By now, most of us know the statistic by heart: two-thirds of Americans are either overweight or obese. This presents enormous costs for the affected individuals, including increased incidence of diabetes, heart disease and other chronic metabolic diseases; diminished quality of life; and curtailed life spans. But it also affects Americans who are not overweight: healthcare for obesity and its related conditions costs some $210 billion to our society annually.
Although two in three Americans are overweight or obese, only one in eight patients visiting doctors receives counseling on the benefits of a healthy diet. Those numbers simply don’t add up.
Medical providers’ lack of training in exercise and nutrition topics seems to be one major culprit. Fewer than 25 percent of physicians feel that they received adequate training to be able to counsel their patients on making lifestyle changes. In part, that’s because fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise science recommended by the National Academy of Sciences in 1985.
But legislation introduced last week could help change that. The Expanding Nutrition's Role in Curricula and Healthcare (ENRICH) Act, co-sponsored by Reps. Tim Ryan (D-Ohio) and Pat Tiberi (R-Ohio), would provide federal grants to develop or enhance integrated nutrition curricula in U.S. medical schools. Under the program, the U.S. Department of Health and Human Services (HHS) would administer three-year grants of up to $500,000 to accredited medical schools, allowing them to design curricula to improve communication and provider preparedness to prevent, manage, and potentially reverse obesity, cardiovascular disease, diabetes, and cancer. Schools would be encouraged to focus on at-risk populations and educate students on nutritional needs, physical activity training and programs, food insecurity, and malnutrition among those populations. The bill authorizes no new funds but directs the HHS Secretary to use existing funds to carry out the program.
This important bill follows on work performed by the Bipartisan Policy Center (BPC), the American College of Sports Medicine, and the Alliance for a Healthier Generation who came together in 2013 to study the problem and search for remedies. At a conference held in Washington, DC in October of that year, we gathered input from medical school representatives, insurance providers, licensing and certification boards, and community-based organizations, as well as recent and current medical students and practitioners. We came to an important conclusion: medical schools need to adapt their curricula to help address this most prevalent of public health challenges. Our white paper, Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care, offers recommendations for implementing curriculum changes. And while we see these changes as an essential tool in the broader debate about the national obesity epidemic, we also believe they have the potential to convey broad societal benefits.
Among our findings, five stood out. These involve actions on the part of medical schools, examining and certification boards, insurers, and governments.
1. Develop and implement a standard nutrition and physical activity curriculum.
Although some schools are ahead of the curve in this area—the University of North Carolina, for example, offers an online curriculum entitled Nutrition in Medicine—a standard nutrition and physical activity curriculum that can be easily integrated into medical schools’ broader programs is sorely needed. And many students recognize this. At Boston University, students started their own group, called the Student Nutrition Awareness and Action Council (SNAAC), to develop extracurricular training opportunities for themselves and their classmates.
2. Include more nutrition and physical activity content in licensing and certification exams, and in residency and continuing education program requirements.
3. Expand board-accredited advanced training programs to create a cadre of experts in nutrition and physical activity who can teach health professionals.
In our research, many physicians felt they needed better training in order to recommend lifestyle changes to their patients. By expanding board-accredited advanced training programs, we can create a group of experts in nutrition and physical activity who can teach current medical practitioners and future providers.
4. Provide federal and state support for reforms in medical education and healthcare delivery that can help providers better meet patient needs with respect to nutrition, physical activity, and other lifestyle factors.
Federal and state governments have a large stake in the success of these programs. After all, obesity and its associated diseases impact public health, worker productivity, and economic vitality. The ENRICH Act represents significant progress in this effort because it provides financial support for enhanced medical training and treatment methodologies.
5. Provide reimbursement for health services that target lifestyle factors such as nutrition and exercise.
As long as the healthcare marketplace undervalues preventive care, healthcare professionals will lack the financial support to address these issues with their patients, and medical schools will have less incentive to train their students accordingly. We believe that insurers—public and private—should expand reimbursement for evidence-based preventive services that address nutrition and physical activity, such as diabetes prevention programs offered through local YMCAs and other community organizations.
Medical schools and health training programs should equip practitioners with the tools to address the problems they will face in practice. Passage of the ENRICH Act could help to support them in doing so. When government, the medical community, and public and private insurers progress toward a common goal, we may finally realize a health care system equipped to address the nation’s most pressing challenges to individual and public health.
Glickman, a former secretary of Agriculture, is a senior fellow at the Bipartisan Policy Center and co-chair of BPC Prevention Initiative; Shalala, a former Secretary of Health and Human Services, is president of the University of Miami and co-chair of the BPC Prevention Initiative.