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Tell Your Doctor About Dr. Gourmet
I was having a conversation with the editor of a major food magazine this week. We were talking about my new book, and the mission of Dr. Gourmet, when I said that one of my goals has always been to build an evidence-based nutrition destination that my colleagues would feel comfortable referring their patients to. This is because your doctor just doesn't have the time to say much other than "You should watch your diet," or "You really need to lose weight."
Red Light / Green Light
Earlier this year I reported on a study that looked at different ways to present nutrition information on a menu in order to affect the number of calories a person ordered. That study compared displaying the number of minutes walking it would take to burn the calories in each item with the number of miles one would have to walk. The menu presenting calorie numbers along with miles of walking appeared to have the most effect, leading those who selected their meal from that menu presentation to choose 20% fewer calories.
Exercise Trumps Heredity
Studying identical twins is very important because they help scientists separate what has a genetic cause and what is caused by a person's environment or their lifestyle. Since their genes are the same, generally speaking health differences between the two individuals in a set of identical twins can be traced to lifestyle or environmental factors.
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Does your doctor talk to you about diet and exercise? It doesn't appear that all that many do. In a study performed at the University of Michigan, researchers surveyed both attending physicians and trainees about their patient counseling habits as well as their own personal dietary and exercise habits (Prev Cardiol 2010;13(4):180-185).
The physicians contacted to respond to the survey were affiliated with the University of Michigan and were those who could be (broadly) considered "primary care" physicians: internists, family practitioners, endocrinologists and cardiologists. Between March and April of 2009, nearly 200 of these physicians responded to an emailed survey, indicating whether they were residents or fellows (these were considered "trainees" although all had graduated from medical school and were in advanced training) or "attendings" (fully trained physicians), their field of specialty and whether they were in hospital-based practice or private practice.
The doctors were also asked to provide information on their sex, age, height and weight (and therefore Body Mass Index), their waist circumference, and lifestyle behaviors such as how much they exercised, whether (and how often) they ate fast food, and how many servings of fruits and vegetables they ate per day.
A second portion of the survey asked the responding doctors about how they talked to their patients about diet and exercise habits. What percentage of their patients did they discuss diet and exercise with? Did they feel confident in their ability to talk with patients knowledgeably about diet and lifestyle? Did they feel that they had received adequate training in this regard?
The researchers compared the responses of the physicians regarded as trainees to those responses from the attending physicians. Interestingly, about 26% of the responding doctor-trainees were overweight or obese, as were about 35% of the attending physicians, who were generally a decade or so older.
Further, both attendings and trainees ate few servings of fruits and vegetables per day (about two of each), and less than 10% of trainees exercised 4 or more days per week (compared to about 40% of attendings). Less than 10% of trainees and 26% of attendings exercised the recommended 150 or more minutes per week. Trainees said that their work schedule was the biggest barrier to more exercise, while the attendings cited "family commitments."
When it came to talking to their patients, those doctors who had been in practice longer (the attendings) were more likely to do so: over 70% of them said that they talked to over two-thirds of their patients about diet and exercise. Only a little more than 1/3 of the trainees, on the other hand, talked to that many of their patients. How much time did they spend on that counseling, however? Less than 5 minutes per visit.
Nor did the physicians feel very confident in their ability to help their patients make positive changes in their lifestyle. Indeed, less than 14% of the trainees felt that they had received adequate training in how to talk to their patients about diet or exercise, while the same was true for less than 24% of attending physicians.
The good news (sort of) is that doctors are human, too: they also struggle with balancing work and family with eating healthy and getting enough exercise. The bad news is that they lack the background information and training they feel they need in order to best help you, the patients (that's one of the reasons I started DrGourmet.com, in fact - to be a resource to other physicians). The truly good news is that I do know from my work doing nutrition lectures to the medical students at Tulane University School of Medicine and in talking with other teaching physicians that many medical schools recognize the need to provide that training to our students - so that both our future doctors and our future patients are healthier.
First posted: October 20, 2014