If Food is Medicine, Why is Nutrition Largely Missing From Medical Practice?

The idea that nutrition is the foundation of health is a given. So why does medical care so rarely focus on food?

Let’s look at three obstacles and three solutions:

Obstacle #1: Education Gap

The unfortunate truth is that doctors learn very little about nutrition. In medical school, students receive an average of only 19 hours of nutrition education total over 4 years (often focused on biochemistry and rare disease states) and 0 hours in most physician training after medical school. Furthermore, physicians in practice typically receive no nutrition CME.

Obstacle #2: Time Pressure

Doctors are already pressured for time. Clinic visits are getting shorter. How much time can realistically be devoted to nutrition with acute problems to deal with in a clinic visit of only 15 minutes? In addition, many physicians believe that nutrition counseling is not in their job description.

Obstacle #3: Lack of Financial Incentives

Insurance providers offer very little (if any) reimbursement for physicians to deliver nutrition counseling.

Good Solutions:

Solution #1: More Nutrition Education

Add practical nutrition and counseling education to all phases of medical training, including specialization. Clinical nutrition should also be a part of all board exams to further encourage learning in this area. The Gaples Institute is on the leading edge of this initiative, providing a rapid and interactive online nutrition course for clinicians.

Solution #2: Align Incentives to Value

The wind is already shifting in this area but the fact remains that writing a prescription still takes less time than nutrition counseling. Insurance payers need to realize the importance of effective nutritional counseling and to provide fair reimbursement for it. Imagine how many fewer prescriptions and procedures would be needed if what we applied what we already know about nutrition.

Solution #3: Leverage Time

Sadly, the 15- or 20-minute return clinic visit isn’t going away anytime soon. Nevertheless, even a brief and informed mention of the value of nutrition, discussed in as few as 2 or 3 minutes, is certainly better than the status quo that approaches zero attention to nutrition. It’s enough for physicians to convey to patients that nutrition is a high-priority item for wellness (equal to that of other medical interventions) even if they don’t have the time to delve deeply. That’s the beauty of a team including dietitians, nutritionists, nurses, and many others.