Should Doctors Tell You You’re Fat and What to Eat?

I’ve heard people criticize doctors for not counseling their patients more about the benefits of diet and exercise. Yet, I’m not convinced most patients don’t already know they’re out of shape. After all, the patients in question are the ones who buy their clothing and perhaps comprehend their clothing sizes are double-digit numbers. I’ve asked a doctor I know if he ever has to just be blunt with a patient. He said yes, belatedly telling one patient, “you didn’t get this way overnight.” As an aside, I’m not convinced this particular physician knows a lot about nutrition. He’s not alone, however. One physician had this to say:

When I ask my patients what they eat, they are often surprised. Most tell me no one has asked before – and certainly not their doctor.

To ignore food is not simply an oversight, it is a failure in care because what we eat has a profound effect on our health. Poor nutrition is a cause or major contributor to at least 80% of illnesses including cardiovascular disease and diabetes.

So why does food take a back seat to everything else? Here’s the dirty little secret: most doctors don’t discuss nutrition because they have no training in it. That should shock you, especially given how critical good nutrition is to prevention and healing.

During my 14 years of medical training at institutions that included Mayo Clinic and Johns Hopkins, the total time devoted to nutrition education was a whopping – wait for it – 0 hours. That’s not a typo. Zero. In a specialty, cardiology, that largely treats disease caused by lifestyle. Medical schools and residency programs are beginning to incorporate nutrition into their curriculum, but we’re a long way from doctors actually being as expert in advising which foods to eat as they are in advising which drugs to take.

An article in the Chicago Tribune proclaimed, “Doctors not taught to discuss diet, nutrition with patients.” An article in The Hill argues, “Our diets are killing us and doctors aren’t trained to help.” The Guardian says, “Doctors ‘know too little about nutrition and exercise’,” while The Washington Post said “Your doctor says he doesn’t know enough about nutrition or exercise.” Indeed, USA Today reports:

Only 14% of doctors feel qualified to talk to patients about food. The American Heart Association recently issued a scientific statement calling for improved nutrition training for doctors. But education is only a part of the problem — financial incentives also keep food out of medicine.

In academic research, whole foods get less money and attention than drugs even though studies show that food can dramatically affect health. Because there is no intellectual property involved in prescribing food, companies are not interested in funding scientists to study it. And in contrast to drug research, nutrition research is harder to conduct and interpret, making it more confusing and easy to ignore. Modern evidence-based medicine calls for high quality studies, known as randomized controlled trials (RCTs), to back up new treatments. Interest in RCTs grew by the mid-20th century, as the pharmaceutical industry allied with medical establishments.

It probably goes beyond a lack of financial incentives to investigate and prescribe a healthy diet. Patients too like the idea of a pharmaceutical fix. Following a healthy diet and exercise are hard, whereas popping a pill is easy. Nowadays a new type of diabetes drug, an injected peptide, is working wonders for people who overeat. Some have said they now forget to eat.

Now that it’s years too late the Wall Street Journal reports medical schools are boosting the teaching of healthy behaviors to fight chronic disease.

An ounce of prevention may be worth a pound of cure, but medical schools have traditionally given little weight to instruction on how to help patients live healthier lives.

“Incorporating lifestyle medicine into medical-school curricula can resolve the inadequacies that exist in preparing physicians for the growing challenge of chronic disease,” says Jennifer Trilk, professor of biomedical sciences and director of lifestyle-medicine programs at the University of South Carolina School of Medicine Greenville, which in 2017 became the first medical school in the U.S. to incorporate more than 80 hours of lifestyle-medicine training over four years of undergraduate education.

One problem is that nutrition classes are generally reserved for undergraduate studies and there is already a lot of curricula students must learn to get accepted to medical school. Another problem is that since only a few medical schools teach nutrition, the knowledge is unlikely to help students get accepted to medical school. Others point out that knowledge doctors were required to memorize in the past is now available with a few clicks on a cellphone screen. Instead of memorizing things that can be referenced quickly using everyday technology, why not use some of that teaching real world prevention.