The leading causes of mortality in the U.S. are well known: cardiovascular disease, cancer and stroke. But, in the field of preventive medicine, the argument is made that these are not the causes of death, but rather the mechanisms of death, in turn the result of true, underlying causes. Of the more than 2 million deaths that occur each year in the U.S., more than 1 million are premature and "preventable" through the modification of lifestyle and environmental exposures. Due to the epidemic of obesity and overweight, a clinical practice that neglects patient nutrition (or physical activity) patterns is neglecting the leading causes of death for patients. On this basis, routine counseling to promote healthful eating is encouraged by the U.S. Preventive Services Task Force and there is evidence that physician training in nutrition enhances counseling.