Culture shapes our food choices. But a dietitian might be unfamiliar with someone's cultural practices and foods, causing a cultural disconnect. "Traditional dietetic training doesn't really account for cultural complexities," says Sue-Ellen Anderson-Haynes, M.S., RDN, CDCES.
For example, the dietitian might not know much about halal or kosher cooking. And the patient might be uncomfortable talking about their cultural practices.
When Anderson-Haynes prepares to meet with a new patient, she reviews their medical history to understand their needs. Often, she finds that the patient's cultural background is one that she isn't very familiar with, so she scrambles to find out what people from this culture typically eat and how their beliefs and other cultural factors might influence their diet.
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But this isn't ideal. Ideally, the dietitian would already be aware of these cultural factors. "While we are registered dietitians, which are food and nutrition experts, we're not experts in everyone's culture," Anderson-Haynes says. Even if a dietitian is generally familiar with a culture, they may be unaware of a specific vegetable that the person eats, for example, so it may be hard to tell whether the vegetable is a carb or a non-starchy vegetable, she says.
Anderson-Haynes says that, over the 15 years she's been a dietitian, "it became clear that there was a need for direct, relatable, professional guidance that should be given to a diverse population." And she's learned that this resonates with many of her dietitian colleagues. So she and her husband, Michael Haynes, developed an app called culturd that connects dietitians with clients based on shared culture. Its slogan: "Get the Dietitian that Gets You."
Both the client and the dietitian provide information about their culture, including language, religion and specific cuisines, and they are matched by the algorithm. The app, the first of its kind, launched in October 2022 and is available in the U.S. and Canada. People can match in any location, communicate through the app and then arrange services independently.
For now, the app is free for clients and dietitians to use, but later, there will be a modest platform fee for dietitians.
Dietitians who match culturally with clients understand the food, but also traditions and "what food means to a culture and that how that matters," Haynes says.
Lifestyle- and diet-related diseases, such as cardiovascular disease and diabetes, are on the rise. And according to a 2021 article published in Nutrients, they are more prevalent among people of color. "The health of the nation is declining. It's concerning, and dietitians can help with preventing, managing, sometimes reversing diet and lifestyle diseases," Anderson-Haynes says. She adds that, according to the CDC, registered dietitians are the only professionals who can provide medical nutrition therapy, a key part of diabetes education and management.
Research has shown that in health care more broadly, patients with providers of the same racial or ethnic group have better outcomes, Anderson-Haynes says. For example, a 2020 study published in JAMA Network Open found that patients preferred providers of the same race.
And people of color are underrepresented among dietitians. A Commission on Dietetic Registration survey found that dietetic professionals are 6% Hispanic/Latino, 3% Black/African American and 5% Asian. So people of color who want to find a dietitian of the same background may face a challenge.
"The hope is that if people access more directly relatable, relevant nutrition information from the experts who get them, that would improve their health outcomes," Haynes says.
Both of culturd's cofounders, Anderson-Haynes and Haynes, have Caribbean roots. Haynes recalls a Jamaican family member who was working with a dietitian to lower his blood sugar. The dietitian told him to watch his carbs, like pasta, potatoes and rice. So he did. "But at the same time, he's eating everything he knows in his culture, so yam, green banana, plantains," Haynes says. He didn't realize those foods were carbs, too, since the dietitian didn't tell him to limit them.
Sometimes, dietitians recommend foods that aren't relevant or feasible for patients. Anderson-Haynes says that, from patients, "the rhetoric that I've heard is 'I don't want to go to a dietitian—they're going to tell me to eat salad.' And 'I went to a dietitian, and they gave me a meal plan, and I don't even like any of these foods…. I don't know why I'm even going.'"
Culturd aims to change that rhetoric. "We now have dietitians on the culturd app who understand how you eat, and they can put your cultural foods on the table, show you how to prepare them this specific way and still help manage medical conditions," Anderson-Haynes says.
"In different cultures, we eat different types of food. And yes, you can educate anyone on the foods that you eat. But many of us grew up feeling like our foods are not good enough," says Ashley Carter, M.S., RD, LDN, program director of EatWell Exchange, which teaches people of diverse cultures how to eat healthy with their cultural foods and provides professional education. "Sometimes we don't share all of our authentic foods that we eat with our providers because we already walk in the door thinking that everything that we're doing is wrong. So when you have a provider that's from your culture, sometimes you're more willing to talk about cultural foods."
Culturally relevant nutrition recommendations are important. "If you have to give up all of your cultural foods to be healthy, it's not realistic," Carter says. "If you can take foods that you're familiar with and just tweak them a little bit, it's more likely that you'll be able to make sustainable changes."
Language is a common barrier, and Anderson-Haynes's typical solution is an interpreter. The interpreter helps her communicate with the patient, but the interpreter can't say whether a particular food is a carb.
Even better than an interpreter, Anderson-Haynes realized, would be having a dietitian that speaks their language. "That's where the idea came up, after repeatedly meeting with clients with these particular barriers," she says.
Dietitians often work in hospitals and health care facilities, "but a lot of students now are increasingly interested in private practice—entrepreneurial pursuits," Haynes says. So culturd is a way to support diversity among dietitian entrepreneurs and help them connect with potential clients, he says.
"Now more than ever before, a lot of individuals of different cultures are requesting providers from their background—RDs of color, they call them," Anderson-Hayes says. She adds that culturd serves as a place where physicians' offices and organizations can find diversity among dietitians and refer them to clients. Companies and organizations seeking diversity in nutrition can reach out to culturd as a resource, and future app enhancements will allow them to connect directly.
The recent growth of telehealth may make it easier for dietitians to work with patients remotely. Since the COVID-19 pandemic, "telehealth has dramatically increased for a lot of dietitians. Some of their practices are still 100% virtual," Anderson-Haynes says.
And in some instances, telehealth has been outperforming in-person care. For example, Anderson-Haynes pointed to the American Diabetes Association's 2022 Standards of Medical Care in Diabetes, which says that telehealth visits for pregnant people with gestational diabetes mellitus had better outcomes than in-person care did.
Culturd is designed to connect people of all backgrounds with cultural matches. While people of color are underrepresented in the dietitian profession, connecting with dietitians who share a background can deliver life-changing care.
"The main benefit that I see is that this is going to change generations," Carter says. "A dietitian, when we teach one person, we're not just teaching that person—we're teaching their family. When someone's family sees that they can eat their traditional dishes and be healthy, "it'll make that family member curious and say, 'Hmm, it's possible to eat healthy foods that taste good and that are familiar.'"
A dietitian who speaks your language, literally and figuratively, offers a certain level of comfort. "When you have someone that speaks your language, that relates with your cultural nuances, that understands you and represents you, you're going to get better health care outcomes," Anderson-Haynes says.
