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Last week’s big announcement: Secretary Kennedy and Secretary McMahon Celebrate Medical School Commitments to Increase Nutrition Training for Future Doctors

The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Education convened leaders from 53 of the nation’s top medical schools across 31 states today to announce commitments to require meaningful nutrition training for future doctors beginning in the next academic year…A 2022 survey published in the Journal of Wellness found that medical students reported receiving an average of 1.2 hours of formal nutrition education each year.

From the Fact Sheet on the initiative:

Even as our nation spends $4.4 trillion annually on treating chronic disease and mental health, an estimated one million Americans die from food-related chronic illnesses each year. To reverse the chronic disease epidemic, health care professionals must be trained to recognize, diagnose, treat, and prevent diet-related diseases.

Nutrition education is sorely lacking in America’s medical training. Historically, less than 1% of total lecture hours in U.S. medical schools has been devoted to nutrition education. As of 2024, 75% of U.S. medical schools required no clinical nutrition classes. Medical students surveyed in 2022 reported receiving an average of 1.2 hours of formal nutrition education each year. Only 14% of residency programs require a nutrition curriculum; only 14% of current health care providers feel comfortable discussing nutrition with their patients.

The list of medical schools that have agreed to participate is here.

Some background

In January, Secretary Kennedy sent a letter to medical schools calling on them to increase nutrition teaching.

HHS welcomes your participation to implement, beginning in fall 2026, either: 1) a minimum of 40 hours of required nutrition education across all four years of undergraduate medical education; or 2) a minimum 40-hour competency equivalent. We encourage your university to display on a public website a detailed plan for achieving, tracking, and assessing your progress.

The letter suggested 71 nutrition competiencies from which schools could pick.

Some ways your university could do this are:
1. Conduct a comprehensive baseline assessment of your current nutrition curriculum and identify any gaps or opportunities that exist.
2. Identify a faculty champion to lead development and ensure sustained implementation.
3. Formalize your institution’s commitment by posting your nutrition education implementation plan and participation as an active partner in this initiative on your website.

Comment

I have written any number of previous posts about this topic. I taught nutrition to students at the USCF School of Medicine fron 1976-1986 and had a federal grant to do so early on.  Even then, it had been 20 years since the American Medical Association held its first conference on nutrition education in medical schools.  It has now been more than 60 years since those first calls with remarkably little progress.

This is not for lack of trying.

• My most recent contribution to this cause: Nestle M, Baron RB. Nutrition in Medical Education: From Counting Hours to Measuring Competence. JAMA Intern Med. Published online April 14, 2014. doi:10.1001/jamainternmed.2014.440.
• In 2024, medial educators, Eisenberg DM, Cole A, Maile EJ, et al., published Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement. JAMA Netw Open. 2024;7(9):e2435425. doi:10.1001/jamanetworkopen.2024.35425  (I particularly like competency #1: “Provides evidence-based, culturally sensitive nutrition and food recommendations to patients for the prevention and treatment of disease.”

But the barriers have been—and remain—formidible.

• The focus of medical care on treatment, not prevention
• The lack of qualified instructors (“champions”)
• The lack of nutrition departments in medical schools (departments own curriculum time)
• The lack of curriculum time
• The lack of reinforcement of didactic training at the bedside
• The absurdly short time available for encounters between doctors an patients
• The complexities of diet and health

Yes, medical students should be taught nutrition, no question.  But how?  From my now lengthy experience with all this, I think medical students need to know:

1. How to recognize a nutrition problem in a patient (not as easy as it sounds)
2. How to refer patients to professional dietetions or nutritionists
3. How to identify good ones to work with (not as hard as it sounds)

What I find utterly remarkable about RFK Jr’s list of competencies is how closely most of them resemble the required competencies for dietitians.

And this entire initiative is voluntary.

If Secretary Kennedy really wants medical schools to teach nutrition, he needs get the medical schools to develop a core curriculum and require it, and also get them funded to support that work.

Press account: The New York Times — Dozens of Medical Schools Back Kennedy Plan on Nutrition After Pressure

One last comment: some of the competencies go way beyond dietetics and address food systems, such as:

#48: Regenerative agriculture as clinical intervention: understand practices restoring soil microbiota and yielding nutrient-dense food
#66  Nutrient density and soil health: understand relationship between soil microbiota diversity and minerat/nutrient content of foods
#67 Regenerative agriculture immersion: participate in on-site learning at farms including soil sampling, composting, crop rotation
#70 Environmental contaminant case studies: review clinical cases linking food-based
exposures to patient outcomes

In my post last week, “The government is actively promoting meat and dairy intake,” I said

The new Dietary Guidelines for Americans actively promote meat and dairy intake, especially full-fat dairy.  The USDA has long acted as a marketing arm of those industries through its research and promotion (checkoff) programs.

I then noted that this government takes promotion to new levels through its milk mustache ads and pronouncements that we have ended the war on protein (protein has long been understood as a euphemism for meat).

I ended with this comment: “I chalk all this up to the extraordinary lobbying power of the meat and dairy industries.”

Whew.  Did that ever get a response.

Readers raised two issues:

I.  The guidelines and inverted pyramid give equal weight to plant foods.

That’s not how I read them.  I see them as giving lip service to plants but prioritizing meat.  They visually present meat most prominently in the interactive graphic at realfood.gov.  Subsequent statements of the USDA and HHS secretaries also support this view.  And then there are the authors with financial links to beef industry groups who wrote the scientific reports relevent to meat.

II. This is not about meat industry lobbying; it is about Robert F. Kennedy, Jr’s ideology.  Well, yes.  That too.  “Ideology” refers to belief systems that structure views of the world.  Everybody has them.

I, for example, am ideologically in favor of the dietary guidelines’ advice to eat real food and avoid highly processed food, but ideologically opposed to advice to prioritize animal protein over plant protein.  I would argue that the vast preponderance of research supports that view.

People holding other ideological views disagree, evidently.  They pick different studies to read and come to different conclusions.

Two members of the nine people writing scientific reviews for the guidelines assure me that their reviews are unbiased.  But those reviews invariably reflect the ideology of the people who wrote them.

As I often point out, nutrition research is impossible to control rigorously, unless you lock people up for extended periods of time.  That is why the best controlled studies, those done in monitored metabolic wards, can only be done for a few weeks at most.  Diets are complicated; eaters are complicated; research is complicated.  Complicated research requires interpretation.  Interpretation depends on the interpreter’s particular ideology.

That is why appointing a diverse committee to look at research questions has its benefits; people with differing ideologies have to work out points of agreement.

I will say this for RFK, Jr.  He makes his ideology clear.  It prioritizes personal experience over science.

My ideology: We need science to distinguish anecdote from fact.

Let’s agree that on the meat priority issue, RFK Jr’s ideology fits well with meat industry objectives.

The meat industry has a long history of lobbying around dietary guidelines (see my book, Food Politics).

I have not seen specific reports of meat industry lobbying around the new dietary guidelines.  Apparently, no lobbying was necessary.

If you are wondering what’s going on at the FDA, and why everyone seems to be worried about its current leadership, take a look at this instructive post on X: “Nearly 90% of senior leaders who were at the FDA a year ago are no longer there.”

As I noted last May, I get asked all the time about what they will say, but have no inside information.  But this may be a good time to go over the clues.

The process

• A scientific advisory committee reviews the research and writes a report.  This was released in December.
• Unspecified (to date) people in USDA and HHS write the guidelines.

The promises

• They will come out “hopefully early fall” (this did not happen)
• Now, according to Reuters, the new dietary guidelines will be released some time in December.

What they won’t say

• They will not continue the tradition of “leftist ideology”  [I think this must mean plant foods]
• They will not promote seed oils (RFK Jr prefers beef tallow).
• They will not promote sugar; RFK Jr says sugar is poison.  [But declared a MAHA Win for Coca’ Cola’s replacement of high fructose corn syrup with cane sugar]
• They won’t say anything about sustainability [anything about climate change is forbidden]

What they will be about

[According to Reuters] Kennedy said the new guidelines would change the kind of food served to military service members and children in schools, but gave no details on the new recommendations.

“If we want to solve the chronic disease crisis, we have to tackle obesity,” Kennedy said. “Obesity is the number one driver of chronic disease,” he said, adding that 50% of the adult U.S. population was obese or overweight, driving costs up for diabetes care and cardiac diseases.

What they might say

Beef

• In its Plan to Fortify the Beef Industry, the USDA says the 2025–2030 Dietary Guidelines will “encourage protein as the foundation for every meal.”
• In an announcement to ranchers, USDA quotes RFK Jr, “we are restoring whole foods as the foundation of the American diet and ending the decades-old stigma against natural saturated fat in beef and dairy products. We will strengthen America’s ranching industry so families can choose nutrient-dense, minimally processed foods.”

Dairy

In a news conference, officials gave some clues.

We are going to be there for the dairy industry…our agencies are about to release more dietary guidelines in the next several months that will elevate those products to where they ought to be…There’s a tremendous amount of emerging science that talks about the need for more protein in our diet, and more fats in our diet, and there’s no industry that does that better than this industry.

Speculation

When RFK Jr first talked about the new guidelines, he said they would ignore the scientific advisory committee report and would be simple, short (5 pages), easy to understand, and out by September.  I’m guessing that the conflict between the science and ideology is proving more difficult to resolve than anticipated.

The science continues to argue for a largely (but not necessarily exclusively) plant-based diet, reduced in meat and ultra-processed foods from current levels.  RFK Jr initially talked about the need to reduce intake of ultra-processed foods, but the second MAHA report merely asked for a definition.

This administration seems obsessed with protein, a nutrient already in excess in US diets.

If it wants to do something about obesity, it needs the guidelines to suggest ways to reduce calories.  Nobody has mentioned that word so far.

As I keep saying, I can’t wait to see what the new guidelines will look like.  Stay tuned.

The September 22 New Yorker had an article titled “Mommy Issues,” a profile of an influencer in the Make America Healthy Again (MAHA) movement.

I was stopped cold by its quoted comment from Del Bigtree, “an anti-vaccine activist who had served as the communications director of [Robert F.] Kennedy’s Presidential campaign.” At a MAHA Action dinner in Washington, DC, Bigtree offered a toast to RFK, Jr, and

thanked the assembled group, singling out [Calley] Means, who, he said, deserved credit for “reaching out and bringing in the food issue, which was such a great cover to get Bobby all the way through.” The room erupted with guffaws.

The real agenda?  Getting rid of vaccines.

Will the MAHA movement make any real progress on major food issues?

I consider food dyes and closing the GRAS loophole to be long overdue improvements, but minor.

If MAHA wants to improve the nutritional healthy of American children, it needs, for starters, to enact policies to:

• Stop marketing unhealthful foods to kids
• Reduce consumption of ultra-processed foods
• Make school meals universally available
• Improve the quality of school meals
• Make sure every child has access to sufficient, high-quality food

The Trump Administration, in its efforts to downsize government, has once again picked on a little known agency that produces data essential for food system analysis and the kind of work I do.  So I take this personally.

In Trump I, it took care of the USDA’s Economic Research Service, which shows few signs of recovering from staff losses.

This time, it’s the CDC’s National Center for Health Statistics, which among other things, runs the National Health and Nutrition Examination Survey.

Stat News reported that the CDC team running top survey on health and nutrition is laid off.  

Oops.  A mistake, apparently.

As Civil Eats explained the head-spinning events,

On Oct. 10, the administration sent out reduction in force (RIF) notices to seven agencies, including the Department of Health and Human Services. This initially included 1,300 employees from the Centers for Disease Control and Prevention (CDC) who direct the National Health and Nutrition Examination Survey (NHANES).

By the next day, 600 of those employees were reinstated, STAT News reported. However, 100 NHANES planners who work at the National Center for Health and Statistics were still included in the RIFs. That is until Wednesday, when a federal judge issued an order temporarily blocking those layoffs and future RIFs issued during the shutdown.

It’s hard to know where to begin.

As ConscienHealth put it, Data? Who Needs Data? 

After all, NHANES merely collects ongoing national data about dietary intake and health and forms the basis of what we know about trends in dietary patterns, disease risk, and obesity, among many other things.

It’s not perfect—no nutrition survey can be—but the people who run it try to do the best they can to survey a nationally representative sample, interview that sample in person, and cross check to make sure responses are as accurate as possible.

We need this information as a basic for public health policy.

The Center for Science in the Public Interest issued a statement.

It should go without saying that if you want to make Americans healthier, you have to have a basic understanding of what they actually eat and how their health is changing over time….The importance of NHANES for monitoring population health through direct and objective measurements cannot be overstated. Not only is NHANES used in the Dietary Guidelines Advisory Committee’s analyses…it is also used in developing the Dietary Reference Intakes which set nutrient recommendations for individuals in the U.S. and Canada. NHANES data has also been used to track the rates of certain health conditions and to provide population reference statistics.

Despite mouthing encouraging words about tackling chronic, diet-related disease, this administration’s actions almost always put real solutions further out of reach. The firing of the NHANES staff is another example, and an indication that the administration would rather push its political agenda than collect the data necessary to address the very real problems it has identified.

This is yet another example of Health and Human Services’ undermining its own agenda.  If you don’t measure it, you can ignore it.

• Hence, let’s end collecting data on food insecurity.
• Hence, let’s end collecting data on diet and disease.

The World Health Organization’s declaration on prevention of non-communicable diseases (NCDs—heart disease, type 2 diabetes, etc) was in the news this week (its source is here).

First, because of what it says and does not say:

These things are miserable to read.  You have to start with the “recognizes.” Here are two:

Recognize also that the main modifiable risk factors of noncommunicable diseases are tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity and air pollution and are largely preventable and require cross-sectoral actions;

Recognize also that obesity is driven by multiple factors, including the unaffordability and unavailability of healthy diets, lack of physical activity, sleep deprivation, and stress;

But after all that, the declaration merely suggests [my comments]:

(i) promoting increased availability and affordability of nutritious food and information on healthy eating including through promoting efficient, inclusive, resilient and sustainable agrifood systems [how?]

(ii) improving policies and taking measures to reduce industrially-produced trans-fatty acids to the lowest level possible and reduce excessive levels of saturated fats, free sugars and sodium [by what means?]

(iii) providing nutritional information to consumers, such as through front-of-pack labeling;

(iv) putting in place public food procurement and service policies for healthy diets;

(v) protecting children from the harmful impact of food marketing, including digital marketing [How?  By what means?]

(vi) protecting, promoting and supporting optimal breastfeeding practices, including by regulating the marketing of breastmilk substitutes [at last, regulation] and

(vii) promoting adequate physical activity, including sports and recreation, and reducing sedentary behavior, including through
increasing access to public spaces.

What’s missing here?  Policy!

• Where, for example, is soda taxation?  [The WHO says it wants soda taxes to increase by 50% as part of its 3 by 35 initiative, but the declaration mentions taxes on tobacco and alcohol, not sodas].
• Where is regulation of marketing to kids?
• Where is reduction of ultra-processed foods?
• Where are warning labels?

Whatever.  All of this could be moot.

Second, because the U.S. will not sign on to the declaration

The reasons are quite different.

HHS Secretary Robert F. Kennedy Jr, oddly since he wants to Make America Healthy Again, objected to the declaration.  He says he cannot “support W.H.O. policies that…promoted abortion and “radical gender ideology.”  This too is odd because neither is mentioned in the declaration.

He is also quoted as saying,

More specifically, we cannot accept language that pushes destructive gender ideology…Neither can we accept claims of a constitutional or international right to abortion. The WHO cannot claim credibility or leadership until it undergoes radical reform. The United States objects to the political declaration of non communicable diseases.

Again, odd because MAHA has a political agenda to end NCDs.

But I am more concerned about the failure of WHO to propose stronger measures.  Earlier drafts, apparently, contained stronger language.

Third, because conflicts of interest could be involved

What’s going on here?  Could this have something to do with it? Alarm as WHO accepts increasing amount of dark money from donors.

The WHO Foundation, according to Who funds the WHO Foundation? A transparency analysis of donation disclosures over the first 3 years of its operation, takes large donations from corporate and philanthropic groups and individuals without revealing who they are.

Oh dear.

Resources

• New York Times 
• Food Fix 

David Kessler, a physician, lawyer, and former FDA Commissioner, has done a great service for the Make America Healthy Again movement.  He has written a letter to RFK Jr presenting a Citizen’s Petition to the FDA: “Petition to Limit the Exposure of Refined
Carbohydrates used in Industrial Processing in order to Prevent Obesity, Diabetes, and Cardiovascular Disease in Children and Adults.”

His petition argues that processed refined carbohydrates should no longer be considered Generally Recognized As Safe (GRAS).

These are:

1) refined sweeteners, including corn syrup, corn solids, glucose syrups, dextrose, invert sugar, xylose, maltose, and high fructose corn syrups; and maltodextrin

2) refined flour and starches that are subjected to food extrusion technology, including wheat, corn, tapioca, oat and potato  flour, and starches that are processed by extraction or similar technology, and

3) sucrose, refined flours, or starches that are used with emulsifiers (e.g. mono- and diglycerides of fatty acids, DATEM, sodium stearoyl lactylate, polysorbates); dough conditioners and strengtheners (e.g. azodicarbonamide, L-cysteine, calcium peroxide); humectants (e.g. propylene glycol); stabilizers and gums (e.g. carboxymethylcellulose, methylcellulose); or modified starches and fillers (e.g. regelatinized starch, modified food starch, dextrins).

The carefully argued and lengthy petition makes a strong case for the unhealthy nature of processed refined carbohydrates.

Wow.

If the FDA agrees—and it has to deal with the petition within 180 days—these ingredients would no longer be GRAS and foods containing them would be considered adulterated and illegal to sell.

Here’s what I said to the press:

• This would cover an extraordinarily large percentage of foods that are ultraprocessed…an extraordinarily impressive document” (New York Times).
• Kessler has given the FDA a way to define the vast majority of ultra-processed foods. In doing so, he has handed RFK Jr a huge gift on the path to regulating these products. It’s just what MAHA has asked for. I hope they take it seriously (CNN).

Can’t wait to see how RFK Jr and the FDA handle this.