- Email: [email protected]
Resources for Building a Diverse and Culturally Competent Workforce in the Dietetics Profession
PRACTICE APPLICATIONS
Topics of Professional Interest
Resources for Building a Diverse and Culturally Competent Workforce in the Dietetics Profession
A
CCORDING TO THE US Census Bureau, ethnic and minority groups accounted for more than one-third of the population in 2012, with projections indicating that the United States will become a “majority-minority” nation for the first time in 2043.1 As the country’s population becomes increasingly more diverse, registered dietitian nutritionists (RDNs) can continue to support and develop a culturally competent workforce that is trained to meet the needs of a wide spectrum of patients and provide quality nutritional guidance in a respectful manner. The focus of this article is to describe the relevance of a culturally-competent workforce and to provide an overview of programs that administer robust cross-cultural communication skills training for future health and wellness professionals and Academy resources for developing diversity and cultural competency.
CULTURAL COMPETENCY AND THE DIETETICS PROFESSION “Cultural competency plays an important role in the communication and counseling carried out by food and nutrition [practitioners]. When cultural customs are ignored or violated, the result can be rejection of essential information,” said Cedric Herring, PhD, MA, professor of sociology and public policy in the Language, Literacy, and Culture Doctoral Program, University of Maryland, Baltimore, and author of Diversity in Organizations: A Critical
This article was written by Tony Peregrin, editor and writer for a Chicago-based medical association and freelance writer in Chicago, IL. http://dx.doi.org/10.1016/j.jand.2015.10.016 Available online 24 November 2015
ª 2016 by the Academy of Nutrition and Dietetics.
Examination. Herring co-presented a session titled “Changing Cultural Composition: Impacts on the Dietetics Profession” at the 2014 Food & Nutrition Conference & Expo (e-mail communication, January 2015). “To plant the seeds of cultural competence in nutritionists and dietitians, educational institutions must focus on multiculturalism and strive to recruit culturally competent educators.”2 Educating the future workforce to be culturally competent not only helps meet the needs of a diverse population, it also boosts recruitment and retention of nutrition and dietetics practitioners. According to the authors of “Population risk factors and trends in health care and public policy,” an article published in Journal of the Academy of Nutrition Dietetics, there is an assumed attrition rate of 2% to 5% in dietetics based on historical workforce data that may be partially alleviated via “recruitment and retention strategies to promote diversity and replacements due to retirements.”2 “Changing the composition of the workforce takes time and sustained effort,” noted Donna M. Parker, MD, associate dean for Diversity and Health Equity and clinical assistant professor of pediatrics, University of Florida College of Medicine, Gainesville. Parker, a co-presenter with Herring on the diversity session at the 2014 Food & Nutrition Conference & Expo meeting, underscored the importance of “leadership and organizational commitment” to enhance workforce diversity (e-mail communication, January 2015). Parker described diversity as “multifactorial,” encompassing “race, ethnicity, age, gender, sexual orientation, religion, socioeconomic, language, and geographic locale (rural, urban, and suburban),” and she cited studies suggesting that commonalities between a health care worker and a patient result
in better outcomes.3 As the “population changes, we are challenged to identify ‘commonality,’” she said.
ROLE OF THE RDN IN DEVELOPING A DIVERSE WORKFORCE RDNs seeking to enhance cultural competency after their formal education and training might consider developing one of the Commission on Dietetic Registration’s Essential Practice Competencies.4 These competencies are divided into two sets of spheres: core and functional. Core spheres—which focus on cognitive, social, and personal resource skills— include Sphere 1: “Ethics and Professionalism,” which includes support of culturally diverse customers, and Sphere 9: “Education and Counseling,” which includes “developing culturally sensitive, evidence-based materials that are appropriate to the audience.” 3,4 RDNs also can access timely and relevant cultural competency-related articles and research via the Journal’s topic collection titled “Cultural Competency and Diversity Collection,” which includes over 60 published articles on a range of issues including global food practices, cultural competency, cultural values in relation to taste preferences, and many more. Engaging in these Academy-supported lifelong learning opportunities will help strengthen the RDN’s cultural competency. When an RDN has attained a level of diversity awareness through these and other training resources, he or she might consider developing a diverse workforce of the future through engaging in mentoring opportunities. The Academy’s Diversity Mentoring project underscores the organization’s commitment to attracting diverse students to the dietetics profession.
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
569
PRACTICE APPLICATIONS According to the Academy’s Diversity Mentoring Toolkit, when a mentoring program is formally organized, it can be a powerful tool to encourage interest in a specific profession. “For. students [from a diverse background] and other targeted groups, mentoring can offer special emphasis on dietetics as a career where their skills are wanted and needed. Mentoring brings dietetics to students’ attention, offers help with their studies when necessary, and enhances [students’] chances of securing internships and, ultimately, employment.”5 RDNs can actively help produce a culturally competent workforce through engaging in mentoring activities. In this role, RDNs can educate culturally diverse students on a range of important skills related to networking, presentation, and interviewing. At the college level, RDN mentors also may help assess a student’s interest and abilities for dietetics as a career, guide students in taking appropriate courses, offer academic support, and offer a real-world view of the dietetics profession and its benefits, rewards, and challenges.5 Mentoring also benefits the mentors; an RDN working with students may begin to think about his or her job more critically. The experience could generate new ideas of research for the mentor, offer opportunities for expanding his or her professional network, and enhance the dietetics profession by developing a diverse, culturally competent workforce.
DEVELOPING A PIPELINE FOR YOUNGER MINORITY STUDENTS Developing a culturally competent dietetics workforce is a long-term commitment that involves educating students from high school to college on how to communicate effectively with a diverse range of individuals. The following programs are examples of youth diversity training organizations with a specific focus on health care and science professions. Each program offers opportunities for RDNs to participate as mentors, providing enhanced visibility of the dietetics profession to future members of the workforce, specifically to minority students who are learning a multicultural approach to problem solving, leadership, and communication skills. 570
HOSA HOSA, formerly known as Health Occupations Students America, was officially launched in 1976 with the goal of developing leadership and technical skill competencies for health science education students or for students who are planning to pursue a health care career.6 HOSA membership categories include secondary (high school), which constitutes the largest portion of membership, followed by postsecondary/ collegiate, professional, and alumni.7 HOSA educational opportunities available through the Area Health Education Center Network—established by the US Congress to recruit, train, and retain a health care workforce committed to underserved populations—include the Medical Explorers group, and can be found in schools where health sciences programs do not currently exist. HOSA chapters provide educational programming to develop students’ “physical, mental, and social well-being” and provide opportunities for members to interact with health care and business professionals, ideally resulting in successful employment in the health care field.6 HOSA members attend chapter, regional, and statewide conferences for leadership training and participation in competitive events that test and acknowledge student competencies related to skills in their chosen health care field. According to the HOSA Common Core State Standards, “HOSA recognizes the responsibility that future health professionals have in working with and caring for people from all cultures, in all settings. Transcultural understanding is critical to the delivery of effective health care. Health care professionals don’t just learn about cultures and world views—they practice cultural understanding through their HOSA experiences that give them opportunities to work in a health care setting.”8
MESA MESA—Mathematics, Engineering, Science Achievement—promotes handson and project-based educational opportunities for disadvantaged students with the goal of developing a diverse workforce in the fields of engineering, science, and other math-based professions. The organization, founded in 1970 in California, serves pre-college
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
students, community college students, and 4-year college-level students.9 The MESA program—which has been replicated in 12 other states—features individualized counseling to ensure that college prerequisites and graduation requirements are met. The program also brokers industry involvement in MESA activities, such as MESA Days, an annual engineering competition, which is grade/level-specific and designed to reinforce the California State Board of Education math and science standards. In California, nearly twice as many MESA high school seniors go to college, compared with all California high school graduates.10
PROJECT 3000 BY 2000 A key cultural competency intervention in the medical field, according to Parker, is Project 3000 by 2000, initiated by the Association of American Medical Colleges (AAMC) in 1991. The aim of the national campaign was to enroll 3,000 underrepresented minority students in medical school by the year 2000. Although the project fell short of its overall goal, the number of minority matriculants to US medical schools increased by 36.3% between 1990 and 1994.11 Project 3000 by 2000 also contributed to the “the growth of the pipeline model” as a viable method to address the academic needs of minority students and functions as a guide for “creating partnerships among K-12 school systems, colleges, health profession schools, and communitybased organizations.”11
HOLISTIC REVIEW PROJECT The AAMC’s Holistic Review Project, another initiative described by Parker, was launched in 2007 with the goal of helping medical schools “develop procedures that are aligned with their diversity interests and institutional mission.”12 The association offers a “Holistic Review in Admissions” workshop that encourages admissions committee members and other staff or administrators to give a balanced consideration to an “applicant’s life experiences, personal attributes, and academic metrics.”12 A total of 54 institutions have hosted the workshop, according to an article published in the AAMC Reporter in February 2014, a number that has continued to grow as school administrators strive to achieve April 2016 Volume 116 Number 4
PRACTICE APPLICATIONS enhanced diversity-related educational goals.13 Using holistic admissions criteria, according to Henry Sondheimer, MD, AAMC senior director of medical education projects, will “create a more diverse physician workforce and one that is better capable of caring for the American public.”13 Working in a team-based care setting with clinicians who are more culturally diverse will enhance communication between RDNs and other members of the team, allowing for increased focus on quality of care for the patient.
to help train, recruit, and ultimately retain, a diverse workforce, one that meets the needs of patients across a wide spectrum of ethnic and cultural backgrounds.
References 1.
6.
HOSA. About HOSA. http://www.hosa. org/node/115. Accessed June 2, 2015.
7.
HOSA. HOSA facts. http://www.hosa. org/sites/default/files/12-13%2BHOSA%2B Demographics-01.jpg. Accessed June 2, 2015.
8.
HOSA. Competitive events and the common core state standards. http://www. hosa.org/sites/default/files/14-15HOSA andtheCommonCoreStateStandards.pdf. Accessed June 2, 2015.
9.
MESA. About us. http://mesa.ucop.edu/ about-us/. Accessed June 2, 2015.
2.
Haughton B, Stang J. Population risk factors and trends in health care and public policy. J Acad Nutr Diet. 2012;112(3):S35-S46.
10.
MESA. MESA works brochure. http:// mesa.ucop.edu/wp-content/uploads/pdf/ mesa_brochure.pdf. Accessed June 2, 2015.
3.
Commission on Dietetic Registration. Essential practice competencies for the Commission on Dietetic Registration’s Credentialed Nutrition and Dietetics Practitioners. https://admin.cdrnet.org/ vault/2459/web/files/FINAL-CDR_Com petency.pdf. Accessed July 21, 2015.
11.
Terrell C, Beaudreau. 3000 by 2000 and beyond: Next steps for promoting diversity in the health professions. J Dent Educ. 2003;67(9):1048-1052.
12.
Association of American Medical Colleges. About holistic admissions. https://www. aamc.org/initiatives/holisticreview/about/. Accessed June 2, 2015.
13.
Uscher J. New medical schools use holistic admissions to create diverse classes that will fulfill diversity-related missions, goals. Association of American Medical Colleges. AAMC Reporter. February 2014. https://www.aamc.org/newsroom/reporter/ february2014/370348/holistic-admissions. html. Accessed June 2, 2015.
WORKFORCE OF THE FUTURE As an increasingly diverse population continues to flourish in the Unites States, the demand for a culturally competent dietetics workforce will continue to rise. Current and future RDNs who do not consider cultural context when offering guidance to patients could affect the patients’ perceptions of the quality of care they receive. In an effort to develop a future workforce that is culturally competent, RDNs can consider engaging in mentoring activities at all education levels
US Census Bureau. U.S. Census bureau projections show a slower growing, older, more diverse nation a half century from now. Press release. December 12, 2012. http://www.census.gov/newsroom/releases/ archives/population/cb12-243.html. Accessed May 5, 2015.
house-of-delegates/resources/diversitymentoring-toolkit. Accessed June 2, 2015.
4.
5.
Worsfold L, Brant BL, Barnhill GC. The essential practice competencies for the Commission on Dietetic Registration’s credentialed nutrition and dietetics practitioners. J Acad Nutr Diet. 2015;115(6): 978-984. Diversity Mentoring Toolkit. Academy of Nutrition and Dietetics website. https:// www.eatrightpro.org/resource/leadership/
DISCLOSURES
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the author.
FUNDING/SUPPORT No funding was received for this article.
April 2016 Volume 116 Number 4
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
571
Topics of Professional Interest
Resources for Building a Diverse and Culturally Competent Workforce in the Dietetics Profession
A
CCORDING TO THE US Census Bureau, ethnic and minority groups accounted for more than one-third of the population in 2012, with projections indicating that the United States will become a “majority-minority” nation for the first time in 2043.1 As the country’s population becomes increasingly more diverse, registered dietitian nutritionists (RDNs) can continue to support and develop a culturally competent workforce that is trained to meet the needs of a wide spectrum of patients and provide quality nutritional guidance in a respectful manner. The focus of this article is to describe the relevance of a culturally-competent workforce and to provide an overview of programs that administer robust cross-cultural communication skills training for future health and wellness professionals and Academy resources for developing diversity and cultural competency.
CULTURAL COMPETENCY AND THE DIETETICS PROFESSION “Cultural competency plays an important role in the communication and counseling carried out by food and nutrition [practitioners]. When cultural customs are ignored or violated, the result can be rejection of essential information,” said Cedric Herring, PhD, MA, professor of sociology and public policy in the Language, Literacy, and Culture Doctoral Program, University of Maryland, Baltimore, and author of Diversity in Organizations: A Critical
This article was written by Tony Peregrin, editor and writer for a Chicago-based medical association and freelance writer in Chicago, IL. http://dx.doi.org/10.1016/j.jand.2015.10.016 Available online 24 November 2015
ª 2016 by the Academy of Nutrition and Dietetics.
Examination. Herring co-presented a session titled “Changing Cultural Composition: Impacts on the Dietetics Profession” at the 2014 Food & Nutrition Conference & Expo (e-mail communication, January 2015). “To plant the seeds of cultural competence in nutritionists and dietitians, educational institutions must focus on multiculturalism and strive to recruit culturally competent educators.”2 Educating the future workforce to be culturally competent not only helps meet the needs of a diverse population, it also boosts recruitment and retention of nutrition and dietetics practitioners. According to the authors of “Population risk factors and trends in health care and public policy,” an article published in Journal of the Academy of Nutrition Dietetics, there is an assumed attrition rate of 2% to 5% in dietetics based on historical workforce data that may be partially alleviated via “recruitment and retention strategies to promote diversity and replacements due to retirements.”2 “Changing the composition of the workforce takes time and sustained effort,” noted Donna M. Parker, MD, associate dean for Diversity and Health Equity and clinical assistant professor of pediatrics, University of Florida College of Medicine, Gainesville. Parker, a co-presenter with Herring on the diversity session at the 2014 Food & Nutrition Conference & Expo meeting, underscored the importance of “leadership and organizational commitment” to enhance workforce diversity (e-mail communication, January 2015). Parker described diversity as “multifactorial,” encompassing “race, ethnicity, age, gender, sexual orientation, religion, socioeconomic, language, and geographic locale (rural, urban, and suburban),” and she cited studies suggesting that commonalities between a health care worker and a patient result
in better outcomes.3 As the “population changes, we are challenged to identify ‘commonality,’” she said.
ROLE OF THE RDN IN DEVELOPING A DIVERSE WORKFORCE RDNs seeking to enhance cultural competency after their formal education and training might consider developing one of the Commission on Dietetic Registration’s Essential Practice Competencies.4 These competencies are divided into two sets of spheres: core and functional. Core spheres—which focus on cognitive, social, and personal resource skills— include Sphere 1: “Ethics and Professionalism,” which includes support of culturally diverse customers, and Sphere 9: “Education and Counseling,” which includes “developing culturally sensitive, evidence-based materials that are appropriate to the audience.” 3,4 RDNs also can access timely and relevant cultural competency-related articles and research via the Journal’s topic collection titled “Cultural Competency and Diversity Collection,” which includes over 60 published articles on a range of issues including global food practices, cultural competency, cultural values in relation to taste preferences, and many more. Engaging in these Academy-supported lifelong learning opportunities will help strengthen the RDN’s cultural competency. When an RDN has attained a level of diversity awareness through these and other training resources, he or she might consider developing a diverse workforce of the future through engaging in mentoring opportunities. The Academy’s Diversity Mentoring project underscores the organization’s commitment to attracting diverse students to the dietetics profession.
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
569
PRACTICE APPLICATIONS According to the Academy’s Diversity Mentoring Toolkit, when a mentoring program is formally organized, it can be a powerful tool to encourage interest in a specific profession. “For. students [from a diverse background] and other targeted groups, mentoring can offer special emphasis on dietetics as a career where their skills are wanted and needed. Mentoring brings dietetics to students’ attention, offers help with their studies when necessary, and enhances [students’] chances of securing internships and, ultimately, employment.”5 RDNs can actively help produce a culturally competent workforce through engaging in mentoring activities. In this role, RDNs can educate culturally diverse students on a range of important skills related to networking, presentation, and interviewing. At the college level, RDN mentors also may help assess a student’s interest and abilities for dietetics as a career, guide students in taking appropriate courses, offer academic support, and offer a real-world view of the dietetics profession and its benefits, rewards, and challenges.5 Mentoring also benefits the mentors; an RDN working with students may begin to think about his or her job more critically. The experience could generate new ideas of research for the mentor, offer opportunities for expanding his or her professional network, and enhance the dietetics profession by developing a diverse, culturally competent workforce.
DEVELOPING A PIPELINE FOR YOUNGER MINORITY STUDENTS Developing a culturally competent dietetics workforce is a long-term commitment that involves educating students from high school to college on how to communicate effectively with a diverse range of individuals. The following programs are examples of youth diversity training organizations with a specific focus on health care and science professions. Each program offers opportunities for RDNs to participate as mentors, providing enhanced visibility of the dietetics profession to future members of the workforce, specifically to minority students who are learning a multicultural approach to problem solving, leadership, and communication skills. 570
HOSA HOSA, formerly known as Health Occupations Students America, was officially launched in 1976 with the goal of developing leadership and technical skill competencies for health science education students or for students who are planning to pursue a health care career.6 HOSA membership categories include secondary (high school), which constitutes the largest portion of membership, followed by postsecondary/ collegiate, professional, and alumni.7 HOSA educational opportunities available through the Area Health Education Center Network—established by the US Congress to recruit, train, and retain a health care workforce committed to underserved populations—include the Medical Explorers group, and can be found in schools where health sciences programs do not currently exist. HOSA chapters provide educational programming to develop students’ “physical, mental, and social well-being” and provide opportunities for members to interact with health care and business professionals, ideally resulting in successful employment in the health care field.6 HOSA members attend chapter, regional, and statewide conferences for leadership training and participation in competitive events that test and acknowledge student competencies related to skills in their chosen health care field. According to the HOSA Common Core State Standards, “HOSA recognizes the responsibility that future health professionals have in working with and caring for people from all cultures, in all settings. Transcultural understanding is critical to the delivery of effective health care. Health care professionals don’t just learn about cultures and world views—they practice cultural understanding through their HOSA experiences that give them opportunities to work in a health care setting.”8
MESA MESA—Mathematics, Engineering, Science Achievement—promotes handson and project-based educational opportunities for disadvantaged students with the goal of developing a diverse workforce in the fields of engineering, science, and other math-based professions. The organization, founded in 1970 in California, serves pre-college
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
students, community college students, and 4-year college-level students.9 The MESA program—which has been replicated in 12 other states—features individualized counseling to ensure that college prerequisites and graduation requirements are met. The program also brokers industry involvement in MESA activities, such as MESA Days, an annual engineering competition, which is grade/level-specific and designed to reinforce the California State Board of Education math and science standards. In California, nearly twice as many MESA high school seniors go to college, compared with all California high school graduates.10
PROJECT 3000 BY 2000 A key cultural competency intervention in the medical field, according to Parker, is Project 3000 by 2000, initiated by the Association of American Medical Colleges (AAMC) in 1991. The aim of the national campaign was to enroll 3,000 underrepresented minority students in medical school by the year 2000. Although the project fell short of its overall goal, the number of minority matriculants to US medical schools increased by 36.3% between 1990 and 1994.11 Project 3000 by 2000 also contributed to the “the growth of the pipeline model” as a viable method to address the academic needs of minority students and functions as a guide for “creating partnerships among K-12 school systems, colleges, health profession schools, and communitybased organizations.”11
HOLISTIC REVIEW PROJECT The AAMC’s Holistic Review Project, another initiative described by Parker, was launched in 2007 with the goal of helping medical schools “develop procedures that are aligned with their diversity interests and institutional mission.”12 The association offers a “Holistic Review in Admissions” workshop that encourages admissions committee members and other staff or administrators to give a balanced consideration to an “applicant’s life experiences, personal attributes, and academic metrics.”12 A total of 54 institutions have hosted the workshop, according to an article published in the AAMC Reporter in February 2014, a number that has continued to grow as school administrators strive to achieve April 2016 Volume 116 Number 4
PRACTICE APPLICATIONS enhanced diversity-related educational goals.13 Using holistic admissions criteria, according to Henry Sondheimer, MD, AAMC senior director of medical education projects, will “create a more diverse physician workforce and one that is better capable of caring for the American public.”13 Working in a team-based care setting with clinicians who are more culturally diverse will enhance communication between RDNs and other members of the team, allowing for increased focus on quality of care for the patient.
to help train, recruit, and ultimately retain, a diverse workforce, one that meets the needs of patients across a wide spectrum of ethnic and cultural backgrounds.
References 1.
6.
HOSA. About HOSA. http://www.hosa. org/node/115. Accessed June 2, 2015.
7.
HOSA. HOSA facts. http://www.hosa. org/sites/default/files/12-13%2BHOSA%2B Demographics-01.jpg. Accessed June 2, 2015.
8.
HOSA. Competitive events and the common core state standards. http://www. hosa.org/sites/default/files/14-15HOSA andtheCommonCoreStateStandards.pdf. Accessed June 2, 2015.
9.
MESA. About us. http://mesa.ucop.edu/ about-us/. Accessed June 2, 2015.
2.
Haughton B, Stang J. Population risk factors and trends in health care and public policy. J Acad Nutr Diet. 2012;112(3):S35-S46.
10.
MESA. MESA works brochure. http:// mesa.ucop.edu/wp-content/uploads/pdf/ mesa_brochure.pdf. Accessed June 2, 2015.
3.
Commission on Dietetic Registration. Essential practice competencies for the Commission on Dietetic Registration’s Credentialed Nutrition and Dietetics Practitioners. https://admin.cdrnet.org/ vault/2459/web/files/FINAL-CDR_Com petency.pdf. Accessed July 21, 2015.
11.
Terrell C, Beaudreau. 3000 by 2000 and beyond: Next steps for promoting diversity in the health professions. J Dent Educ. 2003;67(9):1048-1052.
12.
Association of American Medical Colleges. About holistic admissions. https://www. aamc.org/initiatives/holisticreview/about/. Accessed June 2, 2015.
13.
Uscher J. New medical schools use holistic admissions to create diverse classes that will fulfill diversity-related missions, goals. Association of American Medical Colleges. AAMC Reporter. February 2014. https://www.aamc.org/newsroom/reporter/ february2014/370348/holistic-admissions. html. Accessed June 2, 2015.
WORKFORCE OF THE FUTURE As an increasingly diverse population continues to flourish in the Unites States, the demand for a culturally competent dietetics workforce will continue to rise. Current and future RDNs who do not consider cultural context when offering guidance to patients could affect the patients’ perceptions of the quality of care they receive. In an effort to develop a future workforce that is culturally competent, RDNs can consider engaging in mentoring activities at all education levels
US Census Bureau. U.S. Census bureau projections show a slower growing, older, more diverse nation a half century from now. Press release. December 12, 2012. http://www.census.gov/newsroom/releases/ archives/population/cb12-243.html. Accessed May 5, 2015.
house-of-delegates/resources/diversitymentoring-toolkit. Accessed June 2, 2015.
4.
5.
Worsfold L, Brant BL, Barnhill GC. The essential practice competencies for the Commission on Dietetic Registration’s credentialed nutrition and dietetics practitioners. J Acad Nutr Diet. 2015;115(6): 978-984. Diversity Mentoring Toolkit. Academy of Nutrition and Dietetics website. https:// www.eatrightpro.org/resource/leadership/
DISCLOSURES
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the author.
FUNDING/SUPPORT No funding was received for this article.
April 2016 Volume 116 Number 4
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
571