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South Americans: non-confrontational

Counseling recommendations should be action- or task-oriented Family-oriented programs and group classes may be more successful than individual counseling An in-depth interview is especially important with African American clients

Broad differences exist among the subgroups Lack of refrigeration High intake of refined sugar, cholesterol, fat, and energy Lactose intolerance and obesity are common

living the good life; living the life Creator intended for us

・High intake of carbonated beverages (Mexican Americans) • Limited dental care among migrant workers (Mexican Americans) • Overweight and obesity are common (Puerto Ricans) • Breastfeeding is not common (Puerto Ricans) • Low intake of green, leafy vegetables (Puerto Ricans) • Dairy intake is low (Puerto Ricans)

Access to biomedical health care may be limited for unauthorized migrants of Mexican descent The communication style of Latinos is non-confrontational Folk remedies may be used by many Mexican Americans Family participation in health care is common Members should be consulted in both making a diagnosis and prescribing treatment Central Americans sometimes assimilate into other Latino communities Cross-cultural exchanges of health beliefs and practices may occur An in-depth interview is crucial in counseling Central Americans

RDs may need to accommodate the client’s family as part of the nutrition counseling and allow time to gain trust and get to know both clients and their families. RDs should be aware that the eating habits and health behaviors of Hispanics cannot be stereotyped, and cultural and language barriers can be factors that lead to non-compliance.

East Asian: Traditional Chinese Medicine (TCM), Illness was attributed to imbalance (“yin” and “yang”) Southeast Asian: Supernatural world; Chinese medical practices involving yin and yang; Mexican hot–cold theory South Asian: Ayurvedic medicine, Therapy - diet, herbal remedies, and meditation to reestablish equilibrium, Foods are classified as hot or cold

massage (36.8%), herbal medicine (32.5%)

During my practicum at EFNEP, I had the opportunity to conduct a 24-hour diet recall with program participants. Although they shared what they ate, I struggled to identify the names of certain products or dishes because they were unfamiliar to me. Through studying this topic and my practicum experience, I realized how important it is to try unfamiliar traditional foods from different cultures to better understand diverse dietary choices. Otherwise, I may struggle to connect with my future clients and build trust, as they might feel I’m not someone they can rely on or share their personal experiences with.

Am I comfortable working with patients of all sizes? - I would think critically if I really feel comfortable with working with obese patients, and if not, I need to clarify what made me feel that way and how I can fix the way of my thinking. For example, if I had a patient who was severely obese, I might feel I could not fully understand the patient’s eating behavior or their tough experiences. Even in that situation, however, I should deal with this situation by gathering information through articles, case studies, videos, blogs, etc as a profession and need to treat all patients equally without any assumptions.

Lack of physical activity Unhealthy eating behaviors Not getting enough good – quality sleep High amount of stress Health conditions Genetics Medicines Environment

The natural diversity in body shape and size The ineffectiveness and dangers of dieting The importance of relaxed eating in response to internal body cues The critical contributions of social, emotional, and spiritual, as well as physical factors to health and happiness

Traditional Weight-Loss Paradigm Everyone needs to be thin for good health and happiness People who are not thin are “overweight” because they have no willpower, eat too much, and don’t move enough Everyone can be thin, happy, and healthy by dieting HAES Thin is not intrinsically healthy and beautiful, nor is fat intrinsically unhealthy and unappealing. People naturally have different body shapes and sizes and different preferences for physical activity. Dieting usually leads to weight gain, decreased self- esteem, and increased risk for eating problems.

<Instinctive eating> Enough to satisfy my fuel needs <Overeating> Until the food is gone, I feel comfortable, or I’m interrupted <Restrictive eating> I weigh, measure, and count my food

Concept derived from clinical observations that a subgroup of people with obesity do not exhibit overt cardiometabolic abnormalities. Criteria that have been proposed: BMI>=30kg/m2 Fasted serum TG(<=150mg/dl) HDL chol (>40mg/dl for men,>50mg/dl for women) Systolic BP<=130mmHg, diastolic BP<=85mmHg Fasting blood glucose<=100mg/dl No drug treatment for dyslipidemia, diabetes, hypertension No CVD manifestation

HAES intervention Improved dietary behavior, self-efficacy, and improved body image with postintervention weight reduction Psychological and potential physical benefit particularly with women experiencing disordered eating or chronic dieting behaviors alongside issues of overweight or obesity. 19 full text article included, meta-analysis found a significant reduction for susceptibility to hunger in HAES intervention groups relative to controls (p=0.05), with no significant difference (p>0.05) between HAES interventions and control groups for anthropometric, psychological, or cardiometabolic outcomes HAES approach could have long-term term (e.g., 16 mo follow up) beneficial effects on eating behaviors related to disinhibition and hunger. Limitations Intervention study and design Generalizability to other populations (e.g. gender, individuals with higher BMI, and those without disordered eating) o Does not consider the value of modest weight reduction (5-10%) in improving health.

・Consider that patients may have previously experienced bias from providers ・Recognize that being overweight is a product of many factors, and that it is difficult to sustain significant weight loss ・Explore all causes of the patient’s presenting problems, not just weight ・Recognize that many patients have tried to lose weight repeatedly ・Emphasize the importance of making behavior changes rather than focusing only on weight ・Acknowledge the difficulty of making lifestyle changes, and provide support ・Recognize that small weight losses can result in important health gains

When watching the video in class, I felt sorry for the patient who was mistreated by her physician because of her weight. To eliminate weight bias or discrimination in counseling settings, gaining experience with patients of all sizes and insights from various resources is important. I believe most discrimination stems from a lack of understanding. As I continue learning about different cases related to body shape, I’ll be able to develop a broader perspective and consider the many factors that contribute to a client's weight.

Health Equity The attainment of the highest level of health for all people. Health Disparities A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; or other characteristics historically linked to discrimination or exclusion.

barriers to education insufficient access to health care limited access to healthy and affordable foods safe places to be active.

Food Security The availability of and access to food that is safe, affordable, and consistent with food preferences 2-item Hunger Vital Sign 6-item Food Security Survey Module Classification • Low and very low food insecurity - overall food insecurity • Disrupted food intake and reduced calories Nutrition Security Consistent access, availability, and affordability of foods and beverages that promote well- being and prevent and if needed, treat disease 2-item Nutrition Security Screener 4-item Nutrition Screener survey Needs more research and validation in diverse population

I found that the main message of the video is that the zip code where you're born and raised can determine how healthy and wealthy your life will be. Although this shouldn't happen, the vicious cycle of poor social determinants continues to exist. The video concluded that government efforts are necessary to address this issue. While I agree with this, I’m unsure whether the government is truly working to create equality for all people in the U.S. Still, I believe that the more people become aware of inequality, the more realistic solutions will be developed.

I think it's important to remember that there are many programs and free resources available for socioeconomically disadvantaged clients. However, most of them are unaware of how to apply or what the eligibility requirements are for each program. As a future nutrition professional, I need to become more familiar with these resources and be ready to provide information when needed. The key is to identify clients' needs and address their concerns, so having a range of realistic solutions is the first step I should take.