What do doctors know about food? Not very much.
WHEN Americans hear about a health craze, they may turn to their physician for advice: Will that superfood really boost brain function? Is that supplement okay for me to take? Or they may be interested in food choices because of obesity, malnutrition or the role of diet in chronic disease. But a doctor may not be a reliable source. Experts say that while most physicians may recognise that diet is influential in health, they don’t learn enough about nutrition in medical school or the training programmes that follow.
An estimated 50 to 80 per cent of chronic diseases, including heart disease and cancer, are partly related to or affected by nutrition, according to Martin Kohlmeier, a research professor in nutrition at the University of North Carolina at Chapel Hill. For those experiencing risk factors early on, a change in diet is important.
“People are gaining a pound or two a year, and nobody says anything. But then by age 50 or 55, they’ve often gained 30 or 40 pounds, which has huge impacts on their health,” said Walter Willett, an epidemiology and nutrition professor at the Harvard T.H. Chan School of Public Health. “In the younger years, middle age, people are acquiring the risk factors that often don’t show up as major diseases until later in life.”
“You can practise only what you know,” Kohlmeier said. According to the Journal of the Academy of Nutrition and Dietetics, malnutrition is prevalent but underrecognised in the United States. That does not surprise Kohlmeier, who said, “This is what happens when you don’t teach nutrition.”
Stanford and UNC are among medical schools working to turn that tide by integrating nutrition into their curriculums. “Just like it was really important that doctors stopped smoking - that made them advocates for not smoking,” Willett said. “Doctors need to set an example, both for their own good and for the good of their patient.”
The Association of American Medical Colleges reports a more than 50 percent increase since 2011 in schools offering an elective course that covers nutrition, but that tally counts electives that merely include and don’t necessarily focus on the subject.
AAMC medical education expert Lisa Howley is optimistic. “All of our schools are addressing this in some capacity. Some are doing it quite intensively, and others (not as well) - there’s a spectrum,” she said. “For those who are somewhere on the lower end of that spectrum, it would be lovely to see them learn from their colleagues and, through shared resources, be able to even further integrate this content into their curriculum.”
Teaching nutrition requires expertise and resources, but some efforts are underway to streamline the process so every school doesn’t need to start from scratch. Rydel and colleagues are working to centralise nutrition-related research and recommendations for medical schools, and the American Society for Nutrition announced in September that it would lead a coordinating centre for nutrition education.
Willett said that the initiatives in schools are crucial. He recalled a major study in 2015 that encouraged more-aggressive treatment with drugs that can lower blood pressure even though obesity and excess weight are major causes of hypertension.
“There was not a single statement I saw anywhere that we should encourage weight loss and sodium reduction or increased potassium intake, which means more fruits and vegetables,” he said. “That just is such a glaring example of the result of our extremely unbalanced medical education.” – Washington Post