Medical Schools Struggle to Provide Ample Training in Nutrition, Obesity Prevention

Some Stand-out Programs Offer Solid Models to Build On

May 17, 2010 08:55 am Barbara Bein

Although knowledge about nutrition will be important to future physicians as they treat patients who are overweight or obese, there's not enough instruction about this topic in today's medical schools, say medical educators.

In fact, a 2007 report from the Association of American Medical Colleges, or AAMC, "Contemporary Issues in Medicine: The Prevention and Treatment of Overweight and Obesity, Medical School Objectives Project" said that training in this area has to improve.

According to the report, current and future physicians "must be better informed about the science of weight regulation and be prepared to work effectively with increasing populations of overweight and obese patients to decrease their health risks."

The AAMC findings are repeated in a more recent survey. According to the preliminary results of a nutrition education survey conducted in 2008-09 by the Nutrition in Medicine staff at the University of North Carolina at Chapel Hill, or UNC, although most medical schools offer some form of nutrition education, only one-quarter require a dedicated nutrition course.

Moreover, the survey found, the overwhelming majority of schools fail to adhere to a recommendation from the National Academy of Sciences(books.nap.edu) "that a minimum of 25-30 classroom hours in nutrition be required of all students during the preclinical years," followed by reinforcement of that nutrition instruction during clerkships, electives and postgraduate training.

In fact, the amount of nutrition education that medical students receive is so "inadequate" that "medical school graduates feel unprepared to intervene in their patients' care with regard to nutrition," according to the UNC preliminary survey results.

Martin Kohlmeier, M.D., director of Nutrition in Medicine(www.med.unc.edu) and research professor in the department of nutrition at the UNC School of Public Health and the UNC School of Medicine, told AAFP News Now that, "UNC has been providing nutrition education to medical students as long as I have been here. It is always hard to get as many hours into the curriculum as one might want, and I am certainly among the overwhelming majority of the survey respondents who wish for additional hours."

He is joined in that sentiment by nutrition educators at the University of South Dakota Sanford School of Medicine in Sioux Falls; the Texas Tech University Health Sciences Center, or TTUHSC, in Lubbock; and the East Carolina University Brody School of Medicine in Greenville, N.C. Each of these medical schools has added an emphasis on nutrition education to their respective curricula.

Sanford School of Medicine

Sanford School of Medicine started integrating nutrition training into the medical school curriculum in the early 1990s at the urging of the school's department of family medicine. The addition of nutrition training and skills put Sanford "ahead of the curve," said Roger Shewmake, Ph.D., L.N., nutrition professor and nutrition program director of the Sioux Falls Family Medicine Residency.

At the school, issues of overweight and obesity and their relationship to disease are discussed as part of a four-year, longitudinal nutrition, health promotion and disease prevention curriculum, said Shewmake, who is also co-chair of the Group on Nutrition of the Society of Teachers of Family Medicine.

Medical students receive the following instruction during their four years of school:

  • First-year medical students learn the basics about nutrition and its relation to disease through instruction that includes a seminar with guest speakers, videos and special exercises. Students complete a two-day diet record and come up with a "nutrition prescription."
  • In the second year, students participate in required rural clerkships at 23 clinics across South Dakota, which introduces them to issues of food, weight, disease and community health. Accompanied by a dietitian and a social worker, students visit patients in their homes and note their food habits.
  • In the third-year family medicine clerkship, students receive an "obesity toolkit," which includes growth charts, a BMI calculator and a waist circumference tape.
  • The required senior family medicine clerkship completed at 40 clinics across the state also requires home visits to learn about families' nutrition. Fourth-year medical students can elect to take a four-week nutrition rotation to gain more specialized knowledge.

The home visits are "real revealing to these students," Shewmake told AAFP News Now. "With the overweight and the obese, they might not be eating a lot but they're eating the wrong kinds of foods."

Texas Tech

Nutrition educators at the Texas Tech University Health Sciences Center, or TTUHSC, in Lubbock and at the Brody School of Medicine at East Carolina University, or ECU, in Greenville, said they provide similar training about nutrition and obesity to their medical students.

In fact, since 2003, TTUHSC has more than doubled the hours of nutrition education in its curriculum, from 12 to 25, said Katherine Chauncey, Ph.D., R.D., L.D., professor of clinical family medicine.

In the preclinical years, faculty teaching biochemistry and pharmacology courses have put new emphasis on nutrition concepts. A week's worth of nutrition lectures -- including obesity as an eating disorder -- was added. Second-year medical students now take four courses that deal with obesity.

Chauncey herself lectures on the "obesigenic environment" -- why the environment makes Americans fat -- fad diets and dietary supplements.

"The main goal was the feeling that students were not getting enough training in nutrition and we were trying to make up the deficit," Chauncey said.

In the third-year family medicine clerkship, Chauncey said she is the champion of lifestyle changes in the prevention and treatment of obesity.

"Students are aware that obesity is on the increase and will be a part of their practices. They want to be more proactive with their patients," she said.

Brody School of Medicine

At ECU's Brody School of Medicine, students can avail themselves of the opportunities provided by the Pediatric Healthy Weight Research and Treatment Center, a virtual organization of professionals in various disciplines, including public school teachers, psychologists, physical therapists, family physicians and pediatricians, who are interested in preventing and treating childhood obesity, according to Kathryn Kolasa, Ph.D., R.D., L.D.N., nutrition professor in the departments of family medicine and pediatrics.

First-year medical students meet with a dietitian to learn how to provide nutrition guidance and weight counseling to their patients. In the third year, they learn evidence-based guidelines for assessing and treating obesity and help in counseling an overweight patient.

Like other nutrition educators, Kolasa would like the medical students to receive more education about preventing obesity.

"We don't quite have enough time for the students to develop skills. They develop skills in diabetes and heart disease management. But they get less in terms of prevention."


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