In South Florida it's pretty easy to find a plastic surgeon for a little nip and tuck. But finding a primary care doctor who can tell you how to lose weight by changing your diet is a different story.
When doctors write prescriptions, they know what their patient will receive. But when a patient asks what they should eat, it's hard to be that specific. A developing body of research shows most doctors receive little to no instruction in nutrition.
"When I say ten milligrams of Lisinoprill for high blood pressure, whether I'm in California or Florida and whether it's being made by one of 13 different pharmaceutical companies, it is the same thing," said Dr. Amar Deshpande is a professor at the University of Miami Miller School of Medicine.
But a prescription isn’t enough for patients like Esther Kenney, who sought help when she started to put on pounds and it was affecting her health. Kenney didn't have a lot of energy. She felt unhappy and just generally unwell. Her doctor put her on cholesterol medicine. But she wanted to know how to eat, and her doctor couldn't help her with that.
"They always tell you need to lose weight," said Kenney. "They might prescribe something to say okay this will take care of the high cholesterol or your blood pressure, but they never really sit down with you and say this is how you go about doing it."
Kenney eventually found help from Susan Nowrouzi, a registered dietitian at Baptist Hospital.
Nowrouzi says when faced with questions about nutrition, many doctors can only give very basic advice.
"There are some doctors that they just say oh you have some intestinal problem, you need to avoid gassy foods, but they don't tell them you need to see a dietitian," says Nowrouzi.
Nowrouzi says she sees patients with everything from allergies to cancer, but the bulk of her patients are women looking to lose weight. She says the culture of South Florida plays a role in that.
"Well, Miami, I guess you can say is a vain city. We like to look good," says Nowrouzi.
But seeking treatment for your weight can be about more than just wanting to squeeze into a tiny bikini.
Kenney says she learned how to control her weight and her health by working with Nowrouzi who laid out what she should be eating for both her meals and snacks. Kenney’s lost weight. Her blood pressure has gone down, and her cholesterol is lower. So much lower that her doctor wants to take her off cholesterol medication.
Tania Rivera, director of the Didactic Program in Dietetics at Florida International University, says physicians are more comfortable giving a prescription than a meal plan.
"Normally, a physician will diagnose these chronic diseases such as diabetes, cardiovascular disease based on the laboratory values that come back from the lab, for example, and then they kind of just put them on medication and send them on their merry way," said Rivera.
Rivera would like to see doctors take a more holistic approach.
"We shouldn't really be medicating first. We should be what we call therapeutic lifestyle changing which has to do with things like excellent nutrition, exercising, etcetera, and I think that should be the first step versus somebody going and starting on a medication."
Deshpande says UM medical students learn about nutrition when they study gastroenterology, but there's not a dedicated class on the subject. Students interested in the topic can choose to take additional seminars. Deshpande says nutrition is a hard subject to teach.
"The difficulty is creating a curriculum that you feel adequately addresses that - not only to their satisfaction saying I learned a lot now about different types of diets - but to my satisfaction that what I'm teaching them is grounded in science and not just oh that's what I think some people said that they think works," said Deshpande.
Rivera stresses there is science behind what she other registered dietitians do.
"Our entire profession is evidence based," said Rivera. "In other words, anything that we tell both students as well as clients as well at patients is based on the medical literature. So there absolutely is medical nutrition therapy for all conditions."
She says she's seeing more doctors recommend patients see a registered dietitian, and increasingly insurance is covering the cost.