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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’m indebted to Errol Schweizer, Grocery Nerd, for pointing out in response to my post on we need more vegetables, that if we want more vegetables, somebody has to pick them.  Raids by ICE on farmworkers are not helping this situation; they are wrong, morally and legally, and must stop.

Schweizer writes:  RFK Betrays/ICE Terrorizes Food Workers.

The Border Patrol and Immigration Customs and Enforcement (ICE) division continue to kidnap, persecute and traffic hard working, law-abiding essential food supply chain workers for no just cause.

Now is the time for the grocery industry, including retail and CPG executives, essential workers, brand founders and Make America Healthy Again (MAHA) advocates to stand up against these flagrant violations of human rights, due process, civil liberties and just plain decency.

From the New York Times: Wilted Lettuce. Rotten Strawberries. Here’s What Happens When You Round Up Farmworkers. 

Bottom line, it isn’t easy for farmers and ranchers to replace farmworkers if they’re deported or don’t show up. These positions require experience, endurance and specialized knowledge; as anyone who has worked on a farm will tell you, farm work is not unskilled labor.

From FoodPrint: How the current immigration crackdown is impacting food and farmworkers

Around 40 percent of farmworkers in the U.S. are undocumented. The numbers are similar in many other parts of the food system, especially meatpacking, where undocumented immigrants fill an estimated 23 percent of jobs. ..For the most part, farmers supported the Trump administration in the election, with many believing the president’s claims that he would spare farmworkers from promised mass deportations, focusing instead on “dangerous criminals”….[But] ICE agents began aggressively targeting worksites, visiting farms and packing sites in California and a meatpacking plant in Nebraska on June 10. Those raids generated an immediate flurry of complaints from farmers and the food industry.

From Civil Eats: ICE Raids Target Workers on Farms and in Food Production: A Running List

Immigration enforcement actions at workplaces are likely to increase as the agencies attempt to meet new White House goals of 3,000 arrests per day. We are keeping a record of those actions here.

Here is Civil Eats’ list for August, with contact information for Lisa Held, who is keeping track of all this.

August 7, 2025 – Pittsburgh, Pennsylvania – ICE detains 16 workers during raids of two Mexican restaurants

August 8, 2025 – Woodburn, Oregon – ICE detains four immigrant farmworkers on their way to work at a blueberry farm

August 11, 2025 – Anchorage, Alaska – ICE officials arrest an asylum seeker outside sushi restaurant

August 14, 2025 – Kent, New York – ICE raids Lynn-Ette Farms—where United Farm Workers have been organizing— and detains seven workers

Want to send us a tip about immigration enforcement in your community? Email tracker@civileats.com or securely contact Lisa Held on Signal at @lisaelaineh.47. (Link to this post.)

Enjoy the Labor Day holiday, but then do what you can to make this stop.

Michael Jacobson, founder and former president of the Center for Science in the Public Interest, is now promoting development of a National Food Museum.  One of its projects is keeping score on administration food policies.

He lists them as positive or negative, like this.

The most recent entry is dated June 26, a negative: the huge cut in SNAP benefits.

Alas, the negatives far outweigh the positives.  Take a look.

Thanks to Food Fix for this collection of tracking sites

• STAT News: Isabella Cueto’s report on MAHA’s minimal progress
• HHS: “MAHA in Action” public health wins (Food Fix says this is more like a campaign site).
• FDA:  Food industry pledges to remove food dyes (promises, but not much action yet)

The Bureau of Labor Statistics published this graph of the change in price of fresh vegetables since January 2024.  Prices have gone up a lot this year.

This did not get sent out to subscribers last week, so I’m trying again.

This may be explained not just by inflation, but also by a decline in the availability of vegetables in the food supply (defined as produced in the U.S., less exports, plus imports) as shown in this chart from the USDA.

If we want people to eat more healthfully, we need policies to make vegetables more widely available at lower cost.  Farmers have to make a living.  That’s why we need to rethink which foods get subsidized, and our entire agricultural system for that matter.

How about redesigning the agricultural system to prioritize food for people, instead of feed for animals and fuel for automobiles.

To explain, I’m posting this USDA chart again.

I am indebted to Melissa Fuster at Tulane University (congratulations on achieving tenure!) and Megan Knapp of Xavier University of Louisiana for telling me about this one.

The USDA has just approved a waiver for the State of Louisiana to exclude soft drinks, energy drinks, and candy from allowable purchases with SNAP benefits.

Check the definition of  excluded soft drinks [my emphasis]:

“Soft drinks” are defined as any carbonated nonalcoholic beverage containing high fructose corn syrup or artificial sweeteners.

By this definition, soft drinks made with cane or beet sugar are fully allowed to be purchased using SNAP benefits.

What is the difference between high fructose corn syrup and cane or beet sugar?  Not much.  All are mixtures of glucose and fructose and have the same number of calories.

So why the distinction?

Guess which state is the #2 producer of cane sugar.

As I said, nutritionally hilarious (see my clip in John Oliver’s Last Week Tonight on this point).

I was asked to write an editorial commenting on a study published a couple of weeks ago that looked at changes in weight among people participating in a comparison of ultra-processed vs. minimally processed diets.

The study: Ultraprocessed or minimally processed diets following healthy dietary guidelines on weight and cardiometabolic health: a randomized, crossover trial. Nat Med (2025). https://doi.org/10.1038/s41591-025-03842-0.

The study has a long list of authors: Samuel J. Dicken, Friedrich C. Jassil, Adrian Brown, Monika Kalis, Chloe Stanley, Chaniqua Ranson, Tapiwa Ruwona, Sulmaaz Qamar, Caroline Buck, Ritwika Mallik, Nausheen Hamid, Jonathan M. Bird, Alanna Brown, Benjamin Norton, Claudia A. M. Gandini Wheeler-Kingshott, Mark Hamer, Chris van Tulleken, Kevin D. Hall, Abigail Fisher, Janine Makaronidis & Rachel L. Batterham .

It must have been a huge amount of work to conduct this trial.  I can’t even imagine.

The lead author, Sam Dicken, explained the trial and its results on X.

My editorial has just been published in Nature Medicine:  Ultra-processed diets promote excess calorie consumption (I have no idea why the editorial was not published at the same time as the study, but it is now out).

I fthought several things about the study to be especially interesting.

• Participants, all overweight or obese, lived at their homes while under study.
• They were fed ultra-processed meals for 8 weeks followed by minimally processed meals for 8 weeks, or vice versa.
• Both sets of meals were designed to meet British guidelines for healthy foods; the ultra-processed foods were all healthy.
• They were give about 4,000 calories a day and could eat as much as they wanted from that.
• Participants lost weight no matter which diet they were on.
• They lost twice as much weight on the minimally processed diet.
• They ate more calories on the ultra-processed diet in comparison to what they were eating on the minimally processed diet.

Here’s the summary from my editorial.

One of the co-authors on the study is Kevin Hall, who did a rigorously controlled clinical trial of ultra-processed v. minimally processed diets and reported participants to be unwittingly consuming 500 calories a day more on the ultra-processed.

His study has been criticized for being too short in duration: two weeks on each diet.

This study kept participants on one or the other diet for eight weeks, and got a smaller but similar result.

Dicken et al also addressed a frequent criticism of the concept of ultra-processed foods: that the category excludes healthy foods like whole wheat commercial bread, commercial yogurts, power bars, and the like.  That’s what these participants were fed when they were on the healthy ultra-processed diet.

Here’s how I concluded my editorial:

Overeating, overweight, and increased risks for chronic disease are rapidly increasing public health problems for global societies.  Dietary guidelines in the UK and the United States have had little effect on improving overall dietary intake. None of these guidelines considers the degree of processing; the findings from Dicken et al. suggest that they should.

Brazil’s dietary guidelines, issued in 2015, say “avoid ultra-processed foods.” Researchers in the United States have called for guidelines and regulatory approaches to reduce intake of ultra-processed foods.

Despite ongoing debates about their definition, classification, and effects on health, in the context of maintaining or losing weight the evidence points to a clear message: minimize intake of ultra-processed foods.

If nothing else, the study provided further evidence for this sensible dietary advice.

Dicken et al: press coverage

• New York Times
• The Guardian
• CNN  I’m quoted in this one

Here is yet another industry-funded study with a predictably favorable outcome, this one about a drink containing 6 grams of dietary fiber shown in this study to reduce blood glucose levels after consumption.

The study: Prebiotic soda lowers postprandial glucose compared to traditional soda pop: a randomized controlled trial.

Conclusion: a prebiotic soda is a favorable alternative to traditional soda formulations for managing postprandial blood glucose levels and maximal glucose excursion in generally healthy adults with overweight or obesity.

Competing interest statement: This study was funded by the manufacturer of the prebiotic soda beverage, OLIPOP, Inc. CFM, TB, EM, VK, and CC were employees of Biofortis, Inc., a Contract Research Organization that received funding from OLIPOP, Inc. to conduct the study. NV, MJM, and CM were employees of OLIPOP, Inc., the study sponsor company. AMV was a consultant of OLIPOP, Inc. for research support at the sponsor’s request.

Funding Statement: This study was funded by OLIPOP, Inc.

Comment: I particularly wanted to include this one because it is so blatantly done for commercial purposes, funded by the maker of the soda and conducted by employees or consultants. It belongs in the Journal of Industry-Funded Research, if such a thing existed.  Adding fiber to sodas to feed your microbiome?  I’d rather get mine from vegetables, grains, beans, nuts, and fruits.

The Global Health Advocacy Incubator has issued an action guide to legal advocacy.

As GHAI puts it,

GHAI has launched a new Legal Advocacy Action Guide to show how legal professionals can advance public health objectives by identifying the most feasible legal strategies, drafting robust laws and regulation and using strategic litigation to promote and protect public health policy. Download it here, or read our sponsored Devex article summarizing how legal strategies can help advocates draft stronger laws and hold health-harming industries accountable. The new legal guide complements our Advocacy Action Guide.

This is a how-to manual for lawyers and advocates about how to use the legal system of a country to promote public health.  It’s divided into the 4 sections shown on the cover: Analyze, Draft, Assess, Litigate.

Each of these discussions comes with international case studies.

Here is an excerpt from the litigate section.

This guide is really useful.  Use it!