As a pediatrician serving under-resourced families in Washington, DC, I was pleased to see health leaders gather at the White House Conference on Hunger, Nutrition, and Health. Addressing food insecurity and diet-related diseases is urgently needed to address the chronic disease crisis that affects six in 10 Americans.
One of the important issues discussed at the conference is the critical need for more education and training in nutrition and physical activity for health professionals, especially those working with under-resourced communities.
Although lifestyle intervention is a first-line treatment recommendation for many chronic diseases, few physicians are trained to implement it. On average, only 19.6 hours of medical school are devoted to nutrition education and training, significantly less than the recommended 25. This gap leaves many doctors unprepared to counsel patients on nutrition, much less prescribe food as medicine.
The White House conference recognized this gap and highlighted the opportunity for free continuing medical education in nutrition and food as medicine for the 100,000 physicians and other medical professionals who treat patients in areas with a high prevalence of diet-related diseases. The Lifestyle Medicine and Food as Medicine Essentials Package is available here.
As a pediatrician board-certified in lifestyle medicine, I know how important it is for clinicians to develop a foundation of knowledge that helps patients make sustainable lifestyle changes. I work in Wards 7 and 8, predominantly black communities, where about 72 percent of adults are obese and where diabetes rates are three times higher than in wealthier surrounding communities. The same chronic diseases manifest themselves in children and at ever younger ages. Several times a week, I diagnose children with high cholesterol, prediabetes and sometimes type 2 diabetes.
These differences have complex reasons, such as food and housing shortages; lack of grocery stores and public green space; unemployment; systemic racism; and chronic stress. These social determinants of health must be taken into account to level the playing field for health outcomes. But individual lifestyles related to diet and physical activity also run in families and are the immediate cause of many chronic diseases. In fact, many of the most challenging chronic diseases can be prevented, treated, or even reversed with evidence-based behavioral interventions such as dietary modification.
By developing skills in lifestyle medicine, physicians can more effectively support patients in managing chronic conditions such as obesity. And a lot of support is needed. Often the parents of children I see struggle with their relationship with food. While parents sometimes feel guilty about passing on chronic lifestyle conditions to their children, these are complex illnesses, not personal failings. Many families are already juggling many challenges to get the basic necessities of life. I prefer to initially offer my families a “buffet” of potential lifestyle changes and work with them to identify small but measurable goals that are achievable for both parent and child. Every success, no matter how small, builds confidence and subsequently changes other behaviors.
Education also helps doctors dispel common myths that discourage families from making dietary changes. For example, many people believe that only animal foods can meet adequate daily protein needs, when in fact a whole diet, mostly plant-based, can achieve this. Or that eating healthy on a budget is impossible. With a little strategy and know-how, families can be guided to maximize their public nutrition benefits, buy fresh produce, or buy canned or frozen produce to save money in their grocery budget.
Clinicians can amplify their impact by partnering with social service organizations that are equipped to help families who are medically and socially vulnerable overcome barriers to healthier lifestyles, such as housing or food insecurity. In DC, one colleague started a nutrition program that provides education and delivers products to the homes of families at risk for diet-related illnesses. Through this community program, I developed a plant nutrition curriculum that I teach to parents of children under the age of five. I also regularly work with plant-based chefs to host cooking demonstrations in the community.
To truly address the chronic disease crisis, the clinician must begin to develop the knowledge and skills to help patients change their lifestyles. The opportunity is here.
Qadira Huff is a pediatrician.
