The Importance of Physicians' Nutrition Literacy in the Management of Diabetes Mellitus

Schulman, Jessica A. and Rienzo, Barbara A. (2001) The Importance of Physicians' Nutrition Literacy in the Management of Diabetes Mellitus. [Journal (On-line/Unpaginated)]

Full text available as:



Despite pharmacological advances in diabetes treatment, medical nutrition therapy (MNT) continues to be an essential component of diabetes management. Nonetheless, physicians have missed opportunities to provide nutrition counseling to their patients. This presents a problem because Type 2 diabetes is an epidemic with severe consequences that result from non-adherence to nutrition protocols. The goals of this article are: 1) to explore reasons for the continued paucity of nutrition education in medical training programs, 2) to describe how a power educative approach can be used to improve patient outcomes, and 3) to identify considerations for improving nutrition literacy among physicians. These analyses lead to several recommendations for improving nutrition education for physicians.

Item Type:Journal (On-line/Unpaginated)
Keywords:Medical Education; Health Professional Education; Clinical science education; Leaning theory; Community-based; Nutrition education; prospective physicians; diabetes
Subjects:JOURNALS > Medical Education Online > MEO Peer Reviewed
ID Code:2399
Deposited By: David, Solomon
Deposited On:10 Aug 2002
Last Modified:11 Mar 2011 08:54

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Aronson S. Food for thought. J Nutr Educ. 1988;20(Suppl):8s-11s.

2. Bruer RA, Schmidt RE, Davis H. Nutrition counseling: should physicians guide their patients? Am J Prev Med. 1994;10:308-311.

3. Frankle R. Nutrition education for medical students. II. Who shall teach it? Within what framework? How? J Am Diet Assoc. 1976;68:520-525.

4. Council on Foods and Nutrition. Nutrition teaching in medical schools. JAMA. 1963;183:955-957.

5. Davis C. The report to Congress on the appropriate federal role in assuring access by medical students, residents, and practicing physicians to adequate training in nutrition. Pub Health Rep. 1994;109:824-826.

6. Maillet JO, Young EA. Position of the American Dietetic Association: nutrition education for health care professionals. J Am Diet Assoc. 1998;98:343-346.

7. Winick M, Lowell BC, Shulman L. The value of discrete nutrition courses. Bull NY Acad Med. 1984;60:619-626.

8. U.S. Department of Health and Human Services [DHHS]. National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States. URL:; 1998.

9. National Diabetes Data Group. NIDDK Diabetes Fact Sheet. Bethesda, MD: National Institutes of Health;1997 (NIH Publication No. 98-3926).

10. The American Dietetic Association [ADA]. Position of the American Dietetic Association: medical nutrition therapy and pharmacotherapy. J Am Diet Assoc. 1999;99:227-230.

11. Nair KS. A critical review of [The United Kingdom Prospective Diabetes Study] UKPS, URL:; 1999.

12. Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care. 1997;20:735-744.

13. Sheils JF, Rubin R, Stapleton DC. The estimated costs and savings of medical nutrition therapy: the Medicare population. J Am Diet Assoc. 1999;99:428-435.

14. van Weel C. Morbidity in family medicine: The potential for individual nutritional counseling, an analysis from the Nijmegen Continuous Morbidity Registration. Am J Clin Nutr. 1997;65(6 Suppl):1928s-1932s.

15. Lazarus K. Nutrition practices of family physicians after education by a physician nutrition specialist. Am J Clin Nutr. 1997;65(6 Suppl):2007s-2009s.

16. ADA. Position of The American Dietetic Association: nutrition--an essential component of medical education. J Am Diet Assoc. 1994;94:555-557.

17. Ockene JK, Ockene IS, Quirk ME, et al. Physician training for patient-centered nutrition counseling in a lipid intervention trial. Prev Med. 1995;24:563-570.

18. Travis T. Patient perceptions of factors that affect adherence to dietary regimens for diabetes mellitus. The Diabetes Educator. 1997;23:152-156.

19. Stephenson MG, Levy AS, Sass NL, McGarvey WE. 1985 NHIS findings: nutrition knowledge and baseline data for the weight-loss objectives. Pub Health Rep. 1987;102:61-67.

20. DHHS. Healthy people 2000: Progress review: nutrition. URL:; 1998.

21. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA. 1994;272:205-11.

22. Winick M. The nutritionally illiterate physician. J Nutr Educ. 1988;20(1 Suppl):12s-13s.

23. Glanz K, Gilboy MB. Physicians, preventive care, and applied nutrition: Selected literature. Acad Med. 1992;67:776-781.

24. Lawler FH, Viviani N. Patient and physician perspectives regarding treatment of diabetes: Compliance with practice guidelines. J Fam Prac. 1997;44:369-373.

25. DHHS. Healthy people 2010 objectives: URL:; 2000.

26. Association of American Medical Colleges [AAMC]. Teaching on Nutrition. J Assoc Am Med Colleges. 1947;22:240.

27. Zimmermann M, Kretchmer N. Isn't it time to teach nutrition to medical students? Am J Clin Nutr. 1993;58:828-829.

28. National Research Council. Committee on Nutrition in Medical Education, Food and Nutrition Board: nutrition education in US medical schools. Washington, DC: National Academy Press; 1985.

29. ADA. Position of The American Dietetic Association: nutrition--essential component of medical education. J Am Diet Assoc. 1987;87:642-647.

30. AAMC. 1991-1992 Curriculum Directory. Washington, D.C.: AAMC; 1991.

31. AAMC. 1992-1993 Curriculum Directory. Washington, D.C.: AAMC; 1992.

32. AAMC. 1993-1994 Curriculum Directory. Washington, D.C.: AAMC; 1993.

33. AAMC. 1994-1995 Curriculum Directory. Washington, D.C.: AAMC; 1994.

34. AAMC. 1995-1996 Curriculum Directory. Washington, D.C.: AAMC; 1995.

35. AAMC. 1996-1997 Curriculum Directory. Washington, D.C.: AAMC; 1996.

36. AAMC. 1997-1998 Curriculum Directory. Washington, D.C.: AAMC; 1997.

37. AAMC. 1998-1999 Curriculum Directory. Washington D.C.: AAMC; 1998.

38. DHHS. Report to Congress on the appropriate Federal role in assuring access by medical students, residents and practicing physicians to adequate training in nutrition. Washington, D.C.; 1993.

39. Intersociety Professional Nutrition Education Consortium. Bringing physician nutrition specialists into the mainstream: Rationale for the Intersociety Professional Nutrition Education Constortium. Am J Clin Nutr. 1998;68:894-898.

40. Ginzberg E. The future supply of physicians. Acad Med. 1996;71:1147-1153.

41. Shils M. National Dairy Council Award for Excellence in Medical and Dental Nutrition Education Lecture, 1994: nutrition education in medical schools--the prospect before us. Am J Clin Nutr. 1994;60:631-638.

42. Hafferty FW. Beyond curriculum reform: Confronting medicine's hidden curriculum. Acad Med. 1998;73:403-407.

43. Matson CC, Ullian JA, Boisaubin EV. Integrating early clinical experience curricula at two medical schools: lessons learned from the Robert Wood Johnson Foundation's Generalist Physician Initiative. Acad Med. 1999;74(1 Suppl):53s-58s.

44. Iglehart J. Forum on the future of academic medicine: session V--implications of basic and applied research for AMCs. Acad Med. 1998;73:1241-1248.

45. Schulman JA. Nutrition education in medical schools: trends and implications for health educators. Med Educ Online. 1999;4:URL:

46. Glanz K. Environmental interventions to promote healthy eating: A review of models, programs, and evidence. Health Educ Quarterly. 1988:395-415.

47. Arfken CL, Ben-Sira Z, Benotsch EG, et al. Handbook of health behavior research II: provider determinants. New York: Plenum Press; 1997.

48. Glasgow RE, Orleans CT. Adherence to smoking cessation regimens. Handbook of health behavior research II: provider determinants. New York: Plenum Press; 1997.

49. Green L, Kreuter M. Health promotion planning: an educational and environmental approach. Mountain View: Mayfield; 1991.

50. Halsted C. Clinical nutrition education: relevance and role models. Am J Clin Nutr. 1998;67:192-196.

51. Hiddink GJ, Hautvast JG, van Woerkum CM, Fieren CJ, van 't Hof MA. Consumers' expectations about nutrition guidance: the importance of primary care physicians. Am J Clin Nutr. 1997;65(6 Suppl):1974s-1979s.

52. 52. Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman and Company; 1997.

53. Council on Scientific Affairs. Education for health: a role for physicians and the efficacy of health education efforts. JAMA. 1990;263:1816-1819.

54. National Heart Lung and Blood Institute. Nutrition academic award. Washington, D.C.: National Institutes of Health; 1999.

55. Phillips MG. The nutrition knowledge of medical students. J Med Educ. 1971;46:86-90.

56. Weinsier RL, Boker JR, Feldman EB, Read MS, Brooks CM. Nutrition knowledge of senior medical students: a collaborative study of southeastern medical schools. Am J Clin Nutr. 1986;43:959-968.

57. Mlodinow S, Barrett-Connor E. Physicians' and medical students' knowledge of nutrition. Acad Med. 1989;64:105-106.

58. Winick M. Nutrition education in medical schools. Am J Clin Nutr. 1993;58:825-827.

59. Schulman JA, Wolfe EW. The nutrition self-efficacy scale for prospective physicians: Evaluating reliability and validity through rasch modeling. J Applied Measurement. 2000;1:107-130.

60. Glanz K, Tziraki C, Albright CL, Fernandes J. Nutrition assessment and counseling practices: attitudes and interests of primary care physicians. J Gen Int Med. 1995;10:89-92.

61. Wilkes MS, Usatine R, Slavin S, Hoffman JR. Doctoring: University of California, Los Angeles. Acad Med. 1998;73:32-40.


Repository Staff Only: item control page