How To Address Rural Obesity? New Efforts Aim To Train Doctors About Nutrition


   If you grew up in a farm family like me, there was no shortage of farm-raised food and sweet treats available around the house. And at that time, a few extra calories didn’t make a difference because it seemed like there was always some form of physical activity going on outside.
   But fast forward a few decades and you’ll see that, with new technology and automation, on the job physical activity has decreased for many of us. But the number of calories consumed has not. And not all of those available calories are the most nutritious.
   According to the Centers for Disease Control and Prevention (CDC), fully two-thirds of American adults are overweight or obese and as many as half suffer from one or more chronic diseases like diabetes, heart disease and other health issues. 
   At the same time, nearly 15 percent of Americans have limited access to nutritionally adequate foods and they also have increased risk of diseases such as diabetes and obesity. 
   Several reports indicate that the obesity problem is even more severe in Rural America, home to about 20 percent of the nation’s population. 
   As the Bipartisan Policy Center’s (BPC) 2012 report, Lots to Lose, pointed out: “Chronic poor health affects everything from the academic performance of U.S. students, to the productivity of U.S. workers and the readiness of the U.S. military.”
   So what can we do to address this challenge that’s impacting millions and driving up health care costs across the country?
   One effort starts with training and rewarding doctors and other health care providers for addressing the role that nutrition – or lack thereof – can play in a person’s overall quality of life.
   After all, doctors are usually the first ones to see the results of poor nutrition and have the opportunity to recommend ways in which diet, exercise and other factors can interact. 
   “Getting more doctors and nurses, particular family practitioners and internal Medicine specialists, into various aspects of preventative health to keep people healthier, will be key in helping people, particularly in rural and underserved areas, become aware of better health prevention strategies,” says Dan Glickman, a former Secretary of Agriculture and Co-chair of the BPC’s Prevention Initiative. 
   He says these strategies include better diets, exercise routines and other ways like tobacco cessation to avoid chronic diseases like type 2 diabetes, high blood pressure, COPD and other breathing disorders, and various forms of cancer.
   Nutrition education lacking
   The problem is, the majority of doctors have little or no education in nutrition.
   A 2010 survey of nutrition education in U.S. medical schools found that this subject was covered inadequately or unevenly throughout all levels of medical training, including undergraduate, post-graduate, fellowship, licensing, board certification, and continuing education. 
   Only about 30 percent of the nation’s 170 accredited medical schools meet the minimum number of hours of education in nutrition and exercise science. And those numbers have been getting worse in recent years, not better. 
   The average number of hours devoted to nutrition education in U.S. medical schools has been declining, from 22.3 hours in 2004 to 19.6 hours in 2008 and 2009. Both figures fall short of the 25–30 hours of nutrition education recommended in 1985 by the National Academy of Sciences (NAS) in a 1985 report on the subject.
   The percentage of medical schools that offered a dedicated nutrition course declined from 35 percent in 2000 to 25 percent in 2008, according to “Training Doctors for Prevention-oriented Care,” a white paper that was produced by the Bipartisan Policy Center, American College of Sports Medicine and the Alliance for a Healthier Generation (the Alliance). 
   Now those three organizations, along with the Institute of Medicine (IOM) are joining together in a new, multi-year national effort to ensure medical students, physicians, nurses, and other health professionals are taught about how to initiate discussions with patients that help prevent or treat obesity. 
   “Health care professionals are on the front lines of the battle against obesity and metabolic disease,” says Glickman. “They are uniquely positioned to prompt change among individuals, families and society as a whole. That’s why we need to ensure that they have the tools to help their patients practice healthy lifestyles.” 
   The new effort, funded by a grant from the Robert Wood Johnson Foundation, will focus on implementing three policy recommendations:
   1) developing and implementing core competencies to address, treat, and prevent obesity across health professions; 
   2) improving reimbursement policy to support health services that target lifestyle factors such as nutrition and physical activity; and 
   3) recognizing and rewarding innovation to drive continued funding and administrative support for reform efforts already underway.
   “Few training programs for health professionals teach providers how to begin conversations about obesity and how to engage people with obesity in care,” said Dr. William Dietz, consultant to the IOM Roundtable on Obesity Solutions.
   Dietz will lead an effort to develop these “core competencies,” which will enable BPC and the Alliance to address payment options for addressing obesity among both the public and private players. The Alliance is developing an award, to be launched next year that will recognize, spotlight, and share promising practices from among leading schools engaged in innovative approaches, according to a BPC spokesperson. 
   This effort may take several years before the impact can show positive results. But if medical schools could all provide their students with better nutrition training and if rural communities can continue to attract those new doctors, it could be a big step towards addressing obesity down the road. 
   “Often rural areas do not have large numbers of medical specialists, but well-trained family doctors coupled with the critical needs of other health care professionals like nurses and nurse practitioners, can intervene at various stages to insure a longer and healthier life for folks in smaller communities and rural areas,” Glickman added. 
   “There is no reason why the expensive high cost diseases and prolonging a healthy life expectancy can't be better controlled all over America. This should be a priority of local and state governments, health departments, small businesses, nursing homes, groups like the YMCA and YWCA and others, including elementary and secondary schools.”
   For example, the Centers for Medicare and Medicaid Services recently found that a person enrolled in YMCA’s Diabetes Prevention saved the federal government $2,650 for each person enrolled in their 15-month program. Now Medicare will expand coverage to the YMCA and other “lifestyle change programs” in an effort to prevent more diseases. ∆
   SARA WYANT: Editor of Agri-Pulse, a weekly e-newsletter covering farm and rural policy. To contact her, go to:

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