As our nation works to rein in rising rates of chronic disease and their associated health care costs, nutrition and physical activity are making strides in the medical world as viable—indeed, important—avenues toward better health and disease prevention. While health care providers can be an important source of information and motivation for patients making behavior changes, currently providers are not always equipped with the training or incentives to provide effective nutrition and physical activity counseling to patients.
In our June 2012 report Lots to Lose: How America’s Health and Obesity Crisis Threatens Our Economic Future, BPC recommended that nutrition and physical activity training be incorporated into all phases of medical education, including medical schools, residency programs, credentialing processes, and continuing education requirements. Over the last few months, we have taken our case on the road, challenging the health care community to rethink the role of nutrition and physical activity in medical education. We offer some highlights from our outreach on this topic. Our work on this issue is building toward a public forum in D.C. on the issue on October 17, 2013. More information on that will be forthcoming.
In November 2012, BPC’s Director of the Nutrition and Physical Activity Initiative Lisel Loy and Advisor Dr. Matt Levy presented the case for improved physician training to a group of residents, medical students, doctors, and faculty at Georgetown University Medical Center’s Grand Rounds, using the initiative’s Lots to Lose report as a backdrop. After the presentation, one pediatrician lamented the lack of nutrition training in medical school, residency or continuing medical education (CME), confiding that she had been seeking out weekend courses on nutrition to improve her base of knowledge to support better care for her patients. Judging by the presence of the Dean and positive feedback from participants, there is strong interest in this issue at the student level that leadership, at least at this institution, was aware of.
In June, 2013, Dr. Levy participated in the New York Academy of Sciences’ conference, “Capacity Building in Nutrition Science: Revisiting the Curricula for Medical Professionals.” His presentation urged health care professionals to “be the change you wish to see in health” and argued that changing the paradigm of nutrition and physical activity education in health professional training can drive the system of care toward better health. A physician at the presentation reflected on his profession’s failure to model good behavior: “If we’re going to talk about nutrition with patients, we need to start with our own behaviors in the hospital. Stop serving the danishes and sugar-sweetened beverages at lectures!”
This kind of engagement with the medical community is one piece of our broader strategy for improving the quantity and quality of nutrition and physical activity training in medical school. In speaking with stakeholders such as medical students and practicing physicians, our goal is to highlight explicitly the link between our obesity and chronic disease crisis and the role of health care providers in addressing it effectively. Doing so requires an understanding of the economic implications of disease rates, treatment, prevention, and reimbursement for providers. In addition, it is important to identify solutions and motivate providers to engage proactively in ways to improve behavioral and environmental determinants of health, including the way nutrition and physical activity are being taught in medical schools. Doctors can be essential advocates for improved training in nutrition and physical activity, as well as the broader goals of enhancing prevention laid out in Lots to Lose. Engaging doctors directly serves patients but also supports more systemic change within institutions such as medical schools and hospitals, where doctors are key stakeholders. BPC will continue to work with additional schools in D.C. and across the region to advance these goals.
On October 17th, BPC will convene physicians, medical educators, licensing and credentialing bodies, insurers, and health professional associations to explore this issue in more depth during a day-long forum in Washington., Co-sponsored by the Alliance for a Healthier Generation and the American College of Sports Medicine, the forum will highlight several of the innovative approaches taken by medical schools around the country. We will also identify barriers to change and promising opportunities for accelerating change so that other medical schools can consider implementing similar models. While we are starting our public inquiry with medical schools, we recognize that similar changes should be pursued across the full range of health professions and at multiple levels of training. Physicians are of course essential, but other health care providers and community institutions can reinforce physician education, whether counseling from registered dieticians or diabetes education classes at a community recreation center. As we recommended in Lots to Lose, a significant shift toward more preventive care will also require that we train and deploy a prevention workforce to deliver community-based, prevention-oriented care.
Though nutrition and physical activity have not traditionally been considered an essential part of medical training curricula, it is becoming increasingly necessary that physicians are trained in these topics. At BPC, we seek to partner with outside organizations to promote strategies that support health professionals in shifting care toward more prevention, communicating evidence-based information to patients, and better connecting patients to health care services and community resources that facilitate healthy living. Though not sufficient, improved nutrition and physical activity training for health care providers is an important step toward reducing chronic disease and obesity.