Training physicians to educate patients about fruit and vegetables as an element of a healthful dietary pattern

A well-established association has been documented connecting obesity and other chronic diseases to increased morbidity and mortality. Yet, evidence is robust that nutrition and lifestyle play a critical role in prevention and management of life threatening diseases. Among nutrition recommendations, the World Health Organization (WHO) recommends to consume 400 grams of fruit and vegetables daily. Scaling down, that is five servings of 80 grams (2 spears of broccoli, 1 small bowl of lettuce, 3 tablespoon mixed veggies, ½ bell pepper, 1 large parsnip/onion/yam or a medium tomato). These recommendations are based on the extensive literature that fruit and vegetables can promote health and ultimately reduce chronic disease risk¹. Rationale for increased fruit and vegetables relates to popular dietary patterns such as the Mediterranean Diet or DASH dietary pattern, both with increased potassium and decreased sodium intake².

Although the message has been clear that high intake of fruit and vegetables can promote optimal health, this message is getting lost in translation amid researchers to healthcare practitioners. Researchers have continued to document the lack of nutrition training in medical school and beyond for physicians on nutrition in healthcare. Therefore, patients are not receiving quality nutrition assessments and counseling by physicians, ultimately a failure in medicine.

How can including nutrition discussions with patients improve? Patients are receptive and seek nutrition guidance; therefore, providing amble opportunities for physicians to learn nutrition basics, assessment techniques and counseling strategies is imperative. This can be achieved by highlighting the importance of nutrition in early academics and continued through practice.

• Mandate nutrition course in undergraduate curriculums.
Many universities offer a basic nutrition course (e.g. Fundamentals of Nutrition; Introduction to Nutrition), a course able to be taught by any scientist with nutrition or food science background. Educators can utilize this course as a required component to their curriculum can enhance basic knowledge of nutrient metabolism. More importantly, these courses include conceptual knowledge of healthful dietary pattern including high daily intake of fruit and vegetables. This focus can contribute efforts to meeting national standards including ‘Healthy People 2020’ and ‘European Food and Nutrition Action Plan 2015-2020’, which have goals aimed at improving overall nutrition status of the population.

• Integrate nutrition into medical schools.
Rather than the limited current offerings of nutrition in medical schools (<20 hours), increasing offerings beyond the basic biochemistry of nutrient metabolism³. Medical schools can partner with local institutions and/or Registered Dietitian Nutritionist (RDN) groups to include courses on topics such as: medical nutrition therapy, nutrition physical assessment and nutrition counseling techniques. Utilizing a Problem Based Learning (PBL) approach, cited to be effective with medical students, would encourage physicians to discuss fruit and vegetables among other healthy dietary components with their patients comfortably⁴. This case study approach can provide practical application tools to actually integrate nutrition counseling into patient interactions.

• Offer nutrition focused Continuing Medical Education (CME).
Beyond medical school, encouraging physicians to learn more about nutrition topics focused on their practice needs is a viable method for improving knowledge and confidence. Nutrition science is continuously being updated, except the fact that a healthful dietary pattern including high in fruit and vegetables continues to show improved patient outcomes (e.g. cardiovascular disease, obesity, diabetes). Proposing CME courses on nutrition application and discussing nutrition concepts with patients can enhance delivery to each and every patient.

Conclusion
The topic of nutrition in medical education needs more attention, it needs to begin starting in undergraduate curriculums and continue through medical school and beyond. With continuity among nutrition education, physicians can implement nutrition discussions with patients about healthful dietary patterns including increased quantities of fruit, vegetables and whole grains. Without modifications in the medical education system, we are failing the physicians and ultimately their patients.