Doctors: How to Talk to Patients About Nutrition and Diet
Contributed by Kerin Torpey Bashaw, MPH, RN, Senior Vice President, Department of Patient Safety and Risk Management, The Doctors Company
The American Heart Association estimates that 46 percent of U.S. adults have hypertension and, on average, someone dies of cardiovascular disease every 38 seconds. A 2018 report by the Centers for Disease Control and Prevention (CDC) showed the average U.S. adult is nearly obese. A 2017 study revealed that about 45 percent of deaths from cardiometabolic conditions were due to dietary factors.
Andrew M. Freeman, MD, FACC, co-chair of the Lifestyle and Nutrition Workgroup with the American College of Cardiology, explains that the drugs we use to treat heart disease can be wonderful tools, but they don’t really focus on a cure or reversal—they only control the disease.
But drugs aren’t the only option. Stephen Devries, MD, executive director of the Gaples Institute for Integrative Cardiology, stresses the wealth of research focusing on lifestyle and nutrition as the key component for curing or reversing heart disease. The data suggest that a diet filled with vegetables, fruit, whole grains, and predominantly plant-sourced protein offers the best chance for both prevention and treatment of heart disease, as well as benefits for reducing the risk of certain cancers.
Dr. Devries points to one landmark study, which found that a Mediterranean-style diet emphasizing more fish, vegetables, nuts, and whole grains yielded a 72 percent reduction in the occurrence of nonfatal myocardial infarction and death, compared to a control group. A more recent study of the Mediterranean-style diet found a 28 percent reduction in nonfatal myocardial infarction, cardiac death, and stroke, Dr. Devries notes.
The results that are possible with changes in nutrition and other lifestyle improvements make every drug and procedure pale in comparison, Dr. Freeman says. The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in vegetables, fruit, and low-fat dairy prompted a significant drop in blood pressure in only two weeks.
Dr. Devries explains the compelling results of this research in a four-hour, self-paced CME program called Nutrition Science for Health and Longevity: What Every Physician Needs to Know, recommended by The Doctors Company. One of the keys to making nutrition counseling work in a busy practice is making optimal use of the short period of time that physicians have available for nutrition counseling—a key component of the CME nutrition course.
Effective communication requires a more interactive approach that uses data to back up the recommended changes. For example, Dr. Freeman asks patients what they had for lunch that day, what they had for dinner the night before, and how active they were in the past week for a snapshot assessment of nutrition and lifestyle. He then asks permission to be critical about the diet, which indicates whether the patient is receptive to the changes that are necessary to reverse the course of heart disease.
Dr. Freeman also assesses readiness for change through a technique called motivational interviewing, which helps identify what incentivizes a person to change behaviors. Clinical scenarios that provide tips for motivational interviewing are also included in the nutrition CME course. Physicians also can support patients making healthy lifestyle changes through programs like Walk with a Doc, which encourage doctors and patients to take walks together.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.