High Risk Nutritional Practices Paper
The penchant for food is unique and varies from one individual or culture to the other. Further, food acceptance, habit or preference is a complex human nature determined by various factors. Among the factors include psychological, biochemical, physiological, educational, and social (Reddy & Anitha, 2015). Despite the multiple factors determining food habits, culture is considered a significant determinant. Majority of the people consider nutrition as cultural. According to Ray (2016), culture is defined as customs, values, habits and attitudes that seamlessly and inadvertently become part of a person since childhood.
Similarly, food habits are considered part of culture, and cannot be changed easily, or if forcibly changed can result into various unprecedented and unwelcome reactions (Reddy & Anitha, 2015). To effectively deal with the culturally diverse communities, a healthcare provider must be culturally adaptable. Knowledge on food culture therefore becomes pertinent (Reddy & Anitha, 2015). The purpose of this paper is to describe high risk nutritional behaviors among different cultures, and to elucidate in retro back, the history of such habits. Further, the role of healthcare practitioners in caring for the individuals with diverse nutritional cultures is explored.
The High Risk Nutritional Behaviors
The selection and classification of food varies across cultures. Common classifications include edible or inedible foods, and heavy or light foods (Reddy & Anitha, 2015). Further, other cultures bestow special symbolic references to certain foods and unleash them only during social gatherings, ceremonial functions or during festive seasons (Reddy & Anitha, 2015). Others also believe it is unethical and unholy to eat some foods, an aspect that contributes to the existence of various nutritional behaviors. Below we explore some of the nutritional beliefs and behaviors observed in selected cultures and societies.
Hinduism and Malnutrition
Many scholars have termed Hinduism as the world’s oldest religion and culture. Majority of the Hindus live in India. While cattle have multiple benefits in a society, they hold a special and significant position among the Indians. Hinduism considers cattle as sacred and prohibit slaughtering (Reddy & Anitha, 2015). Due to the religious feelings against slaughtering of cows, less people eat meat (Reddy & Anitha, 2015). This implies that the majority of Indians are vegetarians. Since deficiency of protein rich foods is often associated with protein energy malnutrition, the culture can explain why malnutrition remains high in India despite the sustained economic growth in the past bidecade (Khan & Mohanty, 2018).
Hinduism is a typical case where food selection causes a high risk nutritional behavior. In this case, the selection is informed by religious practices. Malnutrition is associated with significant morbidity and mortality. In Karnataka, a state in India, a study by Ansuya et al. (2018) found that the prevalence of malnutrition remains high at 41%. Many children as per the study were stunted, wasted and underweight. These results came after skyrocketing growth of the Indian economy, which pointed the malnutrition problem towards attributing factors other than socio-economic status. Religion practices and cultural selection of food thence contribute to high risk nutritional behaviors.
American Culture and Obesity
In the United States, obesity is a public health concern that continues to attract debate. The prevalence has risen steadily, from 19.45% in 1997 to 31.4% in 2017 (Hamdy, 2020). Obesity is a condition of both adults and children. The statistics further reveal that 37.5 million males and 40.6 million females above the age of 20, and 12.5 million children and adolescents are obese (Hamdy, 2020). These statistics provide evidence that obesity is a substantial health problem affecting a significant US population.
Part of the American culture, particularly the eating habits, contributes to the condition. The dramatic rise in fast food restaurants in the US that offer fatty foods such as butter, cream, fried varieties, and sweetened drinks cause massive consumption of such foodstuff (Kumanyika, 2018). The foods are high in calories, therefore contributing to the etiology of obesity.
Further, Kumanyika (2018) notes that the sedentary lifestyle among the Americans, staying on computers and televisions for a long time, and ignoring physical fitness is a causative factor. This culture stems from early life, for example, in high school where few students participate in extracurricular activities such as athletics and football (Kumanyika, 2018). Further, some ethnic groups among Americans regard food as central to family gatherings, and failure to consume large amounts is considered as being antisocial or rude (Kumanyika, 2018). Unhealthy as this practice may seem to be, its persistence within the American society does explain why obesity prevalence has continued to rise.
Dental Caries in Eritrea
The etiology of dental caries is multifactorial. In a Venn diagram representing dental caries etiology, nutrition plays a significant role. In addition to the host factors and microbes, nutritional habits determine the prevalence of dental caries among different cultures (Reddy & Anitha, 2015). Eritrea is a low income country in Africa with a high prevalence of dental caries disease and with a slow progress towards its prevention and control (Andegiorgish et al. 2017). In a study of 225 participants, 176 (78%) had at least a carious tooth or a previous history of the same (Andegiorgish et al. 2017). Further, on inquiry about dental hygiene, 28.1% reported to clean their tooth once daily while 19.1% did it twice a day; the rest either had no history of cleaning their tooth or performed oral cleaning using chew sticks (Andegiorgish et al. 2017).
According to Andergiorgish et al. (2017), oral hygiene is a determinant of dental caries in nearly all populations. In addition to the poor oral hygiene, the study found that water in the urban area had sub optimal fluoride levels (0.28ppm). A minimum of fluoride content in water that reduces dental caries is 1ppm (Andegiorgish et al. 2017). Parents play a significant role in determining oral hygiene of their children; therefore, a parental attitude which is culturally dependent contributes to the prevalence of dental caries (Reddy & Anitha, 2015). In Eritrea, the prevalence of the dental caries disease is attributed to dietary behaviors, dental hygiene practices, water quality, parental attitudes, and cultural differences.
Historical Perspectives of the High Risk Behaviors
Culture is usually deeply entrenched effortlessly within an individual as newborns readily adopt the same customs, beliefs or traditions from their parents. Food, being one of the oldest domains of culture, similarly becomes part of a person from childhood (Reddy & Anitha, 2015). In history, vegetarianism among Indians predates history. Various factors including religion support the meatless culture among Indians. Motivations for the meatless way of life in India include the Dharmic law, also known as the law of non-injury; and Karmic consequences, which argues that all actions have karmic consequences including inflicting pain and injury on other creatures have dire consequences.
Further, spiritual reasons that stipulate that ingestion of meat affects one’s consciousness, peace and emotions also explain the meatless culture. An additional factor includes the health reason-vegetables are easily digested and provide diverse nutrients (Croxford & Itsiopoulos, 2020). Further, evidence-based research confirms that vegetables improve the functionality of a person’s immune system and that vegetarians tend to live longer (Croxford & Itsiopoulos, 2020). All these factors contribute to the meatless culture among Indians that in turn denies majority the access to protein-rich food, hence the high prevalence of protein-energy malnutrition.
In the history of America, different authors have shown a continuous rise in the caloric intake across decades. As aforementioned, the rise in the fast-food restaurants is a causative factor of increased caloric intake (Popkin & Reardon, 2018). The rise in the prevalence of obesity can not only be attributed to biological aberrations but also environmental and lifestyle behaviors. According to Popkin and Reardon (2018), American population before the 1970s had little food-associated comorbidities compared to present population.
However, with the invention of fast foods, and increased intake of sweetened drinks and oils, comorbidities such as obesity and various cardiovascular diseases have risen (Popkin & Reardon, 2018). Popkin and Reardon (2018) further note that the American way of cooking had always been home-based until the fast-food restaurants became the modern culture. In their study, Popkin and Reardon (2018) note that sugar sweetened beverages (SSB) consist most of Latin Americans meal. All these factors are termed as high risk nutritional behaviors and contribute to the etiology of obesity.
In Eritrea, dental caries has been a commonly reported disease with high morbidity particularly in the outpatient department. In the years 2013 and 2014, the World Health Organization ranked dental caries as the highest morbid disease (Andegiorgish et al., 2017).
Further, in 2011, 2012, 2015 and 2016, it was ranked as the highest reported disease (Andegiorgish et al., 2017). The statistics provide evidence that dental caries has continually been a problem in Eritrea. Part of this, as described by Andegiorgish et al. (2017), is attributed to the poor oral hygiene and the quality of water. Being that children learn best from the parents, the culture of poor oral hygiene, which is a high-risk nutritional behavior, becomes internalized in members of the population from early stages of life.
Role of Healthcare Provider
Healthcare providers have a role to play in caring for patients from diverse cultures. The high-risk nutritional behaviors can be detrimental, hence the need for nurses with basic knowledge on cultural diversity. Cessation of the behaviors largely requires health promotion education. Nurses play a significant role in educating patients on healthy eating habits (Kurnat-Thoma et al., 2017). Some of the healthy eating education to obese patients include limiting sugar sweetened beverages and fast foods.
Additional education involves increasing physical activity. According to Kumanyika (2018), the high prevalence of obesity in America is partly attributed to the culture of physical inactivity. The physical inactivity is due to prolonged hours of staying on computers and televisions (Kumanyika, 2018). Prescription of physical fitness therefore helps in mitigating the prevalence.
Nurses’ knowledge on health informatics is also crucial during patient education. For example, remote patient monitoring (RPM) has recently been a massive technology in healthcare, used in management of patients with chronic conditions. Management of obesity, a chronic metabolic condition, similarly requires RPM such as smart watches.
The smart watches can record and observe patients’ behaviors, therefore improving physical fitness adherence. Due to the importance of nutrition in healthcare, current nursing curriculum integrates nutritional education. This has led to the emergence of a special specialty within nursing known as nutrition and dietetics. These nurses have knowledge and skills in evaluating patients’ eating habits and designing a personalized dietary plan.
According to Kurnat-Thoma et al. (2017), patients with such conditions as obesity, diabetes, malnutrition, inflammatory bowel diseases and unconscious patients require services of a nutritionist. Nurses also help in treating patients with drug and alcohol addictions.
The initial step towards management of such patients includes education on the harmful effects of drugs (Kurnat-Thoma et al., 2017). In case the patients develop psychiatric conditions, nurses manage their psychosocial issues using both pharmacotherapy and psychotherapeutic interventions (Kurnat-Thoma et al., 2017). This therefore means that knowledge on food, culture, anthropology and clinical practice is vital for healthcare providers.
High risk nutritional behaviors involve the acts that increase the chances for various medical conditions. Food habit, being a cultural domain, varies from one community to the next, often with extensive negative or positive implications on health. For instance, food considered as holy in one community might be unholy in another community or culture. Few selected cultures with high risk nutritional behaviors include the Indians, Americans and Eritreans. While Indians are vegetarians and have high prevalence of malnutrition, Americans consume high calories and therefore have high prevalence of obesity.
Further, due to poor oral hygiene and water quality, Eritreans have high prevalence of dental caries. As broached in this paper, nurses play a significant role in managing patients with varying nutritional behaviors, hence the need for knowledge on both pharmacotherapeutic and non-pharmacotherapeutic interventions. Most importantly, nurses engage in health promotion activities such as education on healthy diet and physical fitness, thus capable of alleviating some of the most pervasive high-risk nutritional behaviors.
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