Should medical schools be mandated to teach nutrition?

Doctor, do you know a lot about human nutrition? You said “yes?”

Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson’s infamous quote “you lie” is applicable.

American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don’t know or care much about a topic, it often gets short shrift.

I personally hate the notion of a legislature mandating that medical education institutions teach certain curricular topics. Yet, sometimes that seems the only way to get it done.

By current count, 15 states — including California, Connecticut, Florida, Iowa, Kentucky, Massachusetts, Nevada, New Jersey, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, and West Virginia — mandate Continuing Medical Education in specific topics.

Rhode Island lists the largest number of topics, six.

The topics required by various states include pain management, geriatric medicine, domestic violence, risk management, end-of-life care, universal precautions, HIV/AIDS, ethics, cultural competence, controlled substances, bioterrorism, and prevention of medical errors.

What this means is that, at some point in time, a state legislature and governor decided that the physicians in their state, no matter what medical school or residency programs they came from, simply were not getting the job done for the people in their state in a field of particular concern at that political moment.

Now, witness the state of California on the topic of nutrition.

Senate Bill 380, approved 37-0 by the Senate, 74-0 by the Assembly, and signed into law by the governor on September 6, 2011, requires the Medical Board of California to disseminate educational materials and to discuss “nutrition and lifestyle behavior for the prevention and treatment of chronic diseases,” presumably as a preamble to more definitive actions.

Look around you on the street or in the hospital, watch TV, read a newspaper or magazine, or go online. How well is the United States medical and public health establishment getting the job done in nutrition?

Not well. More than 60% of adult Americans are overweight, obese, or morbidly obese. This sad state did not just happen overnight.

All of those overweight people have had physician encounters.

Correcting the obesity and subsequent diabesity problem starts with physician knowledge about proper clinical nutrition.

That knowledge must be converted into a positive attitude and then widespread physician behavior that can effect preventive and curative patient behavior.

SB 380 may be too little, and too late for millions, but it is a start.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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  • http://www.facebook.com/paul.c.weiss Paul Weiss

    I couldn’t agree more. In fact, I think that physicians should always consider dietary influences on disease when coming up with a treatment plan for their patients.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Everybody wants to force doctors to pay homage to their little hobby horse.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    How about mandatory continuing education for politicians to learn not to lie, cheat, and steal?

  • http://twitter.com/DanaM_RD Dana McDonald, RD

    “He that takes medicine and neglects diet wastes the skills of the physician.” – Chinese Proverb
    Medical institutions that provide medical training without adequate training in disease prevention and nutrition education do a significant disservice to the medical profession, healthcare community, consumers, and public. Historically, physicians have perceived the quality of nutrition training during medical school as inadequate. Not to mention, a significant barrier to effective obesity prevention and treatment. In 1902, W.G. Thompson, a professor of medicine at Cornell University Medical College, expressed concern regarding the lack of nutrition in medical education. If the U.S. medical education system can not adapt to meet the advances of science (and technology) the system will prove to be a system incapable of training students with the requisite skills, knowledge, and behaviors needed for the demands of tomorrow’s healthcare environment. With this said, I am not a fan of mandating nutrition education in medical schools. If medical institutions do not feel nutrition education is critical to physician training, despite an overwhelming amount of evidence, perhaps it is best to allow the current system to become obsolete. Let the startups and crowdsourcing commence.

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

      yawn

      They taught nutrition in my medical school decades ago.

      It’s taught.

      There are many, many, MANY things that are “critical” to physician training, of which nutrition is just one. There are only so many hours in the day. The teaching institutions and the physicians themselves get sick and tired of getting beat over the head by everybody’s little hobby horse that they feel needs to be “mandated” with the force of law and regulation. That regulation, of course, now requiring someone to monitor that it’s actually being done, and now the cost of medical education is that much higher thank you.

  • http://www.thehappymd.com/ Dike Drummond MD

    Of course nutrition should be on the curriculum of every medical school. Food is medicine. We are in the middle of an obesity tsunami where nutrition is the cause and the solution.

    It is pretty silly that it requires a legislative mandate. This will trigger all sorts of debate on politics rather than the real issue. Your doctor is missing a key skill set that could benefit you and your health if they don’t understand nutrition … nuff said.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • http://twitter.com/JasonBoies Jason Boies

    Medical school? Why not start earlier than that? Looking back on my public school years, we were never given decent information about nutrition.  
    The “four good groups” is what I remember having rammed down my throat. And yet I’ve never felt healthier since cutting out dairy and all but eliminating most meat from my diet.  What would my elementary school health teachers think of that? :P

    Jason Boies
    Radian6

    • http://twitter.com/DanaM_RD Dana McDonald, RD

      I agree Jason! Nutrition should be taught in elementary school. Sadly, the priority has been instead to raise a generation of overweight and obese readers. 

  • Anonymous

    Require physicians to study nutrition, and then refuse to pay them when they counsel patients using this knowledge.

    Makes sense to me.

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

      My medical school was OK, not top-shelf. Average.

      Nutrition was run a a PhD nutritionist, two or three weeks (it’s been a while) of more intense classes on the subject, with the exams and all that, then a few classes interspersed with the system studies (cardiovascular, GI, neurology, geriatrics, etc.).

      They can always do more.

      I wonder if Dr. Lundberg could suggest what to take OUT of the curriculum to make room for the hobby horse du jour.

      I would suggest starting with any healthcare policy classes he teaches.

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    Even nutritionists have a tough time with learning and teaching nutrition. I agree with the previous poster though, you must teach nutrition universally to small children. This is usually left to the parents to do so, but these parents have already succumbed to the joys of processed food(spicy nacho doritos anyone?). Fiscal responsibility and nutrition for young children, two things that should be pushed in schools. My health class was a total joke, that meant little to my GPA, it was usually taught by a fat gym teacher

  • Fred Ickenham

    Another hopeless fad. EVERYONE knows it’s better to eat carrots than lard, but they prefer larding on the tasty calories. So-called nutritional supplements are an unscientific scam, that may make people LESS healthy (see recent Vit E supplements for prostate cancer). The federally funded Center for Alternative Medicine has failed to find any convincing evidence for the claims of CAM hustlers. Everyone already knew about Vit D, which info originated from legitimate medical scientific studies. Biochemistry teaches the basic science of nutrition. All med students study it, and therefore know more about “nutrition” than its advocates, who do not, or they couldn’t honestly push it. This motivational problem is why physicians cannot be held responsible for health outcomes over which they have no control. Allegations implied by the author seek to burden physicians in this manner.

  • http://www.facebook.com/mkramerdc Marc Kramer

    Nutrition counseling, like virtually all other human endeavors, is an art and a science. Yes, most of us know it’s better to eat a carrot than cake, but the question of “Does it make a difference if it’s organic or not?” is still a debatable topic. With a personal history of being a personal trainer and then a chiropractor, I am well educated on the subject of nutrition. However, as southerndoc1 pointed out, mandating courses and then refusing to pay people for disseminating that knowledge is challenge. In other words, there is no fiscal incentive to spend the appropriate amount of time to counsel patients on nutrition, unless you sell nutritional supplements (an unscientific scam as Fred highlights). In addition, knowing what to do and doing what you know, is a bigger challenge. Implementing appropriate nutrition strategies is psychological and behavioral issue. Maybe we should leave the nutrition counseling to its evangelists, like nutritionists and dieticians, and let the medical doctors focus on what they do best, diagnosis and intervene (versus prevent).

  • http://twitter.com/pjcphd Pam Charney

    How about teaching the medical student to refer patients to an RD? Physicians don’t have the time and aren’t reimbursed well for nutrition counseling. So, how about ensuring that the RDs services are reimbursed and then sending patients to see the folks who ARE trained to do nutrition education and counseling?  

  • jennifermf

    The fact that we need water, air, and nutrition to survive (and thrive) should be the only argument needed for medical schools across the board to teach nutrition, and teach it well. I don’t mean “tell your patients they’ll become hideously fat if they don’t stop eating deep fried lard,” either. I mean learn about macronutrients, vitamins, minerals, how the standard american diet (that’s the diet that standard americans eat, not only fat americans, by the way) affects the body. It means learning more about the food industry and their products (and the agricultural technologies that create the ingredients for these products), talking to patients about their food choices and how those food choices make them feel (and whether or not there are barriers to improving food choices)…. That’s definitely in conflict with the current culture of lobbyists and using corporate dollars to stifle good research that shows we should be buying more carrots and green beans and fewer “low fat” “fat free” “sugar free” “fresh from the laboratory” flashy packages of trendy foodlike substances.

    Medicine has become very complex as we (doctors, scientists, patients: everyone in between) learn more (and as we do more harm to the food, water, and air supplies), and we’ve all got to step up and speak out.

    And don’t forget: Nutrition and obesity are not synonymous. They’re apples and oranges, but I don’t know if they’re organic or not. ;)

  • Molly_Rn

    As a nurse who had a full year of nutrition, both basic and how it contributed to the pathophysiology of diseases like diabetes, I was shocked that my husband had zero nutrition education at Emory Medical School. It isn’t just so physicians can do nutritional counseling, but they need to understand it in context of health and disease states. We are what we eat.