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

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.

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.

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.

2. Look at the big picture

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.

3. 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.

4. 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:

• Nutritionfacts.org
• American College of Lifestyle Medicine
• Mayo Clinic
• FamilyDoctor.org

Further reading:

• How lifestyle medicine physicians treat patients
• Going solo: Why I started my own practice based on exercise and nutrition
• Lifestyle medicine track empowers future DOs to encourage healthy choices