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How much does your doctor know about nutrition? Not much, study shows

By Jennifer Abbasi

A poor diet now outranks smoking as the leading cause of death globally and in the United States, according to the latest data. Yet a recent systematic review of studies suggests that medical students in countries around the world haven’t been getting the education they need to counsel patients on healthy eating.

Why This Matters
It’s possible that improved diets could prevent more than 1 in 5 deaths worldwide every year. Physicians are in a position to provide their patients with dietary advice or referrals to nutrition professionals, but prior studies suggest that they lack the necessary training.

The Design
The recent analysis, which appeared in The Lancet Planetary Health, included studies on nutrition education published in late 2012 through 2018 that evaluated

  • Recently graduated or current medical students’ nutrition knowledge, attitudes, skills, or confidence in nutrition or nutrition counseling
  • Their perceptions of nutrition education
  • Medical school nutrition curriculum initiatives

The researchers scoured the literature, but only 24 studies made their cut. The studies took place in the United States (11), Europe (4), Australia (4), New Zealand (2), Africa (1), Asia (1), and the Middle East (1).

If only the doctor prescribed vegetables and fruits.

What We’ve Learned
No study objectively measured whether medical students were competent in nutrition care, but future physicians themselves said that their training left a lot to be desired. They reported little priority given to nutrition education, an absence of scientific rigor in the curriculum, and a lack of faculty devoted to the subject. They also said they witnessed little or no nutrition counseling in clinical practice while shadowing physicians.

The studies consistently showed that

  • Around the world, medical students often don’t get adequate nutrition training.
  • The lack of nutrition education affects their knowledge and skills—and their confidence to provide nutrition care in routine clinical practice.
  • The nutrition curriculum initiatives that do exist can have a modest benefit on outcomes like students’ nutrition knowledge and their confidence and competence in dietary counseling. However, no studies have looked at the long-term outcomes.

What the Researchers Say
According to the review’s lead author, Jennifer Crowley, PhD, of the University of Auckland in New Zealand, it’s often up to individual medical schools to decide whether they’ll integrate nutrition education into the curriculum. While some schools may have extensive nutrition programs, many don’t. “Unsurprisingly, medical students’ nutrition knowledge, skills, and confidence to counsel patients in nutrition are all highly variable,” she said.

One nutrition education curriculum initiative stood out as a potential model for success. Its hands-on cooking and nutrition education improved students’ competencies for counseling patients on nutrition (and reduced their own soft drink consumption). Further studies are needed to bear out the program’s long-term outcomes for both medical students and patients.

Crowley said their findings suggest that “despite the importance of nutrition for healthy lifestyles, graduating medical students are not supported with the required nutrition knowledge and skills to be able to provide effective nutrition care to patients.”

Investing in the Future
To overcome this problem, Crowley said medical schools need

  • An institutional commitment to providing nutrition education
  • A required level of nutrition knowledge for medical graduates
  • Competency-based nutrition curricula

The authors also suggested developing a global benchmark for nutrition knowledge among medical students.

In an accompanying articleStephen Devries, MD, of the Gaples Institute for Integrative Cardiology in Deerfield, Illinois, pointed out that interest in nutrition was “uniformly high” among medical students in the studies. “But,” he added, “without a solid foundation of clinical nutrition knowledge and skills, physicians worldwide are generally not equipped to even begin to have an informed nutrition conversation with their patients and to fully identify opportunities for referral.”
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Credit: JAMA Network.

8 thoughts on “How much does your doctor know about nutrition? Not much, study shows

  1. Why is this considered surprising? Medical Schools and their curricula are controlled by Big Pharma money. All Big Pharma is interested in is that doctors be trained to prescribe their drugs.

    1. That is patently false propaganda. This column points out that there is far more that doctors can do by advising a healthy lifestyle and that more education in nutrition and lifestyle is needed.

  2. This column points out that there is a lot that doctors can do to promote healthy lifestyles and more education in this area is warranted.
    To say that “Big Pharma ‘controls’ Medical Schools to train doctors to prescribe their drugs” is ridiculous.

  3. What Charlie Carroll said is not patently false propaganda but the truth as I was one of those doctors trained in a prestigious medical school. I never received an iota of nutritional information. It was necessary for me to become knowledgeable in nutrition by taking many courses which taught me the essentials of nutrition as well as keeping me updated on the latest precepts of nutrition. When did Ms.die tition attend medical school to refute what Mr. Carroll said!!

    1. Choosing a Natural Diet should be our decision not doctors.
      All kind of drugs we have today, are just to treat the symptoms not the illness itself.
      Most people with Cancer die, because of the Quimio treatment not for the illness. Because they get so much radiation in their weak bodies, they can’t support and the final result is their death.
      I saw this cases very close in Solca, where I Volunteer…

  4. I posted this column not to denigrate all doctors, of courses not. But to point out that there are many doctors who are taking the initiative to use the knowledge and research about lifestyle modifications including managing diet, activity, stress and sleep to promote better care and reduce symptoms of disease before turning to pharmaceuticals: and isn’t it best to be able to see a trained professional who has a number of tools in their toolbox?
    In fact, there is a new organization called the American College of Lifestyle Medicine that is board-certifiying health professionals: Their website, where you can read more about the qualifications and requirements for certification is here. Seek out physicians who are board certified in Lifestyle Medicine: https://www.lifestylemedicine.org/ACLM/About/ACLM/About/About.aspx?hkey=4697cec6-fc2c-4738-834a-2df3cfe2278d

    … address the underlying cause of the chronic disease.

    Most physicians and health professionals receive little to no education on nutrition, exercise, rest or social connectivity, which are the four pillars of Lifestyle Medicine. This is akin to an automotive engineer not spending any time learning how to propel a motor vehicle in the most efficient and sustainable manner, whether that be petrol, diesel, electricity or a combination thereof.

    Learn how to prevent, arrest and reverse chronic disease in a scientific, evidence based manner and receive the official seal of approval that you have studied and mastered the discipline from the American Board of Lifestyle Medicine.

  5. If time in medical school is assumed fixed (i.e., zero sum), then I wonder what courses should be eliminated to allow nutrition? I support nutrition, but I question whether doctors should be overly tasked with this aspect, especially when some public systems already suffer from doc rationing, delay and under capacity. That nutrition is important or whether docs have received the education isn’t the issue, IMHO. I challenge the author’s reported premise that nutrition should be a doc’s responsibility, making the question of whether docs should be primarily responsible for patient nutrition in the first place the issue. Obviously, the litany of non-doc health professionals available could address this. Responsible adults can and should address this.

    At least in the US, being fat and irresponsible (i.e., average person unhealthy by preference) with one’s diet is a “socialized cost” born by people other than the irresponsible person. If a population were put on a scale and the BMI, or some measure, be the basis for one’s payroll deductions for Medicare, might that matter? Public policy that shifts societal costs back onto the individual decision makers (i.e., internalizing costs) will result in better individual decision outcomes, IMHO. As it is now from the perspective of the decision maker, irresponsibility is too cheap and is being overconsumed.

    I’m talking about adults here, but irresponsible people’s bad choices shouldn’t be blamed on doctors. The policy effort should be directed towards better individual choices and personal responsibility, so they don’t need to see a doc in the first place for diet related issues.

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