Physicians have been unsuccessful in treating the obesity crisis, here's why

Physicians have been unsuccessful in treating the obesity crisis, here's why
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It’s a shocking statistic and one that climbs every year: Nearly 40 percent of American adults are obese. While childhood obesity rates in the U.S. have leveled off at about twenty percent, children are becoming overweight and obese at earlier ages, and are at increased risk of developing not only obesity, but its associated medical complications of diabetes, stroke, cancer, and premature death, into adulthood. We all know it’s a crisis. The thing is, it’s a preventable one.

new study published in The Lancet that examined weight and height data on almost 130 million people found that 5.6 percent of girls and 7.8 percent of boys worldwide were obese in 2016, up from less than 1 percent in 1975. Most alarmingly, the data offer no indication of reversal in this trend of mass weight gain.

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Despite the ever-growing impetus to face how unhealthy lifestyle choices are contributing to the weight epidemic, a crucial perspective is often overlooked regarding the structural factors that have led to the current state of affairs: whether physicians are equipped to serve a preventative, rather than reactive role in the obesity crisis.

 

Physician’s discussion of weight-related concerns with patients is correlated with significant, and sustained patient weight loss. A randomized trial published in the New England Journal of Medicine that included 415 obese study participants found that weight-loss support, with reinforcement by physicians at routinely scheduled visits, led to significant, sustained weight loss, compared to a self-directed program. 

And yet, despite the recommendations and known health benefits of weight-loss counseling, physicians fare poorly when it comes to discussion about weight. Only thirty-four to sixty-five percent of adults report they receive guidance from their physicians on how to manage their weight. The numbers are even worse for ethnic minorities and individuals in low-income households.

Why have physicians been so unsuccessful at helping people avoid becoming part of this epidemic?

Medical students have historically received minimal instruction on nutrition, and physicians feel ill-equipped to discuss this topic. Over thirty years have passed since the National Academy of Sciences recommended physicians receive at least twenty-five hours of dedicated nutrition course work. And yet more than seventy percent of U.S. medical schools fail to teach those hours; more than a third of them provide less than half that amount. Exercise education is even less formalized — over half of medical schools do not offer any coursework related to physical activity, and the few available courses are rarely required.

Several national organizations have acknowledged the need for increased physician education in these topics, and rolled out proposals to standardize medical school curricula around nutrition and physical activity. While several dietary interventions have been studied for treating obesity, one in particular has been gaining traction: the whole-food, plant-based diet. Without requiring calorie restriction, this food plan champions the consumption of whole plants high in micronutrients and low in processed chemicals.

The promise of whole-food, plant-centric diets as sustainable weight loss solutions has led to a revolution in how physicians treat obesity. An emerging cadre of academic institutions, hospital systems, and physicians in private practice have embraced the power and value of prescribing food, rather than pharmaceuticals, as medicine and have developed teaching kitchens.

Instead of simply telling patients to eat healthy foods, physicians and health care professionals are now utilizing teaching kitchens to demonstrate how to choose, prepare, cook, and enjoy healthy meals, primarily using whole, plant-based foods.

At the Johns Hopkins University School of Medicine, two medical students founded something that may feel like a throwback to home economics, but is actually a visionary step in educating doctors in how to educate patients about their eating habits.

They’ve established a teaching kitchen inside the university hospital. In this classroom, the teachers are a chef and a nutritionist, and motivated medical students are the audience. These medical students are acquiring skills in the kitchen early in their career and creatively enriching their education, and ability to treat patients, in possibly the most fundamental way. 

While these students may be one of the first to bring the concept of a teaching kitchen into a lab-focused medical school, theirs is not the only home-cooking approach to medical intervention.

Seven years ago, Dr. Susan Blum, a functional medicine pioneer, developed a teaching kitchen in her medical practice in Rye Brook, New York. Once weekly, she holds cooking demonstrations for patients designed to build the foundation for reversing chronic diseases such as obesity and autoimmune conditions fueled by the standard American diet.

While most doctors agree it is important to counsel patients on healthy dietary habits, Dr. Blum believes enabling patients to overcome poor eating habits and embrace a healthy lifestyle requires more than repetitive verbal admonishments. “For long-term success, I know what my patients really need is to learn how to cook and eat,” says Dr. Blum with a conviction that has now weathered the trials of running a teaching kitchen in clinical practice.

Until recently, physicians lack of nutritional knowledge, coupled with patients unsuccessful struggle to lose weight via unsustainable diets, has made it difficult to incorporate whole-food, plant-based diets in practice. Teaching kitchens overcome those barriers and allow patients to acquire the long-term skills they need to cook and eat whole, organic foods rather than the processed, “food-like” items that have contributed to obesity, insulin resistance, and widespread chronic diseases for decades.

Healthier cooking and eating habits do not happen overnight. Neither does a cultural shift toward an emphasis on food, rather than chemicals and pharmaceutical products, as medicine. Without empowering individuals with enduring skills in food selection and preparation, many weight-loss diets do not confer consumers with a sustainable habit of healthy eating that can be incorporated on a long-term basis.

Hands-on education in teaching kitchens will help people confidently create a new way of eating (or rediscover a forgotten tradition) and jumpstart a momentum of healthy dietary habits. Let’s press for better educated physicians who can aid a massive population shift, patient by patient, with simple, inexpensive, and essential practices for all.

Mirjana Domakonda, MD, is a child psychiatrist at Columbia University and a Public Voices Fellow with The OpEd Project. Follow her on Twitter: @anakondamd. George C. Wang, MD, PhD, is an integrative medicine physician, an adjunct assistant professor of medicine at the Johns Hopkins University School of Medicine, and a Public Voices Fellow with The OpEd Project. Follow him on Twitter: @GeorgeWangMD