Friday Favorites: How Much Do Doctors Actually Know About Nutrition?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“A poor diet now outranks smoking as the leading cause of death [on the planet, as well as specifically] in the United States.” In the U.S., the #1 killer of Americans is the American diet. So, if diet is humanity’s #1 killer, then obviously it’s the #1 thing taught in medical school, right? Sadly, “medical students around the world [are] poorly trained in nutrition.” It’s not that medical students aren’t interested in learning about it. Medical schools just aren’t teaching it. “[W]ithout a solid foundation of clinical nutrition knowledge and skills, physicians worldwide are generally not equipped to even begin to have an informed nutrition conversation [about nutrition] with their patients . . .”

How bad is it? One study “assessing the clinical nutrition knowledge of medical doctors” found the majority got 70 percent of the questions wrong. And they were multiple choice questions, so they should have gotten a fifth right just by chance. And the “wrong answers… were not limited to difficult or demanding questions.” For example, less than half could guess how many calories are in fat, carbs and protein; only 1 in 10 knew the recommended protein intake; and only about 1 in 3 knew what a healthy BMI was. I mean, this is like super basic nutrition knowledge.

And what’s worse, not only did the majority of medical doctors get a failing grade, but 30 percent of those who failed had “a high self-perception of their [clinical nutrition] expertise,” meaning not only were they clueless about nutrition, they were also clueless that they were clueless about nutrition, a particularly bad combination given that doctors are trusted and influential sources of healthy eating advice. For those majority of consumers who get information from their personal health care professional, “78 percent indicate making a change in their eating habits as a result of those conversations.” So, if everything the doctor knows they read in some checkout aisle magazine, that’s what the patients are going to be following.

“Only [a quarter of doctors surveyed] correctly identified the American Heart Association[’s] recommended number of fruit and vegetable servings per day, and fewer still… were aware of the recommended daily added sugar limit[s]…”. So how are they going to counsel patients on it? Yet, again, of the doctors who perceived themselves as having high nutrition knowledge, 93 percent couldn’t answer those two basic multiple-choice questions.

“Physicians with no genuine expertise in, say, [brain surgery] are neither likely to broadcast detailed opinions on that topic nor to have their [quote-unquote] ‘expert’ opinions solicited by media. Most topical domains in medicine enjoy such respect: we defer expert opinion and commentary to actual experts. Not so [with] nutrition, where the common knowledge that physicians are generally ill trained in this area is conjoined to routine invitations to physicians for their expert opinions on the matter. All too many are willing to provide [their opinions], absent any basis for actual expertise,” or worse, “made on the basis of… bias and personal preference, [sometimes] directly tethered to personal gain such as diet book sales.” That’s one of the reasons all the proceeds I receive from my books are donated directly to charity. I didn’t want the appearance of any conflicts of interest.

“In a culture that routinely fails to distinguish expertise from mere opinion or personal anecdote, we physicians should be doing all we can to establish relevant barriers to entry for expert opinion [on diet and nutrition], as in all other matters of genuine medical significance.” I mean, we’re not talking celebrity gossip. Lives are at stake, and there are “[e]ntire industries… devoted to marketing messages that may conspire directly against well-informed medical advice in this area.”

“Medical education must be brought up to date. For physicians to be ill trained in the very area most impactful on the rate of premature death at the population level is an absurd anachronism.” “The mission of medicine is to protect, defend, and advance the human condition. That mission cannot be fulfilled if diet is neglected.”

Maybe one place to start is for “physicians and health care organizations [to] collectively begin to emphasize their seriousness about nutrition in health care by practicing what they [at least should be preaching]. Is it appropriate to serve pizza and soft drinks at a resident conference while bemoaning the high prevalence of obesity and encouraging patients to eat healthier? A similarly poor example exists in medical conferences, including national meetings, where some morning sessions are accompanied by foods such as donuts and sausage.”

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• Abbasi J. Medical Students Around the World Poorly Trained in Nutrition. JAMA. 2019.
• US Burden of Disease Collaborators, Mokdad AH, Ballestros K, et al. The state of us health, 1990-2016: burden of diseases, injuries, and risk factors among us states. JAMA. 2018;319(14):1444-72.
• Healthy eating saves lives. Institute for Health Metrics and Evaluation.
• Grammatikopoulou MG, Katsouda A, Lekka K, et al. Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors. Nutrition. 2019;57:69-73.
• 2018 Food and Health Survey. Food Insight.
• Aggarwal M, Singh Ospina N, Kazory A, et al. The mismatch of nutrition and lifestyle beliefs and actions among physicians: a wake-up call. Am J Lifestyle Med. 2020;14(3):304-15.
• Katz DL. How to improve clinical practice and medical education about nutrition. AMA J Ethics. 2018;20(10):E994-1000.
• Devries S, Willett W, Bonow RO. Nutrition education in medical school, residency training, and practice. JAMA. 2019;321(14):1351-2.
• GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-72.

Video production by Glass Entertainment

Motion graphics by Avo Media