Breaking Down the New Dietary Guidelines 2025–2030: Evidence, Gaps, and Real-World Practice - Episode 8
Cultural Diversity, Personalization, and Meeting Patients Where They Are
In the final segment, experts discuss how to navigate traditional or cultural foods with patients in the absence of their inclusion in the guidelines.
In the final segment of the discussion, Colleen Sloan highlighted what she viewed as a notable omission from the dietary guidelines: the lack of explicit inclusion of culturally diverse foods. She noted that this absence can unintentionally lead patients to question whether their traditional or cultural foods are now considered “unhealthy,” or reinforce existing biases that equate certain ethnic cuisines with poor nutrition.
Slaon emphasized that the guidelines missed an opportunity to clearly affirm that healthful dietary patterns can and should exist across many cultural traditions. She asked how clinicians can respond when patients express concern that their cultural foods are not reflected in the guidelines.
Catherine McManus underscored that food is deeply intertwined with culture, tradition, family, and community, making drastic dietary changes neither feasible nor respectful for most patients. She stressed that asking someone to abandon their cultural dietary pattern altogether fails to honor the central role food plays in quality of life and social connection. Instead, she advocated for a collaborative approach that works within a patient’s existing food patterns.
Rather than focusing on restriction, McManus described strategies centered on addition and modification. She emphasized the concept of “crowding out,” encouraging clinicians to ask what healthful foods can be added to a patient’s diet, rather than framing recommendations around eliminating familiar foods. Over time, these additions can naturally displace less healthful options without creating a sense of deprivation.
She also highlighted practical strategies such as 50/50 swaps—for example, combining white rice with brown rice, acknowledging that staples like white rice are foundational in many cultures and should not be dismissed as inherently unhealthy. These incremental changes allow patients to maintain cultural identity while still moving toward improved nutritional quality.
Viet Le echoed these sentiments, emphasizing the importance of grounding recommendations in both science and compassion. He described his approach as first explaining the evidence and what is considered optimal, then shifting the focus to understanding where the patient currently is without judgment or guilt.
From there, the goal becomes working collaboratively to make achievable changes. Le noted that most patients want to be healthy and live high-quality lives; when they are given clear reasoning rather than rigid mandates, they often become curious and open to change. He cautioned against “putting the hammer down,” emphasizing that overly prescriptive approaches rarely lead to sustainable behavior change.
Slaon closed the conversation by thanking both speakers and reinforcing the central takeaway: while dietary guidelines outline population-level ideals, effective nutrition counseling happens one patient at a time. By staying curious about patients’ backgrounds, cultures, and capacities, clinicians can help individuals take small, meaningful steps toward better health without sacrificing identity, dignity, or quality of life.
Our Experts:
Colleen Sloan, PA-C, RDN, pediatric physician assistant and registered dietitian.
Catherine McManus, PhD, RDN, LD, assistant professor of nutrition, Case Western Reserve University; Cleveland Clinic Foundation.
Viet Le, DMSc, MPAS, PA-C, FACC, preventive cardiology physician assistant and associate professor of research, Intermountain Health.
