The authority whom patients most wish to consult for information on the role of diet in the prevention and treatment of disease -- their physician -- is more often than not insufficiently trained to help them, according to an article in the October issue of the American Journal of Clinical Nutrition.

It's well known that diet plays a key role in the prevention and development of five of the ten current leading causes of death in the United States and that diet-disease connections are increasingly catalogued in medical literature.

So, why is nutrition so often largely absent, even missing, in young physicians' medical education?

The most prominent explanation, says the article, is the absence of nutrition-trained physician faculty who can argue persuasively for including nutrition in already crowded medical school curricula and, even more importantly, serve as physician role models for incorporating nutrition into patient care.

A new consortium of the nation's major professional nutrition societies, especially those with a large physician membership, plans to remedy that lack. The first objective of the Intersociety Professional Nutrition Education Consortium, created last year and listed as the collective author of the American Journal of Clinical Nutrition paper, is to increase the number of physician nutrition specialists on medical school faculties.

The Consortium plans to:

Define what a well-prepared physician nutrition specialist is;
establish educational standards for the extensive post-graduate training these specialists will need to receive in nutrition;
implement a system by which training programs can be accredited and monitored and those who complete them properly credentialled, and;
get the word out to medical students and schools that such programs and faculty exist.

"We're operating on the principle of 'build it and they will come,'" says Douglas Heimburger, M.D., M.S., one of the paper's lead authors, and an architect of the Intersociety Professional Nutrition Education Consortium. "we want to help create a supply of physician nutrition specialists. If they exist, then the medical schools and medical students are more likely to recognize the value of nutrition in patient care and demand nutrition faculty who can add this information to medical curricula."

The public also can create demand, adds Dr. Heimburger. "the american public's expectations for nutrition information related to health are increasingly sophisticated and they should expect the same from their physicians.

The presidents of the nutrition organizations that publish the American Journal of Clinical Nutrition believe the new consortium is a giant step forward in bringing nutrition into its proper place in American medicine.

M.R.C. Greenwood, Ph.D., President of the American Society of Clinical Nutrition, Inc. says, "until physicians are better trained to provide high levels of information on nutrition, americans are missing countless opportunities to take advantage of the growing body of scientific research on the role of diet in preventing and treating disease."

Connie Weaver, Ph.D., President of the American Society for Nutritional Sciences, agrees. "people want their physicians to be knowledgeable enough to help them sort through the flood of information on nutrition. this has never been more important," she adds. "americans are spending billions of dollars annually on 'alternative' or 'complementary' medical therapies remedies related to nutrition that are often unproved and in some cases may be harmful."

Despite public interest and congressional mandates, the teaching of nutrition in medical schools and residency programs remains inadequate. According to the most recent study cited in the article, only a fourth of U.S. medical schools require instruction in nutrition. Although more than half offer it as an elective, as few as 6 percent of students actually take such courses. Many schools weave nutrition information into basic science courses like biochemistry and physiology, but studies have shown that students often do not recognize these concepts as being about nutrition. Furthermore, the role of diet in preventing disease is often not adequately highlighted in such an approach. Specialty training in nutrition is not only rare, but programs vary widely from school to school and some do not emphasize prevention.

Organizations participating in the Consortium include:

• American Board of Nutrition
• American Society for Clinical Nutrition
• American Society for Parenteral and Enteral Nutrition
• National Board of Nutrition Support Certification
• American College of Nutrition
• Certification Board for Nutrition Specialists
• North American Association for the Study of Obesity
• American Society of Bariatric Physicians
• American Dietetic Association

Representatives from these societies all participated in the writing of the article.

In addition to the approximately 2,000 physicians included in the participating societies, the Consortium's external advisory committee is made up of representatives from three organizations representing physicians most often faced with nutrition questions: the American Board of Internal Medicine, American Gastroenterological Association, and the American Board of Pediatrics. Other physician groups expect to follow the Consortium's work with great interest. The National Institutes of Health provides support to the new consortium, as do a number of companies interested in nutrition.