The Physician: Healthy, Wealthy, and Wise?

Carol Peckham

| Disclosures | January 23, 2014
 

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.[7] A 2013 Gallup poll on healthy diet found that 60% of Americans claimed to adhere to such diet plans,[8] which was the same percentage cited in a 2012 Gallup poll of physicians who reported this healthy approach.[6] 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.[11] 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[12] 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.

Figure 1.

Mediterranean Diet

Figure 2.

Standard American Diet

Eating Out

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,[17] 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.[23] 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.[24] 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.[25]

 
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Table. Physicians' Routine Dietary Approaches 
Dietary Approach Underweight
or Normal Weight
Overweight
or Obese
Typical American diet (meat most days; carbs most days from white rice, potatoes, or white flour products; high fat) 25% 40%
American Heart Association-type diet (avoid saturated fats; 4-5 cups of fruits and vegetables daily; avoid red meat; at least 2 servings of fish a week; choose high-fiber, whole-grain carbs) 24% 16%
Mediterranean diet (whole grains, seeds, nuts, fruit, olive oil, red wine, protein from fish) 21% 14%
Paleo diet (avoid all processed foods, potatoes, sugar; choose fresh fruits and vegetables, fish, meat from grass-fed animals, eggs, natural oils) 7% 5%
Weight-loss, calorie-restriction diets 6% 11%
Lacto-ovo vegetarian (no meat but dairy and eggs) 6% 3%
Meals on-the-go (take-out, fast food, vending machines) 3% 5%
Weight-loss diets not dependent on calorie restriction (eg, South Beach, Atkins) 3% 5%
Vegan (vegetarian, no dairy, no eggs) 2% 1%
Gluten-free diet 2% 1%
Ornish-style diet (less than 10% of calories from any fat; avoid animal products; large amounts of whole grains and vegetables) 2% 1%

References

  1. PracticeLink. Who's the happiest? Summer 2011 http://www.practicelink.com/magazine/vital-stats/whos-the-happiest/ Accessed December 26, 2013.

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM. NCHS Data Brief. Prevalence of obesity among adults: United States, 2011-2012. 2013;131. http://www.cdc.gov/nchs/data/databriefs/db131.htm Accessed November 23, 2013

  3. Busko M. Current BMI cutoffs may miss metabolic disease risk. Medscape Medical News. November 14, 2013. http://www.medscape.com/viewarticle/814378 Accessed November 23, 2013.

  4. Gallup Well-Being. Americans' desire to shed pounds outweighs effort. November 29, 2013. http://www.gallup.com/poll/166082/americans-desire-shed-pounds-outweighs-effort.aspx Accessed November 23, 2013.

  5. Gallup Well-Being. Americans exercising slightly more in 2012. September 19, 2012. http://www.gallup.com/poll/157505/americans-exercising-slightly-2012.aspx Accessed December 4, 2013.

  6. Gallup Well-Being. U.S. physicians set good health example. October 3, 2012. http://www.gallup.com/poll/157859/physicians-set-good-health-example.aspx Accessed December 6, 2013.

  7. United States Department of Agriculture. Center for Nutrition Policy and Promotion. Dietary Guidelines for Americans 2010. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf Accessed January 8, 2014.

  8. Gallup Well-Being. Americans' eating habits worsening in 2013. November 27, 2013. http://www.gallup.com/poll/166070/americans-eating-habits-worsening-2013.aspx Accessed January 8, 2014.

  9. Wood S. New ACC/AHA/NHLBI guidance on lifestyle for CVD prevention. Medscape Medical News. November 12, 2013. http://www.medscape.com/viewarticle/814139 Accessed November 23, 2013.

  10. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology American/Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Nov 7. [Epub ahead of print]

  11. Rees K, Hartley L, Flowers N, et al. 'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013 Aug 12;8:CD009825. doi: 10.1002/14651858.CD009825.pub2.

  12. The Ornish Spectrum. http://www.ornishspectrum.com Accessed December 30, 2013.

  13. The Paleo Diet. http://thepaleodiet.com/what-to-eat-on-the-paleo-diet/ Accessed December 30, 2013.

  14. Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes. 2012;5:175-189. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/ Accessed December 30, 2013.

  15. McMillan T. The American way of eating. A brief history of Applebee's--and why it's still going strong. Slate. 2012. http://www.slate.com/articles/life/food/2012/02
    /tracie_mcmillan_s_the_american_way_of_eating_doing_the_hardest_job_at_applebee_s.html
    Accessed December 4, 2013.

  16. Thomas D. Cheap eats: How America spends money on food. The Atlantic. March 8, 2013. http://www.theatlantic.com/business/archive/2013/03/cheap-eats-how-america-spends-money-on-food/273811/ Accessed December 4, 2013.

  17. The Keystone Forum on Away-From-Home Foods. Opportunities for Preventing Weight Gain and Obesity. Final Report. May 2006. http://archive.oxha.org/knowledge/publications/us_keystone-center-obesity-forum_may-2006.pdf Accessed January 8, 2014.

  18. Lachat C, Nago E, Verstraeten R, Roberfroid D, Van Camp J, Kolsteren P. Eating out of home and its association with dietary intake: a systematic review of the evidence. Obes Rev. 2012;13:329-346. Abstract

  19. Muñoz-Pareja M, Guallar-Castillón P, Mesas AE, López-García E, Rodríguez-Artalejo F. Obesity-related eating behaviors are associated with higher food energy density and higher consumption of sugary and alcoholic beverages: a cross-sectional study. PLoS One. 2013;8:e77137. doi: 10.1371/journal.pone.0077137.

  20. Laska MN, Story M. Young adults and eating away from home: associations with dietary intake patterns and weight status differ by choice of restaurant. J Am Diet Assoc. 2011;111:1696-1703. Abstract

  21. Poti JM, Duffey KJ, Popkin BM. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of diet? Am J Clin Nutr. 2013 Oct 23. [Epub ahead of print]

  22. Bezerra IN, Curioni C, Sichieri R. Association between eating out of home and body weight. Nutr Rev. 2012;70:65-79. Abstract

  23. Gallup Well-Being. Fast food still major part of U.S. diet http://www.gallup.com/poll/163868/fast-food-major-part-diet.aspx Accessed January 8, 2014.

  24. Pew Research Center: A Social Trends Report. Eating more; enjoying less. 2006. http://pewsocialtrends.org/files/2010/10/Eating.pdf Accessed November 23, 2013.

  25. Hearst MO, Harnack LJ, Bauer KW, Earnest AA, French SA, Michael Oakes J. Nutritional quality at eight U.S. fast-food chains: 14-year trends. Am J Prev Med. 2013;44:589-594. Abstract

  26. Offit P. Which complementary and alternative therapies merit study? Medscape. May 17, 2012. http://www.medscape.com/viewarticle/763604 Accessed January 8, 2014.

  27. National Center for Complementary and Alternative Medicine (NCCAM) The Use of Complementary and Alternative Medicine in the United States. http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm#use Accessed December 4, 2013.

  28. White A, Foell J. Acupuncture is superior to sham for painful conditions. Evid Based Med. 2013;18:e56. http://www.medscape.com/viewarticle/814897 Accessed January 5, 2014.

  29. Charles P. Vega. Choosing Wisely 2013: the need to know for primary care. Medscape. December 13, 2013. http://www.medscape.com/viewarticle/817739_3 Accessed January 5, 2014.

  30. Wu D, Huang Y, Gu Y, Fan W. Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials. Int J Clin Pract. 2013;67:585-594. Abstract

  31. Bailey RL, Gahche JJ, Lentino CV, et al. Dietary supplement use in the United States, 2003-2006. J Nutr. 2011;141:261-266. http://jn.nutrition.org/content/141/2/261.long Accessed December 30, 2013.

  32. Kim HJ, Giovannucci E, Rosner B, Willett WC, Cho E. Longitudinal and secular trends in dietary supplement use: Nurses' Health Study and Health Professionals Follow-Up Study, 1986-2006. J Acad Nutr Diet. 2013 Oct 9. pii: S2212-2672(13)01253-7. doi: 10.1016/j.jand.2013.07.039. [Epub ahead of print]

  33. Lamas GA, Boineau R, Goertz C, et al. Oral high-dose multivitamins and minerals after myocardial infarction: a randomized, controlled trial. Ann Intern Med. 2013;159:797-805.

  34. Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013;159: 850-851. http://annals.org/article.aspx?articleid=1789253 Accessed January 7, 2014.

  35. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 Nov 12. doi: 10.7326/0003-4819-159-12-201312170-00729 http://annals.org/article.aspx?articleid=1767855 Accessed January 5, 2014.

  36. Consumerlab.com. Fish oil and multivitamins most popular supplements in ConsumerLab.com survey. February 5, 2013. http://www.consumerlab.com/news/Most-Popular-Supplements-Survey/2_5_2012/ Accessed November 23, 2013.

  37. Eliason BC, Guse C, Gottlieb MS. Personal values of family physicians, practice satisfaction, and service to the underserved. Arch Fam Med. 2000;9:228-232. Abstract

  38. Pew Research. US Religious Landscape Survey. February 2008. http://religions.pewforum.org/pdf/report-religious-landscape-study-full.pdf Accessed November 23, 2013.

Authors and Disclosures

Author

Carol Peckham

Director, Editorial Services, Art Science Code LLC, New York, New York

Disclosure: Carol Peckham has disclosed no relevant financial relationships.

Figure 1.

Mediterranean Diet

Figure 2.

Standard American Diet

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