How Much Do Doctors Learn About Nutrition?

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The answer: It may not be enough – but it’s not their fault. In recent years, it has become increasingly clear that diet plays a starring role in preventing and treating certain chronic diseases. And physicians are often on the frontlines of counseling patients about how their diets and other lifestyle habits can affect their health and weight – a reality that has gained added importance given the obesity epidemic. And yet,it turns out that only 29 percent of U.S. medical schools offer med students the recommended 25 hours of nutrition education, according to a 2015 report in the Journal of Biomedical Education.  On average, U.S. medical schools offer only 19.6 hours of nutrition education across four years of medical school, according to a 2010 report in Academic Medicine. In a 2016 study, researchers at Case Western Reserve University examined data from 25 family medicine, internal medicine and OB-GYN medical residency programs throughout Ohio: What they found is that these programs averaged 2.8 hours of instruction on obesity, nutrition and physical activity counseling, and only 42 percent of them taught the residents techniques for how to perform health behavior counseling. Given this, it's not exactly shocking that many doctors would receive a failing grade on nutritional know-how. A 2016 study in the International Journal of Adolescent Medicine and Health assessed the basic nutritional knowledge of fourth-year medical/osteopathic school graduates entering a pediatric residency program and found that on average, the incoming interns answered only 52 percent of the 18 questions correctly. Why has nutrition been given short shrift in medical schools? There are several reasons, especially a lack of funding and a shortage of trained faculty to provide high-quality nutrition instruction, and a focus on treating rather than preventing diseases, says Marion Nestle, a professor of nutrition, food studies and public health at New York University. "The assumption is that doctors will refer patients to dietitians." Plus, the medical school "curriculum is crowded, and it's hard to make room for new priorities," notes Dr. David Katz, director of the Yale University Prevention Research Center and a U.S. News Eat+Run contributor. "The basic structure of medical education was put in place in 1920, long before lifestyle-related chronic disease was a major public health focus." 

Barriers to Providing Dietary Counseling It's not that physicians don't want to provide nutritional advice. Many primary care physicians believe that providing nutrition counseling is part of their responsibility, yet there continues to be a sizable gap between those good intentions and the proportion of patients who receive dietary advice from their doctors or who are referred to dietitians, according to 2010 research from East Carolina University. The primary barriers: lack of time and compensation, followed by insufficient knowledge and resources. "Diet and lifestyle counseling tend to be labor-intensive," Katz says, "and the brief clinical visits that now prevail don't really allow for that." The reality is, it's not realistic to expect physicians to be experts on everything. "Most primary care physicians have seven to 22 minutes to spend with each patient," says Dr. Christine Gerbstadt, a staff physician at Walter Reed National Military Medical Center in Bethesda, who is also a registered dietitian. That time includes "offering age- and patient-specific appropriate preventive health advice – wearing seat belts 100 percent of the time, not smoking, eating more fruits and vegetables, avoiding highly processed sugar- and fat-laden foods, being physically active an hour a day, flossing and brushing your teeth, reducing stress, sleeping adequately – the list is truly endless and must be exhausted in seven to 22 minutes, along with listening to the patient, offering guidance for recommended health screening and performing a focused physical exam," she says. That's a tall order, indeed. Another factor: The culture of current medicine, "which has increasingly focused on pharmacologic treatments, rather than lifestyle modifications," says Dr. Marion Vetter, an adjunct assistant professor of medicine in psychiatry at the University of Pennsylvania Perelman School of Medicine who is also a registered dietitian. "Both patients and providers want to see rapid results, whether it is weight change or improvements in blood glucose or lipids. Dietary modifications and lifestyle changes typically involve a slow and steady approach instead of a fast fix. For this reason, patients frequently revert to previous behaviors and tend to make few durable lifestyle changes, which may discourage physicians from spending the time to provide dietary education."

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Turning the Tables One way or another, many health care practitioners would like to see physicians learn more about how nutrition impacts health and disease so they can better advise their patients – or be more proactive about referring patients to registered dietitians. Another option: "If physicians worked with teams and were reimbursed for prevention, they could have trained nutritionists on staff," Nestle says. Already, some progress is being made at the medical school level. "New models like culinary medicine, which teaches medical students how to cook so they can pass along that skill to patients, show real promise," Katz says. The Goldring Center for Culinary Medicine at Tulane University has set up "teaching kitchens" that provide hands-on training for medical students through culinary medicine classes. (Others such as Rutgers Robert Wood Johnson Medical School, the Northwestern University Feinberg School of Medicine and the University of Massachusetts Medical School have followed suit with similar programs.) Meanwhile, Texas Tech School of Medicine has implemented an online nutrition curriculum to help more senior medical students keep up with the latest nutrition science. The timing of such interventions may be important, Vetter says. "Instead of integrating nutrition into the first two years of medical school, where there is limited contact with patients and few opportunities to apply knowledge, it may be more effective to incorporate nutrition training into the clinical clerkships." That way, med students could apply what they're learning to the treatment of actual patients, which would benefit the future physicians and the patients equally. Until that happens, if you’d like to get personalized nutrition advice, your best bet is to ask your physician for a referral to a registered dietitian.

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