25 4.1: How Racism Manifests In Nutrition and Dietetics

The barriers to receiving just, culturally informed, affirming and competent care that are created by systemic racism.

Examples:

• Limited access to Black health care professionals due to Canada’s long history of discriminating against Black students (e.g. Queen’s University’s 1918 ban on Black students) (Queen’s Alumni Review, 2020)
• Before 2021, the estimated glomerular filtration rate (eGFR) calculations used a race-based multiplier that artificially inflated kidney function scores for Black patients, leading to delayed diagnoses and barriers to organ transplant waitlists (American Kidney Fund, 2026)
• Delayed, missed or failure to diagnose mental health issues and cognitive delay in Black communities (CanFASD, 2026; Olanlesi-Aliu, Giwa & Salami, 2025)

Systemic and institutional barriers that restrict equitable access to adequate income, employment, safe housing, and food security.

Example:

• Compounded health complications resulting from structural environmental toxin exposure and lack of urban resources (NCCDH, 2018).

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The long, exploitative and oppressive history of treatment by White scientists and health professionals toward Black people perpetuates the prolonged physical and psychological wear-and-tear caused by systemic policies and interpersonal discrimination. This chronic stress pathway directly:

• Adversely impacts long-term metabolic and physiological health.
• Influences coping or health behaviours (such as altered physical activity levels or smoking).
• Impairs safe and equitable healthcare access.
• Affects other downstream neuroendocrine and biological mechanisms related to health.

Examples:

• Physiological changes due to stress (weathering and high allostatic load) and a significantly greater likelihood of developing early-onset chronic diseases (Siddiqui et al., 2017; NCCDH, 2018).
• Elevated risk profiles for clinical hypertension and childhood cancer (Siddiqui et al., 2017).
• Deep-seated psychosocial trauma from navigating biased institutional environments (NCCDH, 2018)

Gaps and biases in practitioner knowledge

• Healthcare workers unable to recognize indicators of nutritional status or systemic illness (e.g. jaundice, cyanosis, or severe paleness/pallor)  because they are not trained to spot these variations on darker skin tones. Subsequently, nutritional deficiencies or chronic health conditions are missed, or treatment is delayed (Stanford Center for Continuing Medical Education, n.d.)
• Nutrition professionals’ use of BMI or visual assessment of body composition contributes to weight bias, fat phobia and assumptions of poor health within Black communities (Strings, 2023).
• Making an incorrect nutrition assessment and plan after misjudging a patient’s nutrient intake because they are unfamiliar with traditional foods or preparation methods

Low income and lack of access to health benefits/insurance coverage

• Low income, unemployment or precarious work conditions often limit access to employer-sponsored health benefits, creating barriers to accessing dietetic services.
• Subsequent dependence on limited access to free community dietetic services that may not be culturally affirming, particularly since there are very few Black dietitians practicing in Canada and non-Black dietitians have limited training on culturally affirming and anti-racist practice.

White racial framing

• The disrespectful and discriminatory behaviour of nutrition professionals who belittle cultural foods and ways of eating indirectly requests that Black patients deny parts of their cultural identity (Kumanyike, 2006)

Pathologizing health management adaptations (e.g. cultural racism)

• Nutrition professionals pointing blame at cultural and individual eating patterns and cooking traditions (e.g. cooking with oils high in saturated fats such as palm oil or regular inclusion of large portions of starchy foods like provisions)  for health issues (e.g. diabetes, hypertension, obesity) while ignoring the current and historic systemic inequalities that perpetuate health issues (Ng, 2023).

Black communities’ distrust of non-black nutrition professionals and their messages

• Black patients withholding essential information to avoid judgement, being controlled or being harmed. (e.g. not telling a dietitian about their complementary and alternative medicines)
• Black people avoiding or ignoring recommendations intended to improve their health, rendering public health nutrition strategies and clinical dietetic interventions useless. (Etowa, Beagan, Eghan & Bernard, 2017; Beagan & Chapman, 2012).