Why we don’t talk diet with our doctors

The World Health Organisation considers both wasting and overweight as forms of malnutrition, presenting a significant threat to human health. With a long list of chronic diseases associated with being overweight or obese, including cardiovascular disease, diabetes, and several cancers, it would seem that nutrition should be an essential part of health care provision, but when was the last time your doctor asked you about your diet?

A recent survey by the global healthcare professional resource, Medscape Medical News, reported that physicians felt only 55% of their patients could benefit from nutrition advice. Here we provide an overview of the research, which also explored why, despite the evidence for the relationship between diet and so many common diseases, your doctor may not be able to provide nutritional advice beyond ‘get your five-a-day’.

Time

No surprises, time is an issue for doctors. Ten minutes really isn’t long to say hello, find out what the visit is regarding, check notes, discuss options and write a prescription. Throw in a physical examination and they are already running late. The Medscape survey found that two-thirds of doctors said they did not have time to make nutritional advice a priority.

Education

Although doctors who had qualified in the last 10 years were more than twice as likely to have received some nutrition training during medical school, a lot of the courses are elective. Half of the doctors surveyed felt that they were only ‘somewhat knowledgeable’ about nutrition, and a lot of what they do know has been self-taught or learnt on the job.

As Dr Pat Heath, a GP in the UK with a particular interest in lifestyle medicine and men’s health, explained:

‘People often ask me, “What is a healthy diet?” My answers come from my personal research for managing my own health and lots of reading, not anything I learned at medical school’.

The system

According to a 2019 NHS survey for England, 68% of men and 60% of women over the age of 16 are obese or overweight. Currently, the NHS Quality and outcomes framework (QOF) rewards GPs for prescribing medications for conditions like high blood pressure, heart failure and diabetes, rather than any preventative measures. QOF points can also be awarded for annual blood tests in patients who are hyperglycaemic, but not (yet) diabetic, with no guidance on how to stop them progressing towards diabetes. However, it is good to know that advising on smoking interventions do feature. Perhaps one day we will see patients with a high BMI not simply being kept track of, but also given nutritional education.

What can you do?

Talk about your diet with your doctor and ask for advice – if they aren’t sure, it might encourage them to do some research - helping you and their other patients. And in the meantime, Dr Heath recommends not becoming fixed on a certain diet. Instead, think about how you feel, your energy levels, are you getting a good mix of nutrients? What you need is so individual and the best way to find out what works for you is to listen to, and understand, your body.