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How to get patients to grab an apple and ditch the donuts


When it comes to nutrition, Americans in droves are ignoring the advice to eat more fruits and vegetables. Instead, we’re eating donuts. Lots of donuts.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Glen Stream, MD, FAAFP, MBIWhen it comes to nutrition, Americans in droves are ignoring the advice to eat more fruits and vegetables. Instead, we’re eating donuts. Lots of donuts: Ten billion a year by one estimate1.

Thus, a new report from the Centers for Disease Control and Prevention (CDC) should come as no surprise to anyone concerned about the country’s nutritional health: the U.S. has a weight problem and it is only getting worse. According to the CDC’s National Health and Nutrition Examination Survey, 38% of adults and 17% of youth in the U.S were obese as of 2014. Among adult men, the obesity rate was 35%t; among women, it was 40.4%.


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These sobering statistics underscore the persistent challenge of obesity and the need to find new and better approaches to fighting America’s obesity epidemic. It’s of critical importance because poor eating habits can lead to a host of health problems – problems like heart disease, cancer and diabetes.

In our respective professions as a family physician and as a registered dietitian nutritionist, we see patients everyday with chronic conditions linked to morbidity and mortality. In fact, over 70% of patients seen in family medicine clinics have one or more chronic diseases, many of which are associated with poor nutrition.


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Healthcare professionals in primary care settings play an important role in helping their patients live healthier lives. Guidelines from the U.S. Preventive Services Task Force, the American Heart Association, the American Diabetes Association and others recommend that doctors, nurses and registered dieticians provide intensive “self-management” support services to patients, encouraging them to engage in self-care activities like exercise and improving their nutrition.

But the reality is that most family practices lack the time, staff and resources to provide these services. We need a better way. One promising approach for improving this picture is the patient-centered medical home (PCMH).

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A key part of the PCMH is building a team of professionals from various disciplines. In a primary care practice, that would include having a registered dietitian nutritionist (RDN) to counsel overweight and obese patients. Evidence has shown that such counseling can improve health outcomes for everything from type 2 diabetes and weight management to hypertension and high cholesterol.

At one practice in Colorado, the St. Anthony Family Medicine Practice in Westminster, RDN Janette Neel provides nutrition counseling, diabetes education and other services. She wears a second hat as a member of a team that also includes family doctors, behavioral health professionals and care managers. Having them all working on site at St. Anthony’s has the added benefit of provding patients with access to their healthcare team all in one place. It also makes it easier for Neel and other team members to communicate and collaborate with each other and to have quick access to shared patient medical records.


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While family physicians increasingly recognize the benefits of the PCMH model, the typical fee-for-service payment model has been a major hurdle to including RDNs in primary care. What’s needed are newer innovative payment models, similar to the PCMH, that can remove this barrier. With its emphasis on prevention and wellness services, the Affordable Care Act has made it easier for RDNs to provide counseling within family medical practices. Medicare also helps by paying for RDNs to provide nutritional counseling during annual wellness visits.

While family doctors, dieticians and nutritionists can and should provide guidance and advice to patients, the responsibility to make healthful choices about diet and exercise ultimately rests with the patients themselves, especially the millions of Americans who are overweight or obese.

As healthcare delivery rapidly evolves, we must work to build a team-based system that encourages patients to grab an apple and ditch the donuts.




1. Jacques, Renee. "Sweet Baby Cheesus, Americans Eat A Lot Of Mozzarella (And These 11 Other Foods)." The Huffington Post. Accessed April 14, 2014.


Glen R. Stream is a family physician in La Quinta, CA and president and board chair of Family Medicine for America’s Health.Bonnie Jortberg, Ph.D., is a registered dietician and an assistant professor in the Department of Family Medicine at the University of Colorado School of Medicine.



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