A slightly different version of this article was first published on IIFYM.com, December 15, 2016.
I am (happily) married to a family physician. There is a reason I do all the cooking.
If you’re remotely skeptical, you know Dr. Oz is not a reasonable source of nutrition advice. But what about your family doctor? Are they well-informed about healthy eating and how it relates to things like weight loss, disease prevention and treatment, and sports performance? Probably not.
Doctors usually don’t know shit about nutrition. If they do, it’s because they learned it on their own.
“I knew very little about nutrition when I graduated from med school,” said Dr. Yoni Freedhoff, an obesity researcher and family physician in Ottawa. “Neither med school nor my residency prepared me for nutrition in general or for weight management.”
Dr. Freedhoff explained that they did “touch” on nutrition, but there is no nutrition exam. “Theoretically, they could get every nutrition question wrong on every exam they wrote the entirety of their career and still graduate as a physician.” Re-read that previous sentence and let it sink in.
But aren’t we supposed to trust doctors as the ultimate authorities on all things health?
Per the Center for Disease Control, there were almost a billion physician office visits by Americans in 2012, an average of three visits per person. The most common reason for these visits is coughing. However, knee and back pain, type 2 diabetes and hypertension—all of which can be related to nutritional choices / obesity—were among the most popular reasons for visits.
While the family physician is a great resource for many things, one important consideration in this regard is focus. And that’s because nutrition is simply not made a priority in medical education. They are experts it treating the diseases of poor nutrition, but not in preventing them.
“Residents of today are not well educated to have an understanding of what to do to manage weight,” Dr. Freedhoff said. The problem is that there is so much studying required to become a physician, they’re going to focus on what’s required to pass. If medical schools don’t make it a priority, then students won’t bother to learn it. “It’s human nature,” Freedhoff said.
Weight management doesn’t get much attention either.
“It’s ‘eat less, move more’ messaging,” Freedhoff said (read my article about why “eat less, move more” is bullshit). While weight loss is about consuming fewer calories and adding in additional physical activity, sustainable eating strategies that lead to losing weight and keeping it off cannot be boiled down to a sound bite.
I asked Dr. Freedhoff about physicians’ knowledge of sports nutrition and his response was: “Nobody cares. No one was testing me. We didn’t even feel the need to go to the nutrition lectures.” The typical family physicians understanding ends with knowing that calories are what rule. “It’s very rudimentary,” he said.
Alas, seeing those words “MD” make many believe they know all when it comes to nutrition and weight loss. Case in point, the popularity of books written by physicians. Dr. William Davis wrote about the alleged Wheat Belly and Dr. David Perlmutter warned of developing a so-called Grain Brain. Also, that Dr. Oz guy. It’s often science fiction, and not the good kind with light sabers and warp drives.
Slapping an MD on the cover of a diet book gives it instant credibility, even though credibility is not always warranted.
That doesn’t mean all family physicians are clueless about nutrition and weight loss; there are those that have gone beyond their traditional education to become experts in these fields. One such is Dr. Spencer Nadolsky, a Maryland based family physician who referred to putting an “MD” on the cover of a diet book as “a marketing tool.” He explained, “People trust doctors. They’re an authority figure.”
Dr. Nadolsky also repeated much of what Dr. Freedhoff said in terms of how medical education is lacking in regards to nutrition and weight management.
“We received about two weeks of basic nutrition course which was an hour a day at most,” Dr. Nadolsky said. “It was very short. I’ve talked to other physicians and it is my understanding that this lack of nutritional education is still standard practice at other medical schools.” He explained that they are tested on recognizing vitamin deficiencies, but “If you didn’t know anything about nutrition you can still be a doctor.”
Dr. Nadolsky, who completed medical school and did his family medicine residency in Virginia, decided to go above and beyond, however. “In each one of our classes we’re all taught that diet and exercise are first line treatments for hypertension, diabetes and dislipidema, but we’re not taught how to get into specific recommendations,” he said. And so, he took it upon himself to learn.
“A lot of it is self-study,” Nadolsky explained. “After residency I started going to obesity conferences. There is a board specialty for obesity medicine now.” But he had to pursue it independently. (Speaking of independent pursuit of nutrition knowledge, check out the IIFYM macronutrient and metabolic calculators.)
Nadolsky is the author of the The Fat Loss Prescription and has a physique that could easily grace the cover of a fitness magazine (and his shirtless torso has appeared in Men’s Health when I interviewed him for a piece about six-pack abs). But he is far from the norm when it comes to family physicians. He took a special interest in nutrition and obesity medicine to better help his patients.
Dr. Yoni Freedhoff, who authored the bestselling book The Diet Fix, also took the initiative to become knowledgeable in obesity treatment. “I didn’t like not knowing what to tell them,” Freedhoff said. “It was such an important thing. Patients kept coming to me and asking how to lose weight.” Dr. Freedhoff was prescribing medications for conditions related to obesity and knew lifestyle changes would do a better job than the meds would, so he sought out continuing medical education in obesity treatment and prevention. He ended up becoming the third Canadian to be certified by the American Board of Obesity Medicine.
In 2014, the CDC listed five things that cause two-thirds of U.S. deaths. Three of them—heart disease, cancer and stroke—have a high correlation to diet and body weight.
Unfortunately, it is uncommon for family physicians to seek out specialized education such as Freedhoff and Nadolsky did to ensure their patients eat properly and manage their weight. But this problem goes beyond the knowledge that the average family physician lacks in terms of nutrition and weight management, and into how appointments are scheduled and family docs are paid.
“The volume of patients is very high,” Freedhoff said. “Counselling patients on lifestyle change cannot effectively be done in a short period. Fifteen minutes every three months won’t get them very far.”
No knowledge, and no time. That’s the reality of seeking nutrition, weight management and lifestyle advice from your family physician. But what should you do instead?
“That’s why we have registered dietitians to refer out to,” Dr. Nadolsky said.
“To become an RD,” explained Colleen Gerg, a registered dietitian in Pennsylvania, “requires anywhere from four to six years of education in all aspects of nutrition, all science-based. There is also a rigorous internship in both food service and clinical nutrition.” She explained that most RDs go on to earn a master’s degree in a nutrition science related field.
There is an adage that bears repeating so that the buyer can beware, however. It is “All registered dietitians are nutritionists, but not all nutritionists are registered dietitians.” In some places the term “nutritionist” is protected, and in others, not. I saw meme on Facebook that said, “How to become a nutritionist: Call yourself a nutritionist.”
Gerg, who agreed doctors have neither the time nor the expertise to provide nutrition advice, cautioned against hiring people presenting themselves as nutrition experts who are not registered dietitians. “There are unfortunately many self-taught / misinformed / anecdotal ‘experts’ touting the latest trends versus what’s based on science,” she said.
One designation to avoid is known as “Holistic Nutritionist.”
Beware the word “holistic,” as it has been co-opted by the quack side. It is usually obtained in less than a year, online, with no clinical experience requirement, and they push things like organic, cleansing, and a metric shit-ton of supplements that they’ll happily sell you for three easy payments of way too much money. Read my piece about holistic nutritionists for the Los Angeles Times.
Conversely, “The Commission on Dietetic Registration has strict requirement for maintaining RD status,” Colleen Gerg said. “Seventy-five Continuing Education Units are required per 5-year period.” What’s more: “The CEUs must purposefully further one’s education according to their specific area of expertise.”
And it’s not just that registered dietitians know nutrition better than most in general. They are likely to specialize.
“After school is when many RDs choose a specific field, then furthering their education mainly through grad school followed by attending conferences, getting certifications in that specific area and honing their skill set through work,” said Marie Spano, a registered dietitian and the sports nutritionist for the Atlanta Hawks. “Dietitians focus on specific areas of nutrition so clients are getting expert advice for their needs: cardiovascular disease, sports nutrition, renal disease, diabetes and more.”
The important takeaway message is that family physicians are better equipped to deal with your medical issues once you already have them, but not so well-versed in how to prevent them in the first place. Especially since so many such issues are lifestyle-related to begin with.
A registered dietitian, overall, is going to be the best bet for nutrition advice, although they’re not perfect either. Like the medical field has Dr. Oz, there are RDs who have gone to the dark side to profit from food fear mongering and jumping off the deep end into a pool full of goji berries and kale juice. There is also the reality that their associations are not at all above reproach.
“Dietitians of Canada is sponsored by the food industry,” said Emma Train, a registered dietitian in Calgary. “In the U.S. their association is called the Academy of Nutrition and Dietetics (AND), and it is equally influenced / sponsored by the food industry.” Until recently, AND was sponsored by Coke, and the association has done things such as put its “seal of approval” on products such as Kraft Cheese Slices. (Read Emma’s piece on my site about how “The Nutrition Industry Is Full of Shit”.)
It’s worth noting that the RDs I know aren’t pleased about the funding shenanigans of their associations.
There are, of course, other options. But you may wish to investigate thoroughly before hiring the online seller of meal plans who did a physique competition once and now calls themselves “coach.” If they’re selling Shakeology, run.
And bodybuilders may know how to achieve great physiques, but at what cost to health and sanity? Their genetics, endless training and even pharmaceutical assistance doesn’t prevent them from accepting as dogma taking every supplement they saw advertised on some website with “testosterone” in the name, or even buying human breast milk online because it allegedly gets them jacked. (Read my piece about why you shouldn’t take weight loss advice from bodybuilders.)
My friend Jennifer Sygo is a registered dietitian in Toronto who specializes in sports nutrition, and her motto is “The science of nutrition is complex. Eating shouldn’t be.” It’s sage advice.
How, what, and when you eat is an individual thing. It will depend on your age, goals, culture, personal preferences, health, finances, and numerous other inputs, including if you are prone to disordered eating habits.
Regardless of where you get nutrition advice, you’ll need to invest some time and effort into personalizing it to your own tastes. And if you do it well, you may find you’ll require far fewer visits to the doctor’s office.
James S. Fell, MBA, writes for the Los Angeles Times, Chicago Tribune, Women’s Health, Men’s Health, AskMen, the Guardian, TIME Magazine and many other fine publications. His first book was published by Random House Canada in 2014. He is currently working on his next book, which is about life-changing moments.