You are what you eat

Let’s talk about nutrition: 4 ways to advise your patients on what to eat

Prevention is at the heart of osteopathic medicine, and nutrition education can be a critical tool DOs use when advising patients.

Studies have linked dietary habits to a host of maladies. But because of the vast amount of information students need to learn in medical school, nutrition education often gets dropped to the wayside.

Robyn Dreibelbis, DO

A recent study of nutrition knowledge in osteopathic medical students found that more than half of the students in the study failed a basic nutritional knowledge quiz. The study was published in The Journal of the American Osteopathic Association.

“We focus a lot on disease management, and not enough on disease prevention, which I believe is where nutrition really comes into play,” says Robyn Dreibelbis, DO, chief wellness officer at Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest.

Another study found that fewer than 30 percent of medical schools accredited by the Licensing Council for Medical Education were teaching the minimum of 25 hours of nutrition education recommended by the National Research Council’s committee on nutrition in medical education.

Prevention is at the heart of the osteopathic medical philosophy, and nutrition education can be a critical tool DOs use to counsel their patients more effectively. Here are four ways to incorporate nutrition into patient care:

  1. Ask patients what they ate yesterday

When asking patients social history questions, work in a question about their diet, suggests Ryan Seals, DO, interim chair of family medicine and osteopathic manipulative medicine at University of North Texas Health Science Center/Texas College of Osteopathic Medicine.

Ryan Seals, DO

Dr. Seals likes to ask patients what they ate the day before to get a small glimpse of their eating habits.

“Counseling patients on nutrition requires a more in-depth conversation and analyzing an individual person’s food choices beyond them saying, ‘I eat pretty healthy,’ or, ‘I eat fast food,’” Dr. Seals says.

By probing deeper, physicians have the opportunity to have an open dialogue with their patients about diet.

Dr. Dreibelbis, who teaches clinical medicine courses, ingrains in her students the importance of a patient’s diet.

“When we teach the assessment, we have an added requirement that students also ask about diet, and we drill down into what that means and how to counsel patients,” Dr. Dreibelbis says.

  1. Look at the big picture
Elizabeth Vaughan, DO

To see patients make real changes in their lives, give them simple goals to focus on, says Elizabeth Vaughan, DO, a registered dietitian and associate professor at Baylor College of Medicine.

“You have to take broad strokes and not worry about all the tiny details of nutrition, or no one will do anything,” says Dr. Vaughan.

For example, when caring for a patient with obesity, Dr. Vaughan often starts by recommending that the patient stay under a given number of calories per day, then moves on to more detailed nutritional guidance later so her patient doesn’t get overwhelmed at first.

Whether patients substitute a candy bar for a piece of fruit or make a drastic change such as committing to a diet saturated with fruits and veggies, Dr. Dreibelbis believes educating patients can help them choose healthier options.

“Empower the patients to know they are truly in control of their own destiny and by the choices they make,” Dr. Dreibelbis says.

  1. Lead by example

When physicians themselves embrace a healthy lifestyle, they gain valuable firsthand experience they can then share with their patients.

“If you want your patients to be healthier, you need to be healthier yourself,” Dr. Vaughan says. “If you are, it’ll be very natural for you to guide patients on diet and you’ll understand the advice you’re giving a lot better.”

Participating in the lifestyle medicine track at WesternU/COMP-Northwest helped Stephanie Clark, OMS IV, learn how to prepare healthy foods.

“The course gave us personal experience we can share with our patients and use to teach them specific recipes and kitchen strategies they can incorporate in their lives,” Clark says.

  1. Know where to send patients for help

Physicians can refer patients to registered dietitians or registered dietician nutritionists who have more advanced knowledge in medical nutrition therapy and nutrition education, the authors of the recent JAOA study note.

“Have resources available to give them, and after that refer them to professionals for more specific care if you lack the practical knowledge of what a specific diet or plan looks like,” Dr. Seals says.

When primary care physicians can’t overcome common barriers such as a patient’s insurance coverage or finances, they often become the main source of nutrition knowledge and education for their patients, the JAOA study authors point out.

“Patients are going to ask you about nutrition just because you have the title of doctor,” Dr. Vaughan says.

Helpful resources for learning about nutrition:

Further reading:

    2 comments

    1. Medical schools give nutrition a short straw most of the time. The reason is the famous Flexner report which detailed a standard medical curriculum did not enter nutrition as a vital subject for schools to teach.
      You might say all doctors are inadequately prepared to discuss nutrition, unless like one of the contributors of this article they are a registered dietician.
      Food and good digestion is at the root of good health. We prescribe nexium like water and don’t address the digestive issues so the patient continues in poorer health than he could have.
      With today’s obesity and diabetes epidemics every doctor needs a working knowledge of food choices and nutritional needs to help these people who are largely ignored except by the bariatric surgery doctors.

    2. A couple of your points are well taken, but to say all doctors are inadequately prepared is an exaggeration.

      We come from all backgrounds, schooling, and personal interests.

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