What and Where Do Physicians Eat?
Which Diets Do Overweight or Obese Physicians Choose?
This year's lifestyle survey asked a key new question: "Which of the following dietary approaches most closely matches your current meal patterns?" The Table provides the options and responses.
Experts generally recommend eating 5 servings of fruits and vegetables 4 or more days per week. A 2013 Gallup poll on healthy diet found that 60% of Americans claimed to adhere to such diet plans, which was the same percentage cited in a 2012 Gallup poll of physicians who reported this healthy approach. The latest guidelines from the American Heart Association/American College of Cardiology on cardiovascular risk recommend a diet consistent with the Mediterranean type (rich in fruit, vegetables, whole grains, fish, olive oil, lean poultry, nuts, legumes).[9,10] This approach is also supported by a recent major review. In the Medscape survey, it is not surprising that physicians who treated diabetes and heart disease were most likely to choose a classic Mediterranean diet (27% of endocrinologists and 23% of cardiologists) and least likely to choose the typical American diet (17% and 23%, respectively). It is surprising, though, that equal percentages of cardiologists chose diets on opposite ends of the spectrum. General surgeons, the most overweight physicians, were the most likely to choose the typical American diet (38%) (Figures 1 and 2). The diet options that best conformed to expert recommendations on healthy amounts of fruits and vegetables included not only the Mediterranean diet but also American Heart Association, lacto-ovo vegetarian, vegan, Ornish-style, and paleo diets. (Although the Ornish diet has a strong focus on low fat and the paleo on avoiding processed foods and grains,[13,14] both also stress high amounts of vegetables and fruits.)
When analyzing responses to questions about diet by self-reported weight, we found that 62% of normal to underweight physicians but only 39% of those who are overweight choose these healthy diets. Even worse, among the heavier group, 44% report that they routinely choose either meals "on-the-go" or a standard American diet (meat most days; carbs most days from white rice, potatoes, or white flour products; high fat) compared with only 28% of those with healthier weights. Although only a small percentage said they routinely had meals on-the-go, 6% of intensivists were prone to eat that way.
Surprisingly, only 16% in the obese and overweight groups are on weight-loss diets. The gluten-free diet was also an option, but this is an avoidance diet rather than one that emphasizes health, and it garnered very few responses. The verbal responses mostly reflected a mix of these diets, although a large percentage who wrote in said they had Asian-type diets.
The Keystone Forum on Away-From-Home Foods reported that the percentage of American food budgets spent on away-from-home foods rose from 26.3% in 1970 to 46% in 2002, and according to subsequent reports in the popular press, this percentage has not decreased since then.[15,16] The Forum also concluded that eating out more frequently is associated with obesity, higher body fat percentage, and higher BMI, which has been observed in other studies as well.[18-20] Still, it is not certain whether eating out is related to obesity or whether only those who eat at fast-food chains are more vulnerable.[21,22] This is reflected in the Medscape survey, where almost two thirds (65%) of overweight to obese physicians say they eat out at least once a week, but so do more than half (56%) of those who are normal to underweight.
In a recent Gallup poll, 80% of Americans report eating at fast-food restaurants at least monthly, with almost half saying they eat fast food at least weekly. This follows a 2006 Pew report, which found that 41% of American adults ate fast food at least once a week, suggesting an increase in this unhealthy dietary habit. Regardless of weight, when physicians eat out, the majority (68%) choose mid-level local restaurants. However, not surprisingly, more of the heavier physicians say they eat at mid-level (32%) or fast-food (17%) chains than do the physicians with healthier weights (26% and 11%, respectively). There is some evidence that the nutritional quality of fast-food restaurants has increased over the past few years, but improvement is still needed.