GPs' knowledge on nutrition needs updating

GPs must have more accurate knowledge of nutrition to help obese patients, says Dr David Haslam

With rising obesity, GPs and healthcare professionals are at the forefront of providing information and advice on the role of diet in preventing weight gain and maintaining physical health — but how much do we really know?

Adult obesity rates have almost quadrupled in the past 25 years with 22 per cent of the the UK population now obese and three quarters overweight.

Obesity treatment currently takes up 9 per cent of the NHS budget and a recent BMJ article ‘Obesity — can we turn the tide?’ predicts that the rising levels of obesity in the UK could bankrupt the NHS if left unchecked.

GPs are a major source of nutritional advice and, although we live in an era in which drug treatments are used as weapons against obesity, it is important to remember that nutrition and activity advice are, and always will be, first-line treatments in the battle against obesity and related disorders.

A study involving 202 GPs last year, for the British Meat Nutrition Education Service, found that two thirds of GPs gave basic healthy eating advice to their patients more than three times in a normal working week.

Knowledge on nutrition
But are we knowledgeable enough to do this adequately?  From the study, it appears that self-confessed knowledge among GPs of changes in nutrition and food manufacturing practice is poor.

For instance when asked to judge the fat content of lean pork, over a third of GPs thought it was more than 21 per cent, rather than the true level of 4 per cent. 

Food manufacturers are working to reduce the fat, sugar and salt content of their products. For example, up until the 1970s, raw red meat had high levels of fat (25–31 per cent ) but animal breeding advances and improvements in feeding, have seen these levels drop in lean cuts to only 5 per cent, 4 per cent and 8 per cent in beef, pork and lamb respectively.

Better labelling on food is also helping consumers understand what is inside the products that they buy.

Many manufacturers are promoting guideline daily amounts (GDA) on the front of pack labelling, while the Food Standards Agency advocates a traffic light system to identify healthy or unhealthy products.

Under this scheme, good-quality fresh red meat would frequently receive a green light in contrast to some cereals or breads which would turn the traffic light red based on their high sugar or salt content.

Providing healthy eating advice to patients is centred on recommending low-fat, low-sugar or low-sodium foods, but patients also need to consume enough essential vitamins and minerals to promote good health.

Iron deficiency
Nearly half of GPs (48 per cent) surveyed in 2006 stated that beef was the best source of iron — compared to only 32 per cent in 1995.

The most common mineral deficiency in the UK is iron, so it is important for GPs and patients to know the best sources of iron.

Knowledge of the benefits of fruit and vegetables has grown immensely recently, thanks to campaigns like Five a Day.

The benefits of including a diet rich in fibre and wholegrains are also becoming better understood among the general public, along with the protective effect of certain foods
in relation to many cancers.

The role of the media in informing healthcare professionals as well as patients cannot be underestimated.

Forty per cent of GPs surveyed said their nutritional information came from magazines and newspapers, with 6 per cent citing the internet.

It is the role of healthcare professionals to help patients distil and make sense of the key facts and information.

The ongoing review of the quality framework may mean that GPs are better rewarded for fighting against obesity and related disorders.

When the new GMS contract was first implemented in 2004, only three out of 1,050 quality points were for managing obesity.

The National Obesity Forum, other patient groups and professional bodies, are urging an increase in incentives for practices.

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