We live in a pill-popping society. The first line treatment for many of the medical problems that walk through our doors is a medication. Have heartburn? Forget about avoiding the foods that cause your symptoms — just take a pill. New diagnosis of diabetes? We give lip service to lifestyle modifications and then start patients on Metformin. Hypertension? Diuretics, ACE inhibitors, ARBs, beta blockers — take your pick, and I guess make the obligatory mention of weight loss.
I fully realize that there is a time and a place for medication. There are varied medical problems that can only be treated with medication, and there have been many life-changing discoveries on the pharmaceutical front. Heck, humanity owes a large part of our prolonged life expectancy to pills that we pop to treat chronic disease. I am not here to poo-poo taking pills.
My goal is to raise a couple questions: when are we going to emphasize the quality of our diet to the degree that it deserves? When are we as providers going to advance our half-hearted nutrition advice from “you need to eat healthier” to actually prescribing food as medicine?
Take two broccoli and call me in the morning.
Nutrition prescription
Some of us do this already, for sure. But there are many barriers we have to overcome: the confusing landscape of what exact diet is “best,” the time required (and lack of reimbursement for that time), and the patient-centered hurdles of socioeconomic status and presence of food deserts. As physicians, we don’t receive much nutrition education throughout our training, and consequently, we don’t have the knowledge to offer much substance in the nutrition advice column. Thus, our profession as a whole has washed our hands of this problem.
The solution
Achieving a thorough and complete solution involves a steep uphill climb.
First, it would require changes to our medical education and residency training to include comprehensive nutrition education and teaching of effective delivery strategies. It would also involve changes to our insurance/reimbursement structure to include payment for nutrition education given to patients. And we all know that delivering this type of counseling takes time, and time is a commodity that is very scarce in this day and age of increased productivity.
From a patient perspective, it would involve access to affordable, quality foods. If we’re aiming for the full circle solution, it would also involve mass adoption of the newly received education by the general public.
Fat chance of all of these happening.
What to do?
There is one thing that we, as medical providers, can do: Take a greater interest in our own nutrition.
A recent study published in The Journal of Medical Education and Curricular Development examined the prevalence of formal nutrition education in Internal Medicine residency programs, and it looked at the frequency with which nutrition counseling was offered to patients.
It shouldn’t be a shock to anyone that those residents who received formal nutrition training were significantly more likely to offer nutrition advice to their patients. The interesting finding of this study was the other factor that led to the delivery of nutrition counseling — a resident’s total fruit and vegetable intake.
Put another way: Those of us physicians who care enough about our own dietary habits are the ones that take the time to share our knowledge and advice with our patients.
Which group do you fall into?
Ideal scenario
I can imagine a future scenario where a patient comes into a doctor’s office with one of the ever-present lifestyle diseases, and the first line treatment consists of lifestyle changes. Instead of prescribing a quick “fix” medication that removes the responsibility from the patient, we ask them to put more skin in the game and make changes that have the power to cure.
Instead of medication, we decide as a profession to actually offer our patients nutrition counseling. We educate patients on the benefits of eating whole foods, we give patients tools to help them right the scales of their caloric imbalance, and we teach them to speak the vegetable vernacular.
My encouragement to us all is to take a closer look at our dietary habits, educate ourselves in the nutrition realm, make eating healthy a top priority, and share your newfound knowledge and enthusiasm with your patients.
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