This week, we interviewed Sue-Ellen Anderson-Haynes, a registered dietitian, certified diabetes care and education specialist, and founder of 360Girls&Women, about nutrition care for diabetes and racial disparities in healthcare.
In her work as a registered dietitian, Anderson-Haynes has made significant contributions to nutrition for diabetes, including serving as a spokesperson for the Academy of Nutrition and Dietetics and leading a practice that specializes in helping women, especially Black and pregnant women, manage their diabetes.
Shae Puckett: How did you come to work in dietetics and diabetes and what inspired you to do this kind of work?
Anderson-Haynes: I’ve always had a passion for health and helping people improve their quality of life. In high school, I joined Health Occupations Students of America. I was taught early how to take vital signs, ambulate people (help them move from place to place), and facilitate patient care. I became a certified nursing assistant and worked in hospitals while studying in college. Originally, I wanted to be a physician. I took all the pre-med classes in college, but I had a change of heart after working in the hospital. I wanted to be more on the preventative side of healthcare. I spoke with a college guidance counselor and she recommended nutrition and dietetics as an option. From there, I took my first nutrition course at the University of Florida and never turned back!
As I joined the dietetics field and learned more about diabetes management and prevention – its relentless growth rate (especially among diverse groups), its impact on daily life, and the way nutrition can address its causes and effects – I knew this was an area of focus for me.
Throughout my career as a registered dietitian, I have always worked with patients who had diabetes whether it was in acute care settings such as intensive care units, mother-baby units in the hospital, outpatient settings, corporate spaces, or private practice.
The majority of my clients are women – especially now in my private practice 360Girls&Women – but my focus shifted to gestational diabetes and type 2 diabetes as I saw how much diet and lifestyle interventions dramatically changed the trajectory of mother and baby. I developed B.E.A.T (Before Pregnancy, Entering Pregnancy, At Diagnosis, Through Delivery and Beyond) Gestational Diabetes, a program that addresses not just the diagnosis stage of gestational diabetes, which tends to be the majority of focus for many, but all the stages before and after.
Research reports that Black mothers are three times more likely to die from pregnancy-related complications than white mothers. That’s why I am passionate about reducing the incidence and prevalence of gestational diabetes, its conversion to type 2 diabetes, and improving health outcomes for mother and baby, with a special focus on Black maternal and infant health.
Puckett: What do you see as some of the biggest challenges facing diabetes care at this time? How do we overcome these challenges?
Anderson-Haynes: One of the biggest challenges is awareness. One out of every three adults in the U.S. has prediabetes and many of them are unaware. Some are aware of their status, yet unaware that steps (like nutrition and lifestyle changes) can be taken to prevent its progression to type 2 diabetes. Many people living with diabetes don’t know that changes in nutrition and lifestyle can have a great effect on health outcomes and quality of life.
The other major challenge is the lack of referral by primary care providers to see a registered dietitian. In my almost 20 years in healthcare as a registered dietitian, I have had individuals who have seen me for the very first time who have had diabetes for four, five, or even 10 years. I have been around many dietitian circles that see this same issue regarding lack of referral for diabetes education, management, or prevention.
We can overcome this challenge with a call to action among our colleagues through conference presentations, workshops, or webinars to increase awareness of the problem and stimulate conversations about solutions. In addition, initiating public policy campaigns that align registered dietitians and primary care providers as a means to help reduce the growing rates of prediabetes, gestational diabetes, and type 2 diabetes is another solution that should be explored.
Finally, diabetes management is technology management. Access to diabetes technologies such as continuous glucose monitoring (CGM) for people with diabetes is not always equitable – this is a challenge not only for patients but for healthcare professionals who provide care. A grassroots effort is needed to start turning the wheel for better access. Contacting your local legislator and reporting the many incidents of poor diabetes management outcomes due to the lack of important technology requires the work of all of us. This is taking one small but important step in the right direction.
Puckett: Are there any challenges unique to women?
Anderson-Haynes: Yes, women face distinctive challenges and may be at risk for certain complications, particularly as it relates to pregnancy with diabetes – such as gestational diabetes, which is on the rise, increasing 30% between 2016 and 2020. Awareness of healthy steps to take prior to pregnancy, during pregnancy, and postpartum is very important.
To overcome these challenges, healthcare providers should be screening for specific risk factors, monitoring key metabolic markers, and communicating to people with diabetes about the different types of practitioners (like registered dietitians) who can help at any stage.
Then, we need to truly listen to women when they say they do not feel well, despite normal lab values or results. Offering alternative testing and referrals for second opinions before prescribing medication at the onset is critical for patient care.
Opting for a multidisciplinary approach when caring for women, especially women who are pregnant with conditions such as gestational diabetes, type 1 or type 2 diabetes, or those going through other vulnerable life stages like perimenopause and menopause is also the embodiment of what holistic care should be. For example, there has been an uptick in complaints of lack of patient care for women experiencing menopausal symptoms, particularly among Black women. Research shows that women who complain of pain are often dismissed and concerns are often misdiagnosed and said to be all “in their heads.” This has to change. Women deserve better.
Puckett: You’ve mentioned several of the additional challenges that Black women face. We also know diabetes stigma can have an even greater impact on people who are experiencing racism and sexism, which can negatively impact diabetes-related outcomes. Accessing high-quality care can also be more difficult. What is one thing Black, Indigenous, and people of color (BIPOC) should know about diabetes?
Anderson-Haynes: BIPOCs are at higher risk of experiencing not only diabetes stigma but racism, sexism, and other challenges. This creates a need to be vigilant and advocate for themselves by asking questions, especially when they don’t understand treatment plans. Seeking out providers who can relate to them, such as those who have the same racial or ethnic background, has been shown to support better health outcomes.
Quality healthcare for all is essential and a basic human right. Knowledge is power, and the difference between knowing and not knowing is huge. If you know your options, you can take action. So doing your own research, weighing the risks and benefits, and asking for a second (or even third opinion) can be beneficial in many circumstances.
Your experience and viewpoint are important. Advocate for yourself and be consistent. Join or follow organizations that speak up against diabetes stigma.
Puckett: What advice would you give to healthcare providers who are looking to provide better care to women and diverse communities?
Anderson-Haynes: First, listen to the person and be open-minded. We hear many stories of women, especially minorities, who report issues that are ignored or downplayed – coined as medical gaslighting – only to have those issues worsen and lead to terrible outcomes. Do not ignore or downplay what they are reporting. Use the same rigor in care across the board.
Next, be aware of your bias and stigma toward a subset of people or chronic conditions. Ask questions and don’t assume you know everything about their typical meal patterns, way of living, culture, medication behaviors, and so on.
Refer people to a culturally aligned healthcare provider and dietitian – especially if treatment plans or outcomes are not being achieved.
Finally, implement an interdisciplinary approach to care and include a registered dietitian in the plan of care. Registered dietitians work across many healthcare settings, including but not limited to inpatient and outpatient facilities and specialties in areas such as women’s health, diabetes, pediatrics, sports nutrition, weight management, preventive medicine, integrative and functional medicine, corporate health, and more.
Learn more about diabetes in Black communities and nutrition here: