It is one thing to evaluate the diet of a patient with prediabetes or a chronic disease, but when there are many different areas that need attention, it adds one more task to accomplish during the brief office visit. When the dietary habits of a patient with prediabetes or a chronic disease need to be addressed, how can nutrition advice be shared when the physician does not have time?
The AMA Ed Hub™—your center for personalized learning from sources you trust—offers CME on a broad range of topics, including “Nutrition Science for Health and Longevity: What Every Physician Needs to Know,” to help physicians begin an effective nutrition conversation with patients. The four-hour, self-paced course is developed and hosted by the Gaples Institute for Integrative Cardiology, a nonprofit focused on enhancing the role of nutrition and lifestyle in health care, and distributed in collaboration with the AMA Ed Hub.
When it comes to the physician, while they have limited time, there are three things they can do that take only minutes to accomplish.
Establish nutrition as a priority
“Clinic visits are often focused on medication adherence and side effects,” said Stephen Devries, MD, a cardiologist and executive director of the Gaples Institute. “But if the importance of diet isn’t mentioned during a clinic visit, patients understandably walk away assuming that nutrition doesn’t matter.”
This can lead to missed opportunities to successfully intervene on a host of chronic health problems that otherwise could have been avoided, such as type 2 diabetes.
An important message to convey to patients is, “Taking your medicine is extremely important, but medication alone isn’t enough to keep you healthy. A healthy diet and lifestyle—added to your medicine—are essential for the best results,” said Dr. Devries.
This simple statement, he said, helps the patient understand that their physician believes that nutrition is a priority. It also increases the chances that the patient will be motivated to make positive dietary changes.
There is another benefit for physicians to talk to their patients about nutrition.
“Speaking about lifestyle can create a stronger, deeper patient-physician relationship,” said Dr. Devries. “If patients feel like their physician is inclined to do more than write a prescription or recommend a procedure, they feel better understood and taken care of.”
Address one nutrition topic each visit
With multiple lifestyle-related issues in need of change, the idea of addressing them all at one time is daunting. As discussed in the nutrition CME course, a helpful strategy is to choose one nutrition topic to discuss with the patient at each clinic visit.
“At minimum, spend one to two solid minutes devoted to nutrition,” said Dr. Devries. “It may not be all that is needed, but it’s a really good way to start the diet conversation.”
Physicians can have their patients complete a rapid diet survey—available for download in the last module—to find one nutrition topic to focus on.
“The most productive strategy is to ask the patient about the change they would like to make and together with the patient mutually set a nutrition goal,” said Dr. Devries. “Maybe you decide together that sugar-sweetened beverages can be replaced with unsweetened sparkling water. Then you make it a goal to follow-up at the next clinic visit.”
The process is referred to as motivational interviewing, one that is reviewed and practiced in the online course with patient scenarios.
Make a dietary referral that counts
“It’s clear that physicians can’t and shouldn’t do it all when it comes to nutrition counseling,” said Dr. Devries. “The delivery of nutritional interventions needs to be part of a team approach. A team that can include appropriately trained dieticians, nutritionists, nurses, health coaches and chefs.”
For patients with more complex issues and nutritional needs, making a referral to an appropriately trained dietary professional is key. However, physicians with a foundation of nutrition knowledge are better positioned to motivate patients to appreciate the benefits that a dietary referral can achieve.
AMA members are eligible for a 20 percent discount on the Gaples Institute's CME modules. Contact the Unified Service Center for the discount code at (800) 262-3211 or [email protected]. AMA PRA Category 1 Credit™ is available.
Essential Tools & Resources
Managing Type 2 Diabetes: A Team-Based Approach
AMA Doc Talk podcast series
Visit AMA’s Diabetes Prevention Guide