“ I think another challenge beyond just this disparity between diversity and dietetics is just that a lot of times we don't get paid enough as dietitians and sometimes we're starting to seek out other opportunities that help us pay the bill sometimes, but don't always align with our interests or motivations for helping individuals”
Details
Transcript
Resources
In this episode, we welcome Dr. Matthew Landry, an assistant Professor of Population Health & Disease Prevention at University of California Irvine. We’ll discuss food insecurity, health disparities, and cultural food.
Matthew Landry is an Assistant Professor and Registered Dietitian Nutritionist in the Department of Population Health and Disease Prevention at the University of California, Irvine.
Shireen [0:32]: In today’s episode, we welcome Dr. Matthew Landry. We will discuss food insecurity, cultural foods, challenges within the dietitian community and policies that will help expand coverage for dietitian services. Stay tuned. Dr. Matthew Landry is an assistant professor and registered dietician nutritionist in the department of population health and disease prevention at the University of California Irvine. Welcome, Matthew.
Dr. Landry [1:02]: Thanks for having me.
Shireen [1:03]: An absolute pleasure. So Matthew, let’s get into your why first, can you tell us why you became a registered dietician, nutritionist and what really sparked your interest in the field of nutrition?
Dr. Landry [1:14]: Sure. So I come from South Louisiana, where we have some wonderful cuisine. But at the same time, I see a number of health disparities amongst that same community. So we see high rates of heart disease, stroke, overweight and obesity. And at the end of the day, some of those chronic diseases are diet related. So even though we’re getting these wonderful meals, we’re having those opportunities to connect with our families. Some of the foods that we’re choosing to eat sometimes are also linked with poor health outcomes. And so I originally wanted to go to med school with this goal of improving health and conquering some of those chronic diseases and soon realized that I actually liked working much earlier and downstream, really focusing on prevention before we ever had those chronic diseases. And how can we still have prevention, but still have those same enjoyable foods, I mean, that really sparked my interest in going into nutrition and finding that right balance of still enjoying the foods that we love to culturally consume. But also understand that we do want to reduce some of those health disparities.
Shireen [2:27]: Thank you for providing that background. You know, for this episode. Today, I want to talk a little bit about sort of as your background with specifically within being a behavioral nutrition researcher, you have three key points that really guide your nutrition research. Can you walk us through what those three points are? Why those three points? And then also explain to us what sparked your interest in these specific topics?
Dr. Landry [2:52]: Sure. So very broadly, I’m interested in what, why and how. So I’m interested in what people are eating, understanding the behavioral and the social influences as to why people eat the foods that they do, and then working with individuals and also communities to understand how to overcome those barriers and improve their diets. And I think a lot of that covers different segments of nutrition. Number one, even though we think we know sometimes what folks are consuming families or communities or even just individuals, our food system is constantly changing. And we have to stay updated with what are the new food products? What are people now consuming? How have diets changed, and ebbed and flowed over time. Next, I always want to understand what are those behavioral and those social constructs that influence why we’re choosing sometimes the foods that we do? Maybe it’s something that we’ve culturally always eaten, or maybe it’s something now that based on economic kind of circumstances, we have to eat at a certain point. And then the last point that I’m interested in is how do we work with those communities in those individuals to find that right balance, again, of improving their diet by overcoming whatever barriers that are standing in their way. And at the root of it, I always want to make sure that people are still enjoying food. I think it’s this kind of transformative kind of aspect of our lives that really brings us together. And I never want someone to have a negative relationship with foods. I always wanted it to be a positive one. But I also wanted to contribute it to positive health at the end of the day.
Shireen [4:36]: And you know, a lot of this is very well intended. But what do you think is the challenge in the way that healthcare approaches this today?
Dr. Landry [4:46]: Sure. I think one of the big things is that we focus just on individuals and sometimes forget that we’re social beings and that we have, we’re part of families, we’re part of networks. And so when we go to the doctor Are we often go alone, our current kind of health care system is built so that we self manage our chronic diseases, we self manage our health. And if we have to make a lifestyle change, it’s often absent of our families. It’s absent of our networks, our communities, I could give you an example that a physician asked you to stop smoking tomorrow, but everyone in your household still smoked, then chances are, you wouldn’t make that change. And it’s the same thing if a dietitian is asking you to make some kind of dietary shift or change in what you’re consuming. It doesn’t work if our families, our networks, and our communities aren’t also part of that kind of effort. And they’re involved. And so I think one of the big disconnects is that we really need to rework our health and our well being strategies to include those key social networks.
Shireen [5:56]: And when you’re talking about the network, the community, it actually leads me to my next question, which is we know that food insecurity and addressing food insecurity, specifically, it is a huge risk factor, especially when we’re talking about chronic illnesses. I want to take it a step back, which is to say, what connections have you really discovered between childhood food insecurity and chronic diet related diseases later in life?
Dr. Landry [6:22]: Sure. So I think my first role exposure to food insecurity just among children occurred when I was a doctoral student at the University of Texas at Austin, we were working on a school based intervention, where going into low income, primarily Hispanic schools, and I was helping a third grader fill out a survey questionnaire. And I was reading out the questions, and he would tell me back his response. And for one of the questions, I asked him basic kind of food insecurity screener question. And he responded, oh, yeah, I do that I oftentimes eat less so that my younger sister has a little bit more to eat. And immediately, my heart just kind of broke, I never expected a seven year old to give that kind of response, they were so young. And that really, you know, to this day, inspires a lot of the work that I do in food and nutrition security, that I never want any kind of child to have that kind of response at such a young age, to realize that, hey, I have to eat less about a family member has enough to eat
Shireen [7:28]: thats helpful, you know, what common health disparities Do you see, for the most part, and how are you and other dietitians specifically working to address these disparities?
Dr. Landry [7:41]: Sure, in my local community now in Orange County, California, which is oftentimes thought of as a very affluent community, and many pockets of our county aren’t very affluent. However, we do have those pockets where individuals are not as affluent. And they’re suffering from basic needs, insecurities, so they may have challenges paying for their monthly rent or their mortgage, they may have challenges paying for medications, or they may have challenges paying for food, or sometimes all of those things occurring all at the same time. And it’s that constant struggle of trade offs one or the other. And they oftentimes get in this cycle of poverty that unfortunately exists where oftentimes, they may have poor health, and because of their circumstances, they don’t get to choose the foods that would promote better health, their health continues to decline. And at a certain point, they might have to choose food over medication or the vice versa. And then unfortunately, just continues to spiral. And even going back to your question of where does this kind of fit in with children is that they’re born sometimes into those families that don’t really support that good health, that good growth. So what I think many of us are doing here, at least locally, and I think this could be extrapolated, kind of across the country with many dietitians or working in these public health nutrition settings is to identify those families and help connect them with those local resources that are really culturally appropriate for them, you know, sometimes just a little bit of a leg up, and to have those resources where it’s food or medication or those housing assistance, so that they can start improving other aspects of their health.
Shireen [9:29]: You know, when you talk about these types of communities in these groups, it’s important to also talk about groups that have largely been disproportionately impacted by food insecurity chronic conditions, and we see a lot of Western dietitians sort of label be it soul food, cultural foods as unhealthy or even as for the most part, unhealthy just really using that framework of a Eurocentric you know, sort of food model. How do you challenge this model? How do you move the Conversation the needle further on it and implement cultural food within this framework.
Dr. Landry [10:05]: Sure. So again, coming from South Louisiana, I think one of my examples that I always go to is that several years ago, Disney put out a recipe for healthy gumbo. It had kale and quinoa in there. And I just remember the news articles from when I was living in Louisiana that it was like, Absolutely not. And personally, I love kale. I love quinoa. But those things don’t belong. gumbo, no questions asked. So that was something that even for me, you know, a white guy. That’s part of my culture. And I don’t think those two things mix. And I think it rubbed folks in the wrong way. And so I certainly resonate with this kind of topic of how do I as a dietitian wanting to promote health, and promote decreases in chronic diseases. Also, understand that we have strong attachments to many of the foods that we’re consuming. And I think it really comes down to a lot of times our context, that simply making or recommendations for swaps or additions to foods might not always be the best case to go. I think back often to something called the transtheoretical model or the Stages of Change. Oftentimes, we’re not really looking to immediately kind of change our diets. And that’s where most people are kind of starting. So when they see an article that’s telling them that a cultural food that they’ve always consumed is now unhealthy, and they need to change it, that’s going to rub someone the wrong way. But in the right context, where someone is actively looking for some dietary changes is open to that, then I think there’s that window to start recommending a few different changes and things like that. I also think it’s really important to understand that we recommend that the kale or the quinoa goes as a side dish or something like that, that supplements the kind of cultural food, maybe it’s not intertwining the two, we again have these big strong associations with sometimes just the food. So rather than calling it healthy gumbo, or gumbo with kale or something like that, maybe it’s a completely different dish that we describe it as, and we present it in that way. But again, I think it really comes down to that context, in the specific situations of knowing when is appropriate. Are we doing this? How would the community really feel about this? Or how would individuals feel they’re really putting data at the center before giving any kind of recommendations.
Shireen [12:33]: And what I also hear from that is that the implication of a healthy gumbo almost implies that gumbo in the way that you eat it is unhealthy. Right. Right. And that also has its own implications. Right.
Dr. Landry [12:46]: And again, I think as dietitians we never want to be that one that says that, hey, the food that you’ve been consuming, and that your grandmother and your mother or your father or grandfather made for you all these years is unhealthy, and we need to make it better. I think that’s absolutely the wrong approach. And we need to approach this with some cultural sensitivity at the forefront.
Shireen [13:06]: And you know, when we’re talking about cultural sensitivity, some of the other things that came up, what are some issues within dietitian community that exists today that you believe really need to be addressed?
Dr. Landry [13:20]: Sure. One, I would love to see just up front more diversity within the profession. So having more diverse dieticians to be able to go out in those communities and already understand the community understand some of that background that they’re going through, without having to go through that process of really learning. I think it’s totally fine to have some discordance with, you know, a provider and someone that you’re serving either an individual or community but you know, it does require more work to understand the background, things like that. I’ll give an example. I just moved recently to Orange County, and it has some of the highest Vietnamese population outside of Vietnam. And I was surprised to kind of learn that that’s a community that I’ve never had an opportunity to certainly kind of work with before. So before I would ever go into that community do an intervention or do some kind of public health education session, I got a lot of work to do before I go to do that. But what would be even better is someone that is from that community that already understands it already understands the context behaviors, or even things that as much learning as I will, you know, could do, I’ll never going to fully understand. That’s one of the big things that I think would be great. But I think another challenge beyond just this disparity between diversity and dietetics is just that a lot of times we don’t get paid enough as dietitians and sometimes we’re starting to seek out other opportunities that help us pay the bill sometimes, but don’t always align with our interests or motivations for helping individuals. I’ve started to see dieticians charge higher and higher rates. And I think we’re attracting individuals that can pay that money. But sometimes I forget, I worry about the folks that can’t afford that nutrition care or don’t have an insurance provider that would cover that. Where are they getting that nutrition information from? And I think many of us got into the profession of wanting to help. And so I would really encourage the dietitian community to really rethink of, are we doing as much as we can to help out everyone? Or are we creating new barriers and structural problems that we’re providing care to some but not to every one?
Shireen [15:37]: You bring up an interesting point there. And you’re absolutely right. I mean, there’s that lack of diversity, dieticians, but then the flip side to that is that dietitians are not well paid as a profession and yet they’re such a huge part of those chronic disease epidemic that we have. Right. And I just find it baffling that that sort of exist, what are the steps that we are seeing, maybe from policy help us understand what down the road it looks like for dieticians, and access to dieticians, specifically in these communities that are disproportionately impacted by chronic conditions? Sure.
Dr. Landry [16:50]: Sure. So at least right now, there’s two big bills that are kind of going through the legislative process. One is treat and reduce obesity act. And then the other is the medical nutrition therapy act. And both of those bills will number one, expand kind of reimbursement for nutrition services provided by a dietitian, and especially within those kind of low income communities. And so that’s something that not just dietitians, but everyone should be supportive of, we could call up our legislators today and say this is an important thing that everyone, not just the dieticians need to be advocating for, because it expands that coverage. And you know, you could argue that, that might only kind of push the needle a little bit, but it’s a step in the right direction. And I think we’re having greater and greater coverage. And then we’re starting to really be able to effectively serve some of those communities, I think we’ll start seeing more people enter into the profession that they see, again, start to make a difference in this area.
Shireen [17:16]: Can you speak a little bit about each of these acts and also help us define what is medical nutrition therapy?
Dr. Landry [17:22]: Sure, so medical nutrition therapy is provided only by dieticians. So while we might have nutrition education from anyone with some kind of nutrition credential, medical nutrition therapy is really geared at providing nutrition for some kind of chronic disease, either the prevention or the treatment of that particular chronic disease, again, only provided by a registered dietitian. Each of those bills the first wound the treat and reduce obesity Act would provide reimbursement for RDNs. So dietitians to be able to provide services for weight management for individuals or people with obesity to be able to mitigate the impacts of that disease and receive that nutrition assistance. The other big bill would be the m&t Act. So the medical nutrition therapy act. And again, right now, insurance only covers a certain number of n and T kind of services provided by a dietitian under Medicare, this bill would expand that, and then allows a greater number of services that a dietitian could be able to provide that MNT for and get reimbursed for. And so that’s huge in the sense that there’s a number of Medicare picks and the populations that would benefit from that, that increased coverage.
Shireen [18:44]: And the important thing there being that even if dietitians were there to provide services, the flip side of that, where these types of policies will help, which is around coverage of those services, because otherwise you go more into that cash pay population or self insured population where you may or may not get coverage, and it really kind of depends or is up in the air. Meanwhile, if it comes down with the regulatory policy side of things, there is that expanded coverage that all plans regardless will need to provide. Is that correct? That’s helpful to know. We are coming up toward the end of this episode. I do want to take a minute though. And if you wouldn’t mind helping us understand a little bit more around the type of work within which you are doing at UC Irvine. What are the sort of the ripple impact of this type of work that you see in your community there in Orange County? And what can other dieticians listening to this year today? Do Differently in their own practice as well?
Dr. Landry [19:17]: Right. That’s correct.
Shireen [19:19]: That’s helpful to know. We are coming up toward the end of this episode. I do want to take a minute though. And if you wouldn’t mind helping us understand a little bit more around the type of work within which you are doing at UC Irvine. What are the sort of the ripple impact of this type of work that you see in your community there in Orange County? And what can other dieticians listening to this year today? Do Differently in their own practice as well?
Dr. Landry [19:44]: Sure. So one of my kind of new exciting projects and that was actually just funded by the American Heart Association. Looks at first time fathers in particular. So again, kind of going back to that whole family approach. A lot of times in public health we focus on maternal and child’s health and forget about the dads as part of that. So my research really focuses on what are the dads experiences? And how does their health and lifestyle behaviors to diet, sleep physical activity? How do all of those aspects change as they become fathers? And how can we support them, as well as mom and baby as well. And again, I would certainly encourage all dieticians to really think about that social aspect. So we’re not just treating individuals but we’re really focusing on their entire family, that entire network that they’re supported by as well.
Shireen [20:33]: With that we are toward the end of the episode Matthew At this point, I would love for listeners to know how they can connect with you learn more about your work.
Dr. Landry [20:41]: Sure, So folks can find me off of the UC Irvine faculty page. My name is Matthew Landry. Additionally, folks can find me on Instagram and Twitter, use the handle @theguyititian, so dietitian is G-u- Y -i -t -i -t -i-a- n just a play on dietitian since there’s actually very few male dietitians in the profession. And so yeah, I would love for folks to be able to connect with me on either of those kind of platforms.
Shireen [21:10]: Lovely, thank you so very much for your time, your Matthew and we’ll link up by the way, everything that you just mentioned in the show notes below to so to our listeners, a scroll below and you should be able to link up to all of that. Again, thank you so very much for your time here Dr. Landry. For the rest of our listeners, we can continue the conversation here that we’re having over on social media. Your question is how do cultural foods in your community shape your health and lifestyle? So head over to our Facebook or Instagram @Yumlish. Find this podcast post and comment below to tell us again, how do cultural foods in your community shape your health and lifestyle? We’ll continue the conversation there Dr. Landry. Thank you so very much again for your time.
Dr. Landry [21:54]: Yeah, thanks for having me.