"How Much Do Doctors Actually Know About Nutrition?"
A poor diet now outranks smoking as the leading cause of death
on the planet, as well as specifically in the United States.
In the US, the #1 killer of Americans is the American diet.
So, if diet is humanity's #1 killer,
then obviously it's the #1 thing taught in medical school, right?
Sadly, medical students around the world are poorly trained in nutrition.
It's not that medical students aren't interested in learning about it.
Medical schools just aren't teaching it.
Without a solid foundation of clinical nutrition knowledge and skills,
physicians worldwide are generally not equipped to even begin to have
an informed conversation about nutrition with their patients.
How bad is it? One study assessing the clinical nutrition knowledge
of medical doctors found the majority got 70% of the questions wrong.
And they were multiple choice questions,
so they should have gotten about a fifth right just by chance.
And the wrong answers were not limited to dificult or demanding questions.
For example, less than half could guess how many calories are in
fat, carbs and protein; only 1 in 10 knew the recommended protein intake;
and only about 1 in 3 knew what a healthy BMI was.
I mean, this is like super basic nutrition knowledge.
And what's worse, not only did the majority of medical doctors
get a failing grade, but 30% of those who failed had a high self-perception
of their clinical nutrition expertise, meaning not only were they clueless
about nutrition, they were also clueless that they were clueless about nutrition,
a particularly bad combination given that doctors are trusted
and influential sources of healthy eating advice.
For those majority of consumers who get information
from their personal health care professional, 78% indicate making
a change in their eating habits as a result of those conversations.
So if everything the doctor knows they read in some checkout aisle magazine,
that's what the patients are going to be following.
Only a quarter of doctors surveyed correctly identified
the American Heart Association's recommended number
of fruit and vegetable servings per day, and fewer still
were aware of the recommended daily added sugar limits.
So how are they going to counsel patients on it?
Yet again, of the doctors who perceived themselves as having high nutrition
knowledge, 93% couldn't answer those two basic multiple-choice questions.
Physicians with no genuine expertise in, say, brain surgery
are neither likely to broadcast detailed opinions on that topic,
nor have their "expert opinions" solicited by media.
And most topical domains in medicine enjoy such respect;
we defer expert opinion and commentary to actual experts.
Not so with nutrition, where the common knowledge that physicians
are generally ill trained in this area is conjoined to routine invitations
to physicians for their expert opinions on the matter.
All too many are willing to provide their opinions, absent any basis
for actual expertise, or worse, made on the basis of bias and personal
preference, sometimes directly tethered to personal gain such as diet book sales.
That's one of the reasons all the proceeds I receive from my books
are donated directly to charity.
I didn't even want the appearance of any conflicts of interest.
In a culture that routinely fails to distinguish expertise from mere opinion
or personal anecdote, we physicians should be doing all we can
to establish relevant barriers to entry for expert opinion on diet and nutrition,
as in all other matters of genuine medical significance.
I mean, we're not talking celebrity gossip.
Lives are at stake, and there are entire industries devoted
to marketing messages that may conspire
directly against well-informed medical advice in this area.
Medical education must be brought up to date.
For physicians to be ill trained in the very area most impactful
on the rate of premature death at the population level
is an absurd anachronism. The mission of medicine is to protect,
defend, and advance the human condition.
That mission cannot be fulfilled if diet is neglected.
Maybe one place to start is for physicians
and health care organizations to collectively begin to emphasize
their seriousness about nutrition in health care
by practicing what they at least should be preaching.
Is it appropriate to serve pizza and soft drinks at a resident conference
while bemoaning the high prevalence of obesity
and encouraging patients to eat healthier?
A similarly poor example exists in medical conferences,
including national meetings, where some morning sessions
are accompanied by foods such as donuts and sausage.