The Medicalisation of Health: Why Nutrition Deserves a Bigger Role in the NHS
- Laila Charlesworth
- Mar 4
- 6 min read
Recently, I attended a workshop on healthy ageing. While the discussions were well-intended, I was struck by how deeply entrenched the medicalisation of health has become. The default approach to many health issues seemed to involve referring people to community pharmacies. These businesses receive some government and NHS funding to support public health initiatives, such as smoking cessation and weight management programs, through schemes like the Healthy Living Pharmacy framework and the Pharmacy Integration Fund. However, despite this funding, many pharmacies struggle with financial shortfalls, and their primary role remains the dispensing of medication. This raises questions about how much time pharmacists have to provide the necessary support for lifestyle and nutritional advice. Given these financial and time constraints, it is unclear how much support pharmacists can realistically provide beyond medication dispensing. This is particularly concerning when addressing common but complex health issues such as digestive problems, where lifestyle and nutritional interventions could be more effective than long-term medication use. Additionally, their training includes public health elements but remains rooted in medicalisation, which may prioritise medication over lifestyle and nutritional interventions. But why should pharmacists be expected to fill this gap when trained professionals, such as nutritionists, already exist to provide expertise in this area?
This issue became evident during a discussion on constipation. The conversation largely revolved around symptom relief, but when I attempted to bring up the over prescription of proton pump inhibitors (PPIs) and their long-term consequences, the response was dismissive. An NHS representative in the session appeared disengaged, as if the topic was outside the scope of the broader conversation.
The over prescription of PPIs is particularly concerning among older adults. Research indicates that 73.9% of patients aged 75 and over were prescribed PPIs without a clear medical indication, and individuals aged 65 and older make up 37.1% of total PPI users. This suggests that a significant portion of the older population may be receiving these medications unnecessarily, contributing to potential overmedication and long-term health risks. PPIs are widely used to treat heartburn and acid reflux, but their overuse remains a concern, particularly among older adults. Research indicates that 73.9% of patients aged 75 and over were prescribed PPIs without a clear medical indication, and individuals aged 65 and older make up 37.1% of total PPI users. This suggests that many may be receiving these medications unnecessarily, contributing to potential overmedication and long-term health risks.
Nutritionists and dietitians understand that heartburn and acid reflux can sometimes indicate low stomach acid rather than an excess, meaning dietary and lifestyle interventions such as adjusting meal composition and eating habits could be more effective alternatives to medication. However, PPIs are repeatedly prescribed by some GPs for years, often without adequate review. This occurs despite their well-documented impact on digestion, nutrient absorption, and emerging evidence linking long-term use to additional health concerns, including a 33% higher risk of dementia in individuals aged 45 and older, increased risk of bone fractures, infections like Clostridioides difficile-associated diarrhoea, and micronutrient deficiencies (B12, iron, magnesium, and calcium).
Despite these risks, nutrition remains an underutilised resource in patient care. Dietitians and nutritionists have the training to support patients through sustainable dietary changes that could help reduce dependence on long-term medications like PPIs. Strengthening their integration into the NHS would allow for a more holistic approach to health that prioritises non-pharmaceutical interventions wherever possible. Given the financial strain on the NHS, investing in nutrition-based solutions is a cost-effective way to reduce long-term healthcare expenses by decreasing hospital admissions and medication dependency. With 73 million NHS prescriptions for PPIs dispensed in England in 2022-23 (costing approximately £190 million), it's clear that a shift toward preventive care could provide significant economic and health benefits.
This experience reinforced my concern that nutritionists remain significantly overlooked within the UK health system. Meanwhile, the media plays a significant role in shaping public understanding of nutrition, yet there is a worrying trend of influencers, such as 'The Glucose Goddess,' sharing nutrition advice that has been met with criticism from qualified professionals. While Jessie Inchauspé, known as 'The Glucose Goddess,' has a background in biochemistry, many registered dietitians and nutritionists argue that some of her advice oversimplifies complex nutritional science and lacks robust clinical evidence. Concerns have been raised that her methods may lead to unnecessary anxiety around food and misinterpretation of glucose regulation. Instead of relying on social media personalities, the government should take steps to promote trained nutritionists in media and public health campaigns, ensuring that evidence-based dietary advice reaches the population. Given the immense pressures on the NHS, it seems counterproductive to neglect a profession that could play a crucial role in preventive health care, chronic disease management, and overall well-being. Numerous studies show that dietary interventions can significantly reduce hospital admissions for conditions like type II diabetes and cardiovascular disease, making investment in nutritional services a cost-effective solution.
Labour's 10-Year Plan for the NHS in England: What Should It Look Like?
Labour’s proposed 10-year plan for the NHS outlines key reforms to address current challenges and improve healthcare delivery. One of the primary shifts proposed is "From Treating Sickness to Preventing It." This focus aligns with the need to integrate nutrition into healthcare as a preventive measure, reducing dependency on pharmaceuticals and lowering long-term NHS costs. Nutritionists play a crucial role in preventive healthcare, yet their expertise is underutilised within the NHS.
Why Nutritionists Should Be Central to the NHS
Nutritionists offer a wealth of knowledge and practical support that could alleviate many of the burdens currently placed on GPs and the NHS. Here are just a few areas where nutritionists can make a meaningful impact:
Preventative Health Care: By promoting healthier eating habits, nutritionists can help prevent lifestyle-related diseases such as obesity, type II diabetes, and cardiovascular disease.
Gut Health and Digestion: Nutritionists understand the complexities of digestive health and can provide non-pharmaceutical solutions to common issues like acid reflux, bloating, and constipation.
Support for Chronic Conditions: Diet plays a significant role in managing conditions such as IBS, autoimmune disorders, and metabolic syndrome.
Mental Health and Well-being: Growing research shows the connection between diet and mental health, including the impact of gut health on mood disorders such as anxiety and depression.
Reducing Medication Dependency: In many cases, simple dietary changes can reduce the need for long-term medication use, preventing unwanted side effects and reducing strain on the NHS budget.
Post-Surgery and Recovery Nutrition: Proper nutrition can speed up recovery times, improve wound healing, and support immune function.
Paediatric and Maternal Health: Supporting children’s development and maternal health through tailored nutritional advice can have lifelong benefits.
The Need for Change
Despite these benefits, nutritionists are often left out of mainstream health discussions, side-lined by a system that prioritises medication over lifestyle interventions. Even when nutritionists do work within the NHS, they are often paid poorly, with salaries as low as £19,000 per annum. This undervaluation of their expertise makes it difficult to attract and retain skilled professionals in the public sector. Given the immense pressures on the NHS, failing to adequately compensate nutritionists suggests that their role is not seen as essential, despite the clear benefits they provide in preventive health care and chronic disease management. NHS data from 2022/23 shows that for conditions like obesity, 370,000 items (specifically Orlistat) were prescribed, costing £10.8 million. This reflects a reliance on pharmacological treatments over lifestyle modifications. The NHS is under immense strain, and yet we continue to overlook one of the most effective ways to reduce long-term healthcare costs: improving people’s diets and nutritional understanding.
It’s time for nutrition and nutritionists to be taken seriously in public health policy. This includes ensuring that government-backed health messaging prioritises evidence-based nutrition information from qualified professionals rather than social media trends and unverified claims. However, it is important to acknowledge that not all studies are published, particularly those with negative or inconclusive results. While this issue is more pronounced in pharmaceutical research, where companies have financial incentives to suppress unfavourable findings, it can also affect nutrition research. As a result, relying solely on published studies may not always provide a full and unbiased picture of what truly works. Clinical experience and expert guidance from nutritionists should therefore be valued alongside available scientific evidence. The over-medicalisation of common health concerns does not serve the long-term interests of patients or the sustainability of the NHS. While community pharmacies are accessible and frequented by 1.2 million individuals daily in England, their services often emphasise medication dispensing over lifestyle counselling. This suggests a missed opportunity for integrating nutrition and lifestyle interventions into routine care. For meaningful change, nutritionists must be recognised, valued, and integrated into the UK healthcare system.
To improve public health, policymakers must take decisive action by integrating nutritionists into primary healthcare, funding nutrition education, and ensuring the public receives evidence-based dietary guidance. The question is: When will the NHS and government start listening?
Comentarios