My recent JAMAeditorial—"Nutrition Counseling in Clinical Practice: How Clinicians Can Do Better”—discusses why healthcare providers seldom address nutrition with their patients and suggests some small steps we can take.
Clinicians cite lack of time, inadequate training, and limited reimbursement as major barriers to counseling patients on nutrition and obesity. Only 1 in 4 medical schools offer a dedicated nutrition course. While data from STOP’s recent analysis of state employee health plans (unpublished) suggests that coverage for nutrition counseling services has expanded slightly since 2008, many plans only provide full coverage to pregnant women and young children; others fail to provide clear guidance on the intensity of counseling included under the covered benefit or patient cost-sharing obligations. Particularly in the context of obesity prevention and treatment, inconsistent and contradictory language across plans detersclinicians from connecting their patients with effective nutrition counseling services.
Patients with a history of unsuccessful weight loss attempts may be particularly encouraged by a shift in focus that emphasizes every food choice as an opportunity to accrue benefits rather than a mistake to be avoided. Although we lack conclusive individual-level evidence that these steps will improve long-term health outcomes, the available short-term data suggest that incorporating nutrition and behavior change counseling into routine encounters with patients at increased risk for chronic disease is a promising strategy to improve population health.
Below are several steps that nearly all clinicians can take to incorporate nutrition and obesity counseling into daily practice: