How much does your doctor actually know about nutrition?

April 30, 2018, American Heart Association
How much does your doctor actually know about nutrition?
Students from Brown University’s medical school take part in the Food + Health course at Johnson & Wales University in Providence, Rhode Island. Credit: courtesy of Johnson & Wales University

Eat more fresh fruits and vegetables. Cut down on sweets and processed foods. Increase consumption of fish, nuts and legumes.

This rudimentary advice has been dished out to the public for decades, yet soaring rates of diabetes, obesity, and other chronic illnesses linked to poor diet – and which increase risks for stroke and heart disease – fail to reverse.

Part of the problem stems from the fact that doctors don't know how to provide information beyond the basics.

Inadequate instruction during , residency and other additional training is a primary reason for this dearth of expertise, according to an American Heart Association science advisory published Monday in the journal Circulation that looked at gaps in education over the decades.

"Any nutrition education gained is likely to be lost if not reinforced and translated into practical how-to knowledge," the advisory authors write.

Dr. David Eisenberg, director of culinary nutrition at the Harvard T.H. Chan School of Public Health, applauded the AHA report, saying it documents "the total lack of requirement" in most medical schools to understand the practical skills necessary to advise patients struggling with their weight, blood sugar, or heart disease.

"It is a scandal that health professionals are not introduced to these facts above and beyond minimal information about nutritional deficiencies in biochemistry, and that these things do not appear on their examinations to become a practicing physician," said Eisenberg, who was not part of the group that wrote the advisory. "Nor are they required on board certification, whether it's to become an internist, cardiologist, endocrinologist – you name it."

Gaps in nutrition education among medical school curricula go back decades, said Dr. Karen Aspry, the cardiologist who chaired the AHA advisory group.

She pointed out that after a 1985 survey of one-third of U.S. medical schools found "inadequate exposure to nutrition and health and disease," the National Academy of Sciences recommended a minimum of 25 classroom hours.

Yet, various studies conducted between 2000 and 2013 found few schools were meeting that goal. The most recent survey, in 2013, found that 71 percent of medical schools provide less than the recommended 25 hours.

"The average number of hours has actually declined to 19 hours. That means this is not keeping up with the recognition that so much obesity and cardiovascular disease is linked to poor nutrition and poor diet quality," Aspry said.

A was tied to nearly half of U.S. deaths from , stroke and Type 2 diabetes in 2012, found a study published last year in the Journal of the American Medical Association. "This is a huge problem," Aspry said.

The new advisory found that schools which exceeded the minimum recommended hours of did so by integrating the training across the medical school curriculum instead of containing it to a single course.

Several universities have tapped into innovative ways to teach future physicians about how to manage their own diet to build a set of personal tips they can eventually pass on to patients. Schools are incorporating lessons through online, open-access programs, or by turning commercial kitchens into interactive classrooms where students learn about healthy cooking.

Andrew Del Re is benefiting from that kind of innovation. A first-year student at Brown University's Warren Alpert Medical School in Rhode Island, he recently completed a "Food + Health" elective that pairs medical students with culinary arts students from nearby Johnson & Wales University. The course was part lecture – on topics such as healthy cooking on a budget – and part hands-on learning, such as cooking low-sodium meals inside an actual kitchen.

"Becoming a better communicator is also a really big part of the course," he said. "You have to be able to transmit practical knowledge so the patient can leave the office saying, 'OK, now I know exactly what I need to do to live a healthier lifestyle, and change my behavior for the better.'"

Del Re is now leading this semester's Food + Health class with two other student assistants, adding more emphasis on nutrition and diet counseling, and possible ways to customize such lessons to the individual lifestyle of patients.

Other types of nutrition training can be found in medical electives that focus on real-life lessons, the advisory pointed out. At Boston University, for example, medical students were challenged to limit their weekly food budgets to the amount provided by the state's Supplemental Nutrition Assistance Program formerly known as food stamps.

The report also highlights live continuing medical education courses being offered such as the annual "Healthy Kitchens, Healthy Lives" conference that teams the Harvard School of Public Health with the Culinary Institute of America to help bridge nutrition science, health care, and the culinary arts. Eisenberg created the conference 14 years ago to address "the huge gap" on the topic he and others saw in the medical profession.

Eisenberg also advocates for more medical schools to incorporate teaching kitchens into their curricula to help train the next generation of doctors.

"We've always had anatomy labs, maybe we need teaching kitchens," he said. "Teaching nutrition by giving people lists of facts is not the same as inviting students into the kitchen and having a clinician, a dietitian and chef talk to them collectively about how to advise patients about food choices, shopping, cooking, plating, portion control and the pleasure of food. We forget that at our collective peril because everybody eats."

Explore further: New strategies needed to help healthcare providers gain knowledge to counsel patients on diet

More information: Karen E. Aspry et al. Medical Nutrition Education, Training, and Competencies to Advance Guideline-Based Diet Counseling by Physicians: A Science Advisory From the American Heart Association, Circulation (2018). DOI: 10.1161/CIR.0000000000000563

Renata Micha et al. Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States, JAMA (2017). DOI: 10.1001/jama.2017.0947

Related Stories

New strategies needed to help healthcare providers gain knowledge to counsel patients on diet

April 30, 2018
A new scientific advisory from the American Heart Association reviews current gaps in medical nutrition education and training in the United States and summarizes reforms in undergraduate and graduate medical education to ...

Most medical students overconfident, underprepared on nutrition guidelines

October 16, 2017
Ohio University researchers found medical students may be more confident than knowledgeable when it comes to nutrition. Of the 257 medical students studied, more than 55 percent were confident they could counsel patients ...

Mandatory nutrition policies may impact sugar consumption

March 28, 2018
Mandatory nutrition policies could be a valuable tool in helping high school students to lower their sugar intake, a University of Waterloo study has found.

Hands-on cooking education aids docs' nutrition knowledge

February 22, 2013
(HealthDay)—Continuing education that includes didactic and hands-on cooking sessions improves physicians' self-reported nutrition-related behaviors, according to a research letter published online Feb. 18 in JAMA Internal ...

New program teaches medical students about healthy eating

August 19, 2015
(HealthDay)—West Virginia has introduced a program to teach medical students how to talk to patients about healthy eating, and deliver practical advice to engaged patients, according to a report published by the American ...

New study highlights benefits of weekly nutrition classes to improve type 2 diabetes

April 6, 2018
Prescriptions are not enough—diet changes and nutrition education make the difference in people with diabetes, according to a study published in the Journal of the Academy of Nutrition and Dietetics.

Recommended for you

Teen personality traits linked to risk of death from any cause 50 years later

November 20, 2018
Personality traits evident as early as the teenage years may be linked to a heightened or lessened risk of death around 50 years later, suggests observational research of 'baby boomers,' published online in the Journal of ...

One in four U.S. adults sits more than eight hours a day

November 20, 2018
(HealthDay)—Couch Potato Nation: Nearly half of Americans sit for far too many hours a day and don't get any exercise at all, a new study finds.

Gut protein mutations shield against spikes in glucose

November 20, 2018
Why is it that, despite consuming the same number of calories, sodium and sugar, some people face little risk of diabetes or obesity while others are at higher risk? A new study by investigators at Brigham and Women's Hospital ...

Proteins cooperate to break up energy structures in oxygen starved heart cells

November 19, 2018
During a heart attack, the supply of oxygen to heart cells is decreased. This reduced oxygen level, called hypoxia, causes the cell's powerhouses, the mitochondria, to fragment, impairing cell function and leading to heart ...

Emotional abuse may be linked with menopause misery

November 19, 2018
Smoking, obesity and a sedentary lifestyle have long been linked to heightened symptoms of menopause. Now, a study headed by UC San Francisco has identified another factor that may add to menopause torment: an emotionally ...

How AI could help veterinarians code their notes

November 19, 2018
A team led by scientists at the School of Medicine has developed an algorithm that can read the typed-out notes from veterinarians and predict specific diseases that the animal may have.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.