Public Health

What doctors wish patients knew about healthy eating

Sara Berg, MS , News Editor

What you eat plays a leading role in your health and well-being. When someone eats healthy, it helps to protect against many chronic diseases such as heart disease, prediabetes, type 2 diabetes and obesity. But with so many fad diets and food recommendations out there, it can be hard for patients to navigate what to eat and what not to eat.

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Two AMA members took time to discuss what they wish patients knew about healthy eating. They are:

  • Stephen Devries, MD, a preventive cardiologist and executive director of the nonprofit Gaples Institute in Chicago.
  • Ethan Lazarus, MD, a family physician and obesity medicine specialist in Greenwood Village, Colorado. Dr. Lazarus is also president-elect of the Obesity Medicine Association.

Here is what these physicians had to say.

There are many different ways to approach healthy eating, but “it’s not all that helpful to just tell people to eat more fruits and vegetables—they’ve already been told that hundreds of times,” said Dr. Lazarus, adding that “people have a pretty good idea of what healthy food is but we tend to eat in an unhealthy way in spite of this.”

“Instead of just focusing on what to eat, it's nice to back up a few steps and think about why we are eating the way that we're eating because most of our eating behavior is not really predetermined with choice,” he said. “A lot of times we're just eating what's there or what's served or because we're stressed, tired or bored.

“And so, the first step should be to figure out your eating patterns, eating triggers and why you're eating in a certain way,” Dr. Lazarus added.

“A simple way to stack the deck in your favor is to eat meals prepared at home as often as possible,” said Dr. Devries. When cooking at home, focus on “meals made from a combination of unprocessed foods that don’t have labels, such as vegetables, beans, whole grains and fruit.”

It is important to note that “restaurant and takeout foods are nearly always higher in calories and added salt compared to their home-cooked counterparts,” he said. That is because “at home, you have far more control, and most people will eat much smaller portions with much more healthful ingredients than those purchased on the run.”

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When thinking about eating, it is important to approach it like you would with other healthy behaviors, said Dr. Lazarus. “And probably the most important thing a person can do is figure out an eating schedule and an eating plan.

“People who are successful in eating healthier don’t just try to make a choice at every meal—they actually have a plan about what their day or their week is going to look like,” he added. “We’ve got to get away from eating in a haphazard way or what sounds good and start eating based on a plan.”

“Eating healthfully is one of the foundations of good health,” said Dr. Devries. “Even when medication is required, it’s important to emphasize to patients that medication alone can’t do it all.”

“Optimal health will always require attention to nutrition and lifestyle,” he said.

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“An intuitive way to eat more healthfully is to become attuned to signals from your body,” Dr. Devries explained. “For example, how do you feel after snacking on a donut compared to eating a piece of fruit or a handful of nuts? How about a burger and fries compared to a salad topped with beans or fish?”

While “junk food might seem appealing in the moment, a tell-tale sign of how healthful it is for you is how you feel an hour later,” he said. “Do you feel sleepy or energized? In need of another sugar-hit or satiated?”

What is important is that “if you listen carefully, your body will signal what it needs,” Dr. Devries emphasized. 

“Sugar-sweetened drinks are the single biggest source of added sugar in the diet,” said Dr. Devries. “A great start to reducing added sugar is to replace soda and energy drinks with water or unsweetened carbonated beverages.

And if “patients say that healthful eating is too expensive, you can remind them that plain water is far cheaper than soda,” he added, noting that “if sugar-filled desserts are your typical fare, a good strategy is to have a piece of fruit for dessert.

“Even if the temptation for cakes or cookies remains, you’ll likely eat far fewer after starting with fruit,” Dr. Devries said.

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When it comes to choosing what to eat, again, try to focus on “foods that don’t have—or need—labels,” said Dr. Devries. Those include “fruits, vegetables, beans and whole grains.”

“If you add animal-sourced foods, go for the better choices like healthfully prepared fish and unsweetened yogurt,” he said, adding that it is important to also avoid certain foods such as “the main offenders,” which are “sugar sweetened drinks, processed meats and fried foods.”

“With the Mediterranean lifestyle, part of it is the food choices which are fruits, vegetables, nuts, lean protein and olive oil—they’re generally good foods,” said Dr. Lazarus, adding that it is important to avoid highly processed foods.

“The problem is people crave the highly processed foods when they’re stressed,” he added. “And it’s usually crunchy stuff like chips or, more commonly, I see the ice cream and the peanut butter usually in the evening.”

One tip is to prepackage or prepare healthy snacks that are ready to go because “if you’re going to reach for something because you’re craving stuff, you reach for something healthy,” said Dr. Lazarus.

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The COVID-19 pandemic has caused a significant increase in stress in many people. And when stress happens, eating healthy and getting a good night’s sleep go out the window. But a key step in eating better is having a good sleep schedule.

“A good eating schedule starts with your sleep schedule,” explained Dr. Lazarus. That is because “one of the first things to go when people are stressed out is their sleep. It's like they're tired, but then they can't fall asleep, they have insomnia and then they wake up and they're tired and then they're stressed—it’s a self-perpetuating cycle.

“A lot of times where I like to get started is trying to go to bed at the same time, trying to wake up at the same time and getting a reasonable number of hours of sleep,” he added. “That way you will have enough energy to get through the day.”

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Carbohydrates, fats and protein are all macronutrients, which are the main building blocks of food that are needed in relatively large amounts. But how do you know how much of each to choose?

“It isn’t possible to generalize about an ideal macronutrient distribution as individual needs vary based on medical history, stage of life and activity level,” said Dr. Devries. “It’s interesting to note that protein content has become a big selling point on food labels, but most Americans already get more protein than they need.

“For both fats and carbs, quality is even more important than quantity,” he added, noting that “avocados and French fries are both high fat items, but with obviously different impacts on health.”

“The same is true with carbohydrates—quality matters,” Dr. Devries said, adding that “think blueberries versus butterscotch.”

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Micronutrients, needed in smaller amounts, include minerals and vitamins.

“There is no need for most people to focus on micronutrients,” said Dr. Devries. That is because “a daily diet that includes a variety of colorful vegetables and fruit, whole grains, legumes and healthy sources of protein will automatically check the boxes of needed micronutrients.

“One exception is that individuals who consume no animal products generally require a B12 supplement,” he added.

The CME module, “Nutrition Science for Health and Longevity: What Every Physicians Needs to Know,” is enduring material and designated by the AMA for a maximum 4 AMA PRA Category 1 Credit™, and helps 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.

The course includes four modules that are distributed in collaboration with the AMA Ed Hub™, an online platform with high-quality CME/MOC from many trusted sources to support lifelong learning of physicians and other medical professionals. With topics relevant to you—including numerous CME modules on physician burnout—the AMA Ed Hub also offers an easy, streamlined way to find, take and track educational activities in one place, with automatic CME/MOC credit reporting for some state and specialty boards. AMA Members qualify for a 20% discount. Call (800) 262-3211 or email [email protected] for the discount code.

Learn more about AMA CME accreditation.