Long before she decided to help others eat better by becoming a dietitian, Jessica Wilson learned that the profession was unlikely to offer much to people like her.
Growing up as a Black girl in a mostly white area of Sacramento, Calif., she was bullied for her size and subjected to unpleasant visits with dietitians, who taught portion control with the aid of plastic models of green beans and chicken breasts.
Wilson was the only Black student in her dietetics program at the University of California, Davis. One day was devoted to what the curriculum called "ethnic diets."
"It was not 'These are interesting and awesome,' " she recalled. "It is 'These are why these diets are bad. Next class.' "
Mexican food was dismissed as greasy. Indian food was heavy. Wilson was taught to prescribe a bland "kale and quinoa" diet. When she started treating patients — including many who, like her, are people of color or identify as queer — she learned how much those identities informed their perspectives on health, and how little she had been taught about that. "I was no longer able to use the tools that had been given to me in school with good conscience," said Wilson, 38.
In June, Sherene Chou, 36, a dietitian in Los Angeles, organized a group letter to the Academy of Nutrition and Dietetics — the largest and most powerful organization for food and nutrition professionals — outlining steps it should take to address systemic racism in the field, including anti-racism training. Leaders of dietetics groups signed on behalf of 70,000 practitioners and students.
Many of these dietitians say the academy's research, programs and articles ignore non-Western cuisines, or imply that they are unhealthy. And, they said, it perpetuates an ideal of thinness and gender normativity that can exclude different body types and identities.
The academy said it is working to broaden its ranks and resources to better reflect different cultures. The group is influential in setting the Agriculture Department dietary guidelines that Americans are urged to follow; its members make up half of the 20-member committee that oversees the recommendations. In a July report, the committee acknowledged that the dietary approaches it studies don't "qualitatively address cultural variations," yet said the guidelines allow a "tremendous amount of flexibility."
The recipe database on MyPlate, the department's healthy-eating website, includes 98 dishes classified as "American," 28 "Asian" recipes and nine "Middle Eastern" ones. Though it lists 122 "Latin American/Hispanic" recipes, they include "skinny pizza" made with tortillas. The Asian recipes include "Oriental Rice" and "Oriental Sweet and Sour Vegetables."
It rankles Ryan Bad Heart Bull, 36, a Native American dietitian who works with the Oglala Sioux Tribe in Pine Ridge, S.D., that many of his peers praise the nutritional value of traditional Indigenous ingredients like salmon and bison without understanding how federal policies have made it harder for Native Americans to hunt and forage on their own land. "And then to turn around and say … here are the ways you can incorporate it into your diet," he said, "it is insulting."
If the options seem narrow, they may begin with the narrowness of the profession. More than 71% of the nation's roughly 106,000 registered dietitians are non-Hispanic white, according to the academy's Commission on Dietetic Registration. Nearly 84% are women.
Funding for dietetics programs at many historically Black colleges and universities has been cut since the 1970s. The number of Black dietitians fell by 18%, to 1,107, from 1998 to 2019, said the academy's Accreditation Council for Education in Nutrition and Dietetics.
Entry requirements are steep: Practitioners must earn a degree from an accredited program, complete an internship, and pass a registration exam with a $200 entrance fee. Starting in 2024, a graduate degree will be required to take the exam. Lisa Sasson, a professor at NYU, called the new graduate degree mandate "unconscionable" and "an even greater barrier to people of color in our profession."