Doctors are ill-equipped to reduce the burden of chronic disease

July 24, 2017

How would you respond if, when consulting your doctor for a sore throat, that they told you that you were overweight? Would you appreciate your doctor raising this issue with you, or would you be insulted? Professor Caryl Nowson, Chair in Nutrition and Ageing, Institute of Physical Activity and Nutrition at the School of Exercise and Nutrition Sciences, will be providing a commentary on this topic.

Many doctors would not be comfortable raising the issue of being overweight, even if they could do it in a sensitive manner, as they do not have the skills to help their patients address the problem. This gap has been recognised by a group in the UK: Royal College of General Practitioners (RCGP) Nutrition Group,who have developed a range of resources, and educational programs to help support doctors. However, there is little recognition of this knowledge and skill gap in medical training in Australia.

In 2014-15, half of those attending their doctor were either overweight, smoked or consumed excessive alcohol, and almost a quarter had two of these risk factors. Additionally, of the adults consulting their doctors, 34% were overweight and 27% were obese, but less than 1% received any lifestyle counselling. Yet we know that most deaths in the developed world are preventable and related to poor nutrition.

Our poor diets and inactive lifestyles are leading us to an early death

In the US, poor diet exceeds smoking as the number one cause of death and disability in the population.  Poor nutritional care contributes to longer hospitalisation periods and leads to increased health care costs.  Both overnutrition (such as excess energy intake, excess salt, excess saturated fat) and undernutrition (such as inadequate energy, protein, vitamins and minerals) are recognised problems for a large number of Australians. The older we get, the more likely we are to suffer the consequences of a poor diet, such as heart disease, and experience difficulties in getting around and leading active lives.

Medical practitioners are unable to support positive lifestyle changes in their patients

A survey of 135 medical graduates published in June of this year in the Medical Journal of Australia  showed that many graduates felt that they were not well prepared to provide basic nutritional care to patients.  The most common cause for poor nutritional practice is lack of nutritional knowledge. Research suggests that doctors generally do not feel confident enough to talk to patients about their weights (both under and overweight and obesity problems). One of the key reasons is that doctors are not trained to identify and raise nutritional issues with their patients.

In a survey we had conducted of 18 medical schools in Australia, there was no integration of nutrition knowledge and skills across medical courses, and the assessment of nutrition knowledge and skills varied widely. For example, only 44%of medical courses included practical skills, such as gathering dietary information.

So what action is needed?

• Nutrition competencies in the Standards for Assessment and Accreditation of Primary Medical Programs by the Australian Medical Council should be included to ensure that all medical courses deliver appropriate learning opportunities in nutrition for their students
• The profile of lifestyle approaches to prevent and treat disease with academics delivering the teaching and designing the curriculum in medical courses should be raised
• Academic staff need to be upskilled in nutrition and other lifestyle approaches, and those teaching medical courses in nutrition through the sharing of resources such as the Web based Nutrition Implementation Toolkit need to be supported to embed nutrition into the medical curriculum
• The leaders, medical specialists and established medical practitioners need to be educated in nutrition and lifestyle approaches and prevention and disease management through the delivery and widespread uptake of continuing education programs.
  • If there is no re-enforcement and continued learning related to lifestyle approaches to prevention and treatment of disease, then skills and interest of medical graduates is unlikely to be sustained.
  • In a recent survey of doctors interested in nutrition, we found that 49% doctors were not confident in providing nutrition care to infant and toddlers, 58% were not confident for risk of cancer and 20% were not confident for overweight adults and 89% were interested in undertaking additional education in the area.

If more doctors developed skills in supporting their patients to make positive lifestyle changes, then this would have a major impact on reducing chronic disease. In any one year at least 85% of the population see a doctor.

Doctors are usually the first point of call for any health problems. Patients listen and trust doctors, so there is huge potential to improve lifestyles of the population, and ultimately, reduce the burden of chronic disease.

Professor Caryl Nowson

Chair in Nutrition and Ageing, Institute of Physical Activity and Nutrition, Deakin University