Every once in a while a medical journal takes a bit of a leap by publishing an article or opinion piece that may just be a bit out of their usual norm or comfort zone. Today's issue of the Journal of the American Medical Association (JAMA) may have done just that with a discussion of physician eating habits, and exhorting doctors to get to the heart-or should I say "meat"-of the matter and set an example for their patients.
Although I may sound like I am being a bit "tongue in cheek" about the article, it is actually a topic that I have thought about frequently in the past.
Go to a medical meeting, or for that matter to any meeting which is medically oriented or there are medical implications-and take a look at the food service and you will understand what I mean. Or perhaps your local hospital cafeteria would be a good start. Our local hospital is well-known for their fried chicken, and when it is served I understand the line goes out the door. And then look at the puny salad bar, stuck in the corner... Well, I suspect you get the picture. We medical folks just don't do a great job of setting a good example when it comes to what and how much we eat.
So here is the basic thesis of the JAMA article, as outlined in the first paragraph:
"Health professionals spend a great deal of time at meetings...At many of these activities, food is available. Although some members of the health professional community have called for changes to the food environment in the community in which they live, they have paid less attention to the quality of food served at hospitals, physician offices, and at conferences."
To which I say, "Yes, yes, yes!!!!!"
Do you have any idea how many lousy meals I have eaten as a doctor? How many pizza lunches I endured, especially during training? How many wonderful snacks I consumed late at night while in training (one hospital in South Philadelphia-a part of town well-known for its Italian cooking--was particularly notorious for piling plates high at dinner time in the cafeteria and having tons of Tastykakes and other delicious morsels in the "on call" rooms at night). Even today I go to meetings where the food, although delicious, is a heart attack on a plate. You just can't hide from the calories offered on a regular basis in medical meetings and educational settings.
The authors of the JAMA report note that such behaviors are still pervasive throughout the medical meeting world we live in, and that these "are meals at research meetings, funded at least in part by 21,000 grants from the National Institutes of Health and health foundations." And I would be remiss not to include organizations like my own beloved American Cancer Society on that list.
So why all of this interest and concern?
Well, it turns out-as the authors note-that many decades ago it was the changing behaviors of doctors that pointed out to their patients that smoking was dangerous for their health. Once doctors learned of the dangers, they stopped smoking in the hospitals and many gave up smoking for good (yes, Virginia, doctors used to smoke). They were leaders by example.
Today, according to the article, in 2004 44% of physicians were overweight or obese. They also noted that a study of military physicians in residency training showed that over 3 years those doctors gained 4 pounds-and that is despite what I suspect was a lot of walking and other physical activity.
What is their proposed solution?
"Just as patients are advised to increase their consumption of fruits, vegetables, and whole grains, it is time to incorporate this advice into meals served in health care settings, so health care professionals can practice what they preach."
What a novel idea!!!!!!!
Meals should be less than 700 calories, food could be labeled, healthy choices could be offered. Half the plate should be fruits and vegetables. Funding agencies, medical schools and hospitals could require that meals be healthy.
Contrast that to what the authors describe as the typical meal served at a noon medical conference, consisting of a turkey sandwich, a bag of chips, a cookie and a 12 oz sugary beverage. 1280 calories goes right to nowhere except your middle.
There could even be some additional benefits directly related to the care the health professionals provide their patients:
"It might also improve medical education and productivity, because a high glycemic index, unhealthy meal results in sleepiness during the educational event, or after the meeting, during patient care. The healthy food policy could even be expanded to require 10 minutes of activity during every hour of meetings, creating a greater health benefit."
The "new meal," they counter, could be a vegetable and hummus sandwich on whole wheat bread, a small piece of dark chocolate, and unsweetened ice tea. The damage? A mere 700 calories, with probably less of that headed towards the middle of your belly.
I admire the attitude of these doctors who wrote this article. Frankly, I think they are on track. Unfortunately, I suspect a lot of health professionals are not yet on board with this idea so the authors are bound to get some criticism.After all, we doctors and other health professionals do enjoy our meals. Just try offering a veggie sandwich and celery sticks to a bunch of ravenous bored physicians at a medical lecture and see what kind of a reaction you get. I would suggest ducking behind a nearby wall as an appropriate measure to preserve your safety.
Just like we have been trained to provide (hopefully) high quality medical care, we have simultaneously been exposed to eating opportunities that are glutinous by any measure. Maybe if we start thinking about what we are doing and the example we are setting we will start to heed that sage advice of "Physician, heal thyself!"
Now, back to my burger and fries...