Shireen: In this episode, Dr. Melissa Fuster talks about the influence of cultural and structural factors that influence nutritional practices. She specifically looks at these factors through the lens of the Hispanic Caribbean communities. She further talks about ethnic restaurants, nutrition environments, and ties that with healthy eating practices for chronic disease prevention and management.

This episode is part of our series dedicated to addressing health inequalities in nutrition and diabetes, for the month of January. During the series, we hope to educate listeners about how structural and cultural factors impact health care and nutritional practices. This month, we will bring in experts to discuss topics including food sovereignty, the whiteness of the Mediterranean diet, reimagining Hispanic Caribbean nutrition, and how public health food policy gives rise to chronic disease.

Podcasting from Dallas, Texas. I am Shireen, and this is the Yumlish Podcast.

Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions, like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Dr. Melissa Fuster is Associate Professor at the Tulane University School of Public Health and Tropical Medicine. Her research examines the contextual factors influencing food practices and the policies and interventions implemented to improve them as featured in her new book Caribeños at the Table: How Migration, Health, and Race Intersect in New York City, and current research, engaging Latin restaurants in designing and implementing innovations to facilitate healthier eating.

Welcome Dr. Fuster. 

Melissa: Thank you. Thank you so much for having me. 

Shireen: An absolute pleasure! Dr. Fuster, why did you decide to pursue a career in food policy and nutrition with this particular attention on minority and immigrant Hispanic Caribbean populations?

Melissa: Yeah, that, that is a great question, especially when you think about it from the present thinking of your life journey, right, and how did I get to where I am today. Um, I think I can answer this question in two parts. First, my interest in food first came just because food is very interesting to study. Um, and even though I did start my, I started my education in biology and then I switched to social sciences. And in that process, I, I started to become very interested in courses that talked about culture and food. And how food is so personal. Also just having, you know, we all eat and then what you eat, what you don't eat tells a lot about who we are. Um, so as I, as I was starting to figure out what to do when I grow up, um, again, I decided I wanted to focus on food, but I don't want to necessarily become a registered dietician.

So, I was able to come across this, uh, interdisciplinary program that allowed me to study food from a policy and intervention perspective at Tufts University. So, I studied food policy and applied nutrition, um, and, you know, allow me again to understand food, uh, as a, as a vehicle for improving community wellbeing, livelihoods, uh, that reciprocal relationship between that.

Um, and then, you know, and then to go to your other part of the question, my interest in immigrant and minority communities, it's very personal. I, um, I was born and raised in Puerto Rico. So, when I came to the U.S. I was of course, super interested in learning more about my community, and I could see that the issues my community was facing, um, with obesity diet related conditions and, and as a researcher, you want to do something that, that helps. And, and again, it was that, that personal aspect of it with Hispanic Caribbean populations. And then also with, with Latin communities in general, I have done work in, in Latin America and here in the U.S. with Latinos, not only, Hispanic Caribbean but with others as well. 

Shireen: So, let's, let's dig into that a little bit. How do cultural and structural factors, um, such as migration, food insecurity really influence nutritional and practices?

Melissa: Yeah. So, in my work, in the, in the beginning, when I started to understand more about, about food, again, that connection between food and our identity. And again, coming here, uh, technically as an immigrant. And although we can of course talk about it, Puerto Rico, sending immigrants that that's another, another podcast. Um, and, and in that process, I started focusing a lot on, on how culture influences our relationship with food, how we adapt to new food environments, but then as I, as I continue my work and I kept, you know, doing community-based research and also engaging with, uh, for example, I, I taught courses for a future dietetic students.

I also became very aware that we, as a profession, meaning public health nutrition, tend to overemphasize culture at the expense of structural factors. So that's a lot of what pushed my work in trying to say like, okay, yes, culture is important where we're from, because again, it dictates or influences, right, the foods we eat when we grow up at home. Um, but then there are other things like, our race, income, gender that really affects our access to livelihoods and then affects our access to food. And then of course, if, we don't have access to food or, or, uh, we don't know which foods are healthy, all those things can really affect, um, nutritional practices and nutritional outcomes.

Shireen: How, how do these factors impact, in particular, Hispanic Caribbean communities?

Melissa: So, um, that is something I, again, my book really tries to take a deep dive in, in that. And what I do in the book is, um, again, trying to just not say it's just culture, just where we're from, but really understanding our current situation and in, in my development as an academic too, I also think that, you know, looking at food and nutritional issues requires, uh, interdisciplinary perspective.

And in doing that, for example, in the book, I do dwell into history. I took a very deep dive into the history of, of the community. I borrow from amazing scholars in migration studies to understand the theory behind the push and push and pull factors that influence what motivates people to leave their homes, cross borders, and come to the US.

For example, in the specific places that we come to and all of that really influences our wellbeing today. That for example, here in New York city, that the Puerto Rican and the Hispanic Caribbean community in general has a very long history in this city. So, thanks to that, for example, in New York, we have access to all the foods really that, that we can find in the, in the Caribbean, and actually everywhere in the world.

But at the same time, we're also subject to discrimination. Um, the way people see us is because if they see you that you are Puerto Rican, there are of course some bias, even though of course they might be implicit, but they're attached to the community because of the way that, that they view us. And that has to do with, with our history, um, and how we came here.

So, there is a lot of that. And then also as part of that movement, um, we also – immigrants undergo racialization processes that we are, for example, in the Caribbean we do of course have black, white distinctions, but not as stark as here in the U.S. where there is that one blood idea that you're, if you're not white, then you are definitely black.

So, there are people that move from Latin America, from the Caribbean that were not subject to that sort of racialization structures, and they move here and they're subject to, to a different way of viewing them. And that definitely affects discrimination. And again, as I said before, all of that really affects access to, to, to how they view us, uh, access to livelihoods and also access to care, how the medical profession, uh, profession, uh, address patients. How culturally competent they are to, to deal with, with culturally diverse communities, for example. 

Shireen: You know, speaking of your book, um, Caribeños at the Table: How Migration, Health, and Race Intersect in New York City. It really discusses how Hispanic, Caribbean individuals and healthcare players like dieticians conceptualize this “traditional die”t and high rates of diet related diseases. Can you provide an example of how medicine racializes or pathologizes a Hispanic Caribbean cuisine, the helpfulness, or even unhelpfulness of it? 

Melissa: Um, yes, that, that is something I, in the book, the way I, I dug into that is that, um, I have a chapter where I interviewed registered dieticians that work with Caribeños in the city. And I combine those interviews with public health, nutrition research to really understand how my field and addresses or understands or, or approaches the food waste of, of Latino immigrants and specifically Spanish Caribbean immigrants. And in that, uh, again, going back to the history, unfortunately, my, my profession has had a history of, of it seen, for example, the diets of immigrants, of, of the other, as deficient and an example that, that we can think of for example, is, uh, the way Italian American diet was viewed when they first came here.

That it was viewed as, as not having the nutrition, the correct nutrition, all of that, but that interestingly as Italian-American shift and became wider in, in the, in the, in the general population size. Now, if you think about it, you have the Mediterranean diet, so it's really healthy. So, it's, it's interesting how those shifts happen.

And, and even though I will say that the nutrition profession has improved a lot, there is a lot of emphasis on, again, cultural competency, understanding what other people eat. Uh, dieticians are required many times to, to learn other people's foods to better, eh, counsel them in how to improve. I could see some of that authorization in the way they spoke about Caribeños and their diet, and they were saying things like, oh, I could not eat like that every day or, yeah. It's just something, the way they're used to eating that is tied to poverty. So, it was this thing. So, if there is something wrong with the diet and it's tied to culture, so yeah, so that, that, that's what I I've found in that way.

But then on the other hand, they also spoke about culture, as I said, a way to solve the problem. So, it was like this really interesting, uh, contradicting way of, of speaking of culture really. 

Shireen: Um, help us understand the, you know, the, the second part of bio just really talks about all the work that you're doing with the restaurants, help us understand why are ethnic restaurants, nutrition, environments, and healthy eating practices so important specifically as we talk about chronic disease prevention and management, and then what disparities exist for Latin Caribbean restaurants? 

Melissa: Yeah. So, this, this project that I'm working on is the Latin America and Restaurants in Action project, the LARiA project, and the project is funded by the National Institutes of Health. And actually, it came about from my work with Caribeños at the Table where I am in that, in, in the chapter that I was just speaking with another thing that I, I realized that we need to change. Is that there is too much emphasis on individual behavior change, that we put so much into the individual that we have to be right, we have to make the decisions and we need to do more to improve where the food is coming from. Um, and that's what the work with restaurants comes from that of that awareness that we need to improve what environments to make healthier choices accessible. But also, not only accessible and easy to make, but I also think that healthier choices could be made the preferred choice because you know, that people tend to think, oh, healthy food is bland, I'm not going to eat vegetables, all of those things. Um, so I, I see restaurants as a vehicle to, to change. Uh, not only the surrounding food environments in the communities, but maybe as a way for people to, to realize that there are other ways of eating vegetables or, or non, non-fry foods that can be delicious and enjoyable.

So, a lot of that work with the restaurants, um, comes from that. And, and also this work is also inspired because restaurants in general are seeing that there is a demand for more healthy foods. Um, and then, but then when you look back to your second question, when we look at the Latin restaurants in the U.S., um, I see that they're not really benefiting from that increase demand at times.

So, with that, that was also, you know, that the project has this emphasis on, of course, improving food intake, but also trying to boast these, these restaurants and get them to, to take advantage of these new markets that, that is emerging.

Shireen: Can you, can you provide an example of what kind of disparity exists there? 

Melissa: Yeah. So, I don't know if, um, disparities if I can explain them that way, but for example, um, that there are, again, I see that there some movement in the, in the restaurant industry in general, for example, for more vegetable forward dishes. We have amazing restaurants, um, really catering to that increased demand that comes not only from nutrition, but also for concerns over sustainability. But then when you look at, at community restaurants, uh, those ‘mom & pop’ places, um, there's still that they, they really at times fail to, to cater to that knew demand.

So, they still do a lot of, of fried foods, not a lot of vegetables, or if they do vegetables, they do, uh, like the, the steamed, uh, vegetables that, that maybe we grew up as we grew up eating that then marked us for life that we don't want to eat any vegetables anymore. Um, but that, that is what I mean that there's this opportunity for, for Latin restaurants to, to change and, you know, innovate the way the cuisines are being presented. And you see that innovation, if you go to, to Latin America, I've done, uh, of course I've eaten in places in Puerto Rico. I've done some work in Cuba and Dominican Republic and, and the cuisine there is also innovating. You see some farm to table movement happening, uh, but then that innovation is not reaching that much what is happening here. Mexican cuisine of course is another example where here in the U.S. people tend to think of this cheese, heavy sour cream, heavy Mexican American food. Whereas if you go to Mexico, it’s a much simpler, a lighter fair at times and their restaurants doing it here, but then they're not, ironically, they're just seen as not authentic because they're not offering that heavy meal that people hear and learn to do classify as Mexican through places like Taco Bell, for example. 

Shireen: Can you, can you see it? Can you tie it back for us to diet related chronic illnesses like diabetes, like heart disease? What can restaurants really do to address these challenges you talked about in Hispanic Caribbean nutrition, and then again, just tying it back to diet related chronic illnesses. 

Melissa: Yeah. So, we, you know, research shows that more and more we're eating out. Of course, those trends may have changed with COVID, but in pre COVID times, people were eating a lot of their calories or spending a lot of their food budgets away from home.

So, so there are, again, uh, an increased portion of, of calories are coming from restaurants. So that, that is one main piece there. Um, and then as I said, I think, uh, you know, when, when you go to a restaurant, you also see how things are made. So if you see a dish that that's fried or cook with a lot of salt, uh, the reverse could be that if you see a dish that, that instead of being Fridays grills or, or vegetables, that, again, back to the sad steamed vegetables, if you find better preparations on, on the grill or on the oven, I feel that, that, that could have, uh, a motivation.

Like I know this is a, of course anecdotal, anecdotally, but the first time I tried and enjoy a brussels sprouts was at a restaurant. And then from there, or I, I started cooking them at home. Beets is another one that I used to think of beats as that, we're saying that came out of a can. And then when I try fresh beef cooked by a chef, I'm like, oh, you know, this is not that bad, I can do it at home. So that there's that connection that I haven't tested it yet, but I feel it could be, it could, it could happen, but more, more concrete things that, that restaurants are doing already, that I can see it working in Hispanic Caribbean restaurants, you know, a potential one could be, for example, the decreasing frying, not everything has to be fried.

You can grill things or bake or, and they can still be delicious. Um, and other one that I, that I've seen restaurants do is for example, decreasing the portion of the, of the meat in favor of high, bigger portions of vegetable. Um, portion size is another one that, that could be, could make a big difference. Not only decreasing the overall portion sizes, but offering portion choices, so that you can eat half a portion instead of a full portion. But however, um, I'm actually working on an analysis right now of how restaurants view this. And, and even though something as simple as portion size, it might not help so much that the business side.

So, if there's some alternatives that will require some negotiations with, with restaurant.

Shireen: Well, this conversation was very interesting, Dr. Fuster. I think that the big thing there is that it is so multilayered. It's not only what is happening within culturally competent nutrition. It is also a combination of what’s being cooked at home versus what's being consumed outside of the home.

And there's a role for all of us to play in this specifically as we're talking about chronic disease management or even possibly prevention. Um, so that was a very delightful conversation with you. Um, at this point I would love for our listeners to know how can it, how can they connect with you and learn more about your work?

Melissa: Thank you. And thank you also for, for the conversation. Um, yes, so, uh, the listeners can find me, I am more active on Twitter. So, they can find me @MelissaFuster. Uh, I also have my website at WordPress. Um, so if you've look WordPress, Melissa Fuster, you will find me, and my blog Comida Studies. So that is, uh, I post there some updates of my work. And then also, uh, through the LARiA project, you can find us on all Instagram, Facebook, and Twitter, and we also have a website. So, if you're curious about the restaurant work, uh, look up the LARiA project. 

Shireen: Lovely. And, uh, where can we find your book? Uh, Caribeños at the Table: How Migration, Health, and Race Intersect in New York City.

Melissa: Thank you. Yes. Uh, the book can be purchase directly through the press. Is University of North Carolina press, or it can be found in actually any place that then people get their books, uh, including Amazon or, or your local bookstore, even if they don't have it. Um, they can order it for you. 

Shireen: Lovely. And with that, Dr. Fuster, thank you so very much for your time today. It was a pleasure having you. 

Melissa: Thank you for having me.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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