Docs Don’t Know Diet/Nutrition: The State of Medical Care Today
The television industry knows where there’s gold in fat and they are plumbing it in shows such as “My 600-Lb Life,” “My Diet Is Better Than Yours,” “I Used to Be Fat,” “Fat Camp,” and others that have since fallen by the wayside.
The market for these diet plans and weight-loss programs is undeniably huge and lucrative. Estimates are that the diet/weight-loss category market tops out at $72B and it’s still growing with new products and programs being added. Entertainment stars (Oprah, Marie Osmund, Valerie Bertinelli, Jessica Simpson, Kirstie Alley, Jennifer Hudson, Mariah Carey, Sarah Ferguson, and Charles Barkley) with weight struggles signed contracts to hawk the programs. Not all of them were successful in keeping the weight off once their contracts expired.
Oprah, the billionaire entertainment mogul, didn’t travel the same path after her weight loss. She bought a chunk of stock in one of the companies (Weight Watchers) and made money on weight loss in yet another way. Weight Watchers has now changed their name to WW, much like other major corporations have changed theirs. Who wants to constantly be reminded that you’re in a weight-reduction/control program? The executives knew the name change would be a shrewd move in terms of stigma.
All of the programs aim at overweight as a social stigma and self-esteem issue. Similar to the fitness industry, that promises an attractive, healthy body, weight-loss promises to provide brilliant results for the weight-despairing. But some went a bit too far or chose obese persons who were unable to withstand the physical rigors of diet/exercise and/or surgical interventions. Why the need for all this TV attention to weight loss when we all go to our own physicians?
The Sad State of Medical Education
A client we had at a company where I worked as a writer, wanted to introduce a line of weight-control/reduction products. My assignment was to find out how we could approach physicians with the product and whether or not they needed education on nutrition and weight control. The executives were thinking about all of those “talk-to-your-doctor” lines in TV ads and they didn’t want to recreate the wheel if it was there.
Quickly surveying a number of top medical school in the US, the answer came back with a resounding “Help!” The schools admitted that they gave little instruction time to diet and nutrition and assumed it would be picked up later in their residency programs in hospitals; wrong again.
The limited survey I did, by telephone, with a select group of high-profile medical programs in the United States, revealed that all of them gave one hour or less, some gave no instruction, in diet and nutrition. Primarily, the educational component was squeezed into one on overall health and, as you can understand, it could easily be underscored as less important by the students. Of course, we ran with the results and I pitched a successful $1M program to our client.
A 2018 article in The Washington Post, indicated that while Americans may be concerned about their health and foods as well as obesity, malnutrition and chronic disease, their physicians fail to recognize the importance of diet because of this lack of training. The schools, however, are insisting that more attention is being paid to such vital issues and future physicians will be better equipped to handle questions and provide direction regarding diet and nutrition.
In 2014, a physicians’ group addressed the less-than-20 hours of diet/nutrition training medical students receive in four-years of schooling. The group indicated that “nutrition receives little attention in medical practice” and they proposed that “the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training.”
In 2017, 37% of medical schools in the 1980s, had a single course on nutrition and a survey of the most recent data indicates that there is even less time being given to diet and nutrition; it has dropped 27%.
A 2012–13 survey of 121 institutions (91% response rate) revealed that “Most US medical schools (86/121, 71%) fail to provide the recommended minimum 25 hours of nutrition education; 43 (36%) provide less than half that much. Nutrition instruction is still largely confined to preclinical courses, with an average of 14.3 hours occurring in this context. Less than half of all schools report teaching any nutrition in clinical practice; practice accounts for an average of only 4.7 hours overall.”
What About the Specialists?
Cardiologists, the medical specialty we would most associate with concerns regarding diet and nutrition, outline their official list of requirements in residency programs. Residents are required to perform at least 50 stress tests and a minimum of 100 catheterizations, but the 34-page list of requirements makes no mention of a need for nutrition or diet. In this, they are not alone because the official requirements for internal medicine physicians also don’t mention diet or nutrition requirements.
The American Heart Association has expressed its concern about the lack of academic preparation in medical school and residency programs in support of diet and nutrition. In their publication, Circulation, they noted the areas in which the medical field is remiss. “Any nutrition education gained is likely to be lost if not reinforced and translated into practical how-to knowledge.”
Their advisory board has indicated that patients struggling with weight, blood sugar levels, blood pressure or heart disease may not be receiving the overall treatment planning that is required to improve or maintain their health. Some physicians have stated that it is a “scandal” that these lapses in education are not being recognized and remediated.
The Patient’s To-Do List
Patients, who wish to ensure that they are receiving adequate and complete treatment planning for any medical illnesses they may have, do have a number of options. These include:
1. Ask your physician about a total treatment plan
2. Seek a referral to a hospital-based diet and nutrition program
3. Search the Internet for hospital programs and evaluate all of them with your physician
4. Keep up on the latest directives from the major medical associations in the discipline that relates to your illness. Often, this can be accomplished by agreeing to receive press releases from these organizations and this will ensure that you are getting timely information. You can also use the online news aggregator, Feedly, to keep you up-to-date on medical advances.
Is it up to the patient to take care of their treatment plan or should the physician be involved more? It stands to reason that patients cannot sit back and not be involved in their treatment plan after the surveys that we have seen that outline neglect of diet and nutrition. Until this is properly incorporated into training, and that will take years, patients must be their own advocates.
Being the silent, compliant patient may not be in your best interest and may not provide you with the level of care you should expect and require.