The promotion of nutrition and lifestyle medicine has never been more important.
The rise in lifestyle-related disease is unprecedented and there is growing evidence to show that lifestyle modifications have a huge impact on both prevention and treatment. Nutritank’s grass-roots approach is fantastic because it encourages individual medical school curriculum change as well as inspiring autonomy in the next generation of doctors. There are however, important psychosocial, economic and political factors that implicate clinical application, especially in areas of the country with the highest indices of deprivation. I recently sat down to discuss these factors with Dr Alan Gilman, a colleague of mine at a GP surgery in a deprived area of Stockport, Greater Manchester.
From a young age, children can be influenced by their family’s nutrition practices which may include a diet high in processed food or habits such as eating in front of the TV. These can be difficult to change in adulthood and Dr Gilman commented that the concurrent poor availability of nutritious food at school compounds this and despite national improvements, children continue to be served food with low nutritional value.
There is also a paucity of nutritious food available in the community; without transport to larger supermarkets many rely on a restricted supply of food. Energy dense food with a long shelf life is most likely to be bought, which often tends to be of lower nutritional value. Marketing also plays a role and Dr Gilman very rightly commented that “the food sold locally isn’t necessarily cheaper. It is marketed in a way that makes people believe they are getting a better deal and I think that’s unfair.” Some patients experience more complex issues, such as access to basic cooking facilities. There are “patients living in a room with just a microwave, which really limits what and how they can cook”, not to mention a number of homeless patients who find it almost impossible to cook from scratch.
Despite positive intentions, it can also be difficult to communicate nutrition and lifestyle medicine advice if there is a social gradient between the doctor and patient. I have certainly been aware of this issue, as has Dr Gilman “If you say to a patient, ‘hey here’s a healthy recipe’ and they see lentils, broccoli and other unfamiliar food, they’re going to be put off”.
Each patient encounter has the potential to promote nutrition and lifestyle medicine and this should be a priority for doctors. Our colleagues also play a vital role, including practice nurses in chronic disease management, health coaches who have been shown to promote sustainable lifestyle change and of course, our dietetic colleagues when more specialist input is required. More widely, there are important political, economic and social issues that if identified may facilitate change on a local and even national level.
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