Most American doctors are not properly trained in this important health topic.

Why are doctors not properly trained about nutrition during their medical training? Given the growing body of research supporting the importance of nutrition for health in general, it seems easy to answer this question. But that's not it.

"The teaching of nutrition in medical schools is, at best, rudimentary and limited for the duration of higher medical studies in many specialties. The requirements for meaningful nutritional education in all phases of medical education are long overdue, "said Stephen Devries, MD, FACC, executive director, Gaples Institute of Integrative Cardiology, Deerfield, IL, and fellow authors. They posted their comments online in JAMA.

The importance of healthy nutrition can not be overstated. Randomized clinical trials have highlighted the importance of an adequate diet to prevent and manage all types of diseases, including diabetes and cardiovascular disease, as well as other health benefits. But, noted Dr. Devries and his colleagues, "the abundant evidence that supports the benefits of nutritional interventions has not translated adequately into action in medical training or practice."

Measure the deficit

Consider that courses detailing nutrition are limited in medical schools and generally only 19 hours over 4 years. These courses are still focused on biochemistry and vitamin deficiency diseases, a rare phenomenon in the United States.

During the next 3 years of graduate school, nutrition education is not included.

And despite the major updates made in July 2018 to the requirements of the Accreditation Council Common Program for Advanced Education in Medical Education for residency training and research fellowship, no requirement for nutritional or dietary training is included. These requirements are also lacking in specialized training programs.

In a survey conducted in 2017 among 930 cardiologists and members of the cardiovascular team led by Dr. Devries and other researchers, 90% reported receiving minimal or no nutritional education during their training, 59% received none during their internal medicine training and 31% received training in nutrition. none at the medical school. A total of 95% felt that it was their personal responsibility to counsel patients with at least basic nutrition information.

Other researchers, led by Kelly M. Adams, MPH, RD, DR, Department of Nutrition, School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill , North Carolina, conducted a survey to determine the state of nutrition education in American medical schools and compared it to the recommended educational goals. They investigated 133 American medical schools with a four-year program and received responses from 121.

71% of these schools did not offer the recommended minimum of 25 hours of nutritional education and 36% provided less than 50%. In addition, less than 50% of all schools taught nutrition in clinical practice.

The schools that responded reported an average of 19 hours of nutrition education, but 36% required 12 hours or less of instruction. Of these, 9% did not require any.

These findings led Adams et al to conclude: "In the United States, physicians are largely self-sufficient when it comes to learning to look for signs of nutritional problems, to explain the problem. The importance of nutrition-related diseases and appropriate interventions, and to refer patients to nutrition professionals. "

Do doctors even need nutritional education?

"Some might suggest that doctors do not need to be informed about nutrition because other health professionals, including dietitians, are better trained and able to make nutritional recommendations." Said Dr. Devries and his colleagues.

They argued that dietary advice for patients should be treated by a team of dietitians, nutritionists, nurses, health coaches and chefs. It seems intuitive that the patient's doctor is part of this team. Unfortunately, this is not the reality, in most cases.

"The problem is that at present, most doctors do not have enough nutrition training to make a significant contribution to this team. At a minimum, doctors need enough training to at least start the conversation about nutrition with their patients. In addition, clinicians with basic nutritional knowledge will be more likely to recognize the importance of the diet and make more effective referrals, "they added.

According to Dr. Devries and colleagues, adequate nutrition training is imperative for clinicians and should be a priority in medical education for the following reasons:

1. According to a report released by US collaborators Burden of Disease Collaborators in 2018, unhealthy diet is the leading cause of death in the United States. The incidence of food-related illnesses and the attendant costs to health care will only increase.
2. The likelihood of a paradigm shift in health care guidance from disease management to health promotion and prevention forces physicians to have a "solid foundation" in clinical nutrition.
3. Media coverage of health and diet constantly bombarding patients with new information; Physicians must play a role in helping them interpret and sort out the glut of stories.
4. By putting more emphasis on the well-being and self-management of residents and fellows, education in clinical nutrition can improve self-management by the physician, as well as the patient's health . This will also allow doctors to more effectively advise patients on nutritional issues.

According to Dr. Devries and his colleagues, the integration of nutrition education into medical education could be a success if nutritional concepts could be integrated with existing content.

"In this way, nutrition can be more appropriately understood as a vital and practical determinant of health rather than as an isolated discipline," they concluded.

Researchers led by Adams agree: "Many US medical schools still do not prepare future physicians for the daily challenges of nutrition in clinical practice. Nutrition is a dominant factor in most chronic diseases and a factor in poor treatment outcomes. It is unrealistic to think that doctors are effectively tackling obesity, diabetes, metabolic syndrome, hospital malnutrition and many other conditions until they are trained to Faculty of Medicine to recognize and treat the root causes of nutrition.

A cure for lack of nutritional education in medical schools is clearly needed.

"It is unacceptable that we continue to see the same systemic failures over the decades of teaching, hoping that everything will be fine. Ultimately, what counts is the willingness and ability of physicians to recognize and effectively address the nutrition challenges of their patients. The school deficits reported in medical school curricula largely explain why many physicians do not take advantage of opportunities to use nutrition as an effective health tool, "concluded Adams et al.