Let Food Be Thy Medicine

Three quarters of all medical schools in the U.S. offer no training in nutrition
December 12, 2017
Steve Trapasso, Program Coordinator for Seeds of Hope’s Garden-Based Nutrition Education Program

Perhaps the reason that so few doctors discuss nutrition with their patients is because the medical school they attended did not offer any courses in the subject. Even when seeing a patient with a diet-related illness most doctors do not discuss nutrition. This is a serious cause for concern, as five out of the top ten causes of death in the United States are diet related.  If we know that health and nutrition are directly linked, every medical school should be offering nutrition and cooking coursework for future clinicians.

In a recent Journal of the American Medical Association opinion piece, two clinicians, Scott Kahan, MD, MPH; and JoAnn Manson, MD, DrPH; argue that their colleagues can do better in treating patients with chronic, diet-related disease through nutrition counseling. They highlight the reasons why doctors have not focused on nutrition in the past, and offer concrete suggestions for doctors who continually see patients suffering with diet-related illnesses. 
Kahan and Manson also discovered that another reason doctors do not focus on nutrition is the fact that they cannot bill for nutrition counseling, though they can bill for prescribing medications or referring to certain specialties. This causes a disincentive to focus on nutrition and deters them from taking concrete steps to wean patients off medications. The Affordable Care Act has gone a long way toward making prevention a key pillar of overall health, but doctors are still unable to continually bill for “prevention” office visits.

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Here are some concrete steps that Kahan and Manson suggest doctors can take to address nutrition and diet-related chronic diseases as recommended by their colleagues:

• Start the conversation. Today, only 12% of doctor visits include any discussion of nutrition or diet whatsoever. That number needs to rise, because unhealthy eating contributes to more than 50% of deaths from heart disease.
• Structure the encounter with patients using a specific screening tool, motivational interviewing and small commitments.
• Focus on small steps patients can take that will have a large impact.  (eg: Substituting water for soda at every meal, switching from products made with white flour to those made with whole grain, giving up meat once a week).
• Be positive. Avoid discouraging patients by telling them not eat or drink this or that. Instead, focus on encouragement by suggesting the addition of healthful foods and water to their meals. Eventually, as new eating habits take hold, the unhealthful foods will become less a part of their diet.

Doctors and clinicians, by taking diet and nutrition seriously, can go a long way in shifting the their patients’ understanding of how food and health correlate and connect. This is a call to action for Doctors and clinicians.

We are hopeful that more and more medical schools will offer nutrition and culinary medicine training to their students. The change will come in direct response to medical students demanding more training and coursework in nutrition due to the increase in diet-related illnesses they see every day.

Seeds of Hope encourages all patients to start the conversation about nutrition and health with their doctor and to ask about reducing reliance on medications through diet and exercise.  When more and more patients ask about these topics, more and more hospital groups and clinical practices will begin to respond.