Reprinted from the summer 2018 issue of The Ohio Family Physician.
By: David L. Weldy, MD, PhD, FAAFP, FACSM
The phrase “in my experience” is never a good way to practice medicine, but it is a good way to question or challenge conventional wisdom, taking a second look to re-evaluate information and practices in our ever-changing world. One of the enduring truths of medicine is that 50% of what we teach medical students is accurate, but we simply do not know which part of that 50% is true. Many patients need to be educated about nutrition. With that said, a common misconception is that most patients require a consultation with a dietitian.
In my experience, most patients with diabetes, hypertension, congestive heart failure, obesity, and etc., struggle with their diets. The most common recommendation is to send them to a dietician for teaching, which often results in complex exchanges or other techniques of monitoring and choosing foods. Another way to address this is to have patients record everything they eat for one to two weeks, and then review it with them during an office visit (an additional tip is to have them take pictures of their food).
When presented with a visual of what they actually ate, they realized the visual was often quite different from what they recalled after 24-48 hours. Patients can often, if not usually, then identify much of what is wrong with their diet and what needs to be done to correct it, such as eating more fruits and vegetables. With a little help, they can even identify foods that may have hidden sodium or carbohydrates. Often times, patients require additional information about foods such as potatoes, particularly in regard to understanding nutritional value. In fact, potatoes are not even “vegetables,” they are indeed carbohydrates.
There is also a misconception that consuming fruit is being healthy. Fruit contains natural sugars, and many patients are unaware just how much sugar they are consuming. The common recommendation of grouping fruits and vegetables into one category is problematic, because patients will invariably choose fruits because they taste sweet. The “Choose MyPlate,” a nutritional program that encourages healthy eating by the U.S. Department of Agriculture, is a great tool to use and recommend to patients to develop and maintain healthy eating habits.
But still, patients will struggle with their diets. I believe the problem stems from elsewhere. Most patients have a good idea of what they should and should not eat. What they may or may not be aware of is how to use inexpensive products and seasonings to make meals taste good, satisfy one’s appetite, and provide nutritional value. I have had patients who did not know how to cook anything without bacon grease because of their upbringing. When I was young, I was a very picky eater. I was told that “I would learn to like it,” and it would be in the refrigerator for me later. “When you’re hungry enough, you will eat it…cold.”
Since that time, I have been fortunate to live in different parts of the world, where I was forced to eat what was available, and I did learn to try new and different foods. Now I love a wide variety of foods, but could very easily be content with rice and beans, or rice and dahl (split pea) along with some simple vegetables. Tastes can certainly be acquired throughout one’s life, but the younger you are in adopting these healthy eating habits the easier it will be to eat healthy as an adult.
Another common reason I hear from patients for not eating healthy is that it takes too long to cook vegetables. It is a revelation that frozen or canned vegetables (not significantly nutritionally different from fresh) in a sauce pan with a little heat is in fact the easiest and fastest way to prepare food (even I can do that). But, the underlying problem may be multifactorial. There is no place or setting where children, adolescents, and young adults learn to cook for themselves. In today’s society, many parents no longer know how to shop or cook, and therefore cannot teach their children how to either.
The elimination of home economics classes in many schools across the United States is leaving the next generation with little to no knowledge of how to perform an essential life skill—to cook and feed themselves. With very limited items to eat at home, all this results in a very limited palate and no skills to change it, even if there is a desire. If time is also a factor, even with our modern appliances of crock pots and microwaves, people often do not know how to use them efficiently to save time and make quality meals. Some studies have shown an improvement in diet after learning how to cook and shop for one’s food.
As family physicians, how can we help our patients live a healthier, more sustainable life? Instead of referring our patients to dieticians or nutritionists, there needs to be a place or setting where we can send them to learn to cook. They need cooking classes, which should include how to shop affordably as well as learn how to use seasonings to make food taste good. As leaders in our communities, we can also contact local grocery stores about offering both cooking classes and shopping assistance along with live cooking demonstrations that are free to the public. We need to strongly encourage school districts to re-instate home economic courses for both girls and boys. We need to encourage proper nutrition in cafeterias, including expanding palates with ethnic foods.
We should have nutritional resources in our offices and consider shared office visits, perhaps even outside the office. One of our residents at the University of Toledo’s Department of Family Medicine/Sports Nutrition is an excellent cook, and has arranged to take patients on shopping trips, when needed.
Also, a local hospital, near the university, has opened a downtown grocery on the main floor of the building, offering additional health and financial services, which also includes cooking classes on the second floor. I would even encourage agriculture/gardening skills to be taught so that even people with very limited space or ground could grow foodstuffs in their apartments. As a practicing family physician and teacher, I believe the possibilities are limitless. We simply need to be more imaginative in helping our patients help themselves, and in the process make everyone’s lives easier and healthier.
Article references are available on the OAFP website.