Nutrition Gets Short Shrift in Battle Against Chronic Disease – MEDSCAPE

8 September, 2022

I was surprised to read the data in following article about the percentages of various physicians who do not routinely give nutrition advice to their patients. I was even more taken aback to read their reasons, as ‘lack of time’ (quote: ‘When asked why nutrition counseling is not a priority, two thirds of doctors said that they did not have the time. That was the top reason given by 75% of endocrinologists, 65% of primary care physicians, two thirds of gastroenterologists, and half of cardiologists.‘

I thought that every physician-patient contact involves some type of consultation (history, examination, impression, shared decision about what to do about the impression) whether it lasts 2 minutes, 10 minutes, or 40 minutes. And that especially when the impression is an NCD (non communicable disease) that somewhere during the discussion what the patient eats (nutrition) and their weight will come up. Reading this article shows that one should not assume that the traditional consultation is still happening. But how can the world conquer the NCDs if a fundamental item in the causation and expected outcome following intervention does not come up in almost half the instances of physician-patient interaction? Surely, it is time for all medical schools to mandate teaching of nutrition in their curriculum. After all, ‘The Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, adopted by Heads of State and Government in September 2011, provides a road map for Member States and WHO to address the noncommunicable disease epidemic, guided by the WHO Global Strategy for Prevention and Control of Noncommunicable Diseases and its related action plan (WHA61.14, 2008)’’

I am glad that MEDSCAPE published this article. READ ON

Nutrition Gets Short Shrift in Battle Against Chronic Disease

Alicia Ault

August 26, 2022. MEDSCAPE

Good nutrition is foundational to preventing chronic disease and helping people live a healthier life, and yet physicians responding to a Medscape Medical News survey said they believe that only about half of their patients would benefit from counseling on diet.

In the online survey of 1005 physicians, doctors said that 55% of their patients could use some nutrition advice. Broken down by specialty, diabetologists and endocrinologists said that 63% of their patients could benefit. By comparison, nephrologists said that 59% of their patients could use nutrition counseling. For cardiologists, it was 56%, for primary care physicians it was 55%, and gastroenterologists said that just 43% of their patients could benefit.

Those figures strike some specialists in obesity and preventive medicine as low.

"If the question is what percentage of patients could benefit from some nutritional guidance from a health professional, the true number is much higher than 55%; in fact, it's 100%," said Stephen Devries, MD, a preventive cardiologist and executive director of the educational nonprofit Gaples Institute in Deerfield, Illinois.

Devries notes that three quarters of US adults are overweight or have obesity, and at least 50% have prediabetes or diabetes, according to the Centers for Disease Control and Prevention. Patients with other conditions — including hypertension, dyslipidemia, digestive disorders, and food allergies — could also benefit from discussions on nutrition, he said. "A meaningful discussion of nutrition needs to be included in the care of every patient," said Devries, who is also adjunct associate professor at the Harvard T.H. Chan School of Public Health.

Every single patient needs counseling because lack of good nutrition is "the basis of most of the chronic diseases that Americans and other people worldwide suffer from," said Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness in the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women's Hospital in Boston.

"Everyone could benefit from nutritional counseling," agreed Sylvia Bollie, MD, an integrative obesity specialist at Embrace You Weight and Wellness in Silver Spring, Maryland. "We should have at least a baseline of standard nutrition counseling or nutrition assessment for all patients, regardless of weight," Bollie told Medscape.

Bollie said that the lack of proactive action on nutrition reflects the US "sick care" system, in which clinicians wait until a patient has an obesity-level body mass index (BMI) or out-of-control A1c before making a referral for a diet or lifestyle intervention.

Patients Not Seeking Advice?

Interestingly, the physicians surveyed by Medscape said that very few patients ask for nutrition advice. Endocrinologists said that one quarter of their patients seek diet counseling each month, whereas primary care physicians, nephrologists, and gastroenterologists said about 20% of their patients ask. Just 15% of cardiologists' patients ask for nutrition advice in a typical month, according to the survey.

So why aren't patients seeking that information from their physicians?

"It's because they're getting their nutrition advice on the street from…these random people on Instagram," said Bollie. "They're getting it from these noncredible sources because maybe they feel like the doctor doesn't have time to talk to them about it, or the doctor doesn't ask them about it, or the doctor doesn't care." They might even feel "that the doctor doesn't know what they're talking about," she said.

Some patients might be reluctant because they believe that being overweight is their fault, said Apovian. "If most people don't realize it's a disease, then they're not going to ask for help," she said.

Devries said that surveys show that most patients want to receive information about nutrition and lifestyle from their doctor. But, he said, "If the physician doesn't bring up the topic of nutrition, it's understandable that patients come away thinking that diet must not be an important part of their care."

Counseling Seen as a Priority, but Time a Factor

A little more than half of the physicians who responded to the survey said they viewed counseling on nutrition to be essential or a high priority. Broken down by specialty, endocrinologists were significantly more likely to label counseling as essential — 37%, compared with just 13% of gastroenterologists and 19% of primary care doctors.

When asked why nutrition counseling is not a priority, two thirds of doctors said that they did not have the time. That was the top reason given by 75% of endocrinologists, 65% of primary care physicians, two thirds of gastroenterologists, and half of cardiologists.

"The time constraint issue is real, no doubt about that," said Devries. But he said practices could have patients complete rapid dietary assessments in the waiting room, or a single diet-related topic could be discussed for a minute or two at each visit...

[... Note from HIFA moderator: I have redacted the last part of the article for length. The full paper is available here: ]

Joseph Ana

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria, established by HRI Global (former HRIWA). In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

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