How to tell if a patient is eating well

Today I was invited to give a talk to medical students at UCSF.  The talk was about how to talk to patients about nutrition and behavior change.  I started with this question:

"How do you know if your patient is eating well?"

The first responses I received from the audience were:

"Test cholesterol."

"Test blood sugar."

"Weigh them."

"Waist circumference."

Finally, a brilliant student said, "Talk to them."

I had to reframe the question to: "How would you assess a patient's eating by only talking to them?"  We then had a good talk on objective methods to assess eating behaviors.

I was floored that most of the first answers to the question were, "order more tests."  The medical community has already taught these early medical students that a test is the answer to every question in medicine.  Is it any surprise that we order too many tests with minimal value?

On the positive side, we spent the rest of the hour talking about nutrition and behavior.  I was surprised how well the students knew about current concepts in nutrition.  I hope the next generation of physicians become engaged with their patients about nutrition.  I have faith they will, as long as the current system does not steer them in the wrong way.