As a pediatrician serving under-resourced families in Washington, D.C., I was glad to see health leaders converge for the White House Conference on Hunger, Nutrition, and Health. Solutions to food insecurity and diet-related diseases are urgently needed to address the crisis of chronic disease, which afflicts six in 10 Americans.
One of the important issues discussed at the conference is the critical need for more education and training in nutrition and physical activity for health professionals, especially those working with under-resourced communities.
Although lifestyle intervention is a first-line treatment recommendation for many chronic diseases, few clinicians are trained to make them. On average, only 19.6 medical school hours focus on nutrition education and training, well under the recommended 25. This gap leaves many physicians unprepared to counsel patients on nutrition, much less prescribe food as medicine.
Recognizing this gap, the White House Conference highlighted an opportunity for free continuing medical education coursework in nutrition and food as medicine to 100,000 physicians and other medical professionals treating patients in areas with a high prevalence of diet-related disease. The Lifestyle Medicine and Food as Medicine Essentials bundle is available here.
As a pediatrician certified in lifestyle medicine, I know the importance of clinicians developing the foundation of knowledge to help patients make sustainable lifestyle behavior changes. I practice in Wards 7 and 8, predominantly Black communities where about 72 percent of adults experience obesity and where diabetes rates are three times higher than in wealthier surrounding communities. Those same chronic diseases are manifesting in children and at increasingly younger ages. Multiple times a week, I diagnose children with high cholesterol, prediabetes, and sometimes even type 2 diabetes.
These disparities have complex reasons, such as food and housing insecurity; lack of full-service grocery stores and public green spaces; unemployment; systemic racism; and chronic stress. These social determinants of health must be addressed to level the health outcomes playing field. But individual-level lifestyle behaviors related to diet and physical activity are also passed down within families and stand as proximate causes of many chronic diseases. In reality, many of the most troublesome chronic diseases could be prevented, treated, or even reversed with evidence-based lifestyle behavior interventions such as diet change.
By developing lifestyle medicine skills, clinicians can more effectively support patients to treat chronic diseases such as obesity. And a lot of support is needed. Often the parents of children I see struggle with their relationship with food. While parents sometimes experience guilt about passing down lifestyle-related chronic conditions to their kids, these are complex diseases, not personal failures. Many families already juggle multiple challenges to obtain life’s basic necessities. I prefer to initially offer my families a “buffet” of potential lifestyle behavior changes and work with them to identify small but measurable goals that are achievable for both parent and child. Each success, no matter how small, builds confidence to then change another behavior.
Education also helps clinicians debunk common myths that deter families from making changes to their diet. For example, many people are conditioned to believe that only animal foods can meet adequate daily protein needs when, in fact, a whole food, predominantly plant-based dietary pattern can accomplish that. Or that eating healthy on a budget isn’t possible. With a little strategy and know-how, families can be coached on maximizing their public nutrition benefits to buy fresh produce or purchasing canned or frozen options to save money in their food budget.
Clinicians can magnify their impact by partnering with social service organizations equipped to help families who are medically and socially vulnerable overcome the barriers to more healthy lifestyles, such as housing or food insecurity. In D.C, a colleague started a nutrition program that provides education and delivers produce to the homes of families at risk of diet-related disease. Through this community program, I developed a plant-forward nutrition curriculum that I teach parents of children under five. I also periodically partner with plant-based chefs to host cooking demonstrations in the community.
To truly address the crisis of chronic disease, clinicians must begin to develop the knowledge and skills to help patients change their lifestyle behaviors. That opportunity is here.
Qadira Huff is a pediatrician.