This is a follow-up to our previous post which posed a provocative question – who contributes more to your health, doctors or dietitians?

We’ve gotten insightful feedback from Joan Endyke, MS, LDN, CPT, that we’d like to share:

1. Nutrition Training in Medical School.  Some med schools are incorporating more nutrition ed into their programs. This is great because currently some doctors’  “advice” regarding weight loss and food recommendations is appalling. But even with more nutrition ed in med school, unfortunately doctors do not have the time to listen to a patient and teach him how to change his food habits.

2. It takes more than a 10 minute visit…Dietitians typically spend an hour in an intro meeting with a client to be able to really pinpoint a person’s variables: Is it lack of knowledge? Emotional overeating? Poor planning? Which nutrients are in excess? Which are likely deficient?

During the next visit (another full hour) a good dietitian breaks down the findings, explain the physiological reasoning behind the recommendations (people don’t just want to be told what to eat, they want advice so they are able to make their own informed decisions & their habits are likely to last this way too). Lastly comes  the tricky part – realistic food choices that match a person’s job schedule, family life, activity, income, time available, etc.

This can occur with frequent, consistent follow-up to enable one to develop and maintain the right habits with continued support and advice. All of this takes TIME as well as a skilled professional – but it is well worth it in the end.

3. Health Insurance. The CDC has made “overweight” a billable medical diagnosis. Many health insurance companies allow nutrition visits now, and dietitians are able to capture overweight clients before they develop a chronic condition. HOWEVER, some insurance companies limit individuals to 2 or 3 visits per year. This is really ineffective because these scarce visits do not provide enough face-time with a dietitian for most people to change habits.

This should be remedied. Preventive care should be generously available to all via a mandate and co-payments should be reasonable. Yet clients should also have to show they are committed and making progress to continue to use those health care dollars. This can be done with a quick assessment sent to the insurance company or family physician from the RD.

4. Personal Responsibility and Incentives. In Joan’s opinion, the consumer needs to bear more responsibility in this health care mess – you can’t just blame the health insurers and doctors.

Financial incentives targeting consumer would help shift some of this. People pay more for life insurance if they have high cholesterol or are overweight. Young or reckless drives have increased car insurance rates. Similarly, people who choose to smoke, not manage their weight, cholesterol, blood pressure, etc. should pay a higher premium. If and when they have managed those conditions, the premium should be lowered.

Or it could be a tax incentive for hitting your “health goals.” The proof could be a standard assessment signed off by an MD. There is only so much a dietitian or a doctor can do – individuals need to make the changes. But they should be allowed visits with a dietitian to help them. If they choose not to – that’s fine, it’s a free country, but others should not have to bear the burden of their likely use of greater health care dollars in the long run.

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Benjamin Franklin once said that an ounce of prevention is worth a pound of cure. Let’s frame that quote into the context of this country’s current obesity crisis.

According to recent reports, obesity is responsible for about 10% of healthcare costs in the US, an estimated $147,000,000,000 (that’s 147 billion) annually.

And while our highly trained, very capable doctors can help cure, fix, and medicate a patient, a good dietitian may help a client avoid the illness in the first place. (Notice the nomenclature – patient vs client).

If you think your doctor can give you some diet tips, know this – the average physician does not receive a single credit’s worth of nutrition education while at medical school.  So when a doctor tells you to lose some weight, she does not necessarily have the tools to help you make it happen.

The US has over 550,000 doctors but less than 70,000 dietitians. The average annual salary of a physician in the US is $200,000, but the average dietitian will see less than a quarter of that amount, $49,000.

Using some very crude math, let’s assume that 10% of healthcare cost translates to 10% of doctors or 55,000 MDs. What if we magically retrained those doctors and added a nutrition degree to their quiver of skills? Would this reduce  the number of obesity related diseases by 10%?

This is all wishful thinking, because in the US today there is no direct incentive to engage in even half an ounce of prevention. It’s much more profitable to create health problems (fast food industry, junk food manufacturers) and then spend billions to cure them (Medical bills, pharmaceuticals). It’s a profitable business cycle for corporations, but not a sound proposition for consumers.

This is not in any way meant to be a lash out at doctors, who do their jobs tirelessly and loyally. It’s just that doctors are great at helping sick people, mostly after the fact. Pre-emptive care is undervalued today because there is no financial incentive in the current business ecosystem to help keep people lean and fit. In fact, dietetic consultations are not necessarily covered by health insurance.

What can be done?

Policymakers should create financial incentives for industries to prevent people from getting fat and sick. Medical schools should see find ways to integrate nutrition education into their syllabus.

If you are a young, talented and ambitious college student who wants to help people be healthy, where do you think you’ll have more impact? Shoot away in the comments below.

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The Daily Breeze reports on finding from a California study, where only a third of 46,000 respondents said they received dietary and fitness advice from their doctors:

New findings from one of the most comprehensive health surveys in the nation may shed light on one of the reasons obesity and diabetes are tough problems to solve – primary care physicians, the main gatekeepers of health information, aren’t talking enough about the need for good nutrition and exercise.

read more..

What you need to know:

Most doctors are untrained in providing nutritional advice, a job best left to dietitians. There is a wealth of dietary advice freely available on the web, take advantage of it.

What to look for in the supermarket:

Choose more foods in the perimeter aisles – fruits and vegetables, low fat milk products, and lean mets. Choose less of processed foods, sugary drinks, and highly processed snack foods.