Editorial: D-H, Geisel School Step Up Nutrition Focus

  • An instructor in the Geisel School of Medicine and Dartmouth-Hitchcock Food as Medicine class demonstrates the proper technique for cutting and removing an avocado from its skin at the Lebanon Co-Op's teaching kitchen on Tuesday, Sept. 18, 2018. (Valley News - August Frank) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Thursday, October 11, 2018

The classical version of the 2,000-year-old Hippocratic Oath, the series of vows traditionally taken by newly minted physicians, includes a number of improbable components, such as its appeal to Apollo the Healer, Asclepius, Hygieia, Panacea and “all the gods and goddesses.” Even more improbable is its promise of tuition-free medical school (although New York University is working to change that).

But the ancient Greek medical text also connects nutrition and health, a link that has long been given short shrift by the Western medical establishment: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment,” reads a translation of the oath published in 1943 by Johns Hopkins Press.

Doctors have known for a very long time that foods can prevent illness and heal the sick: Fruits and vegetables helped keep long-distance sailors from dying of scurvy, for example. But the food-as-medicine debate has provoked controversy since antiquity and, as the pharmaceutical industry began to be developed, physicians and medical schools largely ignored diet and nutrition in favor of drugs, which not only could be tested for efficacy in controlled trials but were also, not insignificantly, extremely profitable.

In 1985, however, the National Academy of Sciences published a seminal report that pointed to insufficient nutrition education in the curriculum of most medical schools, and in recent years physicians and medical students around the country and the world — including at Dartmouth-Hitchcock and the Geisel School of Medicine at Dartmouth — have begun to get a much more thorough grounding in nutrition and the role food can play in preventing disease and helping patients establish lifestyles that promote good health.

As staff writer Nora Doyle-Burr reported on Sunday, an initiative within the Department of Medicine at Dartmouth-Hitchcock Medical Center called the Culinary Medicine Program now brings together a multidisciplinary team of physicians, dietitians and health coaches to give medical students, health care providers and patients the knowledge and skills they need to incorporate healthful foods into their diets.

Similarly, Dartmouth-Hitchcock two years ago established its Weight and Wellness Center, and D-H’s Aging Resource Center recently added a Cooking for Life program, both with many of the same goals.

At the same time, as part of the process of updating its course offerings, the Geisel School is significantly expanding its focus on food and diet by incorporating evidence-based nutrition study across all four years of the curriculum. First- and second-year students, for example, are now learning the connection among the medical sciences, diseases and nutrition. The third-year obstetrics and gynecology clerkship now includes a focus on nutrition, and the two-year On Doctoring course includes training in nutrition-specific motivational interviewing techniques.

“We’ve realized that we can’t graduate the complete physician unless we include a significant nutrition component,” Rima Itani Al-Nimr, a clinical research dietitian and director of Geisel’s year-old Nutrition in Medical Education program, told Doyle-Burr.

There’s little question that many Americans could use some guidance here.

Nearly 40 percent of U.S. adults — about 93 million of us — are obese, according to the Centers for Disease Control and Prevention. We’re snacking a lot more than we used to. Data from the National Health and Nutrition Examination Survey shows that Americans are eating nearly six times a day, up from an average of 3.9 times a day in the 1970s, with daily calories coming from snacks doubling to about 500. And lots of us — 1 in 3 Americans, according to the CDC — are eating some kind of fast food every day.

The costs are staggering. Medical spending on obesity is estimated at more than $200 billion a year. Obesity-related conditions — heart disease, stroke, Type 2 diabetes, certain types of cancer — are some of the leading causes of preventable, premature death, according to the CDC.

An expanded focus by physicians, hospitals and medical schools on the role nutrition and good eating habits have in preventing disease promises to do a great deal to help.

But the playing field is not even close to level. Doctors see their patients maybe once or twice a year. Meanwhile, the fast food industry generates $200 billion in annual revenues in the U.S. alone. It spends billions of dollars a year on television advertising — preschoolers see more than 1,000 fast food ads a year — and its reach is growing exponentially through social media. According to Fast Food Facts, McDonald’s spends nearly three times more to advertise its high-fat, high-salt, high-calorie products than every fruit, vegetable, bottled water and milk advertiser combined.

It doesn’t seem like a fair fight. But it’s one Americans — with the help of their physicians, dietitians, health coaches and others — must win.