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The Role of the Nutrition Professional in Disability Awareness
Written by: Jeanie Subach, EdD, RD, CSSD, LDN

Credit: ADA National Network (adata.org) 1-800-949-4232

The most recent data from the Centers for Disease Control and Prevention estimates that approximately 61 million adults in the United States live with some type of disability.¹ Persons with disabilities have higher incidence of chronic diseases, including overweight and obesity than persons without a disability, and inequity in quality of healthcare, programming, and services to meet the needs of the disability population often exists.^1,2.The position of the Academy of Nutrition and Dietetics states “nutrition services provided by registered dietitians, nutritionists and dietetic technicians, registered, are essential components of comprehensive care for all people with developmental disabilities and special health care needs.” ³

The strategic plan of the Academy of Nutrition and Dietetics has four focus areas designed to meet their vison of “A world where all people thrive through the transformative power of food and nutrition.⁴” The focus area “wellbeing and prevention” lists “increasing equitable access to food, nutrition and other lifestyle-related services and “promotion of healthful eating and physical activity to improve population health and wellness at all stages of life” as impact goals.⁴

Registered dietitians, nutritionists, and dietetic technicians registered can play an essential role in achieving the Academy’s strategic goals while decreasing inequity by developing appropriately planned nutrition programming for individuals with disabilities. Provision of appropriately planned programs for individuals with disabilities fall within the Academy’s strategy of reducing and eliminating nutrition and health disparities. Program design must take into consideration requirements and guidelines of the American with Disabilities Act (ADA). Nutrition professionals have a responsibility to know and uphold the principles of the ADA in their practices.

It was the “On the Threshold of Independence” report by the National Council on the Handicapped, now known as the National Council for Disabilities (NCD) that facilitated the introduction of the first version of the ADA to Congress in 1988.⁵ The ADA was passed by Congress and signed into law by President George H.W. Bush on July 26, 1990. ⁵ The ADA turns 32 on July 26th and is celebrated through the ADA 32 campaign.⁵

The ADA is a civil rights law designed to prohibit discrimination to individuals with disabilities in all areas of public life, including employment, education, transportation, and any public and private places that are open to the public.⁵ The law was designed to ensure that persons with disabilities are offered the same rights and opportunities as persons without disabilities.

The ADA is divided into five different titles which include:

• Title I: Employment.
• Title II: Public Services: State and Local Government.
• Title III: Public Accommodations and Services offered by Public Entities
• Title IV: Telecommunications
• Title V: Miscellaneous Provisions

While ADA requirements in titles I, II, IV and V are implemented and closely monitored in most public and private corporate, educational, and healthcare settings, it is the responsibility of the nutrition professional to uphold the requirements of title III in their practices and presentations. Title III- Public Accommodations and Services Operated by Public Entities requires practices that provide effective communication to individuals who have a vision, speech, or hearing disability.⁵ Use of voice-overs, closed captioning, and alternate text for images in presentations are examples of accommodations that satisfy title III. A comprehensive explanation of each title, respective regulatory agencies and helpful training information for can be found at ADA Network.⁴ The ADA National Network offers free Self-Paced Informational Courses on a variety of beneficial topics. ⁵

One of the most important concepts that nutrition professionals working with persons with disabilities must understand is that a person’s identify is not defined by their disability. People-first language (PFL), which put the person before the disability, should always be used.⁶ PFL describes the disability the person has, rather than who the individual is.⁷ Person-first language such as a “child with autism” is appropriate, while “autistic child” is not. Commonly used terms such as “handicapped” or “disabled persons” are better described as “Individuals or persons with a disability.”

As in all areas of healthcare, it is vital to keep current with terminology and phrases. The term “mental retardation” is outdated, should not be used, and is often deemed offensive. Terms such as “learning disabled” should be replaced with “has a learning disability”, and “mentally ill” should be replaced with “person with a mental health condition.” A more comprehensive list can be found at Office of Disability Rights.⁶

Practitioners working with an individual with a disability should prepare by researching the specific disability, becoming familiar with the disability-specific culture, terminology, and treatment protocols. Although PFL is termed a “best practice,” it is not accepted by all, so it is important to seek out the preferred language of the disability-specific culture. All nutrition professionals should practice cultural humility, a process which requires continual humility, and engagement in self-reflection and self-critique as lifelong learners and reflective practitioners.⁴ The Academy identifies this practice in its strategic plan as a means of increasing the diversity of professional within the area of nutrition and dietetics.⁴

Individuals with disabilities have the right to self-determine, or make choices concerning their health, including food choices, but this right is not always respected. Adapted culinary programs using the Active Engagement Model, developed by Registered Dietitian Janice Goldschmidt, are beneficial as they are centered to support autonomy, competence, relatedness, and preference.⁷ The “preference” component of the model is unique, giving the individual a choice in food selection. This promotes an increase in the self-determination and self-efficacy of the individual.⁷ Culinary programs using the Active Engagement Model fall into the classification of appropriately planned programming, and help satisfy the Academy’s strategic plan.

Nutrition professional looking to expand their knowledge base should explore practice groups such as the Behavioral Health Nutrition DPG which offers resources and continuing education opportunities.⁸ The ARC Inclusive Volunteering program offers opportunities to get involved in nutrition related programming for persons with intellectual and developmental disabilities.⁹ Nutrition is an important part athletic performance and is stressed in Special Olympics programs across the nation. Get involved with Special Olympics through the Volunteer with Healthy Athletes program and share your nutrition expertise!¹⁰

Nutrition professionals should celebrate ADA32 through learning about disabilities and have a responsibility to share that knowledge and our expertise to achieve the Academy’s vision of creating “A world where all people thrive through the transformative power of food and nutrition."⁴


References:

1. Centers for Disease Control and Prevention. Disability impacts all of us.2020a. Accessed July 12, 2022. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html.
2. Krahn GL, Walker DK, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 2015 Apr;105 Suppl 2(Suppl 2): S198-206. doi: 10.2105/AJPH.2014.302182. Epub 2015 Feb 17. PMID: 25689212; PMCID: PMC4355692.
3. Ptomey, Lauren T. et al. Position of the Academy of Nutrition and Dietetics: nutrition services for individuals with intellectual and developmental disabilities and special health care needs. Journal of the Academy of Nutrition and Dietetics, Volume 115, Issue 4, 593 – 608.
4. Academy of Nutrition and Dietetics. The Academy’s strategic plan. Accessed July 12, 2022. https://www.eatrightpro.org/leadership/governance/board-of-directors/strategic-plan.
5. ADA National Network. Overview of the Americans with disabilities act. 2022. Accessed July 12, 2002. https://adata.org/factsheet/ADA-overview.
6. Office of Disability Rights. People first language. Accessed July 12, 2022. https://odr.dc.gov/page/people-first-language.
7. Goldschmidt, J., & Song, H. Development of cooking skills as nutrition intervention for adults with autism and other developmental disabilities. Journal of Academy of Nutrition and Dietetics, 117(5), 671-76. https://doi.org/10.1016/j.jand.2016.06.368.
8. Academy of Nutrition and Dietetics. Behavioral health nutrition. Accessed July 12, 2022. https://www.bhndpg.org/home.
9. The Arc. Get involved. Accessed July 12, 2022 https://thearc.org/get-involved/.
10. Special Olympics. Volunteer with healthy athletes. Accessed July 12, 2022 https://www.specialolympics.org/get-involved/healthy-athletes?locale=en.


Jeanie Subach, EdD, RD, CSSD, LDN
Jeanie Subach is a Registered Dietitian and a Board-Certified Specialist in Sports Dietetics with over 35 years of experience. She is an Associate Professor at West Chester University of Pennsylvania where she teaches in the DPD (Didactic Program in Dietetics) and dietetic internship programs. Jeanie teaches introductory food selection and preparation, and plant-based nutrition courses. She is also the faculty advisor to the campus gardens which serve the campus resource pantry and local food cupboards. She is the advisor to the Student Dietetic Association and creator of the Ram Chefs program, a culinary program for young adults with developmental disabilities. Jeanie earned her bachelor's and master’s degrees from Immaculata University and her doctorate from Capella University. In addition, she holds a plant-based culinary instructor Certification from the Roubxe Culinary School and is currently pursuing a certification in culinary medicine.

Jeanie has an extensive background in sports nutrition, acting as team nutritionist for the Philadelphia 76er for over 30 years. She served as the team dietitian for the Philadelphia Flyers for eight years and the Philadelphia Eagles for 14 seasons. In addition to working with professional athletes, Jeanie works with area recreational, high school and collegiate athletes. Jeanie served on the Gatorade NBA Advisory Board and was the coordinator of the NBA RD practice group.

Jeanie enjoys running and paddle boarding, and is an avid skier, but finds the most pleasure in the kitchen! Jeanie’s proudest accomplishment is her family, and is the proud mother of 3 daughters, and Mom-Mom to John and Whitney.