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Culture: Think About It

Dec 4, 2018
 

Author: Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE


Man, 32 years of age, of Asian Indian descent, family history of type 2 diabetes, BMI-28,  blood pressure 142/84, WC-92cm visited for annual physical.

Although the patient has not at this time been diagnosed with type 2 diabetes, the numbers and history were revealing that he is at increased risk. Not just because of his family history but also his BMI and WC. We discussed the importance of this person’s weight with him. In discussing this, we talked about making some changes in his meal plan and increasing his activity.

When teaching a patient like this, or any patient, it is important to understand their ethnicity and heredity. Instead of teaching this patient to avoid carbohydrates, we understood that it is not realistic for some people whose whole way of eating revolves around rice. This does not mean the meal plan should stay like that, but talk more with patient about how he can decrease the rice in his meals and replace it with other ingredients. Making drastic dietary changes is not usually sustainable. It can set up a patient to fail.

We referred the patient to diabetes health care provider (HCP) who is of Asian Indian descent and understands the culture. Together the HCP and patient designed a meal plan and exercise prescription that the patient felt was palatable and doable and could help him lose weight.

He returned in 3 months. He had lost weight, BMI was 26, blood pressure 128/70, WC-88. Although he has more progress to make, he is making the changes that can help him prevent diabetes and other complications related to excess weight and obesity. I think this is very much related to working with HCPs who are knowledgeable and culturally sensitive.

Lessons Learned:

  • Know that risks are not the same for everyone. Culture and ethnicity do have an effect.
  • Be culturally sensitive/knowledgeable. You don’t have to be of a certain culture to help someone who is of a different culture than you. Learn more about other cultures than your own and tips to help people of different cultural and ethnic backgrounds. If you don’t think you have the education, experience, or expertise of a certain person’s culture, don’t try to sway the patient “your way.” Refer to someone who can best help the patient. Put together a team who you know can help the patient best meet his or her goals in a sustainable way.
  • Check out Dr. Mohan’s video: Diabetes In India.

Learn more at:

http://obesity.aace.com/files/obesity/toolkit/classification_of_obesity_and_risks.pdf

https://www.hsph.harvard.edu/obesity-prevention-source/waist-circumference-guidelines-for-different-ethnic-groups/

Joy Pape, FNP-CDE
Medical Editor, Diabetes In Control

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