RFK Jr. Plans to Pull Medical Schools' Funding if They Don't Teach Nutrition

 HHS Secretary Robert F. Kennedy Jr. said in April that he plans to tell medical schools to teach nutrition or risk losing federal funding, ABC News reported

opens in a new tab or window last week.

"Under Secretary Kennedy's leadership, HHS is committed to ensuring that nutrition is treated as core clinical knowledge -- not a wellness extra -- in building a healthcare system equipped to prevent and manage chronic disease," an HHS spokesperson told MedPage Today in an email.

Medical organizations have said that doctors do indeed receive nutrition training in medical school. The Association of American Medical Colleges (AAMC), a key oversight agency in medical education, said in an emailed statement to MedPage Today that the vast majority of medical schools already teach nutrition in some form, including topics such as obesity, food access, and food security.

But nutrition experts say there's room for improvement, as courses can be more extensive and more focused on prevention.

Nutrition Experts Supportive

Brenda Rea, MD, DrPH, RD, of Loma Linda University in California and a founding member of the American College of Lifestyle Medicine (ACLM), said current medical school education on nutrition often involves biochemistry and nutritional deficiencies.

"It's not necessarily about chronic disease management nutrition, or the ability to actually reverse and put disease into remission with nutrition," Rea told MedPage Today.

There is currently no nationwide curriculum for nutrition education in medical schools. Nor are medical school students required to demonstrate competencies in advising patients about healthy food, according to David Eisenberg, MD, an adjunct associate professor at Harvard's T.H. Chan School of Public Health.

"I share Secretary Kennedy's desire to increase the degree to which doctors and medical trainees are introduced to nutrition," Eisenberg told MedPage Today. He and colleagues last year published a consensus statement in JAMA Network Openopens in a new tab or window recommending 36 mandatory nutrition competencies in medical education.

It's crucial that medical students, residents, and doctors have hands-on training in what a healthy diet looks -- and tastes like, Eisenberg said.

"Trying to educate physicians or patients to make better food choices in the absence of some experiential learning in a kitchen with real food is like talking to people about the benefits of swimming in the absence of a swimming pool: it can't be done," he said.

Eisenberg co-founded Healthy Kitchens, Healthy Livesopens in a new tab or window, an annual conference that instructs healthcare professionals in nutrition science and healthy eating, and established the Teaching Kitchen Collaborativeopens in a new tab or window, which includes dozens of hospitals and medical schools equipped with "teaching kitchens."

One such kitchen operates at the University of South Carolina School of Medicine Greenville, which requires its students to take 106 hours of lifestyle medicine across their 4 years. The program is a front-runner in the extensiveness of its training, says its director of lifestyle medicine programs, Jennifer Trilk, PhD.

"The model that works best is a classroom, clinic, community model," Trilk told MedPage Today.

Regarding Kennedy's mandate for nutrition education, Trilk said Greenville leans more toward the carrot than the stick.

"The medical schools that want to do this, how can we help them integrate lifestyle medicine into medical education?" she said, adding that it remains to be seen whether Kennedy's proposed mandate will be effective.

Potential Challenges

Kim Williams, MD, chair of medicine at the University of Louisville in Kentucky, believes that nutrition education for doctors is necessary, as is their ability to pass that knowledge along to patients.

However, he thinks that some of Kennedy's other nutrition recommendations -- such as eliminating seed oils -- are not supported by data and should therefore be dropped.

"We need to be very evidence-based," Williams said to MedPage Today, a point that Trilk also emphasized. "Look at the randomized trials. Look at the accumulation of evidence from large observational studies, all of them pointing to the same thing, whether you're talking about heart disease, heart failure, kidney failure, stroke, all of it is reduced dramatically by going on a whole food, plant-based diet."

Rea added that there are real barriers to achieving Kennedy's mandate. "There's curricular overload, there's limited faculty expertise, there's a lot of misconceptions about accreditation and assessment," she said.

There's also the question of whether simply tacking on a few extra nutrition classes to a medical student's training is sufficient, said Colleen Sloan, RD, PA. The whole of the problem shouldn't fall on doctors, she said, noting that there's already a whole healthcare profession -- dietitians -- dedicated to nutrition that should be better integrated into patient care.

Sloan lamented that insurance will cover seeing a dietitian only when "the patient is diagnosed with diabetes or end-stage renal disease. And I find that such a shame and a disservice to our patients that we're waiting until they're sick enough that we want them to see a dietitian to help."

It would be more beneficial, Sloan said, for a doctor to "pass the baton to the dietitian" much earlier to make dietary recommendations and help patients achieve their goals.

Disclosures

Eisenberg reported receiving personal fees from Teaching Kitchen Collaborative, Northwell Health, CancerScan, Infinitus, and Nissin, and honoraria from Barilla outside the submitted work.

Williams, Rea, Trilk, and Sloan had no disclosures to report.

https://www.medpagetoday.com/publichealthpolicy/medicaleducation/116050