Poor diet is the leading risk factor for early death across the globe.
Now, a new systematic review argues that part of the problem is the lack of nutrition education among doctors.
Regardless of their country or year of medical education, the students surveyed in the new study reported deficits in nutrition education that may impair their knowledge, skills, and confidence to incorporate nutrition care into patient care.
Remedying public health nutrition issues means making nutrition education in medical schools mandatory, according to the studyTrusted Source published this week in The Lancet Planetary Health.
But what may seem like a simple fix comes with a cost.
“I think it’s easy to say, ‘Yeah, medical students should get more nutrition education. They should get more pharmacology education…’ They should get a lot more of a lot of things, but whenever you add more of something, then you’ve got to take something out,” said Dr. H. Clifton Knight, CPE, FAAFP, senior vice president of education at the American Academy of Family Physicians.
“So, the question is, do you spend less time studying anatomy, physiology, pharmacology, those sorts of things, in order to spend more time looking at the social determinants of healthcare and health?” Knight told Healthline.
The answer is still up for discussion.
“There’s a bit of a debate in the educational community about what the things are that are most important to impact health and healthcare of the populations we serve. That’s where it gets difficult,” Knight said.
While nutrition education across medical schools varies greatly, the study authors argue that both regionally and globally, there’s a distinct lack of dietary training for doctors.
“In the U.S. healthcare system, we’re so disease-focused and rescue care–focused. I worry that we don’t focus on preserving wellness and preventive aspects,” Knight said.
As a graduate of an allopathic medical school, Knight recalls his education focused on the disease model approach.
“Because of our focus on disease and rescue care, the basics of nutrition may have been overlooked a bit,” he said.
The lack of education on nutrition is a self-fulfilling prophecy that some experts say breeds more disease and keeps our focus on rescue care.
“The model of ‘get sick and fix it’ is not working. The model needs to be ‘don’t get sick’ and nutrition has a huge component with this,” Kristin Kirkpatrick, MS, a registered dietitian who manages wellness nutrition services at Cleveland Clinic Wellness Institute in Ohio, told Healthline.
However, some medical schools are holistic in nature and have more nutrition education on their curriculum.
In particular, “Osteopathic schools do a better job of looking at a holistic approach to medical education and focusing on normal function and preserving it and optimizing it,” Knight said.
While Knight suggests osteopathic schools can help bridge the nutrition knowledge gap for some future doctors, he says it’s more likely this nutritional training will come from hands-on experience in residency.
“In the United States, you can’t get a permanent license until you’ve completed some residency training. That’s an important concept to keep in mind,” Knight said.
While registered dietitians are experts in the field of nutrition, they’re not the first line of defense against dietary-related disease and death.
Rather, it’s primary care physicians people usually see first with concerns.
Kirkpatrick sees this as an opportunity.
“Dietitians provide guidance, but for many patients, the thought of even going to a dietitian may not cross their mind,” she said. “Therefore, physicians are the first line, and perhaps the only individual that may have the opportunity to counsel on diet.”
This puts some pressure on primary care physicians to at least be knowledgeable enough to make the right referrals.
“We do expect physicians to be broad-based experts, but something that has changed significantly [is] we now take a much more effective approach to team-based care. And so, one physician doesn’t need to be the expert on everything,” Knight said.
Knight explains the distinct advantages of this newer approach in the United States.
“If they’re part of a team, they may have physical therapists on the team who are the experts on therapy, and a pharmacist on the team who is an expert in pharmacology, and they may have a dietitian on the team who is the expert around nutrition,” he said.
Integrated care can provide that holistic approach to healthcare, but we need to recognize its importance.
“So what the physician needs to be able to do is prescribe that plan of in-depth therapy, medication, nutritional counseling, those sorts of things, and understand what the folks on the other team are able to do,” Knight said.
“But an individual physician doesn’t need to be the one who knows everything,” he said.