Molly Kimball Discusses Strategies for Culturally Sensitive Dietary Guidance

Oschner Health's Molly Kimball, RD, CSSD, discussed the psychology behind diet and how different cultures obtain various perceptions surrounding food. Kimball serves as a registered dietitian with Ochsner Health System and manager of the nutrition department of Ochsner Fitness Center. She is also the founder of the Ochsner Eat Fit nonprofit restaurant initiative, which works to introduce restaurant chefs to healthier options for their customers while continuing to educate people about their daily dietary choices.

This interview builds on Kimball's presentation at The American Journal of Managed Care^®’s Institute for Value-Based Medicine^® (IVBM) on New Orleans, Louisiana on November 7, 2023.

Transcript

How can dietitians address the psychological aspect of dietary changes within the context of cultural identity to ensure long-term adherence?

I think realizing that all of us, I would say almost all of us, have things that are just non-negotiables. Respecting that, you know it's not asking someone to not have those, as it were, with a restaurant, we would never say not to serve those.

When it comes to that individual, what is the frequency maybe that we indulge in those and maybe what used to be a daily thing or multiple times a day or whatever that might be, maybe becomes less often as a weekly thing or more of that special event.

It's understanding what these foods mean to people, understanding what are those non-negotiables, then having that conversation because sometimes it may surprise us. We may go in making an assumption that because of what someone has been accustomed to having or whatever they've grown up with or whatever has been part of their culture, we may assume they're going to be resistant to change. Then they're actually not, they want to know, and they want to try these other things.

Then they save those items and kind of that original way when they celebrate with family or they're having these special events or occasions but maybe on the daily, they want to make some of those other changes.

As dietitians are working individually with people one on one but also as our dietician team with Eat Fit working out in the community and working with restaurants, it's asking those questions and understanding someone's comfort level, how open they are, and also how they are right now, might look different another year, or two years or three years and sometimes other events happen to them. Then they come back and say, "okay, now I'm ready, I want to hear more about this or try these other things". It's so fluid and not making assumptions either way of where someone might be and simply asking.

When you encounter situations where cultural beliefs or traditions pose challenges for a patient to achieving specific dietary goals, what are some effective ways to address those challenges?

Depending on where someone is starting, there may be multiple things like that. So, understanding which of these is the most important to them that we're not going to touch that right now and the ones they might be a little more flexible with.

Sometimes it's giving the information, giving the specifics of what something is. There was one of our partners who created a dish specifically for his parents who struggle with hypertension. He created the dish that he thought was a healthier version for his parents who both had very high blood pressure and he was concerned about them. He made this dish specifically to be healthy for them.

When we looked at it, the sodium was higher than a fried seafood platter. Yet, he had no idea some of the ingredients he was using was driving the sodium up even though it wasn't specifically salt.

When we were able to show him how much sodium it was and gave him comparisons to the fried seafood platter, he was stunned because that was the exact opposite of his intent.

In those cases, it's in a very respectful way, showing a potential relevant piece of information to them. In this case, he was really alarmed because of the reasons he created this dish. In some cases, people may say they hear you but it still doesn't matter to them. Then we have to accept that and see what the other areas that we might be able to implement as a bit of a wellness shift.