Medical Schools Flunk Doctor Nutrition Training
Even if asked what we ate, the nurse most likely would not know how to process that information. Could it be that nurses and doctors don't have a clue about what a nutritious diet should include? We've heard people say the doctor told them to "eat a balanced diet." What does that advice mean to a patient who has no knowledge of nutrition basics but instead falls prey to junk food TV ads, fast foods, and packaged snacks?
It's a national scandal! Doctors who are treating people for obesity and a host of chronic diseases resulting from excess weight have received very little or no training in nutrition.
In December 2014 the Journal of Biomedical Education published the study "Learner-Directed Nutrition Content for Medical Schools to Meet LCME (Liaison Committee on Medical Education) Standards." The study revealed the "deficiencies" in medical school nutrition education that have existed as far back as the 1960s.
"Nutrition-related non-communicable diseases, including heart disease, stroke, cancer, diabetes, and obesity, are now the most common, costly, and preventable health problems in the US," the researchers point out. "Training medical students to assess diet and nutritional status and advise patients about a healthy diet, exercise, body weight, smoking, and alcohol consumption are critical to reducing chronic disease risk," says the study.
We couldn't agree more! It's shameful that doctors are not given these basic yet valuable tools. It's also disappointing that patients suffer needlessly from preventable chronic diseases and could benefit greatly from medical professionals equipped with today's nutrition research.
When the Association of American Medical Colleges (AAMC) surveyed graduates of medical schools, the organization reported more than half said their nutrition instruction was inadequate. Currently, many doctors feel they don't have the expertise to counsel their patients on diet and lifestyle.
"A review of nutrition content in medical schools showed that, on average, only 4 to 6 hours are devoted to nutrition content over the entire 4-year curriculum. While curriculum hours and teaching methods vary widely among medical schools, nutrition educators have suggested that a minimum of 25 hours are needed to properly train medical students in nutrition," the study reported.
"With the current obesity epidemic and the costs associated with chronic disease skyrocketing, medical schools need to find creative learning opportunities to ensure that medical students graduate with the ability to recognize the association between lifestyle and chronic disease, take a diet and exercise history, and effectively intervene by promoting a healthy lifestyle," the study authors write. We agree. Diet and lifestyle education is critical, not only in medical school but also in public education to address today's health crisis.
The American Medical Association finally got around to declaring obesity a disease in 2013. This disease ends up in the lap of the primary care doctor who has no training in how to deal with it. While the doctor may hesitate to prescribe a pill for obesity, he can offer a pharmacy full of medications to treat a disease that results from obesity.
Doctors say they don't have time to interview the patient and effect changes in diet and lifestyle habits. We say it's critical that doctors face the growing need to reverse chronic disease by seeking the necessary nutrition knowledge and sharing it to help make their patients well. According to James Colbert, MD, of Brigham and Women's Hospital, and Sushrut Jangi, MD, of Beth Israel Deaconess Medical Center, both in Boston, "The front lines of the obesity epidemic often lie in a primary care doctor's office, despite how overworked and 'focused on pharmacologically treatable conditions' primary care doctors are," they wrote in the October 10, 2013 issue of the New England Journal of Medicine.
Some schools are now integrating lifestyle medicine into the curriculum. The University of South Carolina School of Medicine, for example, has initiated a lifestyle medicine program as part of its required curriculum. Classes feature team teaching by specialists in exercise and nutrition working alongside physicians teaching traditional medicine.
Harvard Medical students are now required to enroll in a 14-week Preventive Medicine and Nutrition course in their second year. The course has lectures on healthy diet, vitamins, supplements, obesity, international nutrition, cardiovascular disease, and accompanying tutorials. We commend these medical schools for recognizing a dire need and taking the important steps to incorporate lifestyle medicine into the curriculum.
Doctors cannot solve the obesity crisis by themselves, but they can take steps to learn about lifestyle medicine and nutrition. The crisis must have the combined efforts of food and beverage companies, the United States Department of Agriculture (USDA), the medical community, and the media working together to combat this health menace.
"It takes a village," to bring about major change, but the coordinated efforts of multiple health organizations were successful in tackling the ebola epidemic and the measles outbreak. Surely "the village" can achieve success in addressing obesity and chronic disease.
Efforts have to be made to demonize foods loaded with fat, sugar, and salt. The government can play a significant role by not allowing lobbyists to pervert the goals of the Dietary Guidelines for Americans, 2015. Those guidelines, recommended by the 2015 Dietary Guidelines Advisory Committee, should reflect scientific research by the Committee, not the money spent by lobbyists for special interests.
As food writer Mark Bittman says, "All Americans have the right to nutritious, affordable, sustainable and fair food."
"Recommending a more plant-based diet is something that the government has shied away from. This is partly because the U.S. Department of Agriculture (USDA), which co-authors the guidelines with the U.S. Department of Health and Human Services (HHS), is responsible for managing and promoting agriculture, including animal agriculture," says pathologist Melissa Li, MD, of Providence St. Vincent Medical Center.
"To put it more simply, the USDA is tasked with promoting animal-based products like meat, dairy, and eggs. So while the agency knows what is in the best interest of Americans (eating more plant-based foods), it is torn between giving sound advice (eating more of said plant-based meals and less meat) and protecting one of the largest industries it is tasked to represent," she added.
On the national scene two bills that address physician education in nutrition were introduced in Congress in 2015. The Education and Training (EAT) for Health Act (H.R. 4378) requires six hours of annual continuing education in nutrition for primary care providers employed by the federal government. We hope this act is passed and will be expanded to include all physicians, not just the ones employed by the federal government.
Expanding Nutrition's Role in Curriculums and Healthcare (ENRICH) Act (H.R. 4427) establishes a grant program for medical schools to incorporate nutrition into the curriculum.
Dr. John McDougall was instrumental in persuading the California State Senate to consider amending the Medical Practice Act (SB 380, Continuing Medical Education). requires the Medical Board of California to periodically disseminate information and educational material regarding nutritional and lifestyle behavior for prevention and treatment of chronic disease to physicians and surgeons and acute care hospitals. The bill would require the board to convene a working group regarding nutrition and lifestyle behavior, as specified." The law authorizes the board "to also set content standards for an educational activity concerning chronic disease, as specified."
Although the law was passed, despite the opposition of the California Medical Association, the Medical Board has yet to initiate the law's recommendations.
In addition to states mandating that physicians have continuing education in nutrition, it should be the duty of medical schools to adopt lifestyle medicine as an integral part of their required curriculum.
Public schools could also play a role in curbing the obesity epidemic by offering health classes with meaningful nutrition information. A nutrition unit could be designed by a savvy registered dietitian knowledgeable about current nutrition studies and who is not beholden to either the meat or dairy industries. Schools should be mindful of what they serve in the cafeteria by including more fruits and vegetables in the menu as well as cutting back on fries, pizza, and burgers. Vending machines should not be stocked with high-sugar sodas and juices.
It will "take a village" of children, adults, health professionals, educators, government officials, and food company decision makers all focused on how to prevent chronic disease. They all must recognize the role poor diet plays in poor health.
We, the health care consumers, must also recognize that our health and well being starts with us. That means being conscious of what we are eating, adopting an exercise routine, and eating more fruits and vegetables. We can't wait for doctors to gain expertise in nutrition. If we pursue junk food diets high in calories and sugar, salt and fat and continue to smoke, we should not expect the doctor to rescue us from the resulting chronic diseases.