Nutrition is a cornerstone of health, influencing well-being throughout one’s life. This effect is particularly pronounced in vulnerable groups—such as infants, pregnant individuals, the elderly, and those facing food insecurity—but it is crucial for the general population as well. The alarming increase in obesity rates has been linked not only to heart disease and diabetes but also to a decline in life expectancy in the U.S. Research indicates that merely 12% of American adults can be classified as metabolically healthy based on blood glucose and lipid levels.
In light of these challenges, we welcome the recent initiative by U.S. Secretaries Linda McMahon and Robert F. Kennedy Jr. aimed at enhancing nutrition education in medical training. A physician workforce with a robust understanding of nutrition could yield significant benefits. However, a critical question remains: Are the recommendations from the “Make America Healthy Again” initiative truly based on sound scientific evidence?
Traditionally, physicians receive insufficient training in nutrition during their medical education. Many students arrive with an interest in preventive care and nutrition, making it vital to provide them with the skills needed for effective self-care and professional practice. Over the years, medical students have consistently expressed a demand for more nutrition education, focusing on practical knowledge to address patient inquiries and navigate the overwhelming amount of conflicting information in today’s media landscape.
Nutrition scientists have long highlighted this educational gap, with surveys indicating that medical students typically receive fewer than 22 hours of nutrition education throughout their four years of study.
Responding to these calls, an expert panel of physicians and nutrition scientists published a set of proposed nutrition competencies in JAMA Network Open in 2024. These competencies outline the essential knowledge and skills that future physicians require to effectively address their patients’ nutritional needs. This foundational list serves as a guideline for medical schools to incorporate nutrition into their curricula.
The recent directive from U.S. medical schools to “immediately implement comprehensive nutrition education and training” at all levels of medical training is, on first glance, positive news. It emphasizes the inclusion of nutrition competencies in premedical and medical school curricula, as well as in requirements for medical licensing, board certification, and continuing education.
Such expansive educational initiatives align with what many in the medical community, including ourselves, have advocated for over the years. Recently, the Department of Health and Human Services hosted a symposium where medical school representatives committed to enhancing nutrition education to at least 40 hours over the course of medical training. Additionally, federal officials announced a grant mechanism through the National Institutes of Health for curriculum development.
Yet, certain aspects of the announcement induce caution. For instance, to facilitate these training commitments, HHS has outlined 71 competencies, some of which derive inspiration from the 2024 JAMA Network Open proposed competencies. However, others promote low-to-no evidence practices like specific diets (e.g., “anti-inflammatory diets”), supplementation, and referrals to “functional nutritionists” without clear qualifications. Other competencies delve into agricultural practices and topics of limited relevance to the majority of physicians, such as “understanding practices that restore soil microbiota and produce nutrient-dense food.”
Those familiar with the “MAHA” movement and the views of surgeon general nominee Casey Means will not find these deviations surprising. They do raise concerns about the potential normalization of non-evidence-based practices within medical nutrition training. As healthcare costs continue to rise, and the public grapples with a ceaseless stream of nutrition misinformation, it is essential that physician education in nutrition remains rooted in scientific rigor and free from commercial influence.
We urge medical schools to thoroughly review and incorporate the 2024 consensus nutrition competencies from JAMA Network Open into their curricula. Collaboration among peer institutions can help implement effective nutrition training for physicians. At Harvard Medical School, nutrition is woven into both the preclinical and clinical curriculum, supplemented by dedicated courses. An elective for third- and fourth-year students, titled “Nutrition, Metabolism, and Lifestyle Medicine,” offers training in nutrition assessment and dietary guidance, enhancing critical thinking and evidence evaluation. An engaging culinary medicine elective is also available for smaller groups of students each winter.
Harvard faculty actively promote teaching kitchens for practical learning and lead online courses, contribute to journals, and publish textbooks in nutrition science. While Harvard presents a model for integrating nutrition science into medical training, there remains a need for wider incorporation across the curriculum.
This focus should extend into postgraduate training, clinical settings, and continuing education, particularly as patients are inundated with dubious nutritional claims and advice. Several misleading claims arise from the very administration promoting this nutrition education. Many beliefs associated with the “Make America Healthy Again” movement lack empirical support, such as the assertion that vitamin A should be used as an alternative treatment for measles while undermining vaccine policies, or claims that certain fats like “seed oils” cause obesity without acknowledging other contributing factors. This also includes the misguided notion that fluoridated water poses a health risk while ignoring significant reductions in dental cavity rates.
Although we support the intentions behind the secretaries’ initiative, it is crucial that credible nutrition educators and scientists are involved in shaping these reforms. We call upon medical schools, accrediting organizations, and the broader educational community to build upon the rigorous evidence-based competencies presented in the 2024 JAMA Network Open guidelines, ensuring that this standard isn’t compromised by content lacking scientific backing.
However, we acknowledge that enhancing physician training alone will not resolve the nutrition-related challenges faced by our nation. Public health initiatives and policies play crucial roles in determining nutritional health, as illustrated by recent budget cuts to food assistance programs, water fluoridation rollbacks, and changes in the Dietary Guidelines process.
Physicians with strong nutritional training are uniquely positioned to advocate for legislation that enhances access to registered dietitian services and addresses the issues of hunger and food insecurity. This advocacy must be rooted in rigorous scientific evidence and sustained through commitment to factual integrity, regardless of the political climate.
Christopher P. Duggan, M.D., M.P.H., is the director of the Division of Nutrition and a professor of pediatrics at Harvard Medical School. Marie-France Hivert, M.D., serves as a professor of population medicine and directs the curricular theme of nutrition and lifestyle medicine at Harvard Medical School. Kevin Klatt, R.D., Ph.D., is an assistant professor in the Department of Nutritional Sciences at the University of Toronto’s Temerty Faculty of Medicine. The perspectives shared in this piece are those of the authors and do not represent the official views of Harvard Medical School or the University of Toronto.
