Your doctor doesn’t know much about nutrition

There are certain things that doctors are great at. How to prescribe medications? Yes. How to do surgery? Yes. Nutrition and weight loss? No, definitely not. You might be a little stunned to hear that admission, coming from a highly trained medical specialist like myself. But, it all comes down to a physician’s training and what they see as their circle of competence.

Medical training extends over more than a decade, and there is barely any attention paid to nutrition or the equally thorny question of how to lose weight. Medical training begins in medical school, where standard curricula include a mandated number of hours for nutrition which varies depending upon where you did your training. Generally, during the 4 years of medical school, it is about 10-20 hours. I did my medical training at the University of Toronto and the University of California, Los Angeles (UCLA) but my experience was not unlike most other schools in North America.

Medical school consisted of nutritional lectures discussing things like biochemical pathways of vitamin K metabolism or learning the pathway of vitamin D activation in the kidney and skin. Yes, perhaps you might consider them nutrition, but they are really much closer to biochemistry. Vitamin D becomes 25-OH vitamin D in the kidneys and then becomes activated in the skin during sun exposure to the active 1,25-OH vitamin D. So very useful knowledge when trying to understand how to help patients lose weight.

Talk to your doctor about weight loss? Would you ask your plumber to remove your wisdom teeth? Would you ask your barista to check your vision? It doesn’t have to be this way, of course. The obvious thing to do is include more nutrition into the curriculum of medical school or residency training. It would also help if doctors learned a bit more of the physiology behind weight loss and weight gain. About the hormonal regulators of weight, and how to influence them using diet. Weight gain is a hormonal, not a caloric imbalance.