Why doctors skip diet advice during routine checkups and how to bring it up

Nutrition is not a standard topic that’s currently addressed during routine medical visits. A call to action aims to change that.
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/ Source: TODAY
By A. Pawlowski

A routine medical visit includes a blood pressure check, a temperature reading and depression screening, but most people may be surprised to realize there’s often little discussion about nutrition.

That’s concerning given that a poor diet is the biggest risk factor for dying of heart disease and other illnesses, accounting for 11 million deaths around the world per year, research has found.

Now a new scientific statement from the American Heart Association is urging doctors to explore their patients’ eating habits during routine checkups.

“This was honestly a call to action … We want to encourage (physicians) to have diet be part of the conversation and not something that we ignore,” Maya Vadiveloo, lead author and assistant professor of nutrition and food sciences at the University of Rhode Island, told TODAY.

“Clinicians really do want to talk about diet; they recognize how important it is. With COVID, it’s becoming something people are talking about because obesity is related to more significant health complications.”

So what’s stopping doctors from delving into diet? A “lack of training” is one reason, the statement noted. Many physicians don’t get a lot of instruction about nutrition and obesity prevention in medical school, leading to “persistent gaps” in this part of their training, studies have found.

Doctors also often don’t have the time to ask during what’s already a whirlwind visit. Some feel a “sense of futility” if they do bring up the subject.

But doctors really can make a difference because patients see them as a very trusted source of advice, Vadiveloo said.

An important step to get the conversation started is an automatic dietary screener that would be part of the routine visit, the statement noted. This would be a quick questionnaire patients can fill out at the start of the checkup that will assess their total diet, calculate a score and alert the doctor about any red flags.

The AHA statement reviewed 15 such screening tools already available and although it didn’t endorse a specific one, the authors highlighted a few that could be helpful. They included the Mediterranean Diet Adherence Screener, which asks 14 questions about daily consumption of olive oil, fruits, vegetables, nuts, wine, fish and other foods.

How to talk to your doctor about your diet:

Since nutrition is not a standard topic that’s currently addressed during routine medical visits, your doctor may or may not bring it up. If this is a topic you want to discuss, Vadiveloo recommended simply speaking up.

“Because doctors are very receptive to this conversation, just say, ‘I’d like to make sure that I’m meeting my dietary recommendations. Do you have any advice or information that I can look at, or somebody who I can talk to to help make sure my diet is on track?’” she advised.

What happens next can vary depending on your doctor’s experience and his or her practice. Some doctors are comfortable giving advice themselves; others can refer you to experts within their medical group or an outside registered dietitian.

Vadiveloo, who is an RD, said anyone can book a well discussion about their eating habits with a registered dietitian but they may have to pay for it out of pocket. Insurance may not cover the visit unless it’s tied to a particular health condition.

To avoid fad diets, experts urged people do their own research to stick with trusted sources of nutrition advice such as the American Heart Association, the government’s MyPlate program and the Academy of Nutrition and Dietetics, which also offers help in finding a local registered dietitian.

A study in American Family Physician, the journal of The American Academy of Family Physicians, recently called diet the single most significant risk factor for disability and premature death.

With such recognition, Vadiveloo was optimistic diet would soon be a standard topic of conversation during routine health visits.

“We’re starting to see that it’s almost like a perfect storm where there’s interest, there are tools and there can be partnerships developed to really move diet to the forefront of one of the health signs that we should really be monitoring, tracking and talking about with patients,” she said.