Dear Gerrit,

I think the following recent papers will help you:

Kris-Etherton PM, Akabas SR, Bales CW, Bistrian B, Braun L, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr 2014;99(5 Suppl):1153S-66S. http://ajcn.nutrition.org/content/99/5/1153S.full.pdf+html

Levy MD, Loy L, Zatz LY. Policy approach to nutrition and physical activity education in health care professional training. Am J Clin Nutr 2014;99(5 Suppl):1194S-201S. http://ajcn.nutrition.org/content/99/5/1194S.full.pdf+html

DiMaria-Ghalili RA, Mirtallo JM, Tobin BW, Hark L, Van Horn L, Palmer CA. Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. Am J Clin Nutr 2014;99(suppl):1184S-93S. http://ajcn.nutrition.org/content/99/5/1184S.full.pdf+html

Lenders CM, Deen DD, Bistrian B, Edwards MS, Seidner DL, McMahon MM, Kohlmeier M, Krebs NF. Residency and specialties training in nutrition: a call for action. Am J Clin Nutr 2014;99(suppl):1174S-83S. http://ajcn.nutrition.org/content/99/5/1174S.full.pdf+html

Kris-Etherton PM, Akabas SR, Douglas P, Kohlmeier M, Laur C, et al. Nutrition competencies in health professionals' education and training: a new paradigm. Adv Nutr 2015;6(1):83-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288283/pdf/83.pdf

Danek RL, Berlin KL, Waite GN, Geib RW. Perceptions of Nutrition Education in the Current Medical School Curriculum. Fam Med 2017;49(10):803-806. http://www.stfm.org/Portals/49/Documents/FMPDF/FamilyMedicineVol49Issue10Danek803.pdf

Hark LA, Deen D. Position of the Academy of Nutrition and Dietetics: Interprofessional Education in Nutrition as an Essential Component of Medical Education. J Acad Nutr Diet 2017;117(7):1104-1113. http://jandonline.org/article/S2212-2672(17)30445-8/pdf

Bergeron N, Al-Saiegh S, Ip EJ. An Analysis of California Pharmacy and Medical Students' Dietary and Lifestyle Practices. Am J Pharm Educ 2017;81(8):5956. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701325/pdf/ajpe5956.pdf

Metcalf M, Rossie K, Stokes K, Tanner B. The Perceptions of Medical School Students and Faculty Toward Obesity Medicine Education: Survey and Needs Analysis. JMIR Med Educ 2017;3(2):e22. http://mededu.jmir.org/article/viewFile/mededu_v3i2e22/2

Polak R, Dacey M, Phillips EM. Time for food - training physiatrists in nutritional prescription. J Rehabil Med 2017 Jan 31;49(2):106-112. https://www.medicaljournals.se/jrm/content_files/download.php?doi=10.2340/16501977-2178

Fitzpatrick SL, Dickins K, Avery E, Ventrelle J, Shultz A, Kishen E, Rothschild S. Effect of an obesity best practice alert on physician documentation and referral practices. Transl Behav Med 2017;7(4):881-890. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684083/pdf/13142_2017_Article_514.pdf

Hofmeister M. Overweight/obese physicians: Data from different countries? Canadian Family Physician Online [eLetter] 2017. http://www.cfp.ca/content/63/2/92/tab-e-letters#overweight-obese-physicians-data-from-different-countries

Best wishes from Germany,

Martin

Dear Dr. @Martin Hofmeister,

Thank you, your answer is sooo helpful

Dear Dr Martin Hofmeister,

Thank you very much for your answers on my question!

I like very much the idea that family doctors will improve their nutrition and lifestyle guidance when in the ideal situation they practice whatv they preach! They have to set an example for their patients.

I also appreciated very much your Overweight/obese physicians: Data from different countries? Canadian Family Physician Online [eLetter] 2017.

Nutrition communication styles of family doctors are very important. May be we have also to think about the communication style we use, aimed at obese family doctors.

I give some references:

- Van Dillen SME, Hiddink GJ, Koelen MA, De Graaf C & CMJ van Woerkum. Identification of nutrition communication styles and strategies: a qualitative study among Dutch GP`s. Pat Educ Couns 2006, 63 : 74-83.

- Van Dillen SME, Hiddink GJ, Koelen MA, De Graaf C & CMJ van Woerkum : Nutrition communication in general practice. Current Nutrition and Food Science 2006, 2, 169-179.

- Van Dillen SME, Hiddink GJ, Koelen MA & CMJ van Woerkum : Nutrition communication styles of family doctors : results of quantitative research. Eur J Clin Nutr 2005; 59: S47- S56

- Van Dillen SM, Noordman J, Van Dulmen S, Hiddink GJ. Setting Goal and Implementation Intentions in consultation between Practice Nurses and Patients with Overweight or obesity in General Practice.Public Health Nutr. Nov;18(16):3051-9. Epub 2015 Feb 5.

-Van Dillen SM, Hiddink GJ. To what extent do primary care practice nurses act as case managers life style counselling regarding weight management? BMC Family Practice 2014 Dec 10;15(1):197. . doi: 10.1186/s12875-014-0197-2.

- Van Dillen SM, Noordman J, Van Dulmen S, Hiddink GJ. Quality of weight loss counseling by Dutch practice nurses: an observational study. Eur J Clin Nutr. 2015 Jan;69(1):73-8. doi: 10.1038/ejcn.2014.129. Epub 2014 Jul 2.

- van Dillen SM, van Binsbergen JJ, Koelen MA, Hiddink GJ. Nutrition and physical activity guidance practices in general practice: A critical review. Patient Educ Couns. 2013 Feb;90(2):155-69. Epub 2012 Dec 12.

- Van Dillen SM, Hiddink GJ & CMJ van Woerkum. Determinants of Dutch general practitioners` nutrition and physical activity guidance practices. Public Health Nutr 2013 Jul;16(7): 1321-31. doi: 10.1017/S1368980012003564.

- Truswell AS, Hiddink GJ, Green LW, Roberts R & C van Weel. Practice-based evidence for weight management: alliance between primary care and public health. Family Practice 2012 April; 29, Suppl 1 i6-i9.

- Dijk E van, Kampen JK, Hiddink GJ, Renes RJ, Binsbergen JJ van, Woerkum van CM. A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007. Fam Pract 2012 April; 29, Suppl 1 i61-i67.

-Truswell AS, Hiddink GJ & Chris van Weel: Editorial : Creating supportive environments for nutrition guidance : towards a synergy between Primary Care and Public Health. Family Practice 2008 Dec; 25, Suppl 1, i 7-9.

-Visser FN, Hiddink GJ, Koelen MA, Van Binsbergen JJ, Tobi H & CMJ van Woerkum. Longitudinal changes in task perceptions, self-efficacy, barriers and practices of nutrition education and treatment of overweight of General Practitioners. Family Practice 2008 Dec; 25, Suppl 1, i 105-111

-Fransen G, Hiddink GJ,Koelen MA,Van Dis SJ,Drenthen AJM,Van Binsbergen JJ&CMJ van Woerkum. The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in the Netherlands. Family Practice 2008 Dec; 25, Suppl 1, i 112-115

- Truswell AS, Hiddink GJ, van Binsbergen JJ, Kok F & C van Weel. Empowering family doctors and patients in nutrition communication. Eur J Clin Nutr 2005; 59: S1- S3.

- Van Dillen SEM, Hiddink GJ, Koelen MA, De Graaf C & CMJ van Woerkum. Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults : results of a quantitative consumer study. Eur J Clin Nutr 2004, 58 : 1306-1313

- Van Dillen S, Hiddink GJ, Koelen MA, De Graaf C & CMJ Van Woerkum. Understanding nutrition communication between health professionals and consumers : development of a model based on qualitative consumer research . Am J Clin Nutr 2003; 77 : 1065S-1072S.

- Van Weel C, Hiddink GJ & AS Truswell. Preface: The Heelsum Collaboration of General Practice Nutrition (GPN). Am J Clin Nutr 2003; 77 : 999S-1000S.

- Truswell, AS, Hiddink GJ & J Blom. Nutrition guidance by family doctors in a changing world : problems, opportunities and future possibilities. Am J Clin Nutr 2003; 1089S-1092S.

Greetings from the Netherlands,

Gerrit

Dear Prof Hiddink, Dear Gerrit,

Thank you very much for your friendly feedback. I fully agree with you, nutrition / lifestyle communication styles of family physicians are a key point of long-term obesity management - for the health of doctors as well as patients.

The numerous works on the subject of you and your colleagues are really outstanding. I have given several recommendations. I am looking forward to your further papers.

Have a good research week,

Martin

Dear Gerrit,

You will probably know the following papers:

Pollak KI, Coffman CJ, Alexander SC, Østbye T, Lyna P, Tulsky JA, Bilheimer A, Dolor RJ, Lin PH, Bodner ME, Bravender T. Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents. Patient Educ Couns 2014;96(3):327-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145021/pdf/nihms617612.pdf

Laidlaw A, McHale C, Locke H, Cecil J. Talk weight: an observational study of communication about patient weight in primary care consultations. Prim Health Care Res Dev 2015;16(3):309-15. https://pdfs.semanticscholar.org/f583/1a36f00a30868dc76bb51bd94058f4d0e21f.pdf

Barnes RD, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev 2015;16(4):304-18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491487/pdf/nihms-703360.pdf

Campos C, Nadglowski J. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Communication and Patient Self-Management. J Fam Pract 2016;65(7 Suppl):S5-9. http://www.mdedge.com/sites/default/files/jfp/supplements/pcec_obesity_suppl_0716.pdf

Crowley J, O'Connell S, Kavka A, Ball L, Nowson CA. Australian general practitioners' views regarding providing nutrition care: results of a national survey. Public Health 2016;140:7-13. https://www.researchgate.net/publication/310474956_Australian_general_practitioners%27_views_regarding_providing_nutrition_care_results_of_a_national_survey

Dumic A, Miskulin I, Matic Licanin M, Mujkic A, Cacic Kenjeric D, Miskulin M. Nutrition Counselling Practices among General Practitioners in Croatia. Int J Environ Res Public Health 2017;14(12).pii:E1499. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750917/pdf/ijerph-14-01499.pdf

All the best,

Martin

Dear Martin,

Again, thank you very much for your responses!

Most of the articles I was aware of, but not all, so thank you very much!

Best wishes,

gerrit

Dear Sir,

Very good question. Although it is not my specific area of research, I believe that you are right in questioning this!

All my best wishes.

Prof. Hess

Simply said from the "Father of Modern Medicine: “All disease begins in the gut” “Let food be your medicine and your medicine be your food” Hippocrates (460-377 BC) Known as the “Father of Modern Medicine”

Dear Daniella,

Thank you very much for your reaction!

In his wise words, Hippocrates incorporated our food as the first preventive medicine, and at the same time the first therapeutic regimen.

This wisdom exists already for more than 23 centuries, but in the history it was forgotten for longer and shorter periods.

Best wishes,

Gerrit

CDC: U.S. deaths from heart disease, cancer on the rise By AMERICAN HEART ASSOCIATION NEWS. The report, by the Centers for Disease Control and Prevention, showed that heart disease deaths increased by 3 percent between 2011 and 2014, and that cancer deaths rose by 2.6 percent during that time.

What do they call for definition of insanity? Time for a different approach and I would suggest the first place to look is "diet & lifestyle".

Thank you for your kind words. Best, Danielle

Dear Gerrit,

Here for information two short "Letters to the editor" from me on the subject:

Hofmeister M. Obesity management: General practitioners need support. Australian Family Physician 2017;46(9):630. http://www.racgp.org.au/download/Documents/AFP/2017/September/AFP-2017-9-Letters.pdf

Hofmeister M. Obesity management - an old health problem. BMJ Online [eLetter] 1 December 2017. http://www.bmj.com/content/359/bmj.j5303/rr-0

Greetings from Munich,

Martin

Dear Martin,

Thank you very much for your answer and your publications!

It is clear to me that when about 50% of the GPs is overweight or obese, that that will influence their nutrition and lifestyle advises a lot, directly and /or indirectly

Best wishes,

Gerrit

We carried out a systematic review on Nutrition in medical education. I share with you the abstract and the article:

ABSTRACT

Nutrition in medical education: a systematic review.Jennifer Crowley, Lauren Ball, Gerrit Jan Hiddink. Lancet Planet Health 2019; 3: e379–89

Summary

Background In many countries, doctors are recommended to provide nutrition care to patients to improve the dietary behaviours of individuals and populations. Here, we present a systematic review that aims to critically synthesise literature on nutrition education provided to medical students.

Methods In this systematic review, a literature search was done between May 1 and July 1, 2018, for articles on medicalstudents’ nutrition knowledge, skills, and confidence to counsel patients, from Nov 1, 2012, to Dec 31, 2018. Search

terms related to medical students included “nutrition in medical education”, “medical nutrition education”, and “undergraduate medical nutrition education”. Search terms for topic of interest included “nutrition”, “knowledge”,

“skills”, “nutrition counselling”, “confidence”, “nutrition care”, or “nutrition education”. Included studies examined any aspect of recently graduated (ie, ≤4 years) or current medical students’ nutrition knowledge, attitudes, skills, or

confidence (or all three) in nutrition or nutrition counselling; evaluated nutrition curriculum initiatives for medical students; or assessed recently graduated or current medical students’ perceptions of nutrition education. Quality

assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. Curriculum initiatives were also appraised.

Findings

66 studies were identified by the search and 24 were eligible for full-text analysis. 16 quantitative studies, three qualitative studies, and five curriculum initiatives from the USA (n=11), Europe (n=4), the Middle East (n=1),

Africa (n=1), and Australasia (n=7) met the inclusion criteria. Our analysis of these studies showed that nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education.

Deficits in nutrition education affect students’ knowledge, skills, and confidence to implement nutrition care into patient care. A modest positive effect was reported from curriculum initiatives.

Interpretation

Despite the centrality of nutrition to healthy lifestyle, medical students are not supported to provide high-quality, effective nutrition care. Medical education can be enhanced by institutional commitment to make nutrition education compulsory in medical training, establishment of nutrition competencies to provide a benchmark for nutrition knowledge and skills to be included in curricula, and supported by funding for innovative curriculum initiatives. These initiatives will improve nutrition in medical training to support future doctors for the 21st century.

This Open Acces article can be found on my Research Gate account.

Gerrit J Hiddink

Emeritus Professor Nutrition Communication through Health Professionals

Strategic Communication Chair Group

Social Sciences

Wageningen University

The Netherlands