Bringing more nutrition
talk into the exam room pays off.
Nutrition was not
exactly a prominent component of Dr. Mark Sabo’s medical school curriculum.
“I had one afternoon of
nutrition training in med school,” said Sabo, an OptumCare® pediatrician in Connecticut.
He’s not alone. Only
about one-fifth of American medical schools require students to take a
nutrition course.1 And
yet, “now almost everything we see can be traced back to proper nutrition and
proper exercise,” Sabo said.
Physicians, health
systems and insurers alike can help improve Americans’ health by infusing
nutrition education into their clinic visits and covering it as a part of
preventive care.
About half of American
adults have one or more chronic conditions, many of which are related to poor
eating habits and too little physical activity. Heart disease, type 2 diabetes,
high blood pressure, bone conditions and some cancers are among them.2
Children have not
escaped the effects of a poor diet. About one-third of American youth are
overweight, increasing their risk of type 2 diabetes. Type 2 diabetes used to
be rare in kids, which is why it was called adult-onset diabetes — but no
longer.3
“Before I got into med
school in 1999, type 2 diabetes in children was not a thing,” Sabo said. “If
you saw a child with type 2 diabetes, you would write an article about it and
it would be published, because it happened so few times.”
To better respond to the
needs of his young patients, Sabo — along with his wife, Jennifer Sabo, a
registered dietitian — founded the Healthy Me Childhood Obesity Program. The
goal is to encourage positive lifestyle change through small steps over time.
“It really depends on
what the family is motivated to work on,” Jennifer Sabo said. “It can be, for
instance, decreasing juice intake, reducing screen time, or increasing physical
activity.”
An alternative to medication
The Sabos’ approach can
have lifelong effects. Treating adult patients with drugs like Lipitor for high
cholesterol and metformin for diabetes is “just putting a Band-Aid on a
problem,” said Mark Sabo.
“If we were schooled in
proper nutrition and had the ability to do more for prevention, it would go a
long way to decreasing the need for these medications and decreasing the
prevalence of these conditions,” he said.
Dr. Stuart Seigel, an
endocrinologist with OptumCare in Orange County, California, agreed. “What I
always tell the patients is that food or nutrition is more powerful than any
medication that we could prescribe.”
Seigel has created an
approach that works well for his patients with diabetes — many of whom would
rather avoid drugs if they can, he said.
“I try to simplify the
process. I give them menus that enable them to hit a certain amount of
carbohydrates per meal. Since diabetes is a disease of carbohydrate metabolism,
the fewer carbohydrates they eat, the fewer medications we need to prescribe,”
he said. “It essentially gives people the tools to gain control of their
disease through nutrition.”
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He had one patient who
went on the recommended diet and switched to a newer-generation insulin. The
combination worked wonders, resulting in a weight loss of 40 pounds and
bringing the man’s A1c, a three-month measure of blood sugar levels, down into
the fives. (The normal A1c level is below 5.7%.4)
“He says to me, ‘What
did you do? My friends don’t believe it, and frankly, I don’t believe it,’”
Seigel said. “He was absolutely shocked by the results.”
Like the Sabos, Seigel said
it is vital that patients feel the problem is not insurmountable. “A lot of
times, it's much more complicated than it needs to be. But you make it easy,
the patients are much less overwhelmed. And boom, you have success.”
Supporting more nutrition therapy
Many insurance plans
cover medical nutrition therapy (MNT) for diabetes. Medicare Part B covers it
for diabetes and kidney disease. MNT includes therapeutic services and
counseling by a registered dietitian referred by a physician to help patients
manage the disease.5
In addition, some
insurance companies consider nutritional counseling a medically necessary
preventive service for certain patients, such as obese children and adults.6
Health care providers
have called for broader coverage. In a 2017 Journal of the American
Medical Association article, endocrinologist Dr. JoAnn Manson of
Brigham and Women’s Hospital said insurers should make such coverage consistent
and be sure their policies are comprehensible for patients.7
“It has to be really
clear what’s covered and what isn’t, and hopefully clinicians will be able to
get reimbursed for these interactions,” she said.8
These services are often
underutilized. In one study, fewer than 7% of privately insured people with
newly diagnosed diabetes received diabetes self-management training to help
them learn more about nutrition, checking their blood sugar regularly and
staying active.9
Prevention works best
What if we could prevent
poor nutrition and its consequences from happening in the first place? Mark
Sabo said that’s the most effective way to keep kids and adults from developing
diabetes and other conditions related to obesity, like high cholesterol, heart
problems and kidney disease.
In fact, he incorporates
nutrition education into his encounters with all patients, not just those who
are overweight, Sabo said.
“I bring it up at every
visit. I don't care if the kid is a star athlete — we talk about proper
nutrition,” he said. “The other providers in our Healthy Me program are
encouraged to do that as well.”
Jennifer Sabo said the
program has handouts on a variety of nutrition topics, like the importance of
whole grains and increasing fruit and vegetable consumption. That way, the
provider has a sort of script to guide them.
“We have a lot of
handouts that are just basic, good healthy nutrition tips so that they can have
something every single time the family comes in,” she said.
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