Two weeks ahead of the Nutrition Summit held earlier this week at the ACGME office in Chicago featuring some of the same speakers, the Nutrition and Health: Developing a GME Framework Featured Plenary at the 2023 ACGME Annual Educational Conference discussed nutrition as a social determinant of health through the perspective of community health, examined “food as medicine,” and presented ways the medical community—including residents and fellows—could engage with local populations to improve nutrition education.
Kate Sommerfeld, MPA, president of the Social Determinants of Health Institute for ProMedica, a non-profit health system based in Toledo, Ohio working to improve clinical integration, medical education and training, and strategic community initiatives, presented first. Her community-based perspective set the tone for the presentation as she shared that up to 80 percent of a person’s health is determined by non-medical factors, such as income, food access, race, and geography.
Her team at ProMedica has already conducted close to five million hunger screens to-date in an enormous effort to gather data across 14 social determinants of health. “It is fundamental to how we deliver care,” she said, adding that “if a patient comes in, we are asking about food insecurity.” The goal, she said, is moving patients up the continuum of food security.
Part of this effort includes an initiative to provide two to three days of food at ProMedica food clinics to individuals who come in. Nutrition counseling, dietician consultants, and healthy recipes are also offered. Measuring the impact is hard, Sommerfeld acknowledged, but stressed the importance of asking questions and putting aside assumptions when patients come in. “We don’t know what someone is dealing with until we ask.”
David Seres, MD, ScM, PNS, FASPEN, director of medical nutrition and professor of medicine at Columbia University Irving Medical Center, followed by diving into what we do and don’t know about nutrition. He called the data “squishy,” but acknowledged there is a certain baseline of agreed-upon recommendations by which physicians should abide. He advocated for physician intervention, sharing data that demonstrates how a little goes a long way in this regard. “Around only 20 percent of those who are overweight hear about it from their doctors, [but] if a physician gives a little advice, the chance of improvement goes way up,” he said. He added that those who work with residents and fellows have a serious responsibility. “People follow guidelines to live longer, live healthier, and live happier. The stakes could not be higher. Who are the people to turn to if not a qualified health care professional? We must teach physicians.”
The final presenter was Jaclyn Lewis Albin, MD, CCMS, DipABLM, associate professor of internal medicine and pediatrics and director of culinary medicine at University of Texas Southwestern Medical Center. Dr. Albin credits her work with nutrition as saving her from quitting medicine and shared her perspective, as a farmer’s granddaughter, saying, “the solution of food is food and there’s a lot of joy in that.”
She was inspired to learn more about nutrition after diagnosing her husband’s Celiac disease. As a second-year resident at the time, however, she still was not sure how to properly help him. She stressed that the more nutrition education they have, the more confident physicians are to counsel patients. She emphasized, as did her co-presenters, that knowing where patients come from is how physicians help them. She shared the story of a patient with a history of cancer who was seemingly inexplicably losing weight. They went through $3 million worth of tests trying to find the issue and get to a proper diagnosis, but it wasn’t until the patient was asked about food insecurity that the treatment team got to the root of the problem: the patient was losing weight because of difficulty finding food.
Grassroots movements create change, Dr. Albin said, adding that “we have to make food sexy.” There is disagreement about certain foods and nutrition guidelines, but there is plenty that physicians can do and that can be taught to residents and fellows to help engage communities and improve nutrition.
“Don’t die on a hill of eggs,” joked Dr. Albin, who presented “Teaching the Clinical Experience of Nutrition” at this week’s Nutrition Summit in Chicago.
Visit Learn at ACGME to watch the Nutrition and Health: Developing a GME Framework plenary and other featured sessions from the 2023 Annual Educational Conference.