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Most primary care doctors find it relatively easy to talk with their patients about topics like depression or cancer. Yet many shy away from talking about nutrition, or find it difficult to do. Avoiding that conversation is costly.

For someone with diabetes, it may mean the difference between losing a foot or keeping it. For someone with heart disease, that conversation could free them from workplace disability or empower them to work harder. For someone who is steadily gaining weight, it could save them from gastric bypass surgery or from a lifetime of medications to treat obesity and weight-related complications.


Many people blame lack of willpower for gaining weight. According to the University of Chicago, consumers say that willpower is their No. 1 barrier to weight loss. Americans spend $60 billion each year on diet and diet aids, but aren’t much slimmer for it. Close to 70 percent of adults are overweight or obese. Sixty percent are on diets.

As an internist, here’s what I know: Each of us should take personal responsibility for our health, and our doctors should help lead the way. Diet is the leading cause of death and disability in America. Strengthening our willpower won’t solve our obesity crisis or make us healthier.

Why are physicians so bad at helping their patients make better food choices? It boils down to education. Just 1 in 4 medical schools provide their students with formal nutrition training. This omission shows: While 94 percent of physicians feel nutrition is important, only 14 percent feel comfortable talking to patients about it. That’s a shame, because patients view their physicians as the best source of nutrition information.


Clinicians, however, often get nutrition information that’s influenced by industries selling American-style fare, like red meat, sugar, ice cream, and soda. The “moderation” clause soon creeps in. Easy-to-grab, fast food options are even sold in hospitals, the sacred places where the sickest people go for treatment and recovery.

To effectively heal, physicians should educate themselves, their medical teams, and their patients about food-based prescriptions, not fad diets or industry-backed claims, to treat the root cause of chronic disease. This advice isn’t unsolicited. One in two adults, according to a survey of 10 million people, is asking for nutrition guidance. It’s time for health care providers to take the lead.

Up to 90 percent of type 2 diabetes cases can be prevented by keeping weight under control, exercising more, eating a healthy diet, and not smoking. The glucose-stabilizers here aren’t drugs like insulin or metformin, but a diet rich in leafy greens, beans, fruits, and vegetables, combined with an active lifestyle. That advice can easily fit on a prescription pad and include a referral to a registered dietitian or a local cooking class.

When it comes to weight loss, fiber, a technical term for plant roughage, is the champion. In addition to making you feel full with fewer calories, fiber helps lower cholesterol, blood pressure, and inflammation. Paleolithic cultures consumed at least 45 grams of fiber a day, a three-fold increase from today’s daily intake of 16.

Compare these two options: a 302-calorie serving of broccoli, brown rice, and beans contains 18 grams of fiber. A 312-calorie serving of cheese crackers contains 1.

Fiber is exclusive to plant-based foods. It is one reason why vegetarian diets are one path to a healthy body weight. Willpower works best when we’re nourished and full.

Kaiser Permanente encouraged its health care providers to prescribe this approach — a whole-food, plant-based diet — to all of their patients, especially those at risk for obesity and other chronic diseases like diabetes, chronic kidney disease, and heart disease. This medical group isn’t alone. My organization, the Physicians Committee for Responsible Medicine, encourages health care providers to prescribe a whole-food, plant-based diet to their patients. The current president of the American College of Cardiology has personally adopted this eating strategy and wants his colleagues, and their patients, to do the same.

The idea here isn’t just to eat more vegetables, but to build meals around plant-based foods: vegetables, fruits, whole grains, and legumes. Think butternut squash boats, beet burgers, and DIY dinner bowls brimming with ancient grains, beans, and bountiful greens.

Does it work? Dr. Chad Teeters, the chief of cardiology at Highland Hospital, tried this approach after hearing about it at the American College of Cardiology meeting last year. Realizing that he needed to lose weight so his patients would take him seriously about making their own lifestyle changes, he adopted a plant-based diet. Since then, he has lost more than 50 pounds.

That has inspired many of his patients and his staff members to make diet and lifestyle changes, too. They now stock the staff kitchen with fresh fruits and vegetables instead of soda and less-than-healthful snack foods.

Just as physicians were instrumental in the fights against tobacco, soda, and riding in cars without seat belts, they know that today’s largest health threat is Big Food, not Zika or drug-resistant infections — though they are important.

As we teeter on the brink of a food revolution, we need doctors to lead the way. To shift demand for plant-based eating patterns, they must first understand how they work and how to prescribe them.

By learning about nutrition, passing this knowledge on to our medical teams and patients, and assembling environments in which plant-based dietary recommendations thrive, we can then look to medications and surgeries as supplemental therapy for those who need it. Health-care premiums would inevitably fall, job satisfaction would likely rise, and non-communicable disease rates would plummet. That’s an amazing payoff for simply switching to a delicious and satisfying diet.

Agustina Saenz, MD, is the director of nutrition education and policy at the nonprofit Physicians Committee for Responsible Medicine, a nonprofit organization that believes that vegetarian diets are the optimal way to meet nutritional needs.

  • Dr. Saenz, although I appreciate the jist of your article, I’d like to ask how you came to some of your conclusions based on the papers cited. The paper cited for medical schools with nutrition education is nearly a decade old. The paper you cited in concluding that consumers see physicians as the best source of nutrition information is 20 years old — at the infancy of public internet and pre-Google. Your statement that 14 percent of doctors feel comfortable talking to patients about nutrition comes from a single decade old paper of 114 participants, barely half of which (61) completed the survey. Could you provide some up-to-date sources, or at least lit reviews or summary literature supporting your statements?

  • Due to issues with blocked arteries associated with high cholesterol, my wife and I began a plant based diet. In 4 weeks I have lost 10 lbs and will be doing a lab work up in a few weeks to see how much the cholesterol numbers have improved. I exercise 4 days a week and feel great.

    • That’s great! In the spring of 2013, I cured my (longstanding) diabetes, hypertension, and gout within a few short months by going vegan and exercising several times a week. I lost over 50 pounds in three months. And while all the newfound health benefits were greatly appreciated, it was the knowledge that I was no longer contributing to the unnecessary animal holocaust and my greatly reduced ecological footprint that made going vegan imperative.

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