Nutrition In Medicine?

[bobeanie95]

Hey everyone,

I have a strong interest in a nutrition emphasis to treatment in medicine. I was wondering if anyone knew any medical schools, preferably in the NE, with opportunities (ie. medical curriculum, fellowships, other training) to pursue my interest. For example, I know Columbia Medical School has a one year clinical fellowship that focuses on nutritional regimens.

Thanks!

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[scoutdog]

Not the northeast, but Tulane incorporates nutrition into the curriculum and has opportunities to get involved with the Goldring Culinary Medicine Institute and their teaching kitchen which is awesome

 

[LizzyM]

Keep in mind that a clinical fellowship comes after your MD and residency.
Nutrition education in medical education has been a challenge for more than 35 years.

One of the challenges is that nutrition educators and researchers are often off in their own school separate from the medical school.

It also gets sprinkled through the medical school curriculum in cardiovascular, GI, fetal development, etc.

Some of the big guns in nutrition are located at Harvard (Walter Willett), Tufts (they have a whole school of nutrition and social policy), Yale (David Katz), NYU (Marion Nestle). I don't know if any of them are actually involved in curriculum development for med students.

 

[JPSmyth]

Nutrition to me is protein carbs and fats, plus micronutrients. I know that people can devote their entire careers to this but it seems awfully simple. Not trying to be offensive at all

 

[iandraggia]

Nutrition to me is protein carbs and fats, plus micronutrients. I know that people can devote their entire careers to this but it seems awfully simple. Not trying to be offensive at all

It is extraordinarily far from simple. The biochemical basis of nutrition may seem "simple" but you have to consider the clinical element of nutrition. Many of the most common chronic diseases that internists face daily are in some way attributed to poor nutrition. And as with any dialogue with a patient, it needs to be tailored to the individuals circumstance which can vary by culture, geographic location, SES, etc. The problem is many doctors today (all of the doctors I've shadowed) have had a poor background in nutrition, and in many cases fail to consider the disparities between people and their abilities to access good food.

Not meant to be an attack but Nutrition is IMO essential to promote preventative care. This is coming from a Nutrition/Food Science major whose entire application is centered on childhood obesity prevention haha


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[iandraggia]

OP, many medical schools offer elective coursework in Nutrition (Einstein for example) or have student organizations dedicated towards community nutrition education (Brown for example)


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[LizzyM]

Nutrition to me is protein carbs and fats, plus micronutrients. I know that people can devote their entire careers to this but it seems awfully simple. Not trying to be offensive at all

There is also the role of the GI tract and the microbiome in the digestion and (mal)absorption of nutrients and the gut-brain axis. The role of culture and socioeconomic status has been mentioned. There are issues around disease prevention and health promotion but there are also issues related to the nourishment of patients with specific medical conditions including those who are unable to consume, digest and metabolize food in the usual way and those who are unable to eat for long periods of time.

 

[JPSmyth]

Oversight on my part when it comes to nutrition regarding all different medical problems that we might encounter as physicians. I'm aware that the field has a ton of details to be learned.

But coming from someone who has been a weight class athlete, I stand by my guns that it is calories in vs calories out at the most basic level in terms of obesity prevention.

I saw the movie fed up (I think that's what it's called) about sugar in our society. The entire time I was thinking, sugar or no sugar you HAVE to be in a caloric deficit to lose weight/prevent obesity. I have gained weight on "healthy foods" and lost body fat while eating Nutella every day. I'm not the biggest fan of IIFYM but the basic premise of that ideology is correct

 

[Tenk]

Patients know they shouldn't be eating McDonalds for breakfast, Taco Bell for lunch and Pizza Hut for dinner. They just don't care. There is a reason we have an obesity epidemic and it sure as hell is not due to a lack of education.

 

[bobeanie95]

Oversight on my part when it comes to nutrition regarding all different medical problems that we might encounter as physicians. I'm aware that the field has a ton of details to be learned.

But coming from someone who has been a weight class athlete, I stand by my guns that it is calories in vs calories out at the most basic level in terms of obesity prevention.

I saw the movie fed up (I think that's what it's called) about sugar in our society. The entire time I was thinking, sugar or no sugar you HAVE to be in a caloric deficit to lose weight/prevent obesity. I have gained weight on "healthy foods" and lost body fat while eating Nutella every day. I'm not the biggest fan of IIFYM but the basic premise of that ideology is correct

I think you are completely over simplifying the process. Yes, while you need to balance the in vs. out ratio of calories you are merely considering a very narrow scope with obesity. In reality, just eating Nutella everyday won't promote longevity and minimize disease as you are depriving the body of nutrients. Think for example in Kwashiorkor disease, you could be eating all the Nutella you want but you will eventually develop complications due to a lack of protein in the diet. Or you could develop hyperglycemia, insulin resistance from Nutella even in a caloric deficit. Additionally, many patients with diabetes have to constantly regulate their insulin injections. Its not as simple as taking one pill in the morning. The patient needs to be aware of factors that affect digestion of carbs such as the GI load, fiber composition and processing of the food. It's not as simple as "calories in and out"

 

[iandraggia]

Patients know they shouldn't be eating McDonalds for breakfast, Taco Bell for lunch and Pizza Hut for dinner. They just don't care. There is a reason we have an obesity epidemic and it sure as hell is not due to a lack of education.

What about people who don't know where to buy affordable healthy food? What about immigrants who struggle reading nutrition labels? What you've described massively generalizes the struggles of entire populations. Nutritional science isn't simply "avoiding fast food".


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[bobeanie95]

Patients know they shouldn't be eating McDonalds for breakfast, Taco Bell for lunch and Pizza Hut for dinner. They just don't care. There is a reason we have an obesity epidemic and it sure as hell is not due to a lack of education.

Patients know they shouldn't be eating McDonalds for breakfast, Taco Bell for lunch and Pizza Hut for dinner. They just don't care. There is a reason we have an obesity epidemic and it sure as hell is not due to a lack of education.

I think you are misguided. Lack of information is a major problem with disease treatment. It may seem obvious to you being a science major, but you'll be surprised how many patients don't know the difference between protein and carbs or simple sugars and complex starches. Not only that but you also have to consider socioeconomic status of individuals. Many are under economic constrictions that doesn't allow them to afford nutritious food. Or someone could be working all day and not have time to prepare fresh food without additives and preservatives.

 

[Tenk]

What about people who don't know where to buy affordable healthy food? What about immigrants who struggle reading nutrition labels? What you've described massively generalizes the struggles of entire populations. Nutritional science isn't simply "avoiding fast food".


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All that information is readily available with a simple google search in any language you want.

 

[JPSmyth]

I think you are completely over simplifying the process. Yes, while you need to balance the in vs. out ratio of calories you are merely considering a very narrow scope with obesity. In reality, just eating Nutella everyday won't promote longevity and minimize disease as you are depriving the body of nutrients. Think for example in Kwashiorkor disease, you could be eating all the Nutella you want but you will eventually develop complications due to a lack of protein in the diet. Or you could develop hyperglycemia, insulin resistance from Nutella even in a caloric deficit. Additionally, many patients with diabetes have to constantly regulate their insulin injections. Its not as simple as taking one pill in the morning. The patient needs to be aware of factors that affect digestion of carbs such as the GI load, fiber composition and processing of the food. It's not as simple as "calories in and out"

40/30/30 carb protein fat would be relatively balanced I think most would say. And while excess sugar and high glycemic index carbs are considered bad for you, I thought studies showed that the glycemic index didn't really matter in terms of body composition. White vs wheat bread is going to do the same thing for you essentially, right?

When it comes to general body composition I would say that macronutrient breakdown is by far the most important thing followed then by the smaller pieces such as fiber, micronutrients, etc. and eating a balanced diet within the parameters of a 40/30/30 diet should touch all those bases as well


When it comes to diabetes and those with other medical issues that's an entirely different story

 

[Espressso]

Oversight on my part when it comes to nutrition regarding all different medical problems that we might encounter as physicians. I'm aware that the field has a ton of details to be learned.

But coming from someone who has been a weight class athlete, I stand by my guns that it is calories in vs calories out at the most basic level in terms of obesity prevention.

I saw the movie fed up (I think that's what it's called) about sugar in our society. The entire time I was thinking, sugar or no sugar you HAVE to be in a caloric deficit to lose weight/prevent obesity. I have gained weight on "healthy foods" and lost body fat while eating Nutella every day. I'm not the biggest fan of IIFYM but the basic premise of that ideology is correct

What kinda weight class athlete were you? If you don't mind me asking

 

[bobeanie95]

40/30/30 carb protein fat would be relatively balanced I think most would say. And while excess sugar and high glycemic index carbs are considered bad for you, I thought studies showed that the glycemic index didn't really matter in terms of body composition. White vs wheat bread is going to do the same thing for you essentially, right?

When it comes to general body composition I would say that macronutrient breakdown is by far the most important thing followed then by the smaller pieces such as fiber, micronutrients, etc. and eating a balanced diet within the parameters of a 40/30/30 diet should touch all those bases as well


When it comes to diabetes and those with other medical issues that's an entirely different story

Well my point exactly is that a ratio of 40/30/30 is general guidelines for a full grown, healthy individual. My emphasis with nutrition is that diets and regimens have to be adjusted. Like @LizzyM mentioned, some patients cannot metabolize food in a certain way. Think Von Gierke disease where the liver can't excrete glucose or metabolize glycogen. It is extremely dangerous as it can cause hypoglycemia and the only way to treat it is by feeding cornstarch. I don't know about you but this is not information that is easily accessible to anyone..

 

[JPSmyth]

Well my point exactly is that a ratio of 40/30/30 is general guidelines for a full grown, healthy individual. My emphasis with nutrition is that diets and regimens have to be adjusted. Like @LizzyM mentioned, some patients cannot metabolize food in a certain way. Think Von Gierke disease where the liver can't excrete glucose or metabolize glycogen. It is extremely dangerous as it can cause hypoglycemia and the only way to treat it is by feeding cornstarch. I don't know about you but this is not information that is easily accessible to anyone..

You're definitely right, when it comes to diseases like that (never even heard of it until right now) then yes it's entirely more complicated

 

[JPSmyth]

What kinda weight class athlete were you? If you don't mind me asking

Wrestling, I have manipulated my body weight and composition a lot over the years.

 

[Espressso]

Wrestling, I have manipulated my body weight and composition a lot over the years.

I think wrestling skews the thoughts behind this more than any other sport. Mainly because of the insane amount of physical activity, and the narrow focus on being at a certain weight by a certain date and time. Based on my experience, at least.

I personally don't think this translates well to the general public. And it's obvious - by the current public health crisis that is the diabetes epidemic - that nutritional health as it relates to one's general well-being is much more than simply keeping your caloric intake lower than your caloric expenditure. There's more to it.

 

[JPSmyth]

I think wrestling skews the thoughts behind this more than any other sport. Mainly because of the insane amount of physical activity, and the narrow focus on being at a certain weight by a certain date and time. Based on my experience, at least.

I personally don't think this translates well to the general public. And it's obvious - by the current public health crisis that is the diabetes epidemic - that nutritional health as it relates to one's general well-being is much more than simply keeping your caloric intake lower than your caloric expenditure. There's more to it.

The thing though is that I believe that it is pretty simple, you just have to account for it. On training days I would account for the calories that would be burned. My diet is based around my high activity level. You just need to account for that in the average sedentary person. I would eat 400-500g carbs per day sometimes because I needed it. Would I ever advise that to somebody not training like an athlete? Absolutely not.

I think it's a matter of finding maintenance calories (or BMR + activity level), setting a macro breakdown of P/C/F that works for the individual, and pretty much following that.

This is average people with no underlying conditions im talking about

 

[LizzyM]

I think it's a matter of finding maintenance calories (or BMR + activity level), setting a macro breakdown of P/C/F that works for the individual, and pretty much following that.

This is average people with no underlying conditions im talking about

Well, that's just great but practicing medicine goes much beyond average people with no underlying conditions.

People need to know what to do and they have to want to do what they know they should do. There is information/education and there is behavioral psychology and there is the economic and social forces (you know what to do and you want to do it but you can't find/afford the food that you need in your area).

White vs wheat bread is going to do the same thing for you essentially, right?

No. Which is why physicians (and everyone in middle school) should be educated in nutrition. Fiber is an important and overlooked part of good nutrition. A proper wheat bread is a good source of fiber while white bread has no fiber.

 

[JPSmyth]

Well, that's just great but practicing medicine goes much beyond average people with no underlying conditions.

People need to know what to do and they have to want to do what they know they should do. There is information/education and there is behavioral psychology and there is the economic and social forces (you know what to do and you want to do it but you can't find/afford the food that you need in your area).



No. Which is why physicians (and everyone in middle school) should be educated in nutrition. Fiber is an important and overlooked part of good nutrition. A proper wheat bread is a good source of fiber while white bread has no fiber.

In regards to the white vs wheat I was referring to the glycemic index of each. Fiber is a different story, and I believe that a fiber goal should be reached daily.

 

[Tenk]

I think you are misguided. Lack of information is a major problem with disease treatment. It may seem obvious to you being a science major, but you'll be surprised how many patients don't know the difference between protein and carbs or simple sugars and complex starches. Not only that but you also have to consider socioeconomic status of individuals. Many are under economic constrictions that doesn't allow them to afford nutritious food. Or someone could be working all day and not have time to prepare fresh food without additives and preservatives.

And I think you are naive. It's not lack of information, it's lack of interest on the part of the patient.

Go to YouTube and look up nutrition. Look it up on google. Go to a library. Turn on the TV and watch the food network. There is absolutely no shortage of information on all these topics.

This problem with obesity and poor healthcare America faces will not be solved with education. This is a cultural problem. It is "American Culture." Until you find a way to get rid of the plentifully available cheap abundant calories shoved down American throats, no amount of education will help our society.

 

[JPSmyth]

And I think you are naive. It's not lack of information, it's lack of interest on the part of the patient.

Go to YouTube and look up nutrition. Look it up on google. Go to a library. Turn on the TV and watch the food network. There is absolutely no shortage of information on all these topics.

This problem with obesity and poor healthcare America faces will not be solved with education. This is a cultural problem. It is "American Culture." Until you find a way to get rid of the plentifully available cheap abundant calories shoved down American throats, no amount of education will help our society.

You bring up a good point. I think everybody of sane mind in this country knows that fruits and vegetables are better for you than a bacon cheeseburger from McDonald's. They just don't care. And they don't want to be active either. To each their own

 

[Tenk]

Another point that most of you are probably not that familiar with is how taboo talking about people's weight is now in the clinical setting.

Case: young 30ish year old female, obese came to see me in the ED for knee pain. She is unsure if she twisted it or injured it. Nothing big on exam. X-rays show signs of very early osteoarthritis most likely secondary to her weight. I literally talked to this young woman for 15-20 minutes in the ED about how this could be related to her weight, how she could change things with diet and exercise, etc.

I get told later that she called and complained that the doctor called her fat. (I never used that word)

No shortage of information. Just a shortage of caring. Patients know they are overweight, they just don't care enough to do anything about it.

This is not the only time something like that has happened to me in medicine either.

Not trying to be a Debby Downer, but this is the reality you will face as a physician. It's not pretty.

 

[bobeanie95]

I

And I think you are naive. It's not lack of information, it's lack of interest on the part of the patient.

Go to YouTube and look up nutrition. Look it up on google. Go to a library. Turn on the TV and watch the food network. There is absolutely no shortage of information on all these topics.

This problem with obesity and poor healthcare America faces will not be solved with education. This is a cultural problem. It is "American Culture." Until you find a way to get rid of the plentifully available cheap abundant calories shoved down American throats, no amount of education will help our society.

I see where you are coming from but you are missing what I'm trying to get at. I'm not focusing on pursuing a public health degree and improve nutrition for everyone. That's simply impossible because yes as you mentioned everyone has different priorities and conditions. What I'm specifically referring to is incorporating nutrition into medical treatment. rather than focusing on the general population you focus on the individual patient. Depending on their condition you would tailor a nutrition regimen to minimize complications and side effects with medications. Think inborn errors in metabolism. An individual diagnosed with PKU cannot metabolize phenylanaline. With such high levels it can cause seizures, mental disabilities and so on. Diagnosing and educating a patient abut PKU and ways to avoid phenylalanine is much more complex and individualized in medicine. The treatment has to be individualized to the patients condition and not a "one size fits all"

 

[AnatomyGrey12]

sugar or no sugar you HAVE to be in a caloric deficit to lose weight/prevent obesity

That's not true. Is it one way? Yeah sure, but there are other ways. I for one am a big proponent of a ketogenic diet.

 

[JPSmyth]

Another point that most of you are probably not that familiar with is how taboo talking about people's weight is now in the clinical setting.

Case: young 30ish year old female, obese came to see me in the ED for knee pain. She is unsure if she twisted it or injured it. Nothing big on exam. X-rays show signs of very early osteoarthritis most likely secondary to her weight. I literally talked to this young woman for 15-20 minutes in the ED about how this could be related to her weight, how she could change things with diet and exercise, etc.

I get told later that she called and complained that the doctor called her fat. (I never used that word)

No shortage of information. Just a shortage of caring. Patients know they are overweight, they just don't care enough to do anything about it.

This is not the only time something like that has happened to me in medicine either.

Not trying to be a Debby Downer, but this is the reality you will face as a physician. It's not pretty.

I'm not a physician but I have seen something very similar while I was shadowing. I would imagine that this is fairly common

 

[JPSmyth]

That's not true. Is it one way? Yeah sure, but there are other ways. I for one am a big proponent of a ketogenic diet.

A ketogenic diet must also put you into a caloric deficit to lose weight. It's easier to get into a calories deficit when you aren't eating any carbs.

 

[sliceofbread136]

Nutrition to me is protein carbs and fats, plus micronutrients. I know that people can devote their entire careers to this but it seems awfully simple. Not trying to be offensive at all

That's because you don't know anything. Dunning Kruger effect.

 

[JPSmyth]

That's because you don't know anything. Dunning Kruger effect.

Everything that I've said about nutrition is correct though?

 

[LizzyM]

In regards to the white vs wheat I was referring to the glycemic index of each. Fiber is a different story, and I believe that a fiber goal should be reached daily.

The glycemic index of white bread is higher than the glycemic index of whole wheat bread and something like Natural Ovens 100% whole grain bread is significantly lower.
http://www.health.harvard.edu/diseases-and-conditions/glycemic_index_and_glycemic_load_for_100_foods

 

[JPSmyth]

The glycemic index of white bread is higher than the glycemic index of whole wheat bread and something like Natural Ovens 100% whole grain bread is significantly lower.
http://www.health.harvard.edu/diseases-and-conditions/glycemic_index_and_glycemic_load_for_100_foods

What I'm saying is that the difference that it makes (for an individual with no underlying conditions) is negligible. Glycemic index of individual foods has such a minimal effect in terms of body composition, it should not be prioritized

 

[Beezlebub]

I've been trying to run away from the subjective nature of nutrition for the past 2 years and here you are, running towards it. Obviously nutrition is important to maintain a healthy lifestyle and I commend you for your aspiration. All the best in your endeavors.

 

[sliceofbread136]

Everything that I've said about nutrition is correct though?

Not going to bother to read any of it, but next time I'm trying wean tpn I'll give you a call. Btw do you prefer SMOF lipids or omegevan?

 

[JPSmyth]

Not going to bother to read any of it, but next time I'm trying wean tpn I'll give you a call. Btw do you prefer SMOF lipids or omegevan?

I was making points about nutrition for body composition for the general "normal" public, not IV feeding. I'm not sure why you're offended by anything that I said? I didn't claim to be an expert in nutrition.

Obesity is an epidemic in this country and the simplest way to not be obese is to reduce caloric intake. I'm not saying anything controversial here as far as I know

 

[sliceofbread136]

I was making points about nutrition for body composition for the general "normal" public, not IV feeding. I'm not sure why you're offended by anything that I said? I didn't claim to be an expert in nutrition.

Obesity is an epidemic in this country and the simplest way to not be obese is to reduce caloric intake. I'm not saying anything controversial here as far as I know

You claimed it was easy when it isn't. I'm pointing out your ignore.

 

[Beezlebub]

I was making points about nutrition for body composition for the general "normal" public, not IV feeding. I'm not sure why you're offended by anything that I said? I didn't claim to be an expert in nutrition.

Obesity is an epidemic in this country and the simplest way to not be obese is to reduce caloric intake. I'm not saying anything controversial here as far as I know

Easier said than done. Dietary habit practiced over many decades usually can't be changed overnight and therefore difficult for patients to adhere to recommendations. Even abrupt cut in caloric intake places the patient at risk for withdrawal symptoms and their body may even counteract by binge eating more, thus rendering the attempt futile and even counterintuitive. The approach to persuading patients to gradually meet certain milestones in caloric reduction is crucial for positive lifestyle changes.

 

[JPSmyth]

You claimed it was easy when it isn't. I'm pointing out your ignore.

Apologies, there is definitely a ton to know about nutrition. Didn't realize the poster was referring to specific medical ailments

 

[JPSmyth]

Easier said than done. Dietary habit practiced over many decades usually can't be changed overnight and therefore difficult for patients to adhere to recommendations. Even abrupt cut in caloric intake places the patient at risk for withdrawal symptoms and their body may even counteract by binge eating more, thus rendering the attempt futile and even counterintuitive. The approach to persuading patients to gradually meet certain milestones in caloric reduction is crucial for positive lifestyle changes.

A deficit of 500cal per day (about 1lb loss per week) is sustainable and not drastic. This is not difficult to do. People don't have a great deal of willpower and I understand that, which is the hardest part

 

[Beezlebub]

A deficit of 500cal per day (about 1lb loss per week) is sustainable and not drastic. This is not difficult to do. People don't have a great deal of willpower and I understand that, which is the hardest part

What would your approach in tackling a problem like that? For example, let's say I'm a patient w/ BMI of 40, love food, and need to consume 5K calories a day.

 

[JPSmyth]

What would your approach in tackling a problem like that? For example, let's say I'm a patient w/ BMI of 40, love food, and need to consume 5K calories a day.

I'm not even in medical school yet. I'll get back to you in a few years with a better answer.

I would explain to them calories in vs calories out, proteins carbs fats, etc. I would be able to help guide them with diet and exercise. I would tell them X Y Z are the dangers of obesity and let them know that this is a REAL problem. But at the end of the day, they're in your office for 15 minutes and you aren't going to be there for the other hours of the day month and year. You can't monitor them, they're going to do what they want anyway. It's patient autonomy.

My philosophy is this... were all going to the same place anyway, death. So if you want to eat bad food, eat bad food. If you want to drink, drink. I'm going to inform you of all the risks and advise you against bad things but it is your life and you're in control of it.

 

[Beezlebub]

I'm not even in medical school yet. I'll get back to you in a few years with a better answer.

I would explain to them calories in vs calories out, proteins carbs fats, etc. I would be able to help guide them with diet and exercise. I would tell them X Y Z are the dangers of obesity and let them know that this is a REAL problem. But at the end of the day, they're in your office for 15 minutes and you aren't going to be there for the other hours of the day month and year. You can't monitor them, they're going to do what they want anyway. It's patient autonomy.

My philosophy is this... were all going to the same place anyway, death. So if you want to eat bad food, eat bad food. If you want to drink, drink. I'm going to inform you of all the risks and advise you against bad things but it is your life and you're in control of it.

Pt ed. and autonomy are certainly important factors, but a physician also has a great opportunity to connect w/ pt and prime an approach that is tailored toward improving pt health. Certainly a pt is in control of his body, but that theoretical "15 mins" can either be effective or simply wasted depending on the attitude of the physician in making his case.

 

[Espressso]

And I think you are naive. It's not lack of information, it's lack of interest on the part of the patient.

Go to YouTube and look up nutrition. Look it up on google. Go to a library. Turn on the TV and watch the food network. There is absolutely no shortage of information on all these topics.

This problem with obesity and poor healthcare America faces will not be solved with education. This is a cultural problem. It is "American Culture." Until you find a way to get rid of the plentifully available cheap abundant calories shoved down American throats, no amount of education will help our society.

Another point that most of you are probably not that familiar with is how taboo talking about people's weight is now in the clinical setting.

Case: young 30ish year old female, obese came to see me in the ED for knee pain. She is unsure if she twisted it or injured it. Nothing big on exam. X-rays show signs of very early osteoarthritis most likely secondary to her weight. I literally talked to this young woman for 15-20 minutes in the ED about how this could be related to her weight, how she could change things with diet and exercise, etc.

I get told later that she called and complained that the doctor called her fat. (I never used that word)

No shortage of information. Just a shortage of caring. Patients know they are overweight, they just don't care enough to do anything about it.

This is not the only time something like that has happened to me in medicine either.

Not trying to be a Debby Downer, but this is the reality you will face as a physician. It's not pretty.

I'd argue that it's not limited to the "american culture" but rather western cultures as a whole (with a few exceptions such as France where they consume extremely high amounts of dietary fats).

As for the obese-taboo thing. I can second this, and I'm a measly scribe not even a doc. When I first started at my scribe position just over a year ago, the main doctor I was working with would read off physical exam findings as she goes through them, and frequently there would be a "For general, obese" or "morbidly obese". Mind you, this is just at an allergy/immunology clinic, but it was a part of the p/e findings.

After a little while, she was getting too many anonymous complaints about using the term obese and our office manager told her to try and wait until we're out of the room to mention obese/morbidly obese. I think (and she does too), that this is insane.

 

[ICUBlue]

As precision medicine becomes more of a focal point, nutrigenomics will be more of a focus


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[AnatomyGrey12]

A ketogenic diet must also put you into a caloric deficit to lose weight. It's easier to get into a calories deficit when you aren't eating any carbs.

Not true.. I'll find the study and link it but even in my personal anecdote I personally eat 2000 calories more a day than I did 6 months ago when I was hypertensive and getting overweight. I even worked out regularly. I have since lost 20 pounds and my workout routine has stayed the same. The only thing that has changed is I stopped eating carbs and sugar and started eating more fat (which tends to be higher calorie btw)

 

[Tenk]

I see where you are coming from but you are missing what I'm trying to get at. I'm not focusing on pursuing a public health degree and improve nutrition for everyone. That's simply impossible because yes as you mentioned everyone has different priorities and conditions. What I'm specifically referring to is incorporating nutrition into medical treatment. rather than focusing on the general population you focus on the individual patient. Depending on their condition you would tailor a nutrition regimen to minimize complications and side effects with medications. Think inborn errors in metabolism. An individual diagnosed with PKU cannot metabolize phenylanaline. With such high levels it can cause seizures, mental disabilities and so on. Diagnosing and educating a patient abut PKU and ways to avoid phenylalanine is much more complex and individualized in medicine. The treatment has to be individualized to the patients condition and not a "one size fits all"

And? Most general pediatricians can educate parents about PKU and other inborn errors of metabolism. It's all over their board exams. If anything PKU and other inborn errors are very well taken care of by our pediatricians since newborn screening became the standard of care years ago.

 

[kwood6]

I personally believe that nutrition can be most beneficial in endocrinology, especially if you want to use it as a primary or secondary treatment. A locally renowned endocrinologist who I used to shadow told me if I wanted to be successful with endocrinology, I better have a strong foundation in nutrition. In his practice I saw certain hormone deficiencies/imbalances caused by micronutrient deficiencies and or malnutrition. He was successful in taking many of his patients off of hormone therapy with the help of nutrition as a treatment in many secondary hormone disorders.

 

[LizzyM]

What I'm saying is that the difference that it makes (for an individual with no underlying conditions) is negligible. Glycemic index of individual foods has such a minimal effect in terms of body composition, it should not be prioritized

Body composition is not the only important issue in nutritional status. Macronutrients aren't the only issue on which to focus attention for health adults and in particular for anyone with a health condition which is most of Americans.

You have a lot to learn about nutrition; I hope your school offers what you need. You should also pay attention to the psychological research on behavior change and self-efficacy. (There is a reason that this topic area has been added to the MCAT.) Providing patients with information and then saying "do what you want and don't say I didn't warn you" is not the most effective way to help people improve their health. If that is your goal, you can learn to do it effectively but you are going to need an attitude adjustment from "this seems awfully simple".

 

[Beezlebub]

Body composition is not the only important issue in nutritional status. Macronutrients aren't the only issue on which to focus attention for health adults and in particular for anyone with a health condition which is most of Americans.

You have a lot to learn about nutrition; I hope your school offers what you need. You should also pay attention to the psychological research on behavior change and self-efficacy. (There is a reason that this topic area has been added to the MCAT.) Providing patients with information and then saying "do what you want and don't say I didn't warn you" is not the most effective way to help people improve their health. If that is your goal, you can learn to do it effectively but you are going to need an attitude adjustment from "this seems awfully simple".

I agree w/ being more persistent in connecting and helping patients develop a healthy nutritional plan. However, let's be realistic w/ the health system today. Time constraint is an issue and developing a comprehensive, individualized plan for a patient (then follow-ups to track his progress) is somewhat, in my opinion, not practical given how the current system operates. Usually they would need outside consultation (nutritionist - someone who specializes) or schedule an extended apt w/ physician. The path of least resistance approach (and probably ineffective in most cases) is to simply hand out nutritional brochures/websites, but I highly doubt that would positively impact patient compliance to a nutritional regimen. They need motivation and health education.