Does the Nutrition Education of Physicians Need Advancing?
The Global Burden of Disease (GBD) Study is the most comprehensive worldwide observational epidemiological study to date. It describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels in 195 countries across the world. This comprehensive study has highlighted the astonishing fact that dietary factors are the single leading cause of death. Furthermore, dietary factors comand an even greater health burden than smoking.
The Health Burden of Poor Nutrition
Dietary risk factors attributed to 11 million deaths and 255 million disability-adjusted life-years (DALYs) in 2017. The leading dietary risk factors worldwide were a high intake of sodium, a low intake of whole grains and a low intake of fruits. The GBD study has highlighted the impact of a suboptimal diet on mortality and morbidity and the importance of improving the diet of nations worldwide. Evidence-based dietary interventions, led at a physician level, could positively impact the health burden that dietary factors currently possess.
Nutrition Education in the Medical Community
An article published in the Lancet Planetary Health in September 2019 has highlighted the lack of nutrition training amongst doctors, a thought that has arisen from the facts published in the GBD study indicating dietary factors as a major health challenge facing people across the world in the 21st century. Devries S has hypothesised that as dietary factors are so detrimental to human health that the education of doctors at medical school and beyond should address nutrition at the heart of medical education. He has hypothesised this based on the fact that medical education is centred around the needs of patient and population health.
Research by Crowley J et al has indicated that medical students are not supported to provide high-quality, effective nutrition care, even though nutrition is paramount to a healthy lifestyle. This paper investigated 24 studies worldwide on nutrition education in medical schools and alarmingly has shown that nutrition knowledge amongst medical students, and their confidence in advising in nutritional matters were consistently low. Further to this, the medical students also gave their view that both the quality and quantity of their nutrition education was substandard. Conversely, this study has also shown that, even though the nutrition education of the medical students was low, they had a consistently high interest in nutrition.
Unfortunately, it is known that this interest dissipates by the time the students graduate. Devries S hypothesises why medical students are no longer interested in nutrition by the time they graduate, and he considers that nutrition not largely being taught as part of their curriculum has a profound effect on the students’ assessment of the importance of nutrition. If these students are not observing in the clinic nutritional interventions being incorporated into the patients’ care plans, then they will also continue to have this gap in their medical knowledge and not include nutrition in the future care plans of patients.
Nutrition Education into the Future
It is clear that the lack of interest in nutrition amongst the medical community needs to be addressed. The curriculum for medical students needs to review the evidence showing the impact of dietary factors on human health, and as such be updated to prioritise nutrition education. Furthermore, nutrition needs to be at the forefront of current physicians’ knowledge when determining care plans for their patients. This is not specific to one geographic region or nation, but this need exists worldwide.
The EAT-Lancet Commission recently held their Food Forum in Stockholm, with planetary health included as a focus area within the Commission to highlight the critical role that diets play in linking human health and environmental sustainability. Eat-Lancet Commission believes that there is a necessity to integrate the two into a worldwide programme for food system transformation to achieve the UN Sustainable Development Goals (SDGs) and the Paris Agreement. This stands to reason that the global lack of nutrition education in medicine is an issue that impacts not only human health but also planetary health.
The EAT-Lancet Commission emphasises the importance of a shift towards a more plant-based diet both for human health and the environment. However, this will require significant changes and if physicians are not sufficiently trained in nutrition, how can they hold an important position in aiding a dietary shift that is so very necessary for human and planetary health?
It is the same worldwide, patients rely on their doctors for advice and guidance; and as such it is imperative that physicians are armed with the necessary knowledge to advise patients on their diet to make a positive impact on their dietary choices in order to combat diet-related disease. At the very least, our physicians need to be equipped with a solid foundation in clinical nutrition knowledge in order to identify patients in need for referral to specific nutritional health care professionals.
Discussion
It is clear that nutrition education in medicine is inadequate, and that the education of clinical mentors in nutrition is a key challenge. If doctors are to provide nutritional care to patients to improve their dietary behaviours then it stands to reason that the training of doctors needs to include a high standard of nutrition education in the curricula; not only for human health, but also the health of our planet.
References
Devries S (2019). A global deficiency of nutrition education in physician training: the low hanging fruit in medicine remains on the vine. Lancet Planet Health. Sep;3(9):e371-e372.
Crowley J et al (2019). Nutrition in medical education: a systematic review. Lancet Planet Health. Sep;3(9):e379-e389.
Afshin A et al (2019). Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. May 11;393(10184):1958-1972.
The EAT-Lancet Commission and the Planetary Plate https://www.nutritional-insight.co.uk/the-eat-lancet-commission-and-the-planetary-plate/