Op-Med is a collection of original articles contributed by Doximity members.
COVID-19 vaccine trials are underway, but there’s no need to wait for a proactive intervention. You have the power to change the trajectory of not just this pandemic, but also the chronic disease pandemic, just by talking to your patients about nutrition.
As an integrative medicine doctor, nutrition has always been part of my treatment plans. Ever since early spring when fears of the virus took root, I have had patients actively seeking out support, motivated to improve their diet to bolster their immunity and combat the so-called COVID-15 weight gain from stay-at-home orders, stress eating, and closed gyms. Our patients need us as their trusted source for evidence-informed recommendations to help them navigate the viral claims on social media about miracle diet cures. It’s our responsibility to steer them toward whole food, plant-rich diets that will provide the core macro and micronutrients they need to stay resilient.
In response to the pandemic, the scientific community, private industry, and government have invested heavily in the discovery of pharmaceutical treatments and vaccine development. Public health campaigns urge people to wear masks, practice physical distancing, and wash their hands regularly. Practicing health professionals act in a triage role for outpatients, addressing patient questions that as of yet have no definitive answers. But at a time when obesity is an at-risk factor for COVID-19, we are missing the opportunity to improve patients’ lives through nutrition.
Beyond it being a comorbidity factor for the coronavirus, patients with chronic diet-related diseases and obesity are at significantly greater risk for adverse outcomes from the infection. The virus has disproportionately impacted individuals from at-risk communities most prone to food insecurity, food deserts, and food swamps. The commonality in these underlying factors — and one where physicians can play an immediate and impactful role — is nutrition.
Even prior to the coronavirus, major societies and publications were calling for more attention to how we nourish (or fail to) our bodies.The US Burden of Disease Collaborators identified dietary factors, independent of BMI and physical activity, as the No. 1 risk factor for premature death and No. 3 for disability. In 2019, a systematic analysis of data from 195 countries reported improvement of diet could potentially prevent 1 in every 5 deaths globally. The 2020 Dietary Guidelines Advisory Committee report, used in preparing the 2020–2025 Dietary Guidelines for Americans, highlights dietary patterns and specific components, such as excess added sugars, solid fats, and sodium, that impact disease prevalence. The 2020–2030 Strategic Plan for NIH Nutrition Research promotes rigorous science to clarify the role of nutrition in promoting health and reducing the burden of disease throughout life and across generations, and to identify best practices for implementing the findings in meaningful ways. More recently, the American Heart Association released a scientific statement advocating for broad adoption of diet screener tools in prevention-focused clinical settings.
Despite increased awareness of nutrition and health, the frequency of actual counseling in patient visits remains inadequate. A recent survey across five health systems found that less than half of overweight patients reported receiving advice to address weight or foster healthy eating and physical activity patterns from a health professional in the past year. In addition to lack of time and competing priorities, one of the major barriers identified by practitioners is a widespread lack of confidence in providing nutrition counseling. This deficiency can be blamed in part on insufficient or ineffective nutrition training in the undergraduate and graduate medical education curriculum, with the most recent comprehensive survey of U.S. medical schools showing that 71% of medical schools provide less than the recommended 25 hours of nutrition education, and 36% provide less than half that amount. Much of those lessons are often focused on inpatient or basic science content, with scant attention to real-world nutrition coaching. In an effort to address this failing, faculty in undergraduate and graduate medical education are advocating for standardized nutrition-focused competencies, and implementing novel strategies such as culinary medicine electives that bring trainees into the kitchen and community to learn practical hands-on skills to better counsel patients.
While the majority of CME conferences short shrift nutrition, practicing physicians can take advantage of a small but growing number of nutrition-specific conferences and culinary medicine experiences to bolster their skills and confidence. While I was always interested in nutrition, my formal education didn’t happen until post-internal medicine residency when I completed a two-year integrative medicine fellowship. Since then, I’ve attended conferences annually, such as the annual Harvard-led Healthy Kitchens Healthy Lives conference in Napa and the Food as Medicine professional training hosted by The Center for Mind-Body Medicine. A major bonus — best food you’ll ever have at a meeting! You’ll be nourishing your body as well as your mind, all while meeting your CME requirements. I’ve also completed a plant-based chef certification and nutrition coaching course, both of which can up your game when talking to patients about not just eating, but cooking those greens and whole grains.
Never before have so many factors aligned to raise nutrition to a dominant place in health care. Patients are seeking ways to support their immunity through diet, and are cooking and eating at home more. The combined awareness of disparities in infection rate and national discourse on equity is giving rise to calls to support nutrition and food security at all levels of the ecological health model: individual, community, national, and global. Furthermore, the rise in telemedicine access makes nutrition counseling more accessible and personalized, with an opportunity for applied culinary medicine counseling in each patient encounter.
To be sure, physicians are only a small part of the solution when it comes to changing nutrition behaviors. If individuals don't have access to healthy food options due to financial or geographical barriers, efforts will be futile. In this case, referrals to local food banks and prescription programs like VeggieRx should be part of the treatment plan. Physicians need to have referral sources for more extensive counseling or group programs when needed, while also recognizing that even a few minutes of attention to nutrition in a patient visit makes an impression.
Now, during the COVID-19 pandemic, is the perfect time for all clinicians — regardless of specialty, patient population, or credential — to embrace the relevance of nutrition in a patient's intake and treatment plan. Take time to reflect on your own comfort level in counseling patients. If you’re among the vast majority of providers who feel unqualified to counsel patients about their diets, explore options like virtual nutrition meetings, recorded lectures, podcasts, and food documentaries. And don't feel like you need to do it all yourself. Even the simple act of telling a patient that their diet matters makes an impact. From there, you can utilize the network of resources, ranging from dietitians and health coaches to food pantries and reputable websites, to help them eat healthier. And while you’re at it, consider your own diet and whether you could use some tweaks yourself. This is the time for physicians to be catalysts for change, one bite at a time.
Dr. Melinda Ring serves as the Director of the Osher Center for Integrative Medicine at Northwestern University, and Clinical Associate Professor in the Departments of Medicine and Medical Social Sciences at the Northwestern University Feinberg School of Medicine. Dr. Ring is board-certified in internal medicine and integrative medicine, and has a special focus in women's health. In her roles at Northwestern, she directs both clinical and faculty fellowships in integrative medicine, teaches the Cooking Up Health culinary medicine course, and researches nutrition and integrative strategies to promote health. She is a 2020–2021 Doximity Op-Med Fellow. She reports no conflicts of interest.
Illustration by Jennifer Bogartz