client’s health outcomes, they need to ensure it remains palatable and culturally acceptable.

Additionally, if a nutrition professional is going to modify a dish from a culture that differs to their own, being conscious of not culturally appropriating the food is vital. “Cultural appropriation is when the mainstream culture only adopts the food of the minority to maximise their financial or social capital,” says Dr. Renzaho. A widely accepted example of this is when dietitians release Asian or African inspired healthy foods on their websites, without regard for the cultural significance and authenticity of the food. “It is a form of microaggression when you acquire other cultures’ menus and suddenly become an expert in them,” says Dr. Renzaho.

During Dr. Renzaho’s research on food habits among African migrants in the western suburbs of Melbourne, people consistently reported that when their children were encouraged to bring a dish from their culture to school cultural events, their food would be mocked. “But if the food we send the kids with is deemed ‘healthy’, the dietitian working at the school later on adopts the same cultural food they were laughing at to make it for a healthy school lunch box,” says Dr. Renzaho. “While you can say you are celebrating cultural inclusion, to the community, you are seen as someone who stole it, someone who doesn't adhere to the original recipe or respect the generational knowledge that’s been passed down to develop the recipe, consult the community, or give credit entirely to the community for the recipe.”

“Whatever message you put forward after that, it will never be easily taken up.”

So, what needs to happen to improve dietitians’ engagement with other culture’s cuisines? Dr. Renzaho believes the best way to solve the issue is increasing the cultural diversity of the profession. Shanmugathasan says, “When a client sees a dietitian with the same background, they might feel more comfortable to share that they use a certain ingredient in their cooking. There's an element that you potentially understand because you have shared experiences. But someone else might not understand that and understand that this ingredient is something that can't be changed.” Dr. Choi, who was the resident Chinese dietitian expert when she was practising clinically, acknowledges that even though she worked with many Greek Australian clients, she could never do as good a job as a Greek dietitian. “So I think encouraging a more diverse population into our workforce and empowering them to use their background knowledge to fill this gap is important.”

In the meantime, for dietitians who are currently practising, we need to seek out training around implicit biases and microaggressions in the health and nutrition field, to acknowledge and overcome our own unconscious biases toward other cultures. It is not enough to cook and eat food from different countries. Anyone can do that, and as dietitians we need to set ourselves apart if we are to call ourselves food and nutrition experts.

Note: While no Indigenous Australian dietitians were available to speak to Education in Nutrition when we reached out to them for this story, please read The Conversation’s article on how Australia’s official’s dietary advice disadvantages Indigenous people, written by Dr. Aletha Ward and Professor Odette Best.

Seraphina Seow is a freelance copywriter and journalist based in Melbourne, Australia. She is also a qualified dietitian and nutritionist. She has been published in Huffington Post, Well + Good, SBS Food, and Lacuna Voices.

See also her article: Good Nutrition for all Is Impossible When Most Dietitians Are White