{"id":468,"date":"2024-08-29T14:41:34","date_gmt":"2024-08-29T18:41:34","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/?post_type=chapter&p=468"},"modified":"2026-08-24T16:24:25","modified_gmt":"2026-08-24T20:24:25","slug":"biases-in-nutrition-care","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/chapter\/biases-in-nutrition-care\/","title":{"raw":"4.8: Biases in Nutrition Care","rendered":"4.8: Biases in Nutrition Care"},"content":{"raw":"

\u00a0Case Study #7<\/h2>\r\n
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Meet Mr. Campbell<\/h2>\r\n<\/header>\r\n
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Read the following case study and complete the questions before moving on.<\/p>\r\n

You are a dietitian at a Community Health Centre, and you receive a referral to see Mr. Campbell.<\/p>\r\n

Reason for referral:<\/strong> \"Client loves rice and mostly eats West Indian food. Needs help to make healthy choices.\"<\/p>\r\n\r\n\r\n\r\n\r\n\r\n
Mr. Campbell's basic health information<\/caption>\r\n
Age \/ Gender<\/th>\r\n42-year-old cis-gender male<\/td>\r\n<\/tr>\r\n
BMI<\/th>\r\n>27. Client thinks his weight is fine.<\/td>\r\n<\/tr>\r\n
Medical Hx<\/th>\r\nPrediabetes (elevated A1C)<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Social Determinants of Health (SDoH)<\/p>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Mr. Campbell's Social Determinants of Health<\/caption>\r\n
Social support<\/th>\r\nRaising young daughter on his own<\/td>\r\n<\/tr>\r\n
Housing<\/th>\r\nUnknown<\/td>\r\n<\/tr>\r\n
Employment<\/th>\r\nShift work<\/td>\r\n<\/tr>\r\n
Education<\/th>\r\nUnknown<\/td>\r\n<\/tr>\r\n
Citizenship<\/th>\r\nImmigrated to Canada from the Caribbean 5 years ago<\/td>\r\n<\/tr>\r\n
Language<\/th>\r\nFirst language is English<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

Diet History<\/p>\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Mr. Campbell's Diet History<\/caption>\r\n
First meal ( )<\/th>\r\nWater<\/td>\r\n<\/tr>\r\n
Second meal ( )<\/th>\r\nWater<\/td>\r\n<\/tr>\r\n
Third meal (7pm)<\/th>\r\nA full plate of rice and peas or provisions with stew chicken, stew beef<\/td>\r\n<\/tr>\r\n
Snacks ( )<\/th>\r\nMostly water<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
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  1. Are there any details in the referral that can impact your bias before meeting the patient?<\/li>\r\n \t
  2. Take note of their social identities (e.g. age, gender, sexual orientation, education, citizenship, etc.). What are some identities that you do not know and may never know?<\/li>\r\n \t
  3. Review your own social identities. List how your identities and experiences offer privileges that may create an imbalance of power, or impact your assumptions, understanding or biases of the patient. Recognize these as areas for curiosity, compassion and empowerment.<\/li>\r\n \t
  4. List assessment questions you may have about the patient to better understand their health goals and needs and your capacity to support them.<\/li>\r\n<\/ol>\r\n

    Going through these questions will enhance your cultural safety skills. With practice, you can work towards developing skills in cultural competence, cultural sensitivity, and then cultural awareness. These more advanced skills will be discussed in Chapter 5.5<\/a>. You can see the full case study and how Tameika Shaw, a Black RD from Ontario, navigated this real situation, using all four skills, moving beyond basic awareness and competence toward deeper self-reflection and patient-centred care, on the next page.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n

    Case Study: Anti-Black Racism in Entry-Level Dietetic Practice<\/h2>\r\n

    Author:<\/strong> Tameika Shaw from Ontario<\/p>\r\n\r\n

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    Trigger warning:<\/strong> This case is an example of bias, food insecurity, ignorance, the experience of an immigrant with the healthcare system, food policing, parental buffering and diet culture.<\/p>\r\nKeywords<\/strong>: Bias, Food Insecurity, Systemic Survival, Parental Buffering<\/a>\r\n\r\n<\/div>\r\n

    In my first year as a dietitian, a 42-year-old client was referred to me for having a Body Mass Index (BMI) greater than 27 and for healthy eating. This client was new to Canada (in Canada for less than 5 years and raising his daughter without family support). I worked in a multidisciplinary setting, and it was part of our practice to refer everyone to the various allied health professionals for support. Most of the time, the referrals were appropriate and yielded impactful outcomes for the clients in various ways.<\/p>\r\n

    However, in this particular referral, there was a note that stated that the client \"loved rice\" and \"ate mostly West Indian food\" and needed help to \"make healthy choices\".<\/p>\r\n

    At my first encounter, the client questioned the reason for referral. He said, \"I was told I needed to lose weight.\" However, he believed his weight was fine. Since he was already in the appointment with me, I offered to proceed with an intake and dietary assessment, noting that we did not need to focus on weight management as there were other benefits to eating well. The client agreed to proceed and started to answer questions and share his food recall. He was asked about his ability to acquire and prepare food, which he denied having any concerns. In his diet recall, the client revealed that he ate one main meal per day. This meal was eaten at dinner around 7 pm when he came home from work. He described his meals as a full plate of rice and peas or high starch root vegetables like yam, potatoes or chicken, a meat dish. When asked about his reasoning behind eating one meal per day, he said he wasn't hungry until the evening. Side note: this was 2009, and Intermittent Fasting was not as popularized, so it wasn't as typical to have one meal.<\/p>\r\n

    I provided the counselling and nutrition recommendations as I learned to do. I pulled out the Food Guide as an easy visual graphic, food replica models, and a divided plate to demonstrate the recommendations for food groups, how to eat 3 balanced meals per day with half the plate filled with vegetables, moderate carbohydrates, 1\/4 protein, etc. My other advice included: aim to consume brightly coloured fruits and veggies as snacks, eat fish, drink milk, drink water, and move more often. I did not tell him to eliminate his traditional foods, instead shared information on the nutritional benefits of sweet potatoes, pumpkin, yams and how to include them in a balanced plate. He felt relieved that he did not have to completely eliminate these foods from his diet.<\/p>\r\n

    The client agreed to return for a follow-up appointment to check in on goals. At the second appointment, the client reported that he was still eating one large meal in the evenings, as he says he isn't hungry during the day. Since he was only eating once per day, he kept his portions the same.<\/p>\r\n

    Then the client disclosed that he wanted to try quinoa instead of rice because he heard it was better for him, but saw that quinoa was expensive when he went grocery shopping.<\/p>\r\n

    He then started to talk about his child's food intake, that he made sure his daughter ate well. He provided breakfast before school, packed her lunch with two juice boxes, snacks and dinner. Based on the description, I asked if he made different meals for his child. He answered yes. He stated that the teacher examined his child's lunch and would often send notes home if they felt the lunch didn't meet \"standards\". He said, \"That's why I leave the fruits so she can have those in her snacks\". \"It's why I send 2 juice boxes, I make sure my daughter has plenty of \"Canadian\" food. I don't want her teacher to contact me\".<\/p>\r\n

    By this second appointment, his blood work had been shared by his provider, and it revealed an elevated HbA1C > 6.0%, indicating pre-diabetes.<\/p>\r\n

    The client agreed to try some other strategies, like increasing movement and adding a veggie dish of his choosing to his daily intake, as some small steps. He rebooked for the 3rd appointment but did not show up. When he finally came in, he mentioned that he got called in for a shift, so he took it because that was extra income he needed.<\/p>\r\n\r\n

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    Clinical Insight<\/h2>\r\n<\/header>\r\n
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    Parental buffering is the practice of parents shielding their children from the experience of food insecurity, often by restricting their own food intake or skipping meals to ensure their children have enough to eat (Black food insecurity in Canada, n.d.). This survival strategy should not be mistaken or mislabeled or nutritionally diagnosed as a \"poor choice\" or \"poor eating habits\". It would preferably be captured as a sign of food insecurity.<\/p>\r\n

    Black Canadians face the highest rates of food insecurity among racialized groups in Canada, with nearly 40% of Black households experiencing inadequate access to food due to financial constraints as of 2022-2023 (Carleton University, 2023; Daily Bread Food Bank, 2021; PROOF, n.d.; Statistics Canada, 2023; University of Saskatchewan, n.d.). The evidence reveals that they are 3.5 times more likely to be food insecure than white Canadians, and that the underlying causes are largely driven by systemic racism and income disparities, with 55% of Black households with a disability reporting food insecurity.<\/p>\r\n

    This is an example of how systemic survival exists within the context of food insecurity. Manifesting as adaptive strategies, behaviours, and compromises, individuals and households may adopt to manage chronic or severe food shortages, caused by structural failures in the food system, economic inequality, and inadequate income.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n

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    Stop and Reflect<\/h2>\r\n<\/header>\r\n
    \r\n\r\nFood insecurity, as demonstrated by parental buffering and food policing, is a concern highlighted in this case study.\r\n
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    1. What are the systemic issues and racial discrimination at play, and how did they impact this client\u2019s decision regarding his and his child\u2019s food intake? If you have difficulty identifying the issues, review the case with a friend, family member or colleague to see what you can come up with together.<\/li>\r\n<\/ol>\r\n
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