It’s no secret that preventable chronic diseases are leaders of morbidity, mortality, and health care spending in the United States. In 2017, we spent $3.5 trillion in health care — 16% of which was attributable to three conditions: cardiovascular disease (CVD), diabetes, and obesity. In an attempt to combat this, many students, physicians, and professors are advocating for more nutritional education in medical schools — which I fully support and understand — but I don’t believe a few extra lectures will make a substantial difference in the health of our patients.
Imagine this: a patient suffering from a heroin addiction is in your clinic for a yearly physical. Toward the end of the encounter, you spend two minutes explaining the health dangers of continued drug use, and then schedule him for follow-up in a year. No provider I know would have any faith that this plan would help that patient get sober. The issue isn’t a lack of physician knowledge or the inability to explain the pathophysiology underlying recurrent drug usage.
The brain activity associated with sugar consumption in obese patients utilizes similar reward and behavior pathways that are also active in drug addiction. Therefore, the methods we use to address obesity should mirror many of our interventions that combat tobacco and drug use. This is not done by cramming a handful of nutrition lectures into our medical school curriculums.
In order to appreciably improve our population’s health, interventions need to occur much earlier than a visit to the doctor’s office. First, people need substantial and meaningful education surrounding nutrition and exercise. Second, society needs to increase access to healthy foods — particularly for families of lower socioeconomic status. Finally, our patients need to actually make those choices that will benefit them in the long run. Granted, none of these are easy fixes, but neither is managing diabetes and hypertension superimposed on long-term coronary artery disease.
Increasing nutritional education should start in our schools. Having a licensed nutritionist to teach courses from K–12 would be ideal, albeit, unrealistic. Maybe, we can start with encouraging our science and physical education teachers to strengthen their nutrition curriculums. Incorporating basic nutritional science at all grade levels may cement foundational lifestyle principles into future generations.
We already know that current health education in schools is at least somewhat effective in increasing students’ knowledge of nutrition; however, it has not yet resulted in modification of students’ attitudes and behaviors surrounding nutrition. I believe increasing the quality, volume, and frequency of this education will help shift future attitudes and, by extension, behaviors in the right direction.
Unfortunately, simply making children aware of the importance of making healthy choices would not solve the entire problem. Access to quality foods is a significant problem for much of our population who live in “food deserts”— where healthy foods are scarce or nonexistent due to costs or proximity to grocery stores. The obvious solution, easier said than done, is to encourage corporations to establish stores with healthy foods at a reasonable price in these food deserts. Of course, critics will point out that there is very little financial incentive for companies to do this. However, as a country, we waste over $160 billion in produce per year. Most of this comes at the farming, grocery store, and restaurant stages of food production, due to overstocking and imperfect aesthetic properties of food.
Not only is this wasted food, but it is also wasted potential profits for these companies. Further, we could incentivize healthy companies to open quality, affordable stores by subsidizing healthy foods, which is effective in influencing nutritional behavior. In fact, some startups such as Everytable are already disrupting fast food companies’ predatory practices in food deserts by pricing items proportionally to the socioeconomic status of each branch’s location. By extending this model to other grocers and restaurants we can push back against a multibillion-dollar fast food industry that is disproportionately present in areas of lower income and devastating our country’s health.
Finally, we need to incentivize our population to actually make these healthier decisions. In California (among other states), we levy taxes on tobacco and alcohol, in part to discourage their consumption. Food, on the other hand, is generally tax-free. I propose that we increase taxes on “foods” that are not up to certain health standards — namely candy, soda, and chips — and use that money to offset subsidies mentioned above. Some may call this idea radical, but the UK enacted a similar law on soda, called the Sugar Tax, and raised $194 million in its first year. The consumption of candy, chips, and soda — “foods” with zero nutritional value — is astronomical in the United States and adding a tax would serve as a deterrent to purchasing these foods, while also generating funds to offset the cost of subsidies mentioned above.
Quality nutrition begins with our mothers before we are born, and long-term nutritional and exercise habits develop in childhood, during our most formative years. For these reasons, we need to increase nutritional education from a young age, increase access of high-quality foods regardless of socioeconomic status, and encourage people to make healthy decisions. Let’s start now by adding nutritional education to the curriculums that need it the most — our elementary schools.
Increasing our nutritional education in medical school is important because we counsel patients in every step of their lives. However, many of us know firsthand that patient compliance — even with seemingly simple interventions — can be a significant obstacle in our everyday practices. As many schools look to redesign curriculums to improve medical school education, do we really believe a modest increase in the number of nutrition lectures will have the measurable impact on patient morbidity and mortality that this epidemic so desperately needs?
Daniel McClintick is an MS2 at the David Geffen School of Medicine at UCLA.