Counselling clients from a different cultural or social background often presents challenges. Dietitians can improve their counselling skills by understanding the many different cultures in Canada and learning how to adjust their approach when working with specific populations.
However, as a dietitian, it’s very important not to assume things about our clients just because of the way they look or where they are from. Never the less, understanding common cooking practices and eating habits of various cultures can help you ask better questions and lead to better client centred care.
The beauty of Canada lies in many different cultures coming together to create a successful nation. The Middle Eastern population is a large, expanding population in Canada that has very distinct social and cultural traits. I am a Muslim from Egypt, a Middle Eastern country. I have encountered and worked with clients from many different countries in the Middle East and I want to share some of my insight with you. I will focus on Middle Eastern Muslims, although this information could potentially apply to Middle Eastern non-Muslims as well.
Ensure your client is a Middle Eastern Muslim before you begin sharing all the knowledge you are about to learn with them! Firstly, start to build rapport by having a general conversation. Then, out of interest, ask your client what his/her background is. If he/she mentions a Middle Eastern country, be straightforward and say, “I heard there is a large Muslim population there, are you a Muslim?” People like to talk about themselves and their religions when the person asking looks interested and non-judgemental. In the hospital setting, if a patient requests to be on a halal menu, or if he/she avoids pork, that could be a clue he/she is Muslim. Although, keep in mind that practicing Jews will also avoid eating pork.
1) Know the body language
If you are counselling someone from the opposite sex you could find them looking down often instead of looking you in the eye. Don't take offense to this practice. Many people in the Middle East are brought up to not stare "strangers" from the opposite sex straight in the eye. Eye contact might improve with time but if it doesn't, don't mistaken this for a lack of interest or a sign of hostility.
2) Encourage breastfeeding
The rates of breastfeeding in Middle Eastern societies are high. However, did you know that for Muslims, their holy book, the "Quran," (which Muslims believe to be literally words from God) encourages them to breastfeed for up to two years? It would be neat to use that piece of information with your clients to gain their trust. This topic can be brought up by saying, “I learned that the Quran encourages Muslims to breastfeed for up to two years and I found it interesting that it aligns with our health system’s recommendations.”
3) Talk about nutritious foods mentioned in the Quran
The Quran also specifically mentions many nutritious foods, such as dates, figs, olives, cucumbers, milk, watermelon etc. Knowing that the Quran recommends eating nutritious foods such as these and bringing it up in conversations is another good way to improve your rapport with clients. A simple way to bring this topic up is by saying, “I also learned that the Quran encourages nutritious foods, including many fruits and vegetables, for maintaining good health. Can you tell me more about some of these foods that you enjoy?”
4) Know which foods are not allowed
Muslims are not allowed to eat pork, non-halal meat, or drink alcohol. While not all Muslims practice these requirements, you will encounter many who do. Pork is not allowed at all and some families will not eat any foods that contain pork derivatives, such as gelatin. This will limit a substantial amount of foods, including many yogurts, desserts, and jams.
Halal is very similar to Jewish Kosher: animals have to be treated humanely and slaughtered in a very specific humane manner before consumption. Knowing about local areas that sell halal meats could be a big plus when working with Muslim clients. Finally, alcohol is not allowed at all, not even for cooking purposes.
5) Ask about bulk cooking
It is common practice to cook in bulk in the Middle East. So discussing how to cook healthy in bulk and providing some easy recipes is important. You could say something like, "Are you from the Middle East? I heard bulk cooking is common there. Do you happen to do that?" This is a great way to steer your clients toward the healthy eating and cooking conversation.
6) Help clients choose healthier fats and reduce fat intake
Butter or oil is heavily used when cooking many Middle Eastern dishes. Make suggestions for healthier options such as olive oil, canola oil, avocado oil, etc. and discuss cooking methods that use less oil. Ensure you stress that these suggested oils still provide great flavour!
7) Discuss mindless eating
Many Middle Easterners overeat because of their mealtime setup. Firstly, there is almost always salads, soups, and rice/pasta along with 2-4 main dishes on the table. Family members will sit, socialize and eat together for long periods. Because the main dishes are always on the table, it is easy to go for seconds and thirds. Encourage your clients to serve their dishes on smaller plates and to place leftovers in the fridge right away. Remind them that it takes 20-30 minutes for satiety to kick in!
8) Encourage salt substitutes
Many Middle Eastern families eat a high salt diet. Encourage substitutes such as pre-prepared spice mixes and other dried herbs and spices, such as cumin, pepper, paprika, basil, parsley, bay leaves etc. to add flavour.
Knowing the common cooking practices and eating habits of other cultures can go a long way to save you time during a counselling session and help you to gain your client's trust. Take the initiative to learn more about another culture today!
Editor’s note: Taking the initiative to learn about other cultures and their dietary habits can help your counselling be more effective. However, overcoming language barriers is an important first step. Many hospitals provide interpreter services to help with this. Eat Right Ontario also provides this service. Lastly, be sure to utilize Practice-based Evidence in Nutrition’s culturally adapted handouts, which are available in many languages.
What cultures do you work with the most? Have you identified resources that have been useful for working with certain populations? Please share your thoughts, resources, or questions for Mohamed below!