Do health professionals have sufficient knowledge about nutrition (apart from dieticians* )? Mostly, we have knowledge about broad areas relating to food groups, what is ‘healthy’ and what is not, though ideas and evidence about the ‘ideal’ diet change rapidly. Diets come and go in fashion, with those that purport to aid weight loss being particularly lucrative for their authors.
I have had very little formal education about nutrition though similar to many mainly female adolescents I was obsessed with calorie counting in my teens and as a student. In a packed GP consultation there is little time to take a thorough food history or give appropriate and realistic advice to patients. Nutritionists are important members of the interprofessional healthcare team but may be difficult for some to access or may be too expensive in some jurisdictions.
‘The Heretic’s Feast’* is a somewhat dated history of vegetarianism published in 1993. What is fascinating about this book is the broader history of humankind’s dietary habits and how these are affected by culture, class, geography, politics, religion, fashion, advertising, and vested interests. In many eras people have been involuntary vegetarians due to lack of meat or the wherewithal to buy it. Those who voluntarily gave up meat did so for one of three predominant reasons: all flesh is bad, humans are sinful/unclean because they are flesh themselves and eating meat makes them worse; animals are equal to humans and we should not kill them to eat them; fasting including but not limited to giving up meat is good for the soul and gets one nearer to god/heaven (the ascetic’s view).
I became a vegetarian when I was a medical student at a time when, according to the book, there were about 52 vegetarian restaurants in London. I remember it not being that easy to change what I ate, eating out was expensive, but meatless eating has certainly become easier over time.
One concerned mother brought her teenage daughter to see me. ‘Doctor, she’s stopped eating meat, tell her she’ll get ill’. I had to explain I was a vegetarian of many decades and that a meat-free diet is fine if it has a sufficient variety of different food stuffs. But it is important to exclude possible eating disorders in these scenarios.
Depending on one’s point of view, meat was/is necessary for humans to function or was/is unhealthy and makes one sick. In the west, in the 19th century, if an avowed vegetarian died young it was seen as bad publicity for that way of life.
‘The Heretic’s Feast’ has some medical errors and the writing at times is somewhat turgid. But the scope is interesting from pre-history to the end of the last century, from east to west, taking in the major religions and historical heresies, animal rights and agricultural practices. The impact of poverty and related social determinants through the ages resonates with our current world. For example, when England was recruiting soldiers for the Boer War in the late 19th century, they had to lower the minimum height for infantry from 5 ft 6 in (1.68m) in 1883 to 5 ft (1.5m) due to the poor nutritional status and stunted growth of the working class. In England today children in lower socioeconomic groups are becoming shorter,[1] while globally in 2020 the World Health Organization reports that 149 million children under 5 were estimated to be stunted.[2] Contemporary malnutrition now includes the over as well as the underweight.
Health professionals need to be able to start conversations about nutrition, to recognise malnutrition and the effects of poor diet on health, and to understand a person’s food choices and their beliefs and circumstances that affect these. As always, we need to consider how nutrition training can fit in already overcrowded curricula, and how access to nutritionists may be eased.
*In Australia and many other countries all dieticians are nutritionists and are a regulated health profession; nutritionists do many similar things to dieticians but are not qualified to give medical advice.
**The Heretic’s Feast – a history of vegetarianism. Fourth Estate, London, 1993.
See also: Lepre et al. Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutrition, Prevention & Health 2022;5: doi: 10.1136/bmjnph-2021-000354
[1] https://www.theguardian.com/commentisfree/2023/jun/25/britains-shorter-children-reveal-a-grim-story-about-austerity-but-its-scars-run-far-deeper?CMP=share_btn_tw
[2] https://www.who.int/news-room/fact-sheets/detail/malnutrition
Health professional education and practice 