After decades of research, there is little doubt that nutrition plays a critical role in promoting health across the lifespan. This is especially true among vulnerable populations (infants and young children, pregnant people, the aged, and the food insecure) but also among otherwise healthy people. The well-documented rising tide of obesity has been associated not only with heart disease, diabetes, and cancer, but with a drop in U.S. life expectancy. It is estimated that, based on measures of blood glucose, lipids, and other parameters, less than 12% of the adult American population can even be said to metabolically healthy.
It is against this backdrop that we applaud, on its face, the recent directive from U.S. Secretaries Linda McMahon and Robert F. Kennedy Jr. to promote nutrition education across medical training. There will undoubtedly be many benefits to a physician workforce with a strong, scientifically grounded understanding of nutrition. But are all of the “Make America Healthy Again” nutrition recommendations truly science-based?”
Physicians generally receive inadequate training in nutrition as part of their main medical education. As we know from teaching students, many enter medical school with a commitment to and interest in preventive medicine in general and nutrition in particular, and teaching them important skills in nutrition is helpful 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 address numerous questions from their patients and to untangle the overflow of information and misinformation from contemporary media.
For decades, nutrition scientists and their organizations have also called attention to this critical gap in medical training, with surveys suggesting that medical students receive on average fewer than 22 total hours of education over four years.
In 2024, in acknowledgment of this push, an expert panel of physicians and nutrition scientists published in JAMA Network Open a list of proposed nutrition competencies for future physicians to acquire skills and knowledge necessary for practicing today’s medicine and addressing patients’ nutritional needs. (Each competency details knowledge and skills physicians should obtain during training.) This list proposed a foundation for medical schools and postgraduate medical training to build nutrition into their curricula.
So the recent directive to U.S. 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 makes reference to including nutrition competencies in premedical and medical school curricula, and as part of medical licensing requirements, board certification, and continuing medical education.
Such broad-based educational initiatives seem exactly what we and others have long advocated to our 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 over the four years of medical school, and federal officials announced a curriculum development grant mechanism from the National Institutes of Health.
But elements of the announcement give some pause. For example, to facilitate training commitments, HHS developed 71 competencies, some of which are inspired by the JAMA Network Open 2024 proposed competencies. But others advocate for a number of low-to-no evidence modalities: specific diets (e.g., “anti-inflammatory diets”), supplementation approaches, testing and wearables, and referral to “functional nutritionists” and health coaches without defining qualifications. Other competencies focus on agricultural production methods and other topics of limited relevance to the clinical work of most physicians (e.g., “understand practices restoring soil microbiota and yielding nutrient-dense food”).
To anyone following the MAHA movement and the activities of the surgeon general nominee, Casey Means, these deviations will not be surprising. Nonetheless, they represent a concerning effort to normalize non-evidence-based practice into 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 nutrition misinformation, we must be hypervigilant that physician training 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 competencies across their medical curricula and collaborate with peer schools to implement effective physician nutrition training. At Harvard Medical School, nutrition is taught both in an integrated manner throughout the preclinical and clinical curriculum, as well as via individual courses. An elective for during third- and fourth-year students (“Nutrition, Metabolism and Lifestyle Medicine”) instructs 20-25 people each spring in the principles of nutrition assessment, dietary guidance, and nutrition science inquiry by developing their critical thinking skills and evaluating available evidence. A popular elective in culinary medicine is offered each winter to eight to 10 students of all levels.
Harvard faculty are also active in promoting teaching kitchens for hands-on instruction, as well as leading web-based courses, journals, and textbooks in the science of nutrition. Harvard is just one institutional example of how to lay a strong foundation in nutrition science for medical trainees, but even it needs to more fully incorporate nutrition throughout the medical school curriculum.
It also needs to be built more into post-graduate training periods, in training hospitals, and in continuing education, as patients seize on never-ending questionable claims about food and nutrition. Many of those claims, which physicians must help their patients sort out, come from the very administration advocating for physician nutrition education. The “Make America Healthy Again” movement is populated by beliefs that are not supported, and even contradicted, by robust scientific evidence. These include the belief that vitamin A therapy is indicated as an alternative therapy for measles (while the administration undercuts vaccine policies), the idea that consumption of “seed oils” causes obesity (without addressing other causes of this complex multifactorial health condition), that fluoridated water is a health risk (while ignoring a decades-long reduction in the rate of dental cavities), and the encouragement of product reformulations (e.g., cane sugar for high-fructose corn syrup; beef tallow for seed oils) with no nutritional benefit.
So while we are enthusiastic about the rationale behind the secretaries’ proposal, we believe that credible nutrition educators and scientists need to be closely involved in such reform. We call on medical schools, accrediting bodies, and the broader medical education community to build on the rigorous, evidence-based foundation of the 2024 JAMA Network Open competencies — and to resist the dilution of that standard with content that does not meet the same evidentiary bar.
At the same time, we recognize that the nutrition challenges facing this country will not be solved by better-trained physicians alone. Public health programs and policies are strong determinants of nutritional status, which has direct consequences on individuals’ health, as seen by recent cuts to food assistance programs, rollbacks on community water fluoridation, and alterations to the Dietary Guidelines process.
Nutrition-educated physicians are uniquely positioned to be effective advocates: for legislation that expands access to registered dietitian services and addresses hunger and food insecurity, and for broadly supporting 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, M.D., M.P.H., is director of the Division of Nutrition and professor of pediatrics at Harvard Medical School. Marie-France Hivert, M.D., is professor of population medicine and director of curricular theme nutrition and lifestyle medicine at Harvard Medical School. Kevin Klatt, R.D., Ph.D., is assistant professor in the Department of Nutritional Sciences at the University of Toronto’s Temerty Faculty of Medicine. The views expressed in this piece are those of the authors and do not represent official views of Harvard Medical School or the University of Toronto.
