As a junior doctor working in general practice, I regularly encounter patients with lifestyle related disease. Just last week, during a discussion about Type 2 diabetes, a patient asked how she could improve her diet in order to help with diabetes control. Rather than using any nutritional knowledge that I had acquired at medical school, or during my post-graduate training, I found myself relying on my own personal knowledge of nutrition. Whilst I have an interest in nutrition; this experience felt uncomfortable because as a doctor, I want to be able to provide my patients with reliable, up to date information, as I would for any other form of medical advice.
These experiences are unfortunately shared by many of my colleagues, both in primary and secondary care. Dr Emma Pimlott, GP and a Public Health England Physical Activity Champion, states that,
“Even as a GP with many years’ experience, I still feel uncomfortable about talking to patients about nutrition. It can be confusing which sources of information to trust”
These thoughts are echoed by studies across Europe, and in the USA doctors have reported low levels of nutritional knowledge and more importantly a lack of confidence in engaging in discussion about nutrition with their patients 1,2. Medical students have also expressed concern about the amount and quality of nutrition education they receive, with over three quarters of students in a US study stating they had not been adequately trained in nutrition1. As a medical student, I remember nutrition and other lifestyle factors being mentioned at the start of lectures on topics such as obesity and ischaemic heart disease but they were never elaborated on.
The General Medical Council (GMC), who regulates doctors’ training in the UK, has endorsed the Intercollegiate Group on Nutrition (ICGN) ‘UK Undergraduate Curriculum in Nutrition’3. This published guidance highlights what medical students should be taught regarding nutrition, based on consensus from the Academy of Medical Royal Colleges3. Why then, do we see that such a large proportion of medical students feel dissatisfied with their training on this topic? It may be that nutrition does not fit into the traditional medical model, where students are taught how to treat disease through pharmaceutical or surgical means. It may even be that nutritional advice is not viewed as part of the remit of doctors and rather that of our dietician. Kirsty Donald, Registered Dietician, PG Cert Sports Nutrition, comments on the shared accountability of nutrition,
“Dietitians are there to provide expert knowledge but nutrition is everyone’s responsibility, particularly in our climate of chronic disease where what we eat plays a huge part in the management.”
The reality is that doctors are in an ideal position to educate patients about nutrition. They truly are the gate-keepers of health. Doctors come into contact with patients of all ages, demographics and health states and as trusted health professionals, there is a real opportunity to promote good nutrition, as part of a wider preventative approach to health. Beyond that, if doctors are able to competently assess a patient’s nutritional intake and behaviour, it may help to identify key causes of common presentations such as gastro-oesophageal reflux disease, migraine and fatigue 4,5,6. Dr Ayan Panja, co-founder of the RCGP Prescribing Lifestyle Medicine Course with Dr Rangan Chaterjee, gives a pertinent example of this, recalling a 36 year old patient, who improved his symptoms of dyspepsia and abdominal bloating,
“The answer was obvious…His diet wasn’t great; it contained lots of cereal, sandwiches and pasta dinners – usually eaten quickly, standing up or on the go. I knew exactly what I could do to help him. I felt sure that in 4-6 weeks he’d tell me he felt a lot better”
This change in approach to nutrition is imperative, as we see the rising impact of lifestyle related disease both in the UK and across the world7. What is more, there is an ever increasing volume of health information online and on social media, which is accessible to patients8, and it is vital that doctors are able to provide reliable, evidence based sources of information to patients.
The ability of doctors to fulfil this important role really does start at medical school. There is clear scope for nutrition in medical lifestyle education to be enhanced, so that by graduation, doctors feel equipped with adequate knowledge and skills in nutrition. In the US, it is promising to see students in one university in New Orleans having access to a Culinary Medicine course. Here, the fundamentals of nutrition and mindful eating are taught, in a practical kitchen-based way9. In an article for the Telegraph10, Dr Rupy Aujla, founder of the Doctor’s Kitchen, writes about the success of Culinary Medicine in US and his plans to promote this within medical education in the UK,
“We have a role in nurturing a culture that recognises the power of our plates…We need to teach doctors how to cook and the value of evidence based nutrition. We need to equip them with the skills to have a conversation with patients about lifestyle medicine”
Rupy’s Culinary Medicine course for healthcare professionals is being piloted on 24th February in London. It is also being piloted for medical students at Bristol Medical School in July, forming part of a student selected component. The Nutritank co-founders and Dr Trevor Thompson, a GP in Bristol, have facilitated the development of this event.
Like never before, there is a growing momentum of doctors, medical students and other healthcare professionals who want to transform the way that lifestyle related diseases are viewed, managed and even prevented. This is exciting to me both as a doctor and as a citizen in a country with unprecedented growth of lifestyle related disease. When I came across the organisation Nutritank, I was extremely impressed to see a group of medical students taking the initiative to promote nutrition in medical lifestyle education, using a grass-roots approach. There has already been engagement on social media and from a number of medical schools in the UK and I look forward to working with Nutritank in the future to promote the message of nutrition in medical lifestyle education.
With thanks to…
Dr Emma Pimlott
GP and Public Health England Physical Activity Champion
Registered Dietician, PG Cert in Sports Nutrition
Dr Ayan Panja
GP, co-founder of Prescribing Lifestyle Medicine Course
Dr Rupy Aujla
Founder and author of the Doctor’s Kitchen
- Leong B, Abu-Sharmat L, Kay D. Teaching 3rd & 4th year medical students how to cook: an innovative approach to balance lifestyle modification and medication therapy in chronic disease management. FASEB. 2013; 23(1) – cannot find this online
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