Does your doctor ever talk to you about nutrition or exercise? No? You're not alone. Polling shows that fewer than one-eighth of visits to physicians include any nutrition counseling and fewer than 25 percent of physicians believe they have sufficient training to talk to patients about diet or physical activity. And the number of hours devoted to teaching future physicians about nutrition in medical school has actually declined recently, from 22.3 in 2004 to 19.6 in 2009. (The National Academy of Sciences says it should be 25 to 30 hours.)
Meanwhile, a good number of physicians are overweight and don't exercise regularly themselves. And nearly 15 percent of Americans face food insecurity; it's difficult to worry about adequate nutrition when your primary concern is making sure your children don't go hungry.
This worrisome glimpse of one of the obstacles to addressing the U.S. obesity epidemic is contained in a comprehensive report scheduled for release Tuesday by a group of organizations that are calling for major changes in medical education and other aspects of the health care system to combat the chronic diseases that stem from our unhealthful lifestyle.
"We need to look at the nutrition of children in that first 1,000 days, from conception to the second birthday," said Ann Veneman, former Secretary of Agriculture and co-chair of the Nutrition and Physical Activity Initiative of the Bipartisan Policy Center, a think tank founded by four former U.S. senators that produced the report.
Along with the American College of Sports Medicine and the Alliance for a Healthier Generation, the group issued nine recommendations for reform and held a briefing on them Monday.
The most far-reaching include developing a "standard nutrition and physical activity curriculum" for the nation's 170 accredited medical schools and other health professional schools, encouraging more testing on nutrition and physical activity when health professionals take licensing and certification exams, and providing better insurance reimbursement for preventive care such as nutrition and exercise advice. The latter must be done as part of a long-term shift toward more emphasis on prevention and less on cure, the group said.
"As long as the health care marketplace undervalues preventive care, health care professionals will lack financial support to address these issues with their patients and medical schools will have less incentive to train their students accordingly," the report notes.
Donna Shalala, who headed the Department Health and Human Services under President Bill Clinton and is the co-chair of the Nutrition and Physical Activity Initiative, noted the glacial pace of change in medical school curricula, and higher ed curricula in general. (Shalala is president of the University of Miami.)
"As we're discussing cost containment in health care, this 1/8 shift toward prevention3/8 is a critical piece of cost containment," she said.
The report notes that, at least in piecemeal fashion, some of this is already occurring. The University of Colorado's medical school has added nutrition education to instruction during all four years, and offers nutrition electives for internal medicine and pediatric residents. Faculty and students at the University of South Carolina School of Medicine in Greenville have organized nutrition and fitness activities that include running, cycling and yoga groups.
And the trend toward private employers' taking an active role in employee wellness continues to spread. "Prevention is becoing a core part of their health strategy," said Dan Glickman, a former Secretary of Agriculture and another co-chair of the Nutrition and Physical Activity Initiative. "This is not new stuff. Companies are finding that people who are healthy work more and are more productive."