Doctors held to a higher standard in society, does this include BMI?

[carlosc1dbz]

Many times, I hear conversations about how doctors cannot do crazy things in their personal life because it reflects on their professionalism, example smoking MJ occasionally. I was curious to know whether or not doctors are held at a high standards about maintaining a healthy weight? Any comments?

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[facetguy]

Physicians don't place enough emphasis on diet during discussions with patients for a number of reasons. One is that physicians aren't any different from the population at large in terms of fitness. Another is that physicians aren't adequately trained to have those discussions: http://journals.lww.com/academicmed...on_Education_in_U_S__Medical_Schools_.30.aspx

 

[avatarftw]

Not trying to be a jerk, but how comprehensive is the education of the RD? It seems like nutrition is something that the doctor can kind of pick up and learn. (kind of like business)

Physicians don't place enough emphasis on diet during discussions with patients for a number of reasons. One is that physicians aren't any different from the population at large in terms of fitness. Another is that physicians aren't adequately trained to have those discussions: http://journals.lww.com/academicmed...on_Education_in_U_S__Medical_Schools_.30.aspx

 

[facetguy]

Not trying to be a jerk, but how comprehensive is the education of the RD? It seems like nutrition is something that the doctor can kind of pick up and learn. (kind of like business)

Could pick up and learn, but most won't because the focus is on other aspects of care (not that those other aspects are bad). And the typical RD is not the answer we're looking for; it's pretty clear that the 'standard' diet of low fat, high carbs has gotten us in a lot of trouble.

 

[DOwnage]

Many fat people assume that being fat is genetic, even when it isn't. That way, it is out of their control and they can sleep easier at night knowing that there's nothing they can do about it. They refuse to consider their diet first, which is often composed largely of highly processed carbohydrates instead of natural, real foods. This isn't for just regular fat people, but for fat people who happen to be doctors as well.

 

[facetguy]

Many fat people assume that being fat is genetic, even when it isn't. That way, it is out of their control and they can sleep easier at night knowing that there's nothing they can do about it. They refuse to consider their diet first, which is often composed largely of highly processed carbohydrates instead of natural, real foods. This isn't for just regular fat people, but for fat people who happen to be doctors as well.

While genetics do play a role (e.g., released today: http://www.prnewswire.com/news-rele...en-obesity-and-waist-hip-ratio-104693024.html), you are right that diet will have an impact over how those genes are expressed, and you are right that processed carbs are leading the way to our demise. (I also suspect we may find over time that one's genetic makeup vis-a-vis ability to handle certain environmental toxins will be shown to play a role in obesity as well.)

 

[FutureDoc4]

I always hear this thrown around, but I never see CURRENT hard data on it.

Everyone says doctors aren't trained in nutrition.... how true is this anymore?

My medical school has a nutrition class.....nutrition is also tested (quite heavily actually relative to other biochem concepts) on Step I. So, how many medical schools currently do NOT have nutrition as part of their curriculum?

 

[facetguy]

I always hear this thrown around, but I never see CURRENT hard data on it.

Everyone says doctors aren't trained in nutrition.... how true is this anymore?

My medical school has a nutrition class.....nutrition is also tested (quite heavily actually relative to other biochem concepts) on Step I. So, how many medical schools currently do NOT have nutrition as part of their curriculum?

The article in Academic Medicine to which I linked is from just last month. I'm not sure we'll get much more current data than that.

From the study: "Only 28 (27%) of the 105 schools met the minimum 25 required hours set by the National Academy of Sciences; in 2004, 40 (38%) of 104 schools did so."

If anything, it appears it's getting worse when it comes to nutritional education in medical schools. With the ever increasing influence of pharma, this should come as no surprise.

 

[DOwnage]

I'm probably going to sound crazy when I say this, but I really challenge the current knowledge of nutrition. Not only myself, but several people I know have cut out grains and other foods that humans have not evolved to eat, and we dropped weight like crazy. If anyone has "fat genes" it's me. I used borderline obese and growing AND pre-diabetic. But now, you can see my abs and I have 10-12% body fat on diet alone... and I don't count calories or anything. I know, I know...anecdotal evidence, not scientific, blah blah blah. Personally, I don't care if my diet has been scientifically studied or not, because it works for me. However, it's definitely worth studying. Especially since contemporary nutrition pushes people to eat like 5+ servings of grains a day. If i did that, I'd weigh 200+ lbs and have 30% body fat...like I used to be.

I always hear this thrown around, but I never see CURRENT hard data on it.

Everyone says doctors aren't trained in nutrition.... how true is this anymore?

My medical school has a nutrition class.....nutrition is also tested (quite heavily actually relative to other biochem concepts) on Step I. So, how many medical schools currently do NOT have nutrition as part of their curriculum?

 

[deleted87716]

Give me a break. Being trained in nutrition is like being trained in breathing.

"Eat food. Not too much. Mostly plants."

It's not complicated.

 

[facetguy]

I'm probably going to sound crazy when I say this, but I really challenge the current knowledge of nutrition. Not only myself, but several people I know have cut out grains and other foods that humans have not evolved to eat, and we dropped weight like crazy. If anyone has "fat genes" it's me. I used borderline obese and growing AND pre-diabetic. But now, you can see my abs and I have 10-12% body fat on diet alone... and I don't count calories or anything. I know, I know...anecdotal evidence, not scientific, blah blah blah. Personally, I don't care if my diet has been scientifically studied or not, because it works for me. However, it's definitely worth studying. Especially since contemporary nutrition pushes people to eat like 5+ servings of grains a day. If i did that, I'd weigh 200+ lbs and have 30% body fat...like I used to be.

Some may feel you sound crazy, but there is an increasing awareness among many that gluten-containing grain is a problem for more people than had been earlier believed. The value of low-carb diets is being validated through research. The wisdom of the recommended low-fat diet is being challenged. The health impact of saturated fats is being re-thought, particularly in the presence of a low-carb diet, and such papers are being published by well respected people in the field. And calorie counting doesn't work. So things are changing, but these changes will unfortunately come very slowly, mostly because 1) the USDA (think 'food pyramid') bases its recommendations not on science but on special interests, and 2) MANY experts have been extolling the virtues of low-fat, high-carb for years and years and would have lots of egg on their faces if they admitted their advice was based on thin evidence.

And I read a headline the other day regarding Meridia's recall, and it read "Major blow to obesity treatment...". As if Meridia, or any drug, is the answer to our obesity problem. But unfortunately, that's the prevailing thought with our society (and healthcare system) today.

 

[deleted87716]

It ain't about carbs.

If you want a smaller ass, get off it.

 

[DOwnage]

It ain't about carbs.

If you want a smaller ass, get off it.

While true to an extent, it has been in my experience an oversimplification. I would do sprints, lift hard, and eat "healthy carbs". I never got truly skinny...just chubby buff at best. In fact, I had a brief relapse period and had to eat liquid foods for a time...ended up reverting back to the standard American diet and gained my weight back. I tried something new...I started eating right and since I'm studying most of the time anyway, I don't do as much exercise as I'd like. I look better than I ever did when I was "getting off my ass". I was still pre-diabetic when I was sprinting and lifting every other day, still had fat in areas I didn't want, and it basically plateued. Anybody who has ever tried to lose weight the conventional way will know what I'm talking about. You have to go through extreme measures to actually keep it off.

Eating a standard American diet and exercising your ass off is comparable to digging a pit 20 feet deep and putting a ladder in it to climb into your basement window.

EDIT: I do believe however that genetics does play a role into how carb-sensitive people are, which in turn gives people the perception that if they are fat at age 22, they are "destined to be fat because of genes". Some people can just handle mountain dews, brownies, cakes, pizza, all day long. Others just look at the stuff and get fat. Since a clear majority of people eat that crap anyway, the people who are genetically sensitive to carbs end up suffering with weight gain, while those who stay skinny appear unaffected (simply from a weight loss standpoint, not from an arterial health standpoint). People who are insensitive to massive amounts of carbohydrates tend not to understand why others get so fat. I see it all the time in some of my friends who feel they are better than fat people they see in public because of the fact that those people are "so fat". They feel that those people have no self control and need to "get off their ass" to lose weight, when it is actually that they are more sensitive to the high glycemic load of wheat, rice, and corn-based products at every meal.

 

[deleted87716]

You have to eat right and exercise right. One alone isn't usually going to do it.

 

[facetguy]

You have to eat right and exercise right. One alone isn't usually going to do it.

Exercise has many benefits, no doubt, and should be pursued. However, the evidence that it helps with weight loss is thinner than we would think. Here are a couple of magazine articles that discuss the literature:
http://www.time.com/time/health/article/0,8599,1914857-1,00.html

http://nymag.com/news/sports/38001/

A 2007 joint statement from the American Heart Assoc and the American College of Sports Medicine includes this statement:

"It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling...". http://www.acsm.org/AM/Template.cfm...ty_Guidelines&TEMPLATE=/CM/ContentDisplay.cfm​

Diet, it would appear, is the key to weight and body comp management. And carbs do matter, a lot.

 

[facetguy]

While true to an extent, it has been in my experience an oversimplification. I would do sprints, lift hard, and eat "healthy carbs". I never got truly skinny...just chubby buff at best. In fact, I had a brief relapse period and had to eat liquid foods for a time...ended up reverting back to the standard American diet and gained my weight back. I tried something new...I started eating right and since I'm studying most of the time anyway, I don't do as much exercise as I'd like. I look better than I ever did when I was "getting off my ass". I was still pre-diabetic when I was sprinting and lifting every other day, still had fat in areas I didn't want, and it basically plateued. Anybody who has ever tried to lose weight the conventional way will know what I'm talking about. You have to go through extreme measures to actually keep it off.

Eating a standard American diet and exercising your ass off is comparable to digging a pit 20 feet deep and putting a ladder in it to climb into your basement window.

EDIT: I do believe however that genetics does play a role into how carb-sensitive people are, which in turn gives people the perception that if they are fat at age 22, they are "destined to be fat because of genes". Some people can just handle mountain dews, brownies, cakes, pizza, all day long. Others just look at the stuff and get fat. Since a clear majority of people eat that crap anyway, the people who are genetically sensitive to carbs end up suffering with weight gain, while those who stay skinny appear unaffected (simply from a weight loss standpoint, not from an arterial health standpoint). People who are insensitive to massive amounts of carbohydrates tend not to understand why others get so fat. I see it all the time in some of my friends who feel they are better than fat people they see in public because of the fact that those people are "so fat". They feel that those people have no self control and need to "get off their ass" to lose weight, when it is actually that they are more sensitive to the high glycemic load of wheat, rice, and corn-based products at every meal.

...that is, when they follow the officially recommended Dietary Guidelines.

Here's a nice critique of said Guidelines from this month's Nutrition journal:
http://download.journals.elsevierhealth.com/pdfs/journals/0899-9007/PIIS0899900710002893.pdf

 

[FutureDoc4]

The article in Academic Medicine to which I linked is from just last month. I'm not sure we'll get much more current data than that.

From the study: "Only 28 (27%) of the 105 schools met the minimum 25 required hours set by the National Academy of Sciences; in 2004, 40 (38%) of 104 schools did so."

If anything, it appears it's getting worse when it comes to nutritional education in medical schools. With the ever increasing influence of pharma, this should come as no surprise.

You missed the important part of that paper:

"Most schools (103/109) required some form of nutrition education."


How many hours is necessary I think is up for debate---As Blue Dog has indicated it isn't exactly rocket science. The fact is >90% of schools have nutrition taught in the curriculum.

I know Facetguy you believe Pharma is gaining MORE control of medical students, but in fact, they have less control than they ever have.

They use to (years ago) be able to come and give out Free Lunches/Pens/Whatever to medical students. Now, at the majority of medical schools, they are not allowed to come give out anything on campus (including free pens--which is a shame cause they make some quality pens).

 

[facetguy]

You missed the important part of that paper:

"Most schools (103/109) required some form of nutrition education."


How many hours is necessary I think is up for debate---As Blue Dog has indicated it isn't exactly rocket science. The fact is >90% of schools have nutrition taught in the curriculum.

I know Facetguy you believe Pharma is gaining MORE control of medical students, but in fact, they have less control than they ever have.

They use to (years ago) be able to come and give out Free Lunches/Pens/Whatever to medical students. Now, at the majority of medical schools, they are not allowed to come give out anything on campus (including free pens--which is a shame cause they make some quality pens).

Nobody's saying there's zero nutrition info taught in medical school, just not enough. That's the important part of that paper. And your suggestion that nutrition "isn't exactly rocket science" simply reflects the general lack of respect nutritional science gets in certain medical circles. In my view, that's a problem.

Which dovetails into my point about pharma influence. I'm not talking about pizzas and pens, although I do agree that some of the regulations have been tightened in recent years. I'm talking about the influence (via dollars) that pharma has on what is taught, what research gets done and promoted, how medicine is practiced, and our societal attitudes toward health. There has been a hyper-emphasis on drugs and a diminishing emphasis on lifestyle factors, despite the overwhelming evidence that lifestyle changes are very powerful against many of our most common diseases today. Yes, working lifestyle changes into medical practice today isn't easy (reimbursement, time pressure, etc.), but nonetheless we must find a way to shift at least some of the focus or our healthcare system will continue to be too expensive and too ineffective.

 

[DOtoCanada]

It ain't about carbs.

If you want a smaller ass, get off it.

...and this is why you are my favorite poster on SDN .


A good rule that I follow as much as possible: If I can't grow it or kill it, don't eat it.

I can't grow hydrogenated oils, I can't grow a Yellow #5 tree, etc.

 

[deleted87716]

Exercise has many benefits, no doubt, and should be pursued. However, the evidence that it helps with weight loss is thinner than we would think.

Pun intended, I'm sure.

I encourage patients to focus on the health benefits rather than their weight whenever I recommend therapeutic lifestyle changes. Too many people get discouraged when the pounds don't melt away immediately.

Nobody gets fat overnight, and it takes even longer to lose weight than it does to gain it.

 

[Orbo]

It's very simple: Medical students don't get much teaching on nutrition because even the experts are clueless about nutrition. Yup, it's true. Back in middle school we learned about the old food pyramid with grains on the bottom, fruits&veggies next, etc. That pyramid has literally been turned on its side by the USDA and now we got some incredibly uninformative and ambiguous food pyramid with "steps."

From this unproven junk:

To this...

Can someone please explain this useless piece of s*** to me?

Seriously.


Like others have alluded to, the key is simply not eating all those processed pastries all day every day. It's amazing to me how people will claim their diet is healthy while munching down the third brownie or twinkie of the day. No, that crap ain't healthy. Lard saturated cake is not healthy. Donuts are not healthy. Pretty much everything that you can buy in a grocery store that comes in a box is not healthy. 'Nuff said.

 

[DOwnage]

Thank you. This was exactly what I was alluding to.

It's very simple: Medical students don't get much teaching on nutrition because even the experts are clueless about nutrition. Yup, it's true. Back in middle school we learned about the old food pyramid with grains on the bottom, fruits&veggies next, etc. That pyramid has literally been turned on its side by the USDA and now we got some incredibly uninformative and ambiguous food pyramid with "steps."

On an evolutionary scale, man was definitely meant to do physical activity, but eating right is the foundation of good health. No amount of exercise can overcome a poor diet.

 

[hurdlepup]

Give me a break. Being trained in nutrition is like being trained in breathing.

"Eat food. Not too much. Mostly plants."

It's not complicated.

This is a good book!

 

[deleted87716]

This is a good book!

Michael Pollen's "In Defense of Food," for those who might be wondering.

http://www.amazon.com/Defense-Food-...4964/ref=sr_1_2?ie=UTF8&qid=1287528319&sr=8-2

 

[Melicopter]

Nobody's saying there's zero nutrition info taught in medical school, just not enough. That's the important part of that paper. And your suggestion that nutrition "isn't exactly rocket science" simply reflects the general lack of respect nutritional science gets in certain medical circles. In my view, that's a problem.

Great point. The lack of knowledge will likely continue as long as the lack of respect for the field is there.

Nutrition may not be "rocket science" but it is much more applicable and often ignored. It would take more time to adequately educate doctors in nutrition. In addition, conveying the information to patients includes understanding the components of foods they are eating and how to recommend alternatives, which is more time training in areas that most students would consider a waste of time.

Even if doctors were inherently good at this or picked it up as they went along, it would take so much time to adequately assess someone's diet, find the problem, and address it, why would they? I'm sure you've seen other areas where patients really have no idea about health and physiology. Is it so hard to understand that sometimes someone actually needs to sit down with the patient to tell them they can't have mac and cheese every night? Again, you could do it, but you could do psychological counseling too. It would just take so much time that it's not worth it.