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Content: Diet and lifestyle counseling tend to be labor-intensive," Katz says, "and the brief clinical visits that now prevail don't really allow for that." The reality is, it's not realistic to expect physicians to be experts on everything. " Most primary care physicians have seven to 22 minutes to spend with each patient," says Dr. Christine Gerbstadt, a staff physician at Walter Reed National Military Medical Center in Bethesda, who is also a registered dietitian. That time includes "offering age- and patient-specific appropriate preventive health advice – wearing seat belts 100 percent of the time, not smoking, eating more fruits and vegetables, avoiding highly processed sugar- and fat-laden foods, being physically active an hour a day, flossing and brushing your teeth, reducing stress, sleeping adequately – the list is truly endless and must be exhausted in seven to 22 minutes, along with listening to the patient, offering guidance for recommended health screening and performing a focused physical exam," she says. That's a tall order, indeed. Another factor: The culture of current medicine, "which has increasingly focused on pharmacologic treatments, rather than lifestyle modifications," says Dr. Marion Vetter, an adjunct assistant professor of medicine in psychiatry at the University of Pennsylvania Perelman School of Medicine who is also a registered dietitian. " Both patients and providers want to see rapid results, whether it is weight change or improvements in blood glucose or lipids. Dietary modifications and lifestyle changes typically involve a slow and steady approach instead of a fast fix. For this reason, patients frequently revert to previous behaviors and tend to make few durable lifestyle changes, which may discourage physicians from spending the time to provide dietary education."