Nutrition and lifestyle advice within medical education
“Eat a balanced diet, exercise regularly, avoid stress and sleep well” is the most frequent lifestyle advice I have witnessed given by doctors to patients both in the primary care setting and in outpatient clinics.
As a fourth-year medical student, I vaguely remember several sessions on different vitamins and minerals as well as the infamous food pyramid. However, as interesting as that knowledge may be, it is impractical. With an ageing population comes an increase in the rate of non-communicable diseases such as diabetes, cardiovascular and musculoskeletal disorders 1. This provides an increasing burden on the already strained health service. The 2017 Health Survey for England estimated that over 60% of people were overweight at that time. Nearly 10% of children aged 4-5 were obese and it has been estimated that 50% of boys aged 6-10 will be obese by 2050 2. This rising pandemic requires urgent action and medical schools worldwide need to equip future doctors with better skills and knowledge on how to manage the crisis.
A 2019 systematic review published in the Lancet revealed that medical students lack both the knowledge and the confidence to counsel patients regarding nutrition, despite acknowledging it’s importance in the promotion and maintenance of wellbeing 3. Interestingly, it seems this trend remains unchanged as similar outcomes were shown by a questionnaire of physicians practising in the United States over ten years ago. It was reported that 94% of participants felt a duty to discuss nutrition with patients, yet only 14% felt competent in providing nutritional guidance 4. A recent paper looking at medical students’ and doctors’ views on the topic of nutrition education in the United Kingdom reported that the main barriers to giving nutritional advice were lack of knowledge (75%), time pressures (64%) and confidence (62%) 5. Certainly, in my experience, there was no practical training on how to engage in patient discussions regarding lifestyle choices.
Unfortunately, this is a common phenomenon amongst medical students, so where are we being let down? A national survey of 109 medical schools in the United States found that only 27% satisfied the minimum 25 hour requirement of nutrition instruction 6. European counterparts did better, with 68.8% of schools providing an average of 23.68 hours of tuition 7. However, lifestyle advice includes aspects beyond diet such as physical activity, stress and sleep quality and regrettably, these receive even less coverage in the literature let alone the medical curriculum.
Doctors are viewed by the public as the trusted experts of health and disease and are often relied upon as a first point of contact for lifestyle advice. However, armed with insufficient knowledge, vague national guidelines and the age-old ‘5-a-day’ maxim, dissatisfied patients are forced to seek information elsewhere. Often, this means turning to the depths of the internet, falling prey to misinformation and misleading marketing of possibly dangerous diets and fads. With unsettling statistics of preventable morbidities, we should be taught more than what the public already knows in order to bring valuable and safe insights to the conversation.
Conversely, it might be difficult to preach the benefits of a healthy and active lifestyle when so many doctors are unable to set a good example. The nature of our work means we miss meals; changing shift patterns shatter any resemblance of a sleep schedule; we often lack the time or energy to go to the gym after a busy day at work; and high levels of stress are a given. There is definitely a fault in the constantly strained system, but education on proper nutrition, physical activity and stress management would not only help us inform patients better but promote a healthier work force. Furthermore, financial implications of a healthier population cannot be ignored. An investment now that could lead to a decrease of the preventable demand on healthcare services, and potentially reduce the number of sick-days in a population, could yield exponential returns in the not-so-distant future.
There is an obvious need for a paradigm shift within medical education, so what can we do in the meantime? While the changes are slowly being implemented within the curricula, there are other opportunities available to medical students who wish to become more involved in this particularly important field. This includes joining a Nutritank society branch or creating one at your medical school, intercalating in nutrition or sport science, and spending some time with the dieticians in the hospital. Regularly reading up-to-date articles on this topic published by respected journals such as the British Medical Journal is a great habit to start nurturing. Even more simply, ask patients about their diet when clerking and explore their views and understanding of it. While we have all wished it at some point, knowledge and experience does not materialise in one’s mind. Therefore, it is vital we all start having this conversation regularly. It will take many attempts of many conversations, but we owe it to our patients to not let this seemingly obvious but vital aspect of life be overshadowed by the transient limitations of our education.
- Bruins MJ, Van Dael P, Eggersdorfer M. The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging. Nutrients. 2019;11(1). doi:10.3390/nu11010085
- Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J surgery Oncol. 2017;2(7):e17. doi:10.1097/IJ9.0000000000000017
- Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Heal. 2019;3(9):e379-e389. doi:10.1016/S2542-5196(19)30171-8
- Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes, Self-Perceived Proficiency and Knowledge. J Am Coll Nutr. 2008;27(2):287-298. doi:10.1080/07315724.2008.10719702
- Macaninch E, Buckner L, Amin P, et al. Time for nutrition in medical education. BMJ Nutr Prev Heal. April 2020:bmjnph-2019-000049. doi:10.1136/bmjnph-2019-000049
- Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537-1542. doi:10.1097/ACM.0b013e3181eab71b
- Chung M, van Buul VJ, Wilms E, Nellessen N, Brouns FJPH. Nutrition education in European medical schools: results of an international survey. Eur J Clin Nutr. 2014;68(7):844-846. doi:10.1038/ejcn.2014.75