Medical education not covering basics of nutrition: Research Review

New Zealand: Although diet plays an outsize role in health and wellness and can be crucial to managing many common chronic conditions, medical schools tend not to devote much time to teaching future doctors about nutrition, a recent research review suggests.

Researchers analyzed data from 24 previously published studies that focused on medical students’ nutrition knowledge and confidence in their ability to counsel patients on diet. Overall, nutrition was insufficiently incorporated into medical education regardless of country, setting, or year of education, the review team found.

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“Insufficient nutrition education, impacts on students’ knowledge, skills and confidence to include nutrition care into patient care,” said Jennifer Crowley, a researcher in nutrition and dietetics at the University of Auckland in New Zealand.

“When students do not witness nutrition counseling by senior doctors, it does not become part of holistic patient care and continues into their medical practice,” Crowley said by email. “Also, the importance of nutrition for a healthy lifestyle is not reinforced with patients.”

Worldwide, obesity rates have nearly tripled since 1975, according to the World Health Organization. As of 2016, some 650 million adults worldwide were obese, and 381 million children and teens were overweight or obese.

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While many factors have fueled rising obesity rates, physical inactivity and diets loaded with too many calories and fats are a big part of the problem, according to WHO.

Obesity is a major risk factor for many of the leading causes of death and disability worldwide, including heart disease, diabetes, arthritis and certain cancers.

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The current analysis examined smaller studies of nutrition training in the U.S., Europe, the Middle East, Africa, Asia, New Zealand and Australia.

Even when curriculum initiatives focused specifically on educating doctors about nutrition, the analysis found that these efforts had only a “modest effect” on doctors’ sense that they could competently provide nutrition counseling or advice to patients, the study team reports in The Lancet Planetary Health.

Medical students in many of the smaller studies expressed an interest in nutrition and a willingness to learn about it, but generally perceived their training in this topic as inadequate.

Ideally, medical schools should be graduating new doctors who are well versed in the basics of nutrition and weight management and able to steer patients to the right specialists as needed for extra help making lifestyle changes, the study team argues.

“This study matters because it speaks directly to the type of medical care we can expect to receive,” said Dr. Stephen Devries, author of an editorial accompanying the study and executive director of the nonprofit Gaples Institute for Integrative Cardiology in Deerfield, Illinois.

“If physicians worldwide are not meaningfully educated about nutrition, how can we expect them to emphasize anything besides drug and devices,” Devries said by email.

Moreover, efforts by a growing number of clinicians and public health efforts to promote a plant-based diet for both patient and planetary health are not going to succeed unless doctors can address diet and nutrition issues during exams, Devries said.

Patients who need help eating well may need to advocate for themselves to get the support they need to succeed, Devries added.

“Whether you are concerned about maintaining your good health, responding to some early warning sign, or treating a specific problem, ask your practitioner about opportunities for bettering your situation with diet and lifestyle,” Devries advised. “And if they can’t help, request a referral to a skilled professional who can.”