After decades of research, there is little doubt that nutrition plays a critical role in promoting health throughout life. This is especially true among vulnerable populations (infants and children, pregnant women, the elderly, and the food insecure) but also among healthy people. Well-documented obesity has been linked not only to heart disease, diabetes, and cancer, but with decreased US life expectancy. It is estimated that, based on measurements of blood glucose, lipids, and other parameters, less than 12% of the adult American population can even be called metabolically healthy.
It is against this backdrop that we applaud, on its face, the latest directive from US Secretary Linda McMahon and Robert F. Kennedy Jr. to promote nutrition education throughout medical training. There would certainly be many benefits to the physician workforce having a scientifically sound understanding of nutrition. But are all the “Make America Healthy Again” nutrition recommendations really based on science?”
Physicians generally receive inadequate training in nutrition as part of their primary medical education. As we know from teaching students, many enter medical school with a commitment and interest in preventive medicine in general and nutrition in particular, and teaching them important skills in nutrition helps for self-care, in addition to their professional training. Generations of medical students have voiced their desire for more nutrition education, especially for practical knowledge to answer the many questions from their patients and resolve the overflow of information and misinformation from the contemporary media.
For years, nutrition scientists and their organizations have also been paying attention to this critical gap in medical training, with surveys showing that medical students receive an average of less than 22 total hours of education over four years.
In 2024, in recognition of this push, a panel of medical experts and nutritional scientists published in JAMA Network Open a list of nutritional competencies proposed for future doctors to acquire the skills and knowledge necessary to practice medicine today and address the nutritional needs of patients. (Each competency details the knowledge and skills doctors must obtain during training.) This list is proposed as a foundation for medical schools and postgraduate medical training to build nutrition into their curricula.
So the latest directive to US medical schools to “immediately implement comprehensive nutrition education and training” at all stages of medical training is, on the face of it, welcome news. It refers to the inclusion of nutrition competencies in premedical and medical school curricula, and as part of the requirements for medical licensure, board certification, and continuing medical education.
Such broad-based educational initiatives seem to be exactly what we and others have long advocated to medical school and regulatory peers. Earlier this month, Health and Human Services sponsored a symposium where medical school colleagues pledged to increase nutrition education to at least 40 hours during the four years of medical school, and federal officials announced a curriculum development grant mechanism from the National Institutes of Health.
But the announcement element gave some pause. For example, to facilitate training commitments, HHS developed 71 competencies, some of which were inspired by the JAMA Network Open 2024 proposed competencies. But others advocate for some low-to-no evidence modality: special diets (eg, “anti-inflammatory diet”), supplementation approach, testing and wearables, and reference to “functional nutrition” and health coaches without qualification limitations. Other competencies focus on agricultural production methods and other topics of limited relevance to the clinical work of most doctors (for example, “understanding the practice of restoring soil microbiota and producing nutrient-dense food”).
For anyone who follows the MAHA movement and the activities of surgeon general Casey Means, this discrepancy will not be surprising. Nonetheless, they represent an attempt to normalize non-evidence-based practices in some aspects of physician nutrition training. In a world where evidence-based nutrition is critical, health care costs are skyrocketing, and the public must wade through constant nutritional misinformation, we must be hypervigilant that the training of doctors in nutrition remains scientifically rigorous as well as protected from commercial interests.
We encourage medical schools to critically review and consider the JAMA Network Open 2024 consensus nutrition competency in their medical curriculum and collaborate with peer schools to implement effective physician nutrition training. At Harvard Medical School, nutrition is taught in an integrated manner throughout the preclinical and clinical curriculum, as well as through individual courses. The elective for third and fourth year students (“Nutrition, Metabolism and Lifestyle Medicine”) instructs 20-25 people each spring in the principles of nutritional assessment, dietary guidelines, and nutritional science research by developing critical thinking skills and evaluating existing evidence. The popular elective in culinary medicine is offered each winter to eight to 10 students of all levels.
Harvard faculty are also active in promoting kitchen teaching for hands-on instruction, as well as web-based courses, journals, and textbooks in nutrition science. Harvard is one of the institutional examples of how to lay a strong foundation in nutrition science for medical trainees, but even then it needs to more fully incorporate nutrition throughout the medical school curriculum.
It is also necessary to rebuild the period of post-graduate training, in the training hospital, and in continuing education, as patients grasp on never-ending questionable claims about food and nutrition. Many of those claims, that doctors should help their patients, come from administrations that advocate nutrition education for doctors. The “Make America Healthy Again” movement is filled with beliefs that are not supported, even contradicted, by solid scientific evidence. This includes the belief that vitamin A therapy is indicated as an alternative therapy for measles (while the administration undercuts the vaccine policy), the idea that the consumption of “seed oil” causes obesity (without addressing other causes of this complex multifactorial health condition), that fluoridated water is a health risk (while ignoring a reduction for several decades in sugar levels and restoration, restoration products). high fructose corn syrup;
So while we are enthusiastic about the rationale behind the secretaries’ proposal, we believe that credible nutrition educators and scientists should be closely involved in such reforms. We call on medical schools, accrediting bodies, and the broader medical education community to build a rigorous, evidence-based foundation of JAMA Network Open 2024 competencies – and refuse to dilute those standards with content that does not meet the same evidence bar.
At the same time, we recognize that the nutritional challenges facing this country will not be solved by more trained doctors alone. Public health programs and policies are powerful determinants of nutritional status, which have direct consequences on individual health, as seen with recent cuts to food assistance programs, the rollback of community water fluoridation, and changes to the Dietary Guidelines process.
Physicians educated in nutrition are uniquely positioned to be effective advocates: for legislation that expands access to registered dietitian services and addresses hunger and food insecurity, and to broadly support a food environment that supports rather than undermines public health. That advocacy, like the training that informs it, must be grounded in rigorous science and pursued with the same commitment to evidence regardless of the political party in power.
Christopher P. Duggan, MD, MPH, is director of the Division of Nutrition and professor of pediatrics at Harvard Medical School. Marie-France Hivert, MD, is professor of population medicine and director of the curriculum theme nutrition and lifestyle medicine at Harvard Medical School. Kevin Klatt, RD, Ph.D., is an assistant professor in the Department of Nutritional Sciences at the University of Toronto Temerty Faculty of Medicine. The views expressed in this piece are those of the author and do not necessarily reflect the official views of Harvard Medical School or the University of Toronto.
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