Dear DOCTOR Owen:

I recently went to my doctor and found that I have diabetes and hypertension. I am about 100 pounds overweight (compared to my marriage weight). On numerous occasions, my doctor has mentioned that I need to lose weight. He once sent me to a dietitian, but I gained weight on her diet. I could see the disgust on my doctor’s face. I don’t know where to go or what to do. I feel like such a failure.

Born Loser

Dear “Loser”

Your doctor also feels like a loser. While you are feeling his frustration at your situation, believe me, his deepest feeling is that he is a failure for not being able to offer you more help. You see, in medical school, we physicians receive zero training in Diet Therapy. Even your registered dietitian, while proficient in nutrition and dietetics, doubtfully had extensive behavioral, social, or exercise training.

Physicians know that the primary treatment for diabetes, high blood pressure, high cholesterol, sleep apnea, acid reflux, and spine and joint problems (to name a few) is diet and exercise, but no one ever taught doctors the methods in this regard. If you expected your doctor to know the proper treatment for you and he didn’t, it has put him in a very uncomfortable situation. If you were to undergo bypass surgery, how would you feel about being your heart surgeon’s first case? Well, our medical education system has done just that to the primary doctors who are responsible for advising patients to lose weight and exercise.

Dietitians and physical therapists do not have nearly enough medical training to know what is best for the “average” person or family. Articles published in Obesity Research, Vol. 7, Suppl. 1, 101S, cover this dilemma. In one article from the Medical University of South Carolina, students were polled as to their knowledge on the subject. They had just completed their one-week nutrition course—the only one budgeted into the entire medical school curricula. Only 8% correctly identified that a Body Mass Index (BMI) of 25 or above placed patients at higher risk for cardiovascular disease. But 66% of the medical students did not know that BMI is a measure developed to correlate with risk.

In the area of nutrition, only half of the medical students—correctly—knew that breads and grains were the suggested categories from which most servings should be consumed. Only 42% of them knew that less than 30% of calories should be from fat. Most believed that physicians’ advice would have a strong impact on patient compliance. All of them, however, believed that physicians should have a strong background in nutrition. And that completed the Diet Therapy course!

If you were to read even a few of the articles appearing in Obesity Research with any regularity, you would have more education than the average medical student. I can state with absolute confidence that little, if any, medical residents receive further training in diet and exercise. Yet what top seven diagnoses do Family Practitioners and Internal Medicine specialists see most? Diabetes, high blood pressure, high cholesterol, sleep apnea, spine and joint disease, and acid reflux, for which diet and exercise are recommended as the first line of treatment in all cases.

To begin remedying this problem, in the same issue of Obesity Research cited above, it was announced that several leading medical centers would begin teaching professionals how to deal scientifically with diet and exercise. Each of the centers is responsible for its respective area in the United States: Pennington Research Center (Baton Rouge—Southeast), University of Colorado (West), UCLA (Pacific), St. Luke’s New York (Northeast), and Northwestern and Mayo Clinic (Midwest). Several more may be called on to assist in educating physicians. Called the Centers for Obesity Research and Education, their mission is also to raise public awareness and bring obesity research expertise into the community.