Monday, May 11, 2015

Helping patients choose nutritious foods

- Jennifer Middleton, MD, MPH

Most of us spend little time in medical school and residency learning about nutrition; in 2010, only 25% of U.S. medical schools required any nutrition education. Few medical students value learning about nutrition and what interest does exist at the beginning of medical school tends to wane over time. The sum total of my education in nutrition, for example, consisted of telling patients to eat fewer calories if they wanted to lose weight. An article in the May 1 AFP, "Nutrition Myths and Health Dietary Advice in Clinical Practice," provides an evidence-based structure for providing more meaningful dietary counseling and dispels several common myths along the way.

Perhaps most significantly, they challenge the common dogma that 3500 calories equals 1 pound of body weight; they provide a link to the National Institutes of Health's (NIH) body weight simulator which provides more accurate estimates of expected weight loss based on diet and exercise changes. By entering in a patient's age, gender, current weight, weight loss goal, and willingness to exercise (with specific entries for several types of exercise), the patient's physician can provide more accurate counseling regarding how many calories to cut and how much exercise is needed to reach specific goals. This simulator might be a nice tool to use with patients in the office to concretely demonstrate how the size of their calorie reduction and/or exercise will influence their weight loss success. With all of these components, the NIH researchers wisely included a 2-minute video explaining optimal use of the simulator.

The article also discusses the evidence base against calcium and fiber supplements; multiple meta-analyses have failed to demonstrate any benefit in patient-oriented outcomes from using either. Patients should mostly consume whole foods and minimize ultraprocessed foods; the authors vindicate dietary fats while warning against excess refined sugar consumption. These recommendations, and especially the list of whole food alternatives in Table 1, provide concrete counseling points for family physicians. There's also an AFP By Topic on Nutrition which provides additional resources along with patient education materials.

All of our patients would benefit from eating more whole foods, but finding and cooking healthier foods may be challenging for patients who live in neighborhoods bereft of grocery stores and/or inundated with advertising for ultraprocessed foods. Providing guidance regarding good nutrition smartphone applications ("apps") might help patients make better choices. Apps that only provide calorie counts won't reinforce the importance of choosing fresh, whole foods, but other apps can help patients make better choices at the grocery store (Fooducate and Shopwell) and direct them to fresh, local foods (Lovacore is one example). EatingWell and How to Cook Everything can help patients prepare meals from whole foods who might not know how.

It's up to each of us to overcome the deficiency we likely had in our nutrition education to help our patients make good nutritional choices.




No comments:

Post a Comment