It is not news to anyone paying attention that obesity is a major health problem, not only in the US but increasingly all over the world. According to recent estimates from the World Health Organization, 1.9 billion adults over the age of 18 were either overweight or obese in 2014, a full 39% of adults worldwide. The risks of obesity include increased risks for cardiovascular disease, diabetes, musculoskeletal and joint issues and several types of cancer. I realize that there are issues with how obesity is calculated, particularly its reliance on the Body Mass Index, which certainly has its problems. I am also certainly not promoting fad diets, detoxes or fat shaming. But it is a serious concern from a medical perspective.
Since the passage of the Affordable Care Act, there have been many changes to the field of healthcare. Some of them have to do with technology, some of them have to do with the availability of and the policies of health insurance, but some of them also have to do with a shift towards preventative medicine. The shift was as much out of common sense as it is out of concern for the rapidly rising costs of healthcare. In a fee-for-service system, which is largely how the healthcare field operated until the very recent past, doctors were reimbursed for the number of services or tests they did. Industry experts worried that this would act as an incentive to run unnecessary tests, or tests that were not necessarily effective, in the quest for additional revenue. They pointed out that this was one of the major drivers in the rising costs of healthcare. A better model, they proposed, would shift the focus of healthcare more towards a pay-for-performance model. So doctors would be better reimbursed for treating patients more effectively, rather than simply giving them more treatments. Doing this would prevent the onset of many expensive chronic diseases like diabetes, while at the same time improving the quality of healthcare and quality of life for the patient. It’s common sense really; preventing the chronic disease before it strikes is far cheaper than treating it once it arrives.
Because obesity is such a large factor in many of these chronic diseases, it was targeted for better treatment. But how do you treat it? There are experts who still haven’t unraveled that question yet, but all of them will certainly agree that our diet plays a significant role. So it makes sense to begin addressing diet so that you can begin to address these factors. But one problem is immediately apparent to anyone who has ever wanted to lose a few pounds. What diet is best? When I was growing up, the fad was low fat. Snackwells. Fat free chips. Fat was the great evil, because it was speculated that eating fat made you fat due to its high caloric content. Then it switched to Low Carb, which to a certain extent is still with us today. Suddenly, it was OK to eat massive amounts of fatty meats and foods, so long as you cut sugar and carbs out of your diet completely. Now, a simple Google search will reveal that Paleo is the healthiest diet for humans. Or is it Veganism? Or the Glycemic Index? Or the Mediterranean Diet? Or going Gluten Free?
It turns out many doctors are just as confused by the research from reputable institutions which seems to come out on a daily basis that contradicts research from other equally reputable institutions. This may be one of several factors behind the stunning fact that most medical schools do not include any kind of nutritional training for medical students. This creates a gap for doctors who wish to help patients prevent conditions like diabetes or heart disease, but don’t know how to improve their diet to accomplish this goal.
Enter Tulane University’s pilot program for culinary medicine, a program created by Dr. Timothy Harlan and headed by Dr. Sonia Oyola and Dr. Geeta Maker-Clark, who were frustrated that there was almost no mention of nutrition during their medical school training. The four-week long class features instruction on common health conditions and how they can be treated with diet, as well as hands-on cooking classes where the medical students actually get to practice making meals that they can later recommend to their patients. Right now this course is only an elective, meaning it’s not required for med school students. It is also currently grant funded, so its future suffers from the uncertainty that comes with all grant-funded programs.
I think that is a phenomenal idea, and I hope that it soon becomes standard curriculum in med schools across the country. However there does seem to be a slow institutional response towards changing medical school curriculum, and not just in the area of adding nutritional studies to address obesity and the prevention of chronic diseases. There has been a very recent and much-needed shift towards interprofessional education in medical schools, and a recent NPR article profiled how medical schools are also only now just beginning to add clinical managers into the mix of professionals medical students will work with so that they can get accurate pictures on how clinics are managed.
The healthcare field is in the midst of major changes, and just like other industries the changes are not about to slow down or end anytime soon. I am looking forward to increasing cooperation between nutritional experts and the medical field at all levels.