Nutritional care is often neglected in clinical practice, despite a huge increase in the prevalence of obesity as well as a growing awareness of the hazards of both over- and undernutrition during the past two decades. Recognition of these issues led to the establishment of a College working party to examine the role of doctors in nutritional care in both hospital and community, to look at the impact of malnutrition (over- and undernutrition) on disease processes and medical treatments, and at the potential for change in terms of both nutritional care and medical training. The purpose of the resulting report, Nutrition and patients: a doctor’s responsibility,is to raise awareness of the fundamental importance of nutritional care in everyday clinical practice, and thereby improve patient care.

Although nutritional imbalance is a major issue in public health worldwide, the report focuses on clinical practice in western society, and it deals with principles rather than details of clinical care. It signals the urgency of addressing dietary factors in disease, particularly in a population that is not only becoming increasingly obese but also living to a greater age, with attendant ill health and nutritional vulnerability. Although it centres on the care of adult patients, the issues raised are just as relevant to infants and children.

The report is mainly addressed to doctors, but it strongly emphasises the need for a multidisciplinary approach, involving all the healthcare professionals involved in nutritional care. It also recognises the importance of preventive measures designed to affect diet in the community, thus reflecting local and central government initiatives to improve the national diet and reduce obesity.

Fundamental to any changes in current practice is the need to introduce adequate training in nutritional care. Up to now, teaching of nutrition to undergraduates in medical school has suffered from lack of co-ordination between the different disciplines involved and nutrition is therefore not recognised as a clinical entity. This has arisen because many clinical teachers themselves have had little or no training in the subject and so tend not to teach it. The result is that many doctors neglect clinical nutrition through lack of awareness of its potential benefits. The report identifies areas for change at undergraduate and postgraduate level, and in doctors’ continuing professional education.