Experts urge to improve nutrition education in medical schools for better healthcare

07 Jun 2024 — US researchers warn that current nutrition training in medical education is “inadequate.” They recommend actionable approaches to improve education to minimize harm and pursue “evidence-based, effective and equitable healthcare.”

Additionally, the researchers’ commentary notes that current medical training focuses on weight and body mass index (BMI), which, they say, exacerbates an anti-obesity bias and increases the risk of eating disorders.

The training also does not give future doctors appropriate education on encouraging healthier eating habits.

“Mainstream medicine is still very focused on linking weight to health,” says Kearney Gunsalus, assistant professor at the Augusta University/University of Georgia Medical Partnership, US, and lead author of the paper.

“Because people with obesity and higher body weights are more likely to have health problems, it’s easy to jump to the conclusion that the weight itself is causing those problems. And if you assume that the weight is causing the problems, it seems logical to assume that weight loss is the solution.”

Refocus nutrition education
The authors of the article published in Medical Science Educator underscore that physicians and educators hold positions of influence, adding “what we say and how we say it matters.”

“Nutrition curricula should include motivational interviewing and communication skills training to best serve future patients in these complex conversations,” reads the paper.

According to the article, medical students do not feel prepared to offer nutrition advice to patients, and most physicians report receiving insufficient training to address patients’ nutritional needs. At the same time, they think that it is their responsibility to discuss nutrition with patients.

The paper’s authors provide several recommendations to improve nutrition curricula and propose alternatives where current education fails.

They recommend that nutrition education be grounded in scientific evidence. For example, instead of categorizing foods or food groups as “good” or “bad,” discussions should focus on macro- and micronutrients found in various foods, their digestion, absorption, metabolism or storage and their roles in health and disease.

Conversations with patients should focus on healthful behaviors, not on “good” or “bad” foods.Moreover, the authors note that medical nutrition education should be mindful of eating disorders and the impact physical language and behavior can have on their development. They caution that anti-obesity messages may contribute to the onset of eating disorders.

Education should also emphasize “the importance of social and structural determinants of health and cultural humility in all contexts, including discussions of diet, weight and health.”

Instead of “shaming” foods that are not fresh or canned, physicians should suggest ways to modify them.

Assessing general health
Although BMI is commonly used to assess patients’ general health by grouping them into underweight, healthy weight, overweight and obese categories, the researchers stress that it is inaccurate. They cite previous research revealing that half of overweight US citizens were metabolically healthy.

Instead, they recommend focusing on objective measures of cardiometabolic health, such as blood pressure, insulin resistance and cholesterol levels. Specifically, they suggest: “Nutrition education should stress the problematic nature of BMI as a marker of individual health and convey that health transcends specific BMI or weight targets.”

“When you look at some of the newest studies on obesity surgeries and the use of medications like Ozempic and Wegovy, it appears that patients can see health benefits even without weight loss,” explains Dr. Ellen House, co-author of the publication and an associate professor at the Medical Partnership.

“We love things that are clear-cut and black and white in medicine. But if the benefits precede and appear independent of weight loss, we need to shift the conversations physicians have with their patients to focus more on health and not weight loss.”

The authors assert that cardiometabolic health indicators are a better indicator of general health than BMI or weight.End the weight stigma
The scientists caution that current medical education often neglects to address weight stigma, which connects obesity with moral failures, laziness and gluttony, without accounting for biological and systemic factors affecting weight.

For example, not all patients may have access to affordable, fresh, healthy food or safe spaces to exercise.

The authors worry that physicians may be less empathetic toward overweight patients due to this “anti-obesity bias” and thus provide lower-quality care. For example, dismissing health concerns with a “just lose weight” attitude demoralizes patients and may make them less likely to share problems or seek medical care in the future.

“Overweight patients are less likely to get the appropriate screenings or treatments for their medical concerns,” cautions House. “Physicians will miss asthma, and they’ll miss cancer because they attribute symptoms to weight when weight isn’t what’s causing the patient’s concerns.”

Instead, the team recommends reframing conversations to focus on healthful behaviors. Gunsalus adds: “I think doctors are trying to help people be healthier by advising them to lose weight, they’re just not aware of the harms that that advice can do.”

“If I could wave a magic wand and have doctors do one thing differently when interacting with their patients, it would be to start from the assumption that every patient wants to be and is capable of being healthy,” he concludes.

By Jolanda van Hal

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