Chapter 12: Culturally Centered Approaches to Culinary Medicine

By Martina Cartwright, PhD, RDN; Lauren McCullough, MPH; Lucia Ramonet, MS, RDN, CNSC; Ashley Munro, MPH, RDN, CDCES; Hope Wilson, MPH, RDN

Student Contributor: Czarina Ojeda

Introduction

Food, diet, and culture are inextricably linked. Efforts to support a healthy eating plan must be grounded in an understanding and respect for the individual’s culture and its foods. Although the ideas about what is a “healthy” diet have been heavily influenced by Westernized ideals about what is or is not a healthy eating pattern, no single diet has proved best for all.

Indeed, genetics likely play an important role in food selection, preferences, and health outcomes by influencing sensory pathways that affect taste, smell, texture, and the brain’s reward response, as well as how people respond to specific nutrients. Local culture, environment, and family customs also influence food choices, dietary behaviors, and cooking and food shopping practices.

Consuming a wide variety of nutritious foods and beverages in the amounts recommended is a central tenet of healthy eating. However, evidence-based meal plans such as the Dietary Approaches to Stop Hypertension (DASH) diet, and others recommended in the United States may not adequately include cultural foods. Cultural foods are strongly anchored to familial customs and passed down from generation to generation. Cultural foods, including dietary staples, often stem from regional preferences influenced by local crops or from past influences of different cultures living in the same location. These foods may also be integral to religious or ceremonial functions, often including specific food preparation methods and uses.

Many people connect with their heritage through the foods they eat. The tendency of health-care providers to recommend the removal of cultural foods from a person’s diet causes some individuals to struggle with making dietary modifications because they don’t know how or don’t want to exclude these foods. Understanding cultural foods in the context of meal planning, affordability, and accessibility is paramount to engaging individuals seeking to improve their nutritional health.

Culinary medicine works with clients to support the pursuit of a varied diet to take in adequate energy and essential nutrients within cultural preferences and traditions. Within all diets, opportunities can be found to make small changes compatible with a person’s culture and traditions that promote health. Small, culturally appropriate adaptations are easier for people to adopt and sustain, which is the key to achieving better health.

Culturally Centered Approaches to Culinary Medicine

Traditional nutrition counseling and community nutrition education have focused on modifying foods and behaviors to create healthy eating patterns using tools provided by the US Department of Agriculture (USDA), including MyPlate, or others like the DASH diet.^1-3 However, the healthy eating patterns described in these tools are modeled after Western culture and may not apply to culturally diverse populations.^1-6

To effect dietary change among individuals with nutrition-sensitive conditions, nutrition and medical professionals must be able to engage with their clients on a personal level and to tailor nutrition care plans and education. Although there is increased interest in culturally tailored nutrition education interventions, there are few, if any, practical guides that empower nutrition professionals to develop and implement comprehensive culturally centric culinary medicine plans.

This chapter aims to provide nutrition professionals with an understanding of cultural foods in the context of applied culinary medicine and to describe specific culturally tailored nutrition strategies that can be implemented to address nutritionally sensitive diseases.⁷

Rethinking “Healthy” Eating

Search “healthy diet” on the internet and you’re likely to see images of carefully plated salmon, a green leafy vegetable, and a whole grain (see Figure 12.2). Such “healthy” dietary constructs are heavily influenced by Westernized ideals about what is or is not a healthy eating pattern. Definitions of healthy eating are variable, but central to all healthful eating constructs is consuming a wide variety of nutritious foods and beverages in the amounts recommended. The Healthy Food Pyramid, My Plate, DASH diet, and other meal plans recommend specific food groups to encourage the consumption of nutrient-dense foods and beverages designed to counter diseases.^1-3 However, these meal patterns may not include cultural foods.^4-7

Another example, the Mediterranean diet, is widely accepted as an ideal diet. However, some researchers have noted that bias has historically shaped which diets are studied.⁶ For example, a PubMed search using the phrase “Mediterranean diet” yields more than 4 times as many results as searches using the phrases “traditional Chinese diet,” “traditional African diet,” and “traditional Mexican diet” combined.

Indeed, the Mediterranean diet recommends foods favored by Europeans and Americans, rather than foods of the region it purports to represent.⁶ Other critiques of the Mediterranean diet are the lack of affordability, emphasis on liquid oils, and that it’s not an appropriate substitution of other cultural diets. Thus, as is, the Mediterranean diet may not be a culturally appropriate dietary solution to prevent and manage disease. However, as with all standardized meal constructs, modifications can be made to be more culturally inclusive.^4,6

What Are Cultural Foods?

Cultural foods are strongly anchored to familial customs and passed down from generation to generation. Cultural foods may stem from regional preferences influenced by local crops or from past influences of different cultures living in the same location. These foods may also be integral to religious or ceremonial functions, which often include specific food preparation methods and uses (Figure 12.3).

Regardless of culture, most meal patterns typically include a protein (e.g., meat, fish, legumes, nuts), a starch (e.g., potato, corn, breadfruit, rice, taro), and fruits and vegetables. The presence of the latter often is influenced by seasonality, locality, cost, and availability. Understanding cultural foods in the context of meal planning, affordability, and accessibility is paramount to engaging with individuals seeking to optimize their nutritional health.

Select the words and phrases that describe aspects of cultural foods:

Socioeconomic Factors Influence Food Selection

Income, education, and food access all play a role in food selection, cooking patterns, and portion size. These 3 factors generally affect racial and ethnic minorities more.^8,9 As such, a tailored nutrition care plan should include evaluation of income, education, and food access, and it should explore ways to improve overall health without compromising cultural sensitivity.

Income and Food Access

Income can influence choices about the types of foods individuals purchase and consume regularly. Individuals with lower incomes tend to purchase and consume more energy-dense, nutrient-poor foods, such as fast food and processed snacks, compared with individuals with higher incomes.¹⁰ More nutritious foods, such as fresh fruits and vegetables, lean meats, and whole grains, are often more expensive and may be out of reach for those with lower incomes.⁹ One solution is to encourage consumption of more affordable dietary proteins, such as beans, lentils, tofu, and eggs, which can be used in a variety of dishes.

Adopting healthy eating behaviors is more challenging for those with lower incomes, and they are less likely to consume a healthy diet, even when healthy foods are available, due to a lack of knowledge about healthy eating and limited access to nutritious food options.¹¹ As an example, people who live in low-access regions  have limited access to nutritious foods because they either do not live close to a food market or have inadequate transportation to reach a market. Food deserts tend to affect people living in rural areas and/or urban areas lacking grocery stores (see Figure 12.4). Nutrition knowledge and education have been significantly associated with improved individual health status.¹²

The term food deserts has historically referred to regions with low access to affordable, healthy foods. However, the term food desert has been met with criticism because it carries negative connotations and does not adequately capture all factors related to food access. Efforts are being made to adopt alternative terminology, such as low-access region, to acknowledge diverse perspectives and facets of the issue.¹³ Therefore, the reader should be aware of both the historical term food desert and more inclusive terminology, such as low–access area.

Education

Education is also a significant factor that affects nutrition patterns, food accessibility, and affordability. Higher levels of education are associated with healthier eating patterns, because individuals with more education tend to have more knowledge about healthy eating habits.¹⁰ Higher education levels correlate with higher incomes, which can allow individuals to purchase healthier foods.

A 2009 Food and Research and Action Center study found that individuals with higher levels of education were less likely to experience food insecurity, which can negatively affect diet quality.¹⁴ Additionally, individuals with higher levels of education are more likely to have access to information about healthy food choices and cooking methods, which can further improve diet quality.¹⁵

Food Insecurity

Food insecurity, or the lack of access to sufficient, safe, and nutritious food to meet needs, is a growing issue that affects millions of people worldwide, and disproportionately affects certain minority populations and cultures.¹⁶ It may culminate from a lack of resources (e.g., income) and food access.

Food insecurity contributes to nutritional deficiencies and poor diet quality. In a 2015 study, food-insecure Canadian households had a lower intake of calcium and magnesium when compared with food-secure households,¹⁷ suggesting food insecurity may limit access to and procurement of healthy foods, favoring low-cost, poor-nutrient foods to meet basic needs.¹²

Additionally, food insecurity has a bearing on weight status and chronic disease risk.^18,19 Individuals who are food insecure are more likely to consume energy-dense, nutrient-poor foods, which can lead to weight gain and an increased risk for chronic diseases such as diabetes, heart disease, and hypertension.²⁰ Food insecurity is also associated with stress and anxiety, which may affect eating behaviors such as overeating or making unhealthy food choices.²¹

Supporting Optimal Nutrition

There is significant evidence to suggest that socioeconomic factors have a significant influence on nutrition patterns. Education, income, and access to healthy food all play crucial roles in determining dietary choices and, ultimately, overall health outcomes. People from lower socioeconomic backgrounds often have limited access to nutritious foods, leading to a higher risk of malnutrition, obesity, and chronic diseases. Addressing these socioeconomic factors is a priority and integral to promoting healthier diets and improving overall public health.^9,10,12 With this in mind, the nutrition professional can foster improvements in nutrition patterns and help reduce health inequalities through targeted, comprehensive, and culturally responsive nutrition education.

Cultural Food Staples

A staple (see Figure 12.5) is a food that comprises most of a population’s diet.²² Staples are eaten regularly, often daily, and supply most of a person’s energy and nutritional needs. Staples vary by culture and location and are typically plant-based foods (see Table 12.1). There are 50,000 edible plants in the world, but only 15 make up 90% of the world’s food energy intake.²² Rice, corn, and wheat make up two-thirds; other staples include millet, sorghum, and tubers (e.g., potatoes, cassava, yams, taro).

Tropical climates favor growth of starchy fruits such as plantains and breadfruit, whereas in parts of Africa and Asia, legumes (e.g., beans, lentils) are considered traditional foods. In regions where plants are scarce, such as in polar climates, meat and fish are staples.²²

Table 12.1. Staple Foods and Dishes of Certain Cultures

Culture	Staple foods	Staple dishes
African Diaspora	Rice, beans, tubers, okra, leafy greens, seafood, chicken, peanuts, squashes, plantains, fruits, and juices such as mango and guava	Soups, stews, chicken dishes, fish cakes, rice, vegetables platters
Mexican	Rice, beans, vegetables (e.g., onions, garlic, squash, corn, avocados), chicken, seafood, corn-based flour, spices such as cumin and cinnamon	Tortillas (flour and corn), tamales, ceviche, burritos, tacos, nopales, fajitas
Chinese	Rice, seafood, noodles, pork, spring onions, bok choy, ginger, bean sprouts, snow peas, soybean products such as tofu	Steamed dumplings, rice dishes, noodle dishes, mooncakes, soups, congee
American Indian (Native American)	Corn, beans, squash, pumpkins, peppers, tomatoes, yams, peanuts, wild rice, wild game (e.g., deer, buffalo, rabbit)	Three sisters stew; grayish-blue bread called piki made by the Hopis; pemmican. Panocha is a traditional Native American cuisine dish. In New Mexico and southern Colorado, panocha is a pudding made from ground sprouted wheat and piloncillo (sugar).
Alaskan Native	Salmon, halibut, reindeer, seafood, wild blueberries, strawberries	Salmon dishes, muktuk (whale skin and blubber), akutaq (Eskimo ice cream)
Pacific Islander Hawaii and Samoa	Taro, sweet potatoes or yams, breadfruit, cassava, banana, plantain, pandanus, arrowroot	Poi, kalua pork, lau lau, breadfruit, dried fish
Caribbean Islands	Beans, rice, coconut milk, green bananas, plantains, breadfruit, cassava, dasheen (taro), peppers, seafood, tropical fruits (e.g., mango, papaya, pineapple), okra	Cou cou, crab, and callaloo
Eastern Indian	Rice, wheat, millet, pulses, dairy, vegetables, spices, beans, fruits	Machher Jhol, dalma

The population often reflects the local demographic fingerprint of the region in which health providers practice. Determining the predominant culture of the town, city, or county of practice may assist in the development of cultural competency.

The state of Arizona is demographically 1 of the most diverse in the United States.²³ As of 2022, among the more than 7 million residents, 53.2% identify as White, 32.3% as Hispanic or Latino, 5.4% as Black or African American, and 5.3% as American Indian or Alaska Native.²² The percentage of people born outside the United States and reside in Arizona from 2017 to 2021 was 13%.²³

Arizona’s population is also age diverse, with nearly one-fourth under the age of 18 years and 18.3% over the age of 65 years; more than 400,000 military veterans call Arizona home and more than 50% of Arizona’s population is female. Each city in Arizona has a unique cultural fingerprint, with diversity of ethnicity and age varying significantly within cities, towns, and neighborhoods.²⁴

Nutrition professionals in Arizona are encouraged to learn more about local diversity by visiting the University of Arizona’s Community, Research, and Evaluation Development Resources webpage, especially noting the “secondary data resources,” including the “existing data resources handout.”²⁵ Also, local hospitals and organizations may have demographic data available that will reveal a bit more about the population in a specific area. Understanding the surrounding community is key to developing nutrition care tools tailored to the primary population in the region. Another method of getting to know your local culture is through community engagement, as referenced in chapter 11.

Cultures in Arizona

Arizona’s culinary heritage is richly influenced by local crops as well as Hispanic-Latino and American Indian cultures, giving rise to the state’s reputation as the home of some of the oldest documented food traditions in North America.²⁵ Arizona became the 48th state in 1912, but cultivation of corn and squash in the region dates back 4,100 years.²⁶

In Arizona, crop production differs by location, and despite modernization, today’s local farmers maintain tradition by growing more than 160 heirloom varieties of fruits, grains, and vegetables that were available at the time of statehood.²⁶ Arizona is home to numerous varieties of cacti, lending to long-held traditions of harvesting saguaro cactus fruit and prickly pear fruit to make syrups, candy, and fruit spreads. Figure 12.6 shows prickly pear fruit prepared at different degrees of ripeness.

Local culture, environment, and familial customs influence food choices, dietary behaviors, and cooking and food shopping practices. Genetics also may play a role in food selection, preferences, and how people’s bodies respond to specific nutrients. Nearly 500 genes influence food preferences, with several genes influencing sensory pathways that affect taste, smell, texture, and, in turn, the brain’s reward response (Figure 12.7).²⁷

Defining cultural awareness from the standpoint of the nutrition professional sets the foundation for creating an inclusive and welcoming nutrition education environment.

Embracing Cultural Foods

Many people connect with their heritage through the foods they eat. Therefore, individuals may be hesitant to seek dietary advice from a nutrition professional for fear of being advised not to eat core cultural foods. However, efforts have been made to address and include culturally tailored dietary modifications for those with nutrition-senstive diseases through the development of cookbooks and culture-centric nutrition intervention programs, thus reducing the tendancy of health-care providers to recommend removal of cultural foods altogether.^28-30 Cultural influences on dietary self-management of diseases such as diabetes also include social aspects of eating.^28–30

Research has found that certain dietary changes may compromise the taste of traditional food, and there are concerns that making changes in diet will exclude them from familial meals, thus reducing the joy of dining as a family, a value deeply held by some cultures.^28–30

The USDA’s Dietary Guidelines for Americans are a gold standard for nutrition guidelines and recommend including cultural foodways.³² However, the MyPlate food recommendations skew toward North American preferences.^1,32,33 For example, grains in MyPlate include bread, pasta, cereals, rice, and tortillas and lack foods such as taro, breadfruit, and other starchy foods considered “cultural foods.” Similarly, the widely recommended DASH diet discourages refined carbohydrates, such as white rice; however, rice is a staple of many culturally centric diets.^22,26,29,34

The USDA has made advances in providing resources dedicated to American Indian and Alaska Native Communities, including My Native Plate, which depicts balanced meals with reasonable portion sizes and sample meals with traditional foods.³⁴ However, tools for other cultures are lacking.

Cooking Traditions and Methods

Cooking traditions and methods are as varied and diverse as the many nations and ethnicities from which they originated. Many cultures include nutritious dishes prepared with healthy ingredients (see Table 12.1) and cooking methods. For example, in Mexico and the Global South, dishes such as ceviche contain fish that has been prepared by marinating it in citrus such as lemon or lime juice. Steam is often used by many cultures as a primary cooking method. In Mexican culture, tamales are prepared by steaming them. Dumplings originated in China during the Han dynasty and today are cooked by various methods, including steaming, boiling, steam frying, or deep frying.

When working with a community member or individual who expresses an interest in modifying a cultural recipe to reduce sodium, increase fiber, or make other modifications for disease prevention or management, it is important to be prepared with culturally appropriate suggestions, or to know what resources exist to guide modifications. In the example shown in Figure 12.9, dumplings could be steamed instead of fried to reduce saturated fat. Another consideration is the practical impact such a modification would make. For example, if a patient rarely consumes a particular food or if the portion size is routinely small, nutritional modifications in the name of “health” would have minimal impact on overall nutrition quality, and may, in fact, impair rapport with the patient.

As mentioned, white rice is a staple in many ethnic diets (see Table 12.1); however, it tends to be lower in nutrients and fiber than brown rice. Brown rice may be swapped for white rice, but if this substitution is not acceptable to the individual due to tradition, preference, or cost, dietary instruction encouraging reduced portions of white rice is recommended. Other ways to help individuals make gentle dietary changes is to suggest fiber-rich lentils or unpeeled whole potatoes as occasional substitutes for low-fiber choices (e.g., peeled potatoes). Also, modifying cooking methods or recipes using high-fat condiments, sauces, and or saturated fats is recommended. For example, collard greens are often prepared with bacon fat; suggest preparation with a mono- or polyunsaturated fat (e.g., olive oil) as an alternative.

An Example of Cultural Sustainability: Reuniting the 3 Sisters

For centuries, Native Americans grew corn, squash, and beans together in plots (Figure 12.10). The term “3 sisters” describes how the 3 plants thrived when cultivated together, the planting and harvesting of these Native American staples is making a comeback. Planting corn, beans, squash, and sunflowers produces synergistic growing conditions favoring these plants. Corn stalks create a trellis for the beans to climb while the beans stabilize corn stalks against the high winds. Corn and beans grow well together because bacteria on the bean plant’s roots draw in nitrogen from the air, encouraging growth of both plants. Squash provides essential ground cover, preventing weeds and preserving water, and sunflowers around the edge serve as natural fencing and attract pollinators. Some squash vines have thorns that discourage deer, racoons, and other animals from eating crops.³⁵

Native Americans are disproportionately affected by high rates of obesity and diabetes.³⁶ By revisiting and reinitiating farming practices of their ancestors, access to cultural food staples may expand and help reduce rates of these diseases.^31,35-37

Cultural Humility and Competence

Cultural humility involves understanding the complexity of identities and cultivating conversations that attempt to understand a person’s identities related to race, ethnicity, gender, socioeconomic status, and other factors.³⁸ A culturally competent provider needs to have knowledge and awareness of health-related beliefs, practices, and cultural values of diverse populations; illness and diagnostic incidence and prevalence among culturally and ethnically diverse populations; and treatment efficacy and safety data for diverse populations.³⁸

Certain nutritionally sensitive diseases disproportionately affect many ethnic minorities, due to several factors, including somewhat modifiable factors such as environment and lifestyle choices but also nonmodifiable factors such as genetics and social-systemic constructs fostering health disparities.³⁹ Diabetes, hypertension, heart disease, and obesity may be managed, in part, through nutrition education and strategies. However, successful nutrition intervention requires a tailored approach attentive to cultural food aspects.³⁷

In Arizona, the 2 most common and costly chronic highly nutrition-sensitive diseases are heart disease and diabetes.³⁸ Poor nutrition and lack of physical activity are the most frequently cited risk factors.⁴⁰ However, both factors are influenced by environmental limitations to nutritional variety (e.g., low-access areas), access to healthier food options, and access to locations conducive to physical activity.⁴¹

In 2019, Banner Health Banner Thunderbird Medical Center (Maricopa County) undertook a needs assessment survey to identify and understand community health needs. Surveys were administered to 152 professionals who were identified as health or community experts familiar with target populations and demographic areas in Maricopa County.⁴² The survey asked respondents about factors that would improve quality of life, most important health problems in the community, risky behaviors of concern, and their overall rating of the health of the community.

When asked to rank the 3 most important risky behaviors seen in the community, the top 5 answers included being overweight (57.2%), alcohol abuse (42.8%), poor eating habits (39.5%), drug abuse (35.5%), and lack of exercise (34.2%). The report also identified perceived lack of cultural competency and health literacy as barriers to health improvement and chronic disease management. The Partnership to Fight Chronic Disease for Arizona found that 62% of the population is overweight or obese, with 40% eating fewer than 1 fruit per day and 24% eating fewer than 1 vegetable a day. It’s thought that these risk factors contribute, in part, to higher rates of heart disease and diabetes in the state.⁴³

Addressing Nutrition-Sensitive Diseases

Heart Disease

Heart disease ranks as the number 1 cause of death in Arizona.⁴⁴ People can help prevent heart disease by understanding the risks and taking simple steps to address them. Among these steps is modification of nutritional habits. Helping individuals at risk for cardiac ailments to be mindful of the type and amount of dietary fats found in foods and fats used in cooking is essential to help reduce cardiac disease mortality and morbidity. Encouraging plant-based, fruit- and vegetable-rich meal plans, while being aware of economic constraints that prevent or limit purchasing ability, is key to help those with cardiac risk factors to make lasting change.⁴⁵

Diabetes

Diabetes is the seventh leading cause of death in the United States.^46,47 Although diabetes affects people of all cultures, races, and ethnicities, higher rates are reported among Hispanics, Black people, Asian Americans, and American Indians and Alaskan Natives.⁴⁶

It is important to recognize that rates of type 2 diabetes mellitus (T2DM) vary within cultures as well. For example, South Asian, Filipino, Pacific Islander, and certain Japanese groups have a higher prevalence of T2DM compared with the East Asian subpopulation (i.e., populations originating from China, Korea, Japan, and Taiwan).^48–51

Body weight is a strong predictor of diabetes risk.⁵² Chronic elevated blood glucose level is associated with increased risk of cardiac and renal comorbidities.^46,47 Stabilizing one’s blood glucose level throughout the day is critical to managing diabetes. This is done through a combination of meal planning, meal timing, and portion control. Educating those with diabetes or diabetes risk factors about portion size and focusing on limitation instead of elimination will encourage meaningful dietary change. However, many cultures view special diets as disruptive to social harmony and burdensome to others.^51,53

For example, among East Asian individuals with T2DM undergoing nutritional counseling, dietary recommendations did not always align with their beliefs of food as medicine or as a source of balance in life or healing. Chinese American, Korean American, and other subpopulations of Asian Americans found it difficult to adapt to T2DM dietary modifications because doing so caused them to feel distanced from familiar and shared cultural food habits and practices.^30,48–51 Chinese American patients noted that rice is a vital food, both physically and symbolically, and to remove such a critical cultural staple from their diet is difficult.^30,48–51 For many Asian cultures, dietary management and food preparation are the responsibility of the patient and the spouse or partner.^30,51 Therefore, including significant others in conversations about dietary change, food preparation, and even meal timing is essential to supporting the individual on their journey to make dietary changes.

Check your understanding with this case study:

Significance of Mealtimes

Commensality is central to many cultures.^54,55 Mealtimes offer opportunities for people to engage in eating and socialization. For children, mealtimes can be a time of apprenticeship, where they can actively observe and participate in mealtime customs and traditions. Mealtimes vary within and across social groups in relation to participation, setting, duration, meal items, meal sequence, and food symbolism. Regardless, commensal meals are a time for participants to master cultural knowledge and practices associated with shared gatherings. A key tenet of the Mediterranean diet is the concept of conviviality, which involves enjoying family meals as a way to promote healthy eating.⁵⁶

• Ask questions about family traditions, recipes, and ceremonies.
• Query about the type of foods eaten, as well as quantity and environment, time of day meals are typically eaten, and with whom.
• Encourage clients to share their health-related values and beliefs.
• Have clients describe examples of how culture plays a role in eating habits.
• Ask about traditional spices used in dishes.
• Actively listen to what is important to the individual about their concerns or hesitancy to make dietary or meal pattern changes.
• Involve other family members or supporters in dietary modification discussions.

Respond

• Provide tips on how to involve family when preparing meals.
• Provide reasonable and practical modifications to traditional recipes.
• Encourage the use of traditional foods with attention to portion sizes.
• Include tips on incorporating traditional flavors using lower sodium or reduced-fat options.
• Give positive feedback regarding dietary changes.

Taking a Mindful Approach

Creating cultural humility and practicing cultural competency in the context of the application of culinary medicine are a recipe for success. The act of bridging these 2 elements is largely dependent on the practitioner’s motivation to seek resources to expand understanding of cultural food preferences, choices, and beliefs of the individuals they encounter.

Although the medical literature may be lacking evidentiary support of best practices on how to enhance nutritional cultural competency, the best source of this knowledge is the individuals themselves, who can offer the practitioner a firsthand accounting of the food traditions and cultural aspects that influence their nutritional behaviors. By partnering with those seeking nutritional guidance, the nutrition professional can optimize personal development toward the goal of offering culturally centered approaches to culinary medicine.

References

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