Doctors Are Not Taught Enough About Nutrition In Medical School

"Mainstream medicine is still very focused on linking weight to health," said Kearney Gunsalus, lead author of the paper and an assistant professor at the Augusta University/University of Georgia Medical Partnership. "Because people with obesity and higher body weights are more likely to have health problems, it's easy to jump to the conclusion that the weight itself is causing those problems. And if you assume that the weight is causing the problems, it seems logical to assume that weight loss is the solution."

Nutrition is a key determinant of health, but this study suggests that American physicians are not receiving the effective training required to advise their patients on the subject. The researchers recommend small changes to medical education and how healthcare providers interact with their patients that could have an impact on some of the health challenges facing modern society.

Focus more on health not specifically on weight

BMI places people into 4 categories: underweight, healthy weight, overweight, and obese. This is taught in medical school as a way to gauge general health. These researchers suggest that BMI overestimates the number of people who are unhealthy and that medical education should focus on objective measures of cardiometabolic health instead.

The main difference is that cardiometabolic health also includes measures like blood pressure, insulin resistance, cholesterol levels, and other measures to predict a more accurate predictor of overall health. 

For example, previous research demonstrated that close to half of Americans who were overweight using BMI standards were metabolically healthy. Additionally, around 1 in 3 who had a BMI in the healthy range, were actually unhealthy when assessed using more comprehensive measures. 

"When you look at some of the newest studies on obesity surgeries and the use of medications like Ozempic and Wegovy, it appears that patients can see health benefits even without weight loss," said Dr. Ellen House, co-author of the publication and an associate professor at the Medical Partnership. "We really love things that are clear-cut and black and white in medicine. But if the benefits precede and appear to be independent of weight loss, we need to shift the conversations physicians have with their patients to focus more on health and not weight loss."

The researchers suggest that current medical education is also lacking in training students how to address weight stigma with patients, whether that be under or overweight. These stigmas do not account for the biological and systemic factors that may be intersecting with weight. Factors may include availability of healthy food, affordability, and access to safe places to exercise among others. 

"Overweight patients are less likely to get the appropriate screenings or treatments for their medical concerns," said House, who is also a board-certified psychiatrist. "Physicians will miss the asthma, they'll miss the cancer, because they attribute symptoms to weight when weight isn't what's causing the patient's concerns."

Potential missed physician interactions affect patient outcomes. Being told to just lose weight based on BMI standards can demoralize a patient and make them less likely to share problems they may be experiencing. Reframing conversations to focus on healthful behaviors like moving more by doing things they enjoy could help encourage people in more positive ways toward better health. 

"I think doctors are trying to help people be healthier by advising them to lose weight; they're just not aware of the harms that can be done by that advice," Gunsalus said. "If I could wave a magic wand and have doctors do one thing differently when interacting with their patients, it would be to start from the assumption that every patient wants to be and is capable of being healthy."