Ambivalence and Nutrition Education


Childhood Obesity News mentioned a few observations about the nutritional education that medical students receive, which is widely considered to be inadequate. Medical schools have been criticized. But, as with most obesity-related subjects, there is nuance.

Of course everyone should be aware of some basic things, like the destruction wreaked on the microbiome by antibiotics, which affects the metabolism deeply, which in turn affects the body’s nutritional needs and failures. An orthopedic surgeon might be particularly interested in the whether any nutrients tend to help bones heal faster.

But unless the physician aspires to dive all the way in and embrace functional medicine, nutrition info may not actually be that important in the overall scheme of things. For starters, dietary advice has the maddening habit of changing with ever-increasing frequency. Sometimes it turns out to be flat-out wrong.

Doctors tend to hold onto what they learned in med school — which is, after all, the purpose of going there. But those teachings might result in actually giving bad dietary advice to patients. Nobody has negative intentions, but when absorbed in her/his specialty, that orthopod will probably sign up for continuing education opportunities that feature the newest hip replacement hardware. Staying current with the nutrition scene may not be a high priority.

Buckle up, the ride gets rough

Pediatrician Dyan Hes writes:

Many parents ask me for a “diet” or a “print out” of exactly what their child should be eating daily. They’re often surprised that my reply is “No.” I’m not a nutritionist.

At first glance this is rather shocking. But maybe she is on to something. Taking this stand certainly doesn’t let doctors off the hook. They should learn as much as possible about nutrition. But maybe it shouldn’t be their responsibility to teach patients, or get bogged down by the many mundane tasks that effective anti-obesity therapy necessarily includes.

A convincing case is made, in some quarters, for increasing the number of professionals who do hands-on clinical obesity medicine. The point is for primary care physicians or any other specialists to refer patients to the obesity expert, just like they are referred to a physical therapist.

Another factor comes into play. As Dr. Pretlow found from listening to thousands of young people, they mostly feel like they have enough nutrition information. Cheeseburger, bad. Apple, good. Got it. Many parents echo this sentiment. They know what is supposed to be eaten. They just can’t get their kids to eat it. Hopefully, the obesity specialist has creative solutions.

Meanwhile, physicians can use their expertise in other ways. Dr. Hes says:

My job is to examine your child with a medical eye. I’ll point out complications from weight that you may not have been aware your child already had, like worsening asthma, acanthosis nigricans (a dark, velvety skin change commonly found around the neck, underarms, and groin), obstructive sleep apnea that can lead to school failure or school issues due to hypoxia (low oxygen levels) while sleeping.

Weigh the options

A parent who seeks nutritional education from a doctor might want to rethink the priorities. That knowledge is available through classes, online, and from children’s books and in many places in many forms. Why waste valuable face-time with a doctor to ask for information that is so freely accessible?

Granted, the Internet can be a wilderness of ignorance, so how does a parent know where to pay attention and give credence? Most parents don’t read journal articles. The primary care physician might pick a respected nutrition guru, and steer them in that direction. As for the rest, let the obesity consultant do the heavy lifting.

Your responses and feedback are welcome!

Source: “What I Wish Everyone Knew About Childhood Obesity: A Pediatrician Explains,”, 03/24/14
Photo credit: bertknot via Visualhunt/CC BY-SA

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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