As a preventive cardiologist, member of the AMA Stephen Devries, MDhas witnessed the suffering of his patients with advanced heart disease and how it has changed their lives, often requiring expensive medications and serial procedures.
Indeed, in the United States, medicine has generally focused on treating acute problems while paying less attention to the underlying problems causing those problems. It became clear to Dr. Devries that doctors should learn as much about preventing these conditions as they know how to treat their serious manifestation. And it starts with nutrition.
“Patients often ask their doctors about nutrition but unfortunately, most doctors have not received the training they need to respond meaningfully,” said Dr. Devries, executive director of the nonprofit educational organization. Gaples Institute in Chicago and adjunct associate professor of nutrition at the Harvard TH Chan School of Public Health.
“Doctors generally do not receive sufficient training to meaningfully answer patients’ nutrition questions – an uncomfortable situation for everyone involved. »
In an interview with the AMA, Dr. Devries discussed the importance of nutrition, how to keep up with changing information, his invitation to the White House Nutrition Conference, and how THE Gaples Institute Podcasts And course can help.
AMA: How to follow nutrition and diet trends?
Dr Devries: I stay in touch with the growing body of research in nutritional science by reviewing hundreds of new nutrition studies each year. This is an important part of the work we do to prepare the annual update of the Gaples Institute Nutritional Science Course. The Gaples Institute is strongly committed to ensuring that medical students, residents and practicing clinicians who complete our course receive the latest and best evidence available. This is a key reason why six major medical schools now require this course in their curriculum and why 97% of the more than 4,000 clinicians who have taken the course say it will change their practice.
I am also on the faculty at the Harvard TH Chan School of Public Health, where I will be teaching a new course titled “Integrating Nutrition into Clinical Medicine: The Role of Health Professionals as Change Agents” . I am fortunate to have the opportunity to work with exceptional people in the Department of Nutrition at the Harvard School of Public Health, as they have a large group of researchers who have long been at the forefront of the discovery of nutrition.
AMA: How do you find that balance between what works for one person and what works for another?
Dr Devries: There are fundamental principles of nutrition science: avoid excess sugar, salt and saturated fats and increase the consumption of vegetables and fruits. But how these principles are applied should be individualized based on each patient’s cultural preferences and personal health goals.
Healthcare professionals can help emphasize the importance of nutrition to patients, but there needs to be a true two-way conversation. This is the basis of motivational interviewing. Motivational interviewing is heavily emphasized in the Gaples Institute course, which includes realistic role-play clinical scenarios that demonstrate how motivational interviewing can be put into practice to develop common dietary goals.
AMA: You recently participated in the White House Conference on Hunger, Nutrition and Health, and at the meeting the Food and Drug Administration (FDA) released a proposal for a new definition of “healthy” eating. . What does that mean?
Dr Devries: The FDA has released a new proposal to modify the current criteria for a food label. The previous definition was too easy for food manufacturers to play and badly needed to be redefined. The proposal calls for a “healthy” label to require significant amounts of nutrient-dense ingredients and limit salt, added sugar and saturated fat.
The problem the FDA seeks to solve is that currently food manufacturers can create heavily processed “Frankenfoods” and label them as “healthy” simply because extra vitamins have been added. This new proposal strengthens the sense of what is healthy to make it more consistent with science and less subject to industrial manipulation.
AMA: How did the White House event highlight the need for doctors to better understand nutrition?
Dr Devries: I felt honored, in recognition of the work of the Gaples Institute, to be invited to attend the White House Conference on Nutrition. The event, including President Biden’s keynote address, affirmed a high-level recognition of the growing problems arising from nutritional insecurity and diet-related diseases. Much of the problem of food and nutrition insecurity is linked to unequal distribution: we have plenty of food, but much of it is wasted and the most nutritious foods are not equitably accessible.
The Conference made it clear that government alone cannot do the job and that a response from all of society, including community and non-profit organizations, is necessary. The White House agenda also highlighted the need to strengthen nutritional education for doctors and other health professionals. What has been clearly recognized is that patients trust their doctors and look to them for advice on all important health matters. But without proper nutrition training, how can doctors gain the knowledge they need to begin guiding their patients?
A good example of how additional training of doctors in nutrition could have a considerable impact is the screening of food insecurity. More than 1 in 10 households in the United States are food insecure, and it’s not always obvious who needs it. A simple solution to identify patients at risk is a screening tool which consists of two brief questions and requires approximately 30 seconds of the doctor’s time. But most doctors have not received the nutritional education they need and are unaware of this rapid screening tool.
Another example of the need to improve physician nutrition education relates to the current lack of referrals to Medicare-funded programs. Diabetes Prevention Program. This program of modest changes in diet and exercise has been proven to prevent the development of type 2 diabetes almost twice as effectively as medication. But enrollment remains low, largely due to doctors’ lack of awareness and knowledge of the benefits. This is a huge missed opportunity.
This is the basis of our work at the nonprofit Gaples Institute: providing clinically relevant and highly actionable nutrition education. We are proud that the AMA Education Center™ has been offering the Gaples Institute nonprofit nutrition course since 2017.
And we are definitely making progress. The feedback has been overwhelmingly positive and very gratifying from the six leading medical schools who now require our course. Our nutrition course isn’t just for medical schools: our nonprofit organization’s Nutrition CME is just as widely adopted by forward-thinking medical practice groups. Some medical practices even require newly hired doctors to complete the Gaples Institute course as part of their onboarding process.
AMA: How did you become interested in sharing more nutrition information for physicians with the Gaples Institute?
Dr Devries: During my 25 years of practice as a preventive cardiologist, it has become increasingly clear that nowhere is the gap between science and medical practice greater than in nutrition. One of the major barriers preventing physicians from realizing the full potential of dietary interventions is the lack of nutrition education in medical training.
The Gaples Institute nutrition course was developed to fill this gap in medical education. The course focuses on clinically relevant topics, has no set dietary agenda, and only takes learners two to four hours to complete, depending on how many of the 130 clickable references to key literature are explored.
Ninety-seven percent of learners say the course will change their practice, but the feedback we are equally proud of is that clinicians consistently find the course enjoyable, a key element if we are to have the desired impact. The high level of engagement is made possible by building the course on a sophisticated platform that maximizes interactivity far beyond what is possible with the more typical slideshow or video format.
There is another important point to make regarding the importance of nutrition education: Doctors who receive more training in nutrition are more likely to refer their patients to nutrition and dietetics specialists. Dietetics and nutrition specialists are essential in caring for patients with more complex dietary needs and assisting with detailed meal planning. And we know that these highly trained dietetics and nutrition specialists are woefully underutilized in practice.
I led a study which showed that physicians who participated in a nutrition-focused continuing medical education program were nearly twice as likely to refer to dietetics and nutrition specialists as those who did not participate. It makes sense that physicians who are better trained in nutrition are more likely to recognize opportunities for effective referrals to dietetics and nutrition professionals.
AMA: Are there other benefits of nutrition education for physicians?
When doctors begin to focus more on nutrition, even just including a brief nutrition topic at each visit, they tell me it strengthens the relationship with their patients and brings them closer to the reason they came. oriented towards medicine.
And as we point out in the Gaples Institute Nutrition Coursethere is ample evidence that when doctors adopt healthier lifestylesthey not only improve their own care, but are also more likely to advise their patients to do the same.
