“It’s as if we fish patients out of the water at the bottom of the river, but don’t teach them to swim”, “we need to build windmills, not just dykes”, and “turn around the pyramid.” This Tuesday evening in February in a lecture hall at Erasmus MC – which is well-filled with over 50 students – the metaphors tumble over each other. Strong language, but it’s not just words. At the end of the presentation by rheumatologist Richard Verheesen, some participants even cautiously talk about setting up a political party.

Generating real change in how society thinks about health

Over the past ten weeks, the students have been taking part in the extra-curricular course SELF (Students Experienced in Lifestyle and Food). Eighteen months ago, the Rotterdam branch of the Student & Nutrition Foundation started planning a series of lectures and workshops aimed at filling the gap in knowledge about nutrition, lifestyle and productivity management within the basic medical programme. According to Student & Nutrition, there are far too few doctors who can advise patients on how they can become and remain healthier by making different choices.

“It’s about generating real change in how society thinks about health. Eighty to ninety percent is now aimed at curing, yet there is so much uncertainty in society about how to live healthily,” explains Jan-Willem Kruijt. Kruijt is a member of the Rotterdam board of Student & Nutrition. Many studies have shown that prevention is ultimately cheaper and more efficient, but as doctors we learn very little about it.”

Jan-Willem Kruijt gives a concluding talk to last season’s participants.

Lifestyle as medicine

Communication between nutrition experts and doctors is often difficult. There is too little information available about the influence of everyday choices on the development of disease, improving the quality of life or curing people who are already ill. Although politicians have been questioning the affordability of the current system for some time, changes in policy – and thus in medical programmes – are strangely enough often delayed. Student & Nutrition therefore wants to play a leading role, distribute knowledge about ‘lifestyle as medicine’ and thus create support to improve the process. Kruijt: “We’ll leave it to the nutrition and lifestyle experts, for example doctors, dieticians as well as food scientists from Wageningen, to decide exactly how to ultimately plan the programme.”

The doctor as advisor

In partnership with Arts en Voeding (the Doctor and Nutrition Association), the students were able to find enthusiastic experts to fill their programme amazingly quickly. The SELF course is very diverse: so far, the lectures have ranged from the latest research into fat metabolism to psychologists who advised on how to motivate patients in a dignified way to make different choices. Students are also urged to look critically at their own lifestyle choices: ‘The time when the overweight doctor tells his patients that they need to lose weight has gone.’ From the back row, one participant says that she is now less tempted by a bag of crisps.

The fact that students and doctors are going to make healthier choices, fits the gradually expanding role of the doctor as advisor, says Kruijt. With the multitude of self-appointed food experts on the Internet and on chat shows, patients increasingly need clear and scientifically based advice on how to get and remain healthier.

The question, naturally, is why an initiative like that of Student & Nutrition has to come from the students themselves. According to the foundation, the medical curriculum is lagging considerably behind the current burden of disease in society. How is it possible that our next generation of doctors is not always given the most accurate knowledge?


Open letter to the programme director

Kruijt explains that all the medical programmes largely adhere to a national framework plan, in which the content and competences of the curriculum are established. The aim is therefore to include nutrition and lifestyle advice as a mandatory part of this framework plan. When these ambitions are given a national platform, it will be easier to implement these subjects in the Rotterdam medical programme too.

But because the organisation of the curriculum at Erasmus MC is largely decentralised, specialists from the organisation itself are needed who understand the importance of these subjects. Together with a number of these professionals, Student & Nutrition set up a work group and at the end of January sent an open letter to the programme director of Medicine, to which they have since had a response. That mainly means that when setting up a new bachelor, they will incorporate the suggestions of Student & Nutrition and contact the foundation if they have any questions.

Socially involved doctors

For the current participants in the programme, the necessity to implement more education about nutrition and lifestyle is clear at least. Some participants are already working in residencies or practices, but are happy to give up their free Tuesday evening to add to their already intensive programme. Pieter (second year): “It sounds activist, but I feel it’s actually logical that doctors become more socially involved. I mean, I already find it hard sometimes to convince my friends not to use the deep fryer so much and we have the benefit of all our knowledge of the human body.” A student who is working at a medical centre also notices that she can already use the tips and information from the course.
Besides the SELF course, which this season ends in March, the foundation is lobbying national politicians and is active in the ‘Challenge Accepted’ campaign of Erasmus University and in the city of Rotterdam as one of the partners of Gezond010 . Next year, the course will be held again for and by a new group of active students, which can hopefully accommodate the huge enthusiasm. Furthermore, there are plans for a lifestyle course in which all students from Leiden, Delft and Rotterdam can take part via a joint venture with the LDE Sustainability Hub.

All the participants receive a certificate signed by Liesbeth van Rossum (internist and Professor of Obesity and Stress at Erasmus MC) and Tamara de Weijer (president of Doctor and Nutrition).