
There's almost no medical schools that have nutrition courses, and so [aspiring physicians] are taught how to treat illnesses with drugs but not how to treat them with food or to keep people healthy so they don't need the drugs.
One of the things that we'll do over the next year is to announce that medical schools that don't have those programs are not going to be eligible for our funding, and that we will withhold funds from those who don't implement those kinds of courses."
This didn't come out of left field. MAHA seems to believe that diet is the root cause of just about every illness that we suffer. However, this demand actually predates MAHA. In 2022, Congress adopted a resolution calling for nutrition education for medical trainees.
“Expressing the sense of the House of Representatives that the United States recognizes the mounting personal and financial burden of diet-related disease in the United States and calls on medical schools, graduate medical education programs, and other health professional training programs to provide meaningful physician and health professional education on nutrition and diet.”
Food As Medicine
There are two separate movements that believe that food is medicine. One is MAHA and all those aligned with them (e.g., functional medicine, wellness, and food influencers). The other is working to ensure access to food and grocery stores, e.g., money and transportation. These are distinctly different perspectives on the concept of food as medicine, and it is essential to distinguish them from one another.
MAHA and their minions believe that clean eating/organic/whole foods/not-ultraprocessed foods, whatever the buzz phrase du jour is, will cure us of just about all of our ailments. Never mind that for a diet to change our health, people must 1) have money to buy enough food, and 2) have access to a grocery store. Those are not givens in the United States.
In 2023, 13.5% of households in the United States experienced food insecurity - a lack of reliable access to a sufficient quantity of affordable, healthy food. For the food-insecure, diet is often not at the top of mind; a compromise between basic needs must be considered, as decisions must be made between food, medicine, heat, water, and other essentials.
“Even with perfect, universal access to food retailers, millions of Americans would not be able to afford enough food, or enough of the kinds of food, to meet their household’s needs. In the case of food, demand is suppressed among lower-income households. Low-income households spend less than a third of what high-income households spend on food each year, yet food expenditures account for a disproportionate share (36%) of their disposable income.”
The current “Big Beautiful Bill” proposes deep cuts to the Supplemental Nutrition Assistance Program (SNAP), including eliminating funding for SNAP-Ed, which provides nutrition education to low-income people. It's more than a bit strange that RFK Jr. would be calling for “more education in nutrition” for some (physicians), while the administration is actively attempting to cut nutrition assistance and education for the people with a demonstrated need. If food is medicine, why wouldn't we want to ensure that people are educated in how to select and prepare healthy food, and have access to it?
Understanding Care Providers
Much has been said about physicians and their paltry knowledge of nutrition. However, this overlooks the role of physicians as leaders of healthcare teams. Given the complexity of healthcare and its attendant bureaucracy, we can’t and shouldn't expect one person to have all the knowledge necessary to make a complete care team, which is why we have multiple types of providers who specialize in different areas.
Physicians have specialties, and we don’t expect them to know much outside of their specialty. For example, I would not expect a pulmonologist to know much about resetting broken bones. That’s not what they do. However, if you present to a pulmonologist with a broken bone, they could tell you that you need to consult with an orthopedist. Physicians tend to have sufficient knowledge of the specialties within medicine to make informed referrals. However, they often lack in-depth knowledge of the rest of the healthcare team's specialties.
What if instead of a nutrition class, we trained physicians to understand the basics of what other healthcare professionals and practitioners do? For example, many physicians are not aware of the difference between a nutritionist and a registered dietitian. Many physicians make referrals for nutrition and dietetics expertise, but it seems relevant that they should know how to find a qualified professional in the field. Hello, registered dietitians!
What if we simply relied on the experts we already have who specialize in nutrition and dietetics and work in healthcare? Why wouldn’t we lean on these nutrition professionals instead of asking even more from our physicians? At some point, we’re expecting too much of them. Before making blanket statements about how physicians should know more, it seems relevant to have a genuine appreciation for what physicians undergo in training, as well as the experiences of other healthcare professionals, such as registered dietitians, and how care teams are intended to function.
Physicians would benefit from knowing more about nutrition in general. However, the real problem is food insecurity in the United States, and education and financial assistance to the food-insecure are currently on the chopping block. Proposing that physicians, already overburdened and in short supply, are somehow responsible for fixing this systemic problem misses the point entirely. We already have individuals, registered dietitians, whose entire job is to be experts in nutrition and dietetics, to help educate and navigate individuals through the consumer end of the food chain. We are underutilizing this profession; physicians are no longer our one-stop shop for care.
“...I don't think people should be taking advice, medical advice, from me.”
There are good-faith conversations to be had about what should or should not be required in medical training. However, those conversations are best left to people working in medical training who understand the competing priorities that physicians-in-training experience. RFK Jr.'s proposed solution is irrelevant to our actual problems and avoids engaging with the real challenges that food as medicine presents.