JAMA commentary: Nutrition knowledge essential for today's physicians

Nutrition knowledge is essential for today's physicians, according to a JAMA Internal Medicine commentary published July 1. The commentary--authored by Neal Barnard, MD, president of the Physicians Committee for Responsible Medicine--points out that overweight, diabetes, heart disease, and many forms of cancer are driven by unhealthful diets, and that most doctors do not have the knowledge to turn this problem around. In a 2018 survey, 61 percent of internal medicine residents reported having little or no training in nutrition.

In the commentary, Dr. Barnard recalls a patient who was hospitalized with a foot infection that was a complication of longstanding diabetes. Although Dr. Barnard notes that with sufficient change in the diet, insulin resistance and diabetes itself can improve and sometimes even disappear, the patient's doctors recommended amputation.

"Although the roots of type 2 diabetes are in the everyday food choices that lead to obesity and insulin resistance, we were ready to amputate, but never started a discussion about improving her diet," writes Dr. Barnard. While 94 percent of resident physicians recognize the importance of diet and feel that nutrition counseling should be part of patient visits, only 14 percent feel trained to offer it.

Research shows that a diet rich in fruits, vegetables, grains, and beans, can help fight heart disease, hypertension, diabetes, and cancer. But just 9.3 percent of U.S. adults meet the daily vegetable intake recommendation, while only 12.2 percent of adults get enough fruit.

Dr. Barnard recommends five steps the medical community can take to address this lack of knowledge about nutrition: (1) Nutrition should be a required part of continuing medical education for physicians everywhere; (2) Doctors should work with registered dietitians; (3) Electronic medical record services should include customizable nutrition questions and handouts; (4) Doctors are role models and should embrace that fact by modeling healthy eating habits; (5) The medical community should support healthier food environments, including in hospitals and schools.

Legislators throughout the U.S. are also calling for nutrition education for physicians. Last month, Washington, D.C., Councilmember Mary Cheh introduced a bill recommending continuing education on nutrition for physicians, nurses, and physician assistants. In New York, lawmakers have introduced similar legislation: A7695/S5887.

Founded in 1985, the Physicians Committee for Responsible Medicine is a nonprofit organization that promotes preventive medicine, conducts clinical research, and encourages higher standards for ethics and effectiveness in education and research.