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Nutrition January 20, 2023

4 Tips for Counseling Patients on Nutrition and Diet

Clinicians know that a well-balanced diet and proper nutrition can help lower blood pressure, cholesterol levels and the risk of developing heart disease, yet as noted in this AMA Journal of Ethics podcast, many lack the time or expertise to counsel patients on lifestyle interventions.

Mixed roasted root vegetables on a metal sheet pan

As the American College of Lifestyle Medicine points out, most health care providers spend little time learning about nutrition during their formal training. Fortunately, the fast-growing field of lifestyle medicine offers opportunities to improve nutrition education and thus physician-patient conversations around healthy eating. Here are four tips for advising patients on choosing a nutritious diet, plus a corresponding activity to dive deeper into each tip and earn CME credit.

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  1. Guide patients toward plants.

    Keto. Paleo. Mediterranean. Vegetarian. Vegan. So many dietary patterns exist that it can be overwhelming to keep up with the nutrition science. The American College of Lifestyle Medicine found that a common theme emerges across all these diets: Eating more unrefined, plant-based foods helps prevent, treat and reverse chronic disease. Encourage your patients to choose a whole-food, plant-based (WFPB) eating pattern that emphasizes vegetables, fruits, whole grains and legumes, bearing in mind that any movement toward a WFPB lifestyle is positive. As In Defense of Food author Michael Pollan writes, "Eat food. Not too much. Mostly plants."
    Learn more: Food as Medicine: Nutrition for Prevention and Longevity

  2. Remember the six micronutrients of concern.

    The Centers for Disease Control and Prevention has identified six essential vitamins and minerals required for optimal health: iron, vitamin A, folate, zinc, vitamin D and iodine. Helping patients understand how micronutrient deficiencies impact their overall health (e.g., a lack of vitamin A can lead to eye diseases and poor bone growth), and what foods contain these micronutrients (e.g., vitamin A can be found in leafy greens, fish, oranges and tomatoes), may motivate them to choose a better variety of foods. Patients need to know that the best way to get vitamins and minerals is via a well-rounded diet versus taking supplements. As this Gaples Institute podcast makes clear, what you add to your diet is as important as what foods you want to minimize.
    Learn more: Nutrition CME Series: Micronutrients and Diet

  3. Eat a healthy, balanced diet yourself.

    "There's a very powerful historical precedent for physicians and other allied health professionals leading by example—with great success," says David Eisenberg, MD, adjunct professor at the Harvard School of Public Health. (See the Stanford Medicine module, "Introduction to Food and Health," linked below). He cites the example of smoking cigarettes and how, by the 1970s, many physicians quit en masse and became advocates for their patients quitting. Similarly, physicians might affect positive change among their patients by choosing minimally processed food and cooking their own food.
    Learn more: Introduction to Food and Health

  4. Recognize the role food insecurity plays in poor nutrition.

    One out of every nine Americans is food insecure, meaning their household lacks regular access to safe and nutritious food to support the health of all family members. Any conversation about optimal diet must consider this statistic. Two questions clinicians should ask to screen for food insecurity are: "Within the past 12 months, were you worried that your food would run out before you got money to buy more?" and "Within the past 12 months, was there ever a time when the food you bought just didn't last and you didn't have money to get more?" From there, you can start connecting vulnerable patients to resources.
    Learn more: Success Story: Screening for Food Insecurity with Two Questions Results in Sixteen-Fold Increase in Food Resource Referrals

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