NUTRITION
July 23, 2019

Dietitians to the Rescue

Few MDs feel qualified to make dietary recommendations. That's a problem for patients' health.

More often than not, it’s the everyday food choices people make that bring on chronic diseases like obesity, type 2 diabetes, heart disease and certain types of cancer. So it would seem to make sense that doctors would be giving their patients nutrition counseling to prevent or manage these diseases. But the reality is that few doctors do this, largely because they are simply not trained in the basics of nutrition.

This issue was recently addressed in a commentary published in JAMA Internal Medicine.

Dietary changes should be the first-line therapy for the treatment of conditions such as overweight, high blood sugar, high blood pressure or high cholesterol.

The commentary, written by Neal Barnard, MD, the president of the Physicians Committee for Responsible Medicine, offers examples of patients who received either no nutrition advice or wrong nutrition advice. The most extreme is the case of a patient with longstanding diabetes. The woman was hospitalized for a foot infection, a common complication. Amputation was recommended. In all her years with the disease, no one had ever counseled this patient about improving her diet, even though dietary changes can improve diabetes, and in some cases make the disease disappear.

Too Many Doctors with No Nutrition Training

When internal medicine residents were surveyed in 2018, 61 percent said they had little or no nutrition training. Another study found that the 94 percent of internal medicine residents agreed that nutrition counseling should be included in patient visits, but only 14 percent felt trained to perform it.

This is surprising since research clearly shows that when people eat reasonable amounts of fruits, vegetables, grains and beans, they can decrease their risk of developing heart disease, high blood pressure, diabetes, cancer and other health problems. Slightly over nine percent of U.S. adults meet the recommended intake for vegetables, and only about 12 percent eat enough fruit; having doctors actively advocating for better nutrition could make a big difference.

So it makes sense that doctors should prescribe dietary changes when troubling symptoms appear and see that their patients get proper nutrition counseling. Dietary changes should be the first-line therapy for the treatment of conditions such as overweight, high blood sugar, high blood pressure or high cholesterol. In addition, a healthy diet should be part of the overall plan for managing obesity, heart disease, diabetes, hypertension, and cancer.

A handout and an encouraging word are not the same as nutrition counseling. Perhaps patients would take an official prescription for nutrition counseling and referral to a registered dietitian/nutritionist (RD or RDN) more seriously than a simple verbal suggestion.

Referrals to specialists are standard medical practice. “Physicians do not need to do their own diet counseling, any more than they need to perform their own radiographs or laboratory assays.”

Registered dietitians/nutritionists have the expertise to evaluate a patient’s current diet and recommend changes within the patient’s dietary preferences. When patients practice better nutrition, dietary changes can have a positive impact on abnormal lab values, and ultimately, the path a chronic disease takes.

A handout and an encouraging word are not the same as nutrition counseling.

Obviously, medical schools need to teach more about nutrition than the food groups or the diseases associated with vitamin deficiencies, but change takes time. Barnard recommends five steps the medical community can do now to address the lack of nutrition knowledge among physicians:

  • Nutrition should be a requirement of continuing medical education for all physicians.
  • Registered dietitians/nutritionists should be the go-to professionals that doctors work with to provide patients with the best nutrition care and counseling.
  • Customizable nutrition questions and educational handouts should be included in electronic medical record services.
  • Physicians should act as role models and model healthy eating habits (and other healthy behaviors) to their patients.
  • Healthier food environments in schools and hospitals should have support from the medical community.
  • Legislators around the United States are also calling for physicians to become savvier about nutrition. A bill was recently introduced in Washington, DC that recommends nutrition become a part of continuing education, not just for physicians, but for nurses and physician assistants, too. Similar legislation has been introduced in New York.

    Dr. Barnard's conclusion is a call to action along these lines, “Rather than allowing nutritional ignorance to fester like a gangrenous sore, the medical community can take advantage of current knowledge for patient benefit, as well as their own.”
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