Nutrition must be essential in medical education

WE are now facing a double burden of malnutrition. Almost 2 billion people are overweight or obese and yet approximately 800 million people wake up hungry every day. One hundred and fifty million children are stunted, while almost 42 million children, and rising, are overweight or obese.

Nutrition has been increasingly recognised as a priority area in reducing the global burden of disease. Twelve of the 17 Sustainable Development Goals require good nutrition to be met and the United Nations has declared 2016–2025 as the Decade of Nutrition.

Non-communicable diseases are now the leading cause of death worldwide and numbers are increasing.

Nutrition has been identified as one of the most modifiable determinants to reduce the burden of disease attributable to non-communicable diseases and in Australia, the Global Burden of Disease study has identified “dietary risks” as the leading risk factor for death and disability.

Given the extent of poor health outcomes related to dietary factors, we need to ensure that doctors at the front line have the fundamental nutrition skills to undertake dietary assessments and provide appropriate and targeted advice to their patients. The development and integration of nutrition competencies into medical curricula will ensure that medical graduates can become nutritionally competent medical practitioners. This in turn has the potential to improve the health of Australians and reduce the escalating burden of chronic disease.

Current nutrition teaching in medical curricula varies widely across Australian universities. The accreditation standards for medical courses in Australia state that medical practitioners need to have appropriate knowledge and skills in identifying nutritional issues for patients to prevent and treat common chronic disease. However, a 2010 review of key staff from 19 Australian medical courses, published in the MJA, found no consistent integration of nutrition knowledge and skills in medical school curriculum and assessment of this content varied widely between universities.

Historically, nutrition teaching in medical education has consisted of fundamental biochemical and metabolic information. In order to take nutrition education beyond vitamins and minerals, there is a need for teaching and training in clinical nutrition that is practically based and covers preventive as well as therapeutic aspects of nutritional care. Medical graduates need to be competent to conduct nutrition counselling for patients and be able to determine a patient’s readiness for change.

Furthermore, skills in epidemiology and biostatistics are central to understanding the complexities of the food system and the significant influence of the greater food environment on a person’s eating patterns and behaviour.

While multidisciplinary teams are often emphasised in medical teaching, understanding the role of allied health practitioners could be improved. Dietitians, along with other skilled allied health professionals, are important partners for doctors to learn from and work with. To best assist patients to make realistic and practical diet and lifestyle changes, doctors need to work with the wider multidisciplinary team.

The importance of incorporating nutrition into the medical curriculum has been widely recognised internationally (here, here, and here), but in Australia it has been challenging to integrate and implement a comprehensive nutrition curriculum due to the size of the subject matter which needs to be covered to meet the Australian Medical Council graduate outcomes. However, incorporating nutrition into medical education is important for two key reasons.

First, many patients are aware of the link between diet and health and look to doctors for guidance on nutrition. The public considers doctors to be one of the most trusted health professionals in the community. An Australian study of patients living with a lifestyle-related chronic disease found that doctors were the preferred providers of nutrition care, rather than dietitians and nutritionists, as they were perceived to provide the most trustworthy and personalised nutrition care. This is despite the fact that many GPs do not feel confident or adequately prepared to provide nutrition counselling. The most common cause for insufficient nutritional practice is lack of nutritional knowledge.

Second, we need doctors to act as role models. Doctors have and continue to be important role models in public health initiatives. For example, doctors have played a pivotal role in supporting antismoking campaigns and have been leaders behind movements to reduce road trauma and skin cancer. The growing burden of chronic diseases means we need doctors to be advocates for change.

In today’s obesity-promoting environment, we need doctors who support bans on the marketing of energy-dense, nutrient-poor foods and drinks to children; encourage taxation measures that promote consumption of healthy foods and drinks; and back initiatives which aim to assist the community in making healthy choices easy. Doctors must take the lead in encouraging patients to follow healthier eating habits and promoting better food environments.

Doctors are not being asked to replace dietitians and nutritionists who they may refer to, but to position themselves with the knowledge and skills to facilitate healthier food choices and eating patterns among their patients and community. Fostering medical graduates who are well equipped to identify and appropriately manage nutritional issues in patients and the community is an ideal starting point.

Alyce Wilson is a medical doctor with a background in nutrition and dietetics. She is pursuing a career as a public health physician and has a strong interest in the prevention of non-communicable diseases in disadvantaged populations.

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