Research shows as little as two hours of food education is being taught in five to six years of medical school. Two Bristol students have set up an award-winning social enterprise to address this…
High blood pressure, type two diabetes and cardiovascular disease. These are some of the UK’s major chronic health conditions associated with mortality and disability. With many of these, the first step in the management pathway is to offer patients diet and lifestyle advice; such a crucial step that you’d think current front-line doctors and medical students would be confident in delivering this important advice to patients.
But that is not the case, according to medical students Iain Broadley and Ally Jaffee at Nutritank – the Bristol-born social enterprise which recently won the prestigious Pat Llewellyn prize at the BBC Food and Farming Awards. “They feel ill-equipped to give such advice and we saw why, through our own experience at medical school. From discussions with students nationwide we realised that this problem was systemic in medical education. The only ‘nutrition’ we learn concerns the physiology, anatomy and biochemistry of the digestive system. But within the context of chronic disease, theoretical teaching of nutrition and lifestyle and how this knowledge can be used to advise patients is hardly touched upon.”
So what does this mean for patients? “Missed opportunities to advise on beneficial lifestyle modifications can lead patients to look elsewhere and receive non-evidence based, potentially harmful advice,” say Iain and Ally. “This is a real problem.”
Lifestyle-related health conditions are rising exponentially and putting the NHS under immense strain as the demand for resources increases. “Of course, we don’t want to develop an individual blame culture, especially as societal issues have largely contributed to this rise, with our modern-day food environments, junk food advertising and socioeconomic inequality,” the pair continues. “However, doctors can suggest basic modifications for better nutrition, physical activity, sleep and stress management and include diet and lifestyle within a clinical history. We now have good quality evidence that lifestyle interventions can prevent cardiovascular disease and type two diabetes, particularly when implemented early in the time-course of their pathophysiology.”
Findings from the Lyon heart study, involving patients who’d had previous heart attacks, showed that when healthcare professionals advised them on Mediterranean diet principles, these patients had a 50 to 70% lower risk of recurrent heart disease. Findings from a meta-analysis involving over 200,000 cancer patients showed that sticking to a high-quality diet reduced the risk of overall mortality by 22% in cancer survivors. Meanwhile, keeping to a western dietary pattern was associated with a 46% increase in overall mortality risk.
Addressing the issue
Iain and Ally created Nutritank less than two years ago as a hub for nutrition and lifestyle medicine, with the aim to campaign for greater emphasis on this type of education within UK medical schools. Beginning from the bottom-up and taking grass-roots community action, they empowered a network of medical students through national conferences and events with registered dieticians and nutritionists collaborating with doctors to educate students, and established their own Nutritank branch at their medical school, with 23 of the total 33 UK medical schools following suit.
“As this takes place outside of the curricula, ultimately our branches seek to showcase the importance of this type of education to their medical faculty,” say Iain and Ally, who have been collecting data on nutrition in current medical education and practice. “Our research shows that as little as two or three hours of nutrition is being taught in five to six years of medical school. And interestingly the data showed the reasoning behind doctors not giving diet and lifestyle advice was primarily due to lack of confidence, not lack of time during consultations. We use this data to make educational policy briefs to be presented to faculties, the ministry of health and international governing bodies to show them the need for greater nutrition and lifestyle medicine.”
Feedback on Nutritank workshops, equipping students and professionals to speak about lifestyle changes in a sensitive, informed manner, has been positive. “An engaging and extremely relevant workshop that every medical student should take part in,” summarised one participant; “An excellent foundation for consulting future patients about their diet.”
“At a time when lifestyle-related disease is on the rise, there’s never been a more important time to bring nutrition to the forefront of medical education,” said another. ““It was really useful to highlight small, manageable approaches that we could suggest patients adopt. Enabling doctors of the future to give sound nutritional advice will bring so many benefits and help us improve the nation’s relationship with food, weight and a healthy, sustainable lifestyle.”
Having chatted with Sheila Dillon on BBC Radio 4’s The Food Programme and appeared alongside Jamie Oliver on Channel 4’s Jamie and Jimmy’s Friday Night Feast, Iain and Ally helped Jamie’s team launch the #Nutrition4Medics campaign – instrumental in adding a clause to the NHS long-term plan on a commitment to increasing nutrition education for healthcare professionals. They also helped enable a Culinary Medicine UK course to be piloted at Bristol to change the nutrition education landscape; the pair have really raised the issue in medical training. “In less than a year, having gained a large student following nationwide and through our research work, the Association for Nutrition invited us to join their interprofessional working group, who have been tasked by the General Medical Council to ensure more nutrition education is included in curricula. We were recognised as the collective medical student voice wanting a change to help our future patients.”
By the end of 2019, they’re aiming for a commitment, from each UK medical school, to increasing nutrition and lifestyle education within the curricula so future doctors can more confidently advise patients within consultations. Bravo, both!
Lead image: co-founder Iain Broadley