By: Taylor Empey ISSA – CFT, SFN, SET, Elite Trainer Level I
Over the years patients have been conditioned to believe that in order to get proper advice on how to engage in fitness, adopt a healthy diet, and understand the depths of dietary supplements, they need to consult with their primary care physician (PCP). However, as more recent research has exposed, it is becoming shockingly clear that many PCPs are far from qualified from giving any advice related to these aspects of health.
The range of PCPs and their various areas of specialization vary greatly so the exact number of these individuals who may have been fully qualified to help overweight, obese, or unhealthy patients is not entirely known.
However, to justify the claim that not all (in fact many) PCPs are not qualified to be counseling their patients in areas of fitness, nutrition, and supplementation, here are some interesting findings about the education that many physicians receive in the realm of nutrition as found in a survey that was conducted among many accredited medical schools nationwide.
“During the 2012/13 academic year 141 US medical schools were fully or provisionally accredited by the LCME. Only information about the 133 schools with a fully operational four-year curriculum at the time of the survey is included in this report. A total of 121 (91%) medical schools responded to the survey.”
The questions in the survey addressed specifically how many hours of nutritional education did medical students receive, as well as how many minimum hours were required (if any) specifically dedicated to nutrition.
“The responding medical schools reported that they provide on average 19.0 hours of nutrition
education with a standard deviation (SD) of 13.7 hours and a median of 17 hours. Over a third of the responding medical schools (43/121, 36%) reported requiring 12 or fewer hours of nutrition instruction; twelve of those institutions (9%) required none. Less than a third (35 of 121, 29%) of the responding medical schools reported that they provide at least 25 hours of nutrition education across the four-year curriculum.”
Though some schools reported higher numbers of hours for some medical students these numbers seem to be low given the amount of responsibility that is placed on doctors to provide patients with nutrition and healthy weight management advice.
“Primary care physicians overwhelmingly supported additional training (such as nutrition counseling) and practice-based changes (such as having scales report body mass index) to help them improve their obesity care. They also identified nutritionists/dietitians as the most qualified providers to care for obese patients.”
The PCPs that participated in the study ‘overwhelmingly supported’ that Licensed Nutritionists and Registered Dietitians should be who these patients should be referred to.
So, it seems the next best step for a patient to take, regarding addressing at least their nutrition behavior to begin living a healthier lifestyle, would be to consult a Registered Dietitian if studies are showing that PCPs are not qualified to be giving such advice. This seems to be the most logical professional patients should be seeking out to receive more credible education and training than from the average doctor. However, there are in fact issues with seeking out even a Registered Dietitian for nutritional counseling as well.
According to a study that was conducted surveying undergraduate students studying nutrition and dietetics it was stated that, “several studies have indicated that college students majoring in dietetics have more problems associated with food than do students majoring in other disciplines. If this is true, dietetics students may need more counseling and education on eating disorders, especially because many will eventually be counseling others professionally.”
The abstract continued and clarified that there were some students who did show positive responses and psychology oriented around their views of nutrition and their nutritional habits in relation to the questions in the survey. However, it was also found that “the results of the second survey, however, indicated that dietetics majors had significantly more negative eating patterns than did students from other majors.”
It should be noted that the study did indicate that with more experience students showed a more positive understanding and psychology oriented around nutrition behavior.
However, other research findings have revealed that individuals who have a preexisting unhealthy relationship with food are more likely to pursue education and a career in dietetics. Evidence Suggests that people majoring in dietetics have a notably higher tendency to develop or suffer from eating disorders or disordered eating behaviors.
It seems that even if a patient seeks out, or is referred to, a qualified Registered Dietitian they may still not be receiving adequate, accurate, or healthy nutrition counseling.
People then often seek out Certified Personal Trainers or Nutrition Coaches who are more prevalent in the fitness industry. However, those many individuals in this space can be highly qualified, there is no significant regulation of education and services offered in these industries.
With so many conflicting diets and protocols available on the internet, a lack of regulation in the fitness industry, unqualified primary care physicians, and registered dietitians who suffer from disordered eating patterns themselves, we as a nation are in a serious predicament when it comes to properly seeking out appropriate, healthy, personalized, and long-term sustainable nutrition advice.
Fitness and Healthcare professionals, and their prospective regulatory organizations, need to take action to remedy this problem so consumers can get the help they need safely, effectively, and from the appropriate professionals.
Bleich, S. N., Bennett, W. L., Gudzune, K. A., & Cooper, L. A. (2012). National survey of US primary care physicians’ perspectives about causes of obesity and solutions to improve care. BMJ Open,2(6).
Adams, K. M., Butsch, W. S., & Kohlmeier, M. (2015). The State of Nutrition Education at US Medical Schools. Journal of Biomedical Education,2015, 1-7.
Reinstein N., et al. Prevalence of eating disorders among dietetics students: does nutrition education make a difference? J Am Diet Assoc. 1992 Aug; 92(8): 949-53.
W.V. Strauss, et al. A Comparison of Dietetics Career Choice Motivators and Prevalence of Eating Disorders in a College Female Population. Journal of Academy of Nutrition and Dietetics. September 1999.
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