This famous quote, attributed—perhaps mistakenly—to Hippocrates, captures the essence of the role nutrition plays in preventing and treating disease.
What a person eats and drinks in all stages of the lifespan has a profound impact on overall health and development of chronic disease. Four of the top ten leading causes of death in the United States are related to nutrition: diabetes, heart disease, cancer, and stroke.
But doctors-in-training are graduating without the nutrition knowledge and skills that they will need on day one. Surveys of medical school faculty show that most US medical schools are not providing the minimum recommended 25 hours of nutrition education, as per the National Research Council’s Nutrition in Medical Education Committee.
Medical residents report that they need more training in nutrition and behavioral counseling to feel confident in their ability to address their patients’ nutritional status and to guide them to make appropriate and healthful lifestyle choices.
Surveys of practicing physicians show that many still are not able to adequately provide effective nutrition counseling to their patients.
“Surveys of practicing physicians show that many still are not able to adequately provide effective nutrition counseling to their patients.”
It’s a pretty tall order: clinicians need to be able to stay abreast of research in nutrition science, synthesize and integrate it with the existing knowledge base regarding the role of nutrition in treating disease or preventing illness, translate it into practical guidance related to food behaviors, communicate it to patients in a clear and nonjudgmental manner, and empower their patients to make difficult behavior changes.
The clinician-patient relationship is a powerful one. Patients look to their healthcare providers for accurate information on nutrition and health, but patients also need considerable guidance on adopting healthy lifestyle habits. And they need providers that fully appreciate the role of nutrition.
Consider the evidence basis: the Diabetes Prevention Program showed that counseling patients on diet and exercise works better than medication in preventing diabetes among patients with impaired glucose tolerance. In fact, it works two times better than metformin. A DASH diet with reduced sodium is as effective as thiazide diuretics in lowering systolic blood pressure.
Still, many patients are simply given a prescription, without a mention of lifestyle changes being a proven successful strategy in managing their chronic diseases and reducing risk factors.
In 2013 the American Medical Association (AMA) officially recognized obesity as a disease — a disease that has multifactorial causes and clearly has links to lifestyle, including dietary and physical activity patterns.
Even though over 40 percent of adults in the US have obesity, clinicians rarely discuss obesity with patients or document the diagnosis in the medical record, even among those with ‘super obesity’ (BMI>50).
Healthcare providers on the front lines when it comes to promoting healthy lifestyles need a way to quickly and effectively fill in the gaps in their training, and institutions that train clinicians need a way to integrate nutrition throughout the curriculum so that their students are better prepared to prevent and manage the many diseases related to poor nutritional status, obesity, and physical inactivity.
“…many patients are simply given a prescription, without a mention of lifestyle changes being a proven successful strategy in managing their chronic diseases and reducing risk factors.”
Registered dietitian nutritionists are the experts on the healthcare team when it comes to translating nutrition science into individualized guidance for patients, by providing what is called medical nutrition therapy. But they cannot do it alone.
The best results for patients come when they are treated by a multidisciplinary, integrated healthcare team, where each member has enough foundational knowledge that they can reinforce the expertise of the others.
Clinicians with expertise in nutrition care are better able to diagnose and intervene early when diet-related issues can profoundly impact disease progression. And the more skilled that clinicians of all backgrounds are at understanding and providing nutrition guidance, the better they can recognize when referrals are needed.
With the rising and intractable obesity and diabetes epidemics, and the fact that both conditions are better prevented than treated, a broad, evidence-based course in nutrition that focuses on the skills and foundational knowledge that providers need to put nutrition care immediately into practice, is key.