AbstractFor over a hundred years, the profession of dietetics has lacked diversity. Increasing diversity in dietetics is essential because food and eating habits are closely linked to culture. Dietitians must embrace and understand cultural practices, norms, and beliefs in order to effectively serve the diverse U.S. patient population. The Academy of Nutrition and Dietetics has been aware of this need for over two decades but has not yet made sufficient progress towards diversifying the field.
This study aims to investigate the following: first, how the professionalization process in the field of nutrition and dietetics has contributed to a membership that is primarily White and female; second, the role race and institutional racism plays; third, how this harms the profession, and what can be done about it; fourth, it seeks to shed light on underexamined subjects discussed in forums that have yet to receive comprehensive research attention.
This research uses qualitative content analysis methods to explore the factors contributing to the lack of diversity. The study identifies barriers by analyzing 1,207 online listserv conversations among dietitians, educators, and preceptors from 2014 to 2023. The textual materials were coded into thematic categories by three coders using Dedoose qualitative analysis software.
Five thematic categories emerged from the online conversational threads: Academy of Nutrition and Dietetics (AND), Accreditation Council for Education in Nutrition and Dietetics (ACEND), Commission on Dietetic Registration (CDR), 2024 Masters Mandate, and Diversity. These themes had several sub-themes including Voices, Weight Bias, Costly Profession, Socioeconomic Privilege, Racism, Dietetics, Credentialing, Data Collection, Graduate Degree, Diversity Landscape, Diversity in other healthcare professions, Recruitment, and Cultural Humility.
The Academy and its affiliated organizations, ACEND and CDR, have a track record of developing educational initiatives without considering their potential impact on diversity. This issue is illustrated by the 2012 master’s degree proposal, which was implemented on January 1, 2024, without the consensus of the House of Delegates. Currently, ACEND does not provide a specific definition for cultural competence, and CDR does not mandate cultural competence training as part of its credentialing process.
The nutrition and dietetics profession should address the existing barriers. First, the Academy, ACEND, CDR, and its membership association should actively seek new approaches to attract BIPOC individuals at earlier stages of their education by involving BIPOC mentors. Second, there is a need for further research and initiatives to promote greater cultural inclusivity and humility. Third, future research should focus on the implications of master’s degrees concerning diversity and explore ways to foster diversity and inclusion without creating additional barriers. Additionally, to address the current obstacles within this profession, potential remedies could include removing the unpaid dietetics internship requirement. This would involve allowing graduates to participate in supervised work under mentors and preceptors while receiving compensation for their hours, similar to the structure in social work.
To promote greater inclusivity, the Academy should adopt a more comprehensive and inclusive approach centered on cultural humility, rather than focusing solely on cultural competence. The Academy must integrate thorough training programs on cultural humility into its curriculum and offer ongoing education for its members and leaders. Regrettably, cultural humility was not initially included in the master’s program, a gap that urgently needs to be filled to ensure progress in this area.