Ilyn Mendoza

NUTR 510
Section 2C
September 25, 2014

Dietitian Role Counseling Mrs. Therese Kim

Mrs. Therese Kim is a new client that was referred to my private practice by her sister, a
former patient. Mrs. Kim is a 42-year-old second-generation Japanese American. She is married,
has few children, and is an elementary school teacher. At 54 and 154 pounds Mrs. Kims BMI
is 26.4, which puts her at a slight overweight status. Mrs. Kim says that she has tried
everything to lose weight. According to her glucose tolerance test, Mrs. Kim results are
borderline for diabetes.
In order to successfully counsel a patient, it is important for dietitians to respect and be
aware of the ways different cultures communicate (1). The interpersonal communication styles
of Japanese Americans are very similar to Japanese communication styles but can vary by
generation. There are four main generations of Japanese Americans: Issei (first generation, born
in Japan), Nisei (second generation, born in the United States), Sansei (third generation), and
Yonsei (fourth generation) (2). Since Mrs. Kim is a second-generation Japanese American, she is
classified as a Nisei. Niseis do not exclusively speak Japanese like their Issei parents. However,
they will learn to speak Japanese to maintain communication and a close relationship with their
parents (3). Because formality and politeness is an important aspect of communication in Japan,
it is considered a sign of disrespect to address Japanese elders, Issei, and some Nisei by their first

name (2). It is also important to remember the Japanese are a non-touching culture. Because of
this, they may require more personal space compared to other cultures. However, upon initial
communication, most Japanese Americans can tolerate a light handshake (2). To avoid being
disrespectful, many Japanese Americans avoid eye contact (3). Additionally, many Japanese feel
uncomfortable saying no due to the fact that they do not like confrontation (2). Therefore, it is
important for dietitians to make their Japanese patients feel comfortable during counseling
sessions to avoid negative feelings of confrontation.
When Buddhism became popular in Japan, the idea that the cause of illness was due to an
imbalance of harmony was highly emphasized (2). This health belief concept is still present in
Japan, as an aspect of health that is taken seriously in Japan is stress-induced illness. As a result,
more stress relievers that focus on maintaining balance are emphasized in Japanese culture.
Such stress relievers include massage parlors, different spa treatments, and napping on the job
(2). For Japanese Americans, an acculturation of traditional health beliefs may affect health
outcomes and how health is viewed (4). Therefore, some Japanese Americans may or may not
adopt the same health beliefs as those living in Japan.
Japanese foods are prepared in numerous ways, such as broiled, grilled, simmered in
liquid, steamed and deep fried. (2). Key staples in a traditional Japanese diet include rice,
soybeans, and tea. Popular food items that include these staples include sushi, tofu, and miso (2).
However, Japanese American diets are becoming less traditional and more westernized with each
generation (2). For example, Japanese Americans will consume less tea and less fruits and
vegetables (2). Additionally, later generations of Japanese Americans consume more animal fats
and simple carbohydrates while they eat less complex carbohydrates (5).

During my first counseling session with Mrs. Kim, it is imperative that I make her feel
comfortable by not giving constant eye contact and by giving her the proper space that she needs.
Two goals that I would like to accomplish after this first counseling session is to develop a better
understanding of her weight history and the weight loss methods she has tried in the past.
However, it is important to be aware of how Japanese Americans communicate when asking
these certain questions because if not, miscommunication can occur which can cause Mrs. Kim
to feel negative and uncooperative.
Regardless of whether or not Mrs. Kim believes in traditional Japanese health beliefs or
not, it is essential to keep her health beliefs in mind. By asking Mrs. Kim questions about her
personal health beliefs, it will be easier to personalize her nutrition care plan for her next
counseling session to better fit her needs.
It is important to ask Mrs. Kim about her current dietary habits and to figure out if there
are any aspects of her diet that may be making it difficult for her to lose weight/keep weight off.
A key point to keep in mind is that Japanese immigrants are shown to have an increase in
diabetes with a more westernized lifestyle (4). Though this can be a potential reason as to why
Mrs. Kims results are borderline for diabetes, it is still important to evaluate her three-day food
record to see if there are improvements that need to be made.

References
1. Holli BB, Beto JA. Nutrition Counseling and Education Skills for Dietetics
Professionals. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:242.
2. Kittler PM, Sucher KP, Nahikian-Nelms M. Food and Culture. 6th ed. Belmont, CA:
Wadsworth; 2012:321-331.
3. Japanese Americans. San Francisco Public Library Web site.
https://www.library.ca.gov/services/docs/japanese.pdf. Accessed September 25, 2014.
4. Salant T, Lauderedale DS. Measuring culture: a critical review of Acculturation and
health in Asian immigrant populations. Social Science & Medicine. 2003;57(1):76-86
5. Kudo Y, Falciglia GA, Couch SC. Evolution of meal patterns and food choices of
Japanese-American females born in the United States. European Journal of Clinical
Nutrition. 2000;58(4):665.