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HHS Secretary Robert F. Kennedy Jr has announced that medical schools will now have to teach nutrition.  This is a great idea in theory; in practice, no so much,

First, here’s what RFK Jr is saying:

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I can’t believe I’m writing about this again.  

I taught nutrition to medical students at the University of California San Francisco (UCSF) School of Medicine from 1976-1986.  The lack of nutrition training in medicine had already been an issue under discussion since the early 1960s.  Not much has changed since then.

Why?

Have you been to a doctor lately?  If so, how much time did you have?

Even if your doctor has a degree in nutrition, she doesn’t have time to take a diet history and work with you to improve your particular diet.  She also will not get reimbursed for that time.

Nutrition can be complicated as applied to specific disease conditions.  Who is going to teach it?

I think doctors only need to know three things about nutrition.

1.  The importance of diet for good health
2.  How to refer patients to a dietitian/nutritionist
3.  How to work with a dietitian/nutrition to improve patient care

Yes, doctors can also write prescriptions for healthy foods, if they are involved with a Food Is Medicine program.

But the single best way to deal with the nutrition issue is to refer patients who need help to a dietitian/nutritionist.

I sure hope that is Number 1 on the required curriculum.

Two previous posts on this topic:

• From 2014: No nutrition in medical education? An old story that might be changing.

   I wrote almost identical articles in the 1980s based on my experience at UCSF (here’s one).

  I asked a former UCSF colleague, Dr. Robert Baron, to co-author the commentary with me: Nutrition in Medical Education:  From Counting Hours to Measuring Competence.

• From 2024: Some thoughts about the current state of nutrition I: Medical Education

  I wrote my first book, Nutrition in Clinical Practice, in which I briefly summarized what all of us at the time thought medical students needed to know.  The book was published in 1985, and is long out of print.  In 2020, a used copy was available on Amazon for $930 (even more surprising, it is no longer on that site).

I subscribe to Jerry Hagstrom’s Hagstrom Report because he gets to go to things in Washington, D.C. and elsewere that I can’t get to but wish I could.

He reported last week (December 7) on the Food As Medicine Summit, and wrote about it in the National Journal — “Food as medicine’ on the table”.  This notes, among other things, that the minimum fee for attending was $399.

So what is the food-as-medicine movement? Advocates believe changing Americans’ diets away from the fat, sodium, and added sugars that have led to high levels of obesity and instead toward fruits, vegetables, fiber, and lean protein can reduce the need for prescription drugs and hospitalizations. The advocates want Medicare, Medicaid, and private insurers to pay for diet interventions like produce prescriptions.

He also reported on the accompanying Trade Show.

Food as Medicine is still an emerging concept, but there was a small trade show on the sidelines of the Food as Medicine Policy Summit that showed the range of companies that believe the food and health care industries need their products.

I was particularly interested in the trade show because the monetization of Food Is Medicine is a big concern.

Also last week, JAMA published a critique of the concept: “A “Food Is Medicine” Approach to Disease PreventionLimitations and Alternatives,” arguing that “the medical and public health communities’ enthusiasm for food is medicine seems unjustified by its likely benefit.”

The authors argue (my paraphrasing):

• Evidence in support of FIM’s ability to improve health is weak.
• Existing studies do not differential FIM from the effects of standard care.
• FIM requires enrollment in the health care system (overburdened, dysfunctional, difficult to access).
• Patient adherence to interventions is low (unless they are provided intact and paid for).
• Existing federal food and nutrition programs are already known to work; they deserve more support.
• The main beneficiary is the food industry, which gets to shift responsibility to the health care system.
• Food companies will also benefit from sales of FIM products [hence the Summit Trade Show].

Count me as an FIM skeptic.  It’s nice for people who can get it; it is not likely to scale up enough to address chronic disease in any significant way.

Hagstrom lists these resources:▪
▪ USDA National Institute of Food and Agriculture — Gus Schumacher Nutrition Incentive Program
▪ Grey Green Media — Events
▪ Food is Medicine Coalition