One of the great paradoxes of American health care is that there’s so much agreement about what’s driving our current chronic disease epidemics, but so little agreement about how to do what ought to be done to reduce risk and prevent these diseases.

Few would deny that lifestyle change, healthier diets, exercise and nutrition guidance are good medicine. So why is it that so few doctors are practicing lifestyle-based medicine, and so few Americans have access to good comprehensive preventive care?

There are many reasons: lack of reimbursement; pressure to see more patients in less time; the need to practice “defensive” medicine; excessive time spent on administrative tasks; patient expectations that doctors have magic bullets to “fix” them quickly, painlessly, and free of charge. None of these factors is likely to be substantially improved under the proposed federal healthcare “reform.”

It’s very easy to understand the anger, frustration, disappointment and resentment physicians feel. Those feelings are certainly justifiable, but unfortunately, they don’t help doctors, and they certainly don’t improve patient care! It may be easier to focus one’s rage against the externals, but it is much more constructive to try to understand how one’s own attitudes, beliefs, and habits are contributing to the current situation.

For the past 20 years as a clinical nutritionist, I have been implementing and teaching nutrition counseling programs that enable primary care doctors to provide comprehensive, drug-free, food and lifestyle-based weight loss and disease management programs. I’ve worked with more than 700 physicians, and I’ve had a unique opportunity to understand the challenges—both external and internal—doctors face. By identifying the internal places where you get “stuck” you’ll be better able to find ways to improve your external situation.

Embracers vs Resisters

I find that the physicians I work with fall into two general personality types when it comes to making changes in their practices: those that embrace change and those that resist it.

The “Embracers” are entrepreneurial and excited to add new services to their practices. On the positive side, they like to review the medical literature with open minds, and they’re always on the lookout for new things they can quickly pull into their practices. I often find myself having to slow these doctors down and get them to do a little more critical thinking. Just because something’s new and “hot” doesn’t mean it’s good and healthy—for the patients or the practice. Whenever you consider bringing a new service or modality, you have to consider how it fits with your scope of practice, patient demographics, and staffing capacity. It’s not something to rush into.

The “Resistors” are reluctant to change their routines—either clinical routines or practice management routines—even when they recognize the potential benefits of these changes. Just as lifestyle change can be hard for patients because it requires them to embrace new ways of doing things, nutrition and lifestyle-based medicine can be challenging for many doctors because it requires new skill sets, new routines, and a willingness to change.

A New Look at Nutrition

The most common stumbling block confronting doctors who want to introduce nutrition counseling is lack of training in the nutrition sciences. Where do you turn for credible nutritional information? How to you incorporate this information in your clinical routines? When new nutritional studies are published how do you know what to really believe? When and how do you adapt your practice to new findings? These questions can be daunting, and many doctors—even those who earnestly want to develop a lifestyle-based practice—get stuck right there.

Nutritional science is like any other clinical skill set: it can be learned! With a little commitment, time, good training, and guidance, many doctors find that adding nutrition counseling to their practices is similar to adding new laboratory tests or new diagnostic evaluations.

For some physicians, the resistance to engage in nutrition, weight loss or preventive medicine is rooted in the belief that, despite vast scientific evidence of clinical benefit, these things are for “quacks” It’s a stigma that carries over from all the fad diets, “magic bullet” weight loss products, and dangerous quick-fix drugs that have characterized weight loss in the past. Improper advertising, outrageous claims, and bad patient experiences with commercial weight loss programs add to the mistrust and have maligned the entire preventive/lifestyle medicine field, even programs that don’t involve drugs, hormones, or other quick fixes.

That said, I’ve worked with many doctors who feel much more comfortable introducing a whole-food nutrition program based on educating patients on long-term behavior modification. The Lifestyle Nutrition programs that we teach give patients this guidance via medical assistants, through 4-6 weekly nutritional sessions. The patients learn how to lose weight eating real, wholesome, tasty foods, not processed pre-purchased meal plan foods. There are no products to sell, and nothing unscrupulous about it.

Honoring Your Value

Some clinicians have a deep-seated sense of guilt about putting price tags on services and charging patients directly. The insurance-based model has effectively hidden health care costs from both doctors and patients. In the process, it has destroyed the sense that a practitioner’s time, expertise and attention are valuable! Patients seldom understand the true costs of care, and many doctors—being helpers by nature—are reluctant to ask for and receive what they are truly worth.

In reality, this helps nobody: doctors who are constantly scrambling just to keep their clinic running, and who try to make up for lost revenue by seeing more patients, can’t really provide optimum quality care, and they’re more prone to making dangerous medical errors. Patients who have no investment in their health care are less likely to follow guidance and less likely to get better.

Here’s another important dose of reality: your patients are already spending a lot of out-of-pocket money on weight loss. They’re just not spending it with you! Rather, they’re spending on questionably effective products and programs without medical supervision! According to the Consumer Center (CSPI), Americans spend up to $8,000 per person of post-tax income on weight loss programs that are not physician-supervised. A 20-lb weight loss outcome in one of these programs—for as long as it lasts—costs between $960-$1,600.

A Different Approach

Most commercial programs focus on “quick weight loss” and sell expensive processed weight loss foods or products that provide short-term results. Few of these programs teach relapse prevention and patients often regain weight once they go off the pre-packaged foods and start eating real food again. If patients don’t learn to make long-term lifestyle and diet changes, they inevitably regain weight, but with more body fat and less lean muscle.

The Lifestyle Nutrition programs are designed to enable doctors to provide a better option without selling nutritional products or imposing unrealistic food restrictions. It is based on tailoring recommendations to each patient’s metabolic rate, age, height, weight, lean mass and activity level, while teaching patients how to eat in a way that supports health and enables them to control their weight.

According to a recent study of comparing slow, moderate and fast weight loss programs in 262 obese women at the University of Florida, the best long-term outcomes were from a lifestyle-based program that promoted weight loss at a rate of 0.68 kg (1.5 lbs) per week weight loss (Nackers LM et al, Int J Behav Mod. 2010). The patients in our Lifestyle Nutrition Counseling programs lose between 1-3 pounds per week. This approach is also effective in helping patients with hyperlipidemias, pre-diabetes, metabolic syndrome, fatty liver disease, sports nutrition, pregnancy, chronic fatigue, and many other conditions.

It’s good medicine and good value: Doctors who’ve implemented these programs charge about 40% of the national average for a typical commercial weight loss program. Generally, patients pay out of pocket, but Medicare & insurance plans will usually pay $300- $700 per patient per year for Medical Nutrition Therapy (MNT) and similar services, depending upon the patient’s diagnosis and the insurance company. Should a doctor feel guilty for earning a living by providing needed services, improving patient health in a safe way, and educating people on how to take care of themselves? I certainly don’t think so!

Mixed Emotion on Promotion

Just as some doctors feel guilt about charging for their services, many also shudder at the mere mention of the words “marketing” or “promotion.”

That attitude is deeply ingrained in conventional medical culture. It was only 30 years ago that most state medical boards frowned on physicians advertising in newspapers or on television. In 1975, the Federal Trade Commission (FTC) actually accused the profession of “restraint of trade,” and persuaded medical organizations and boards to permit physician advertising. The idea was that by stimulating market forces and inciting competition, doctors—like any other professionals–would become better at what they do; preventing or inhibiting market forces would lead to professional stasis.

Still, many physicians felt—and still feel—that it is unscrupulous or unethical to advertise. As a result, they leave the market wide open to less scrupulous physicians who have no hesitations about promoting products and services. In the nutrition and weight loss field, we saw a surge of doctors advertising “quick” weight loss programs of questionable efficacy and safety. This only reinforced the idea that “marketing” is unethical and only the unethical will “market” their medical services.

It’s time to re-think this equation. There’s nothing wrong with letting your community know about the services you provide—all the more so when those services are ethical, effective and safe! Understandably, it may not feel comfortable to advertise new “niche” services like nutrition counseling. But if you don’t want your patients spending their money at corporate-owned commercial weight loss programs, you need to learn how to promote your services effectively but without compromising credibility and integrity. It is possible!

The American Medical Association has published guidelines for charging fees directly to patients and for direct-to- consumer advertising (see sidebar). They are pretty reasonable, and keeping these guidelines in mind makes for a more credible marketing campaign.

In reality, advertising is not always necessary for launching a nutrition counseling component in your practice. Many of the doctors using the Lifestyle Nutrition approach start out by using surveys, health risk assessments and questionnaires to screen existing patients to find out which ones are interested in nutritional counseling. This is especially effective if you don’t yet offer nutrition counseling services but you’re thinking about doing so.

By letting your patients know you’re considering bringing nutrition into the practice, you’re already cultivating demand. Once patients engage in the program and start to lose weight and improve health, they spread the word for you. Doctors who can offer patients safe, effective, medically guided weight loss programs are already in high demand, and that trend will only increase as the obesity, heart disease, diabetes epidemic continues to take its toll on our national health.

Christopher Fuzy, MS, RD, LD is the Founder of PhysicianWellnessProgram.com. He has a Master’s degree in Clinical & Sports Nutrition, and maintains a clinical practice with offices in Ft. Lauderdale and Boca Raton, FL. Over the past 20 years, he has trained over 700 physicians nationwide in the implementation of his Lifestyle Nutrition Counseling Program®. For More Information or try your own nutritional program, visit www.PhysicianWellnessProgram.com or call 800-699-8106.