Commentary: Nutrition Counseling—Should Physicians Guide Their Patients?

Bruer, Ruth A.; Schmidt, R. E.; Davis, H C

doi:10.1016/s0749-3797(18)30583-x

Cited by 16 publications

(6 citation statements)

References 5 publications

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“…These findings agree with Kushner and colleagues, who found that primary care physicians often note a lack of knowledge, in addition to a lack of time and physician confidence, as main barriers to diet counseling [2]. This is also in keeping with a U.S. Public Health Service study noting that physicians are "woefully undertrained in nutrition" [3]. Additional training may well be an important component, as cardiologists in our sample had a much better understanding of the effects of dietary changes on triglycerides and HDL than their general internist counterparts.…”

Section: Discussionsupporting

confidence: 88%

“…Given the level of importance assigned to lifestyle changes in the TLC diet from the ATP3 report, it may prove more useful to develop counseling services from allied health care providers [3]. This is the standard of care for patients with diabetes, as the American Diabetes Association recommends yearly counseling with a nutritionist for all patients with diabetes [5].…”

Section: Discussionmentioning

confidence: 99%

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Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.

Flynn

Sciamanna

Vigilante

2003

Nutr J

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BackgroundTo assess the nutrition knowledge of physicians on the basic effects of diet on blood lipids and lipoproteins.MethodsAnonymous mailed dietary knowledge surveys to 6000 randomly selected physicians in the United States licensed in either Internal Medicine or Cardiology.ResultsResponse rate: 16% (n = 639). Half of the physicians did not know that canola oil and 26% did not know olive oil were good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists; p < 0.001) did not know that a low-fat diet, in general, would increase blood triglycerides. Approximately three-quarters (70% of cardiologists vs. 77% of internists; p < 0.01) did not know a low-fat diet would decrease HDL-c and almost half (45%) thought that a low-fat diet would not change HDL-c.ConclusionsIf physicians are to implement dietary and cholesterol management guidelines, they will likely need to become more knowledgeable about nutrition.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.

Flynn

Sciamanna

Vigilante

2003

Nutr J

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“…This result should be seen in the context of what might be described as a quandary for most family practitioners – surveys generally show a strong feeling among physicians of the importance of nutritional counseling but a limited ability to provide such counseling [ 23 - 25 ] due to a lack of training, limitations of time or adequate reimbursement as well as low confidence in their own ability to advise or patients' ability to comply. In addition, there is a palpable negative response of the media and a documented bias in the nutritional community to low carbohydrate diets [ 19 - 21 ].…”

Section: Resultsmentioning

confidence: 99%

Low carbohydrate diets in family practice: what can we learn from an internet-based support group

Feinman

Vernon

Westman

2006

Nutr J

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The Active Low-Carber Forums (ALCF) is an on-line support group started in 2000 which currently has more than 86,000 members. Data collected from posts to the forum and from an online survey were used to determine the behavior and attitudes of people on low carbohydrate diets. Members were asked to complete a voluntary 27-item questionnaire over the internet. Our major findings are as follows: survey respondents, like the membership at large, were mostly women and mostly significantly overweight, a significant number intending to and, in many cases, succeeding at losing more than 100 lbs. The great majority of members of ALCF identify themselves as following the Atkins diet or some variation of it. Although individual posts on the forum and in the narrative part of our survey are critical of professional help, we found that more than half of respondents saw a physician before or during dieting and, of those who did, about half received support from the physician. Another 28 % found the physician initially neutral but supportive after positive results were produced. Using the same criteria as the National Weight Registry (without follow-up) -30 lbs or more lost and maintained for more than one year -it was found that more than 1400 people had successfully used low carb methods. In terms of food consumed, the perception of more than half of respondents were that they ate less than before the diet and whereas high protein, high fat sources replaced carbohydrate to some extent, the major change indicated by survey-takers is a large increase in green vegetables and a large decrease in fruit intake. Government or health agencies were not sources of information for dieters in this group and a collection of narrative comments indicates a high level of satisfaction, indeed enthusiasm for low carbohydrate dieting.The results provide both a tabulation of the perceived behavior of a significant number of dieters using low carbohydrate strategies as well as a collection of narratives that provide a human perspective on what it is like to be on such a diet. An important conclusion for the family physician is that it becomes possible to identify a diet that is used by many people where the primary principle is replacement of starch and sugar-containing foods with non-starchy vegetables, with little addition of fat or protein. Used by many people who identify themselves as being on the Atkins diet, such a strategy provides the advantages of carbohydrate-restricted diets but is less iconoclastic than the popular perception and therefore more acceptable to traditional nutritionists. It is reasonable for family practitioners to turn this observation into a recommendation for patients for weight control and other health problems.

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“…1–4 Student groups have attempted to define the goals related to incorporating essential nutrition-related teaching into the curriculum, 5 and a major funding initiative by the National Heart, Lung, and Blood Institute created the Nutrition Academic Award. 6,7 …”

mentioning

confidence: 99%

Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey

Adams¹,

Kohlmeier²,

Zeisel³

2010

Academic Medicine

269

233

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Purpose To quantify the number of required hours of nutrition education at U.S. medical schools and the types of courses in which the instruction was offered, and to compare these results with results from previous surveys. Method The authors distributed to all 127 accredited U.S. medical schools (that were matriculating students at the time of this study) a two-page online survey devised by the Nutrition in Medicine Project at the University of North Carolina at Chapel Hill. From August 2008 through July 2009, the authors asked their contacts, most of whom were nutrition educators, to report the nutrition contact hours that were required for their medical students and whether those actual hours of nutrition education occurred in a designated nutrition course, within another course, or during clinical rotations. Results Respondents from 109 (86%) of the targeted medical schools completed some part of the survey. Most schools (103/109) required some form of nutrition education. Of the 105 schools answering questions about courses and contact hours, only 26 (25%) required a dedicated nutrition course; in 2004, 32 (30%) of 106 schools did. Overall, medical students received 19.6 contact hours of nutrition instruction during their medical school careers (range: 0–70 hours); the average in 2004 was 22.3 hours. Only 28 (27%) of the 105 schools met the minimum 25 required hours set by the National Academy of Sciences; in 2004, 40 (38%) of 104 schools did so. Conclusions The amount of nutrition education that medical students receive continues to be inadequate.

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Commentary: Nutrition Counseling—Should Physicians Guide Their Patients?

Cited by 16 publications

References 5 publications

Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.

Inadequate physician knowledge of the effects of diet on blood lipids and lipoproteins.

Low carbohydrate diets in family practice: what can we learn from an internet-based support group

Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey

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