The Argument to Include Nutrition Education in Medical Schools

Guest post by Dr. Jessica Duncan

Please welcome Dr. Jessica Duncan—today’s guest editor, an obesity specialist and Medical Director of Ivim Health, who advocates for the importance of physicians receiving proper education in nutrition.

Her work couldn’t feel more timely in light of RFK’s recent announcement that the Trump administration will introduce new dietary guidelines in December for Americans, aimed at reducing our alarming obesity rates and changing our country’s food culture for the better.

Thank you Jessica!

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Some have wondered why MAHA has resonated with so many moms over the past year, and as a mom and a doctor, I believe that there are concrete actions that will move the needle for the overall well-being of the country.

For example, earlier this summer, Health and Human Services Secretary (HHS) Robert F. Kennedy announced that within the year, US medical schools that do not include nutrition curriculum may see their federal funding impacted. As an Obesity Medicine physician, I applaud this move: nutrition education is long overdue in American medical training. Studies have consistently shown that US physicians feel unprepared to have conversations about nutrition education with their patients after medical school. I recall the bulk of my medical education focusing on vitamin and nutrient deficiencies rather than skills for promoting health with food choices. The concept of treating symptoms of disease rather than using medical knowledge to prevent disease is inherent to the current US obesity crisis. If you or your child sees a doctor for a medical concern and they’re better equipped to have a conversation about potential lifestyle changes instead of immediately reaching for the prescription pad, we’re headed in the right direction.

Additionally, the MAHA report correctly identified the tremendous negative impact that ultra-processed foods have had on the health of Americans, both adults and children. I wholeheartedly agree that ultra-processed foods have been one of the biggest detriments to the health of Americans in the 20th century. The worsening of the obesity crisis in the US correlates closely with the popularity of these foods in the American diet. The collaboration of multiple government agencies to not only examine the impact of ultra-processed foods on American health, but also aggressively move towards enacting change will certainly have a tremendous impact.

As a young resident physician, it was not unusual on post-operative floors to see mealtime patient trays filled with premade nutritional shakes. We were taught that these high calorie, high protein meal replacements would help our patients maintain their weight and heal more quickly after surgery and other health crises. But that wasn’t the whole picture. It wasn’t until I began studying nutrition on my own and embracing the concept of food as medicine that I examined the ingredient label on a nutritional shake. Corn maltodextrin, the second ingredient on the list, is an intensely processed carbohydrate (or sugar) which can cause drastic spikes in blood sugar as well as disrupt the delicate balance in our gastrointestinal tract, leading to inflammation and bloating. Maintaining balanced blood sugar levels in healing patients is so important, so it baffled me that we were treating patients with this ingredient rather than whole, nourishing foods.

If physicians aren’t properly educated on nutrition—particularly the impact of processed and artificial ingredients—we are missing a key component to address one of the major causes of the obesity crisis and other chronic diseases. Studies have shown that the vast majority (86%) of physicians feel unprepared to provide nutrition education to their patient, yet the foods we eat account for one of the largest modifiable risk factors for diseases like obesity, diabetes, heart disease, and even cancer. A study conducted by the American Cancer Society found that a diet low in fruits and vegetables was associated with a 30.7% increased risk of oral, pharyngeal, laryngeal, and esophageal cancer. What’s more, 4.9% of overall cancer cases in men and 3.4% in women are attributable to dietary factors alone.

When asked about their training in medical school, only 29% of newly graduated medical interns felt they received sufficient nutrition education. This is not a surprise, considering just a quarter of medical schools require a nutrition course. Anyone who went through 4 years of medical school will tell you that there is a tremendous amount of knowledge to acquire in a short period of time. Lecture time is focused on pathology, physiology, and anatomy before you quickly hit the ground running on hospital rotations. With so much coursework devoted to learning how the body works and how to treat disease, there’s only so much time for nutrition. But I would argue that a core nutrition requirement that focuses on not only the impact of diet on disease, but also how food can be used to potentially improve disease and promote health is imperative. I would guess that most physicians remember learning about the rare disease Ehrlichiosis, but few were taught about the potential impact of a ketogenic diet on conditions like epilepsy.

A fresh look at core competencies for this education process is overdue. One study out of Harvard Law Schools’ Food Law and Policy Clinic, “Doctoring Our Diet,” looks at opportunities for policy changes that could impact medical school nutrition training. I particularly agree that physicians should graduate from medical school with a clear understanding of which specific dietary patterns could be used to not only prevent disease, but also treat certain diseases. Addressing the root cause of disease is fundamental to the MAHA Commission and should be foundational to physician training as well.

Across the board, medical students are knowledge-hungry and driven by a desire to help others. In speaking with colleagues about nutrition, it’s not uncommon to hear, “I wish I learned that in med school!” If we provide the education, they will not only embrace it—they’ll use it. And patients, as well as our entire healthcare system, will feel the impact. It’s high time that we as physicians add nutrition expertise to our skill set.