Editor's note: On September 24 The conversation published an article by Nathaniel Johnsonuniversity lecturer of Nutrition & Dietetics at UND, and UND Nutrition & Dietetics alum and medical student Madeline Comeau, explaining how the nutrition knowledge gap in medical school affects patient care and what can be done to solve the problem. The article is below and can be read in its original form at The website of Het Gesprek.
On television shows like "Grey's Anatomy," "The Resident" and "Chicago Med," doctors always seem to have the right answer.
But when it comes to nutrition and dietary advice, that may not be the case.
One of us is a university lecturer in nutrition and dietetics; the other is a medical student with a master's degree in nutrition.
We both understand the powerful effects food has on your health and longevity. A poor diet can lead to cardiovascular disease, diabetes, obesity and even mental health conditions such as depression and anxiety. Diet-related diseases are the leading cause of death in the US, and poor diet is responsible for more deaths than smoking.
These health problems are not only common and disabling, but also expensive. Treating high blood pressure, diabetes and high cholesterol costs approximately $400 billion per year. Within 25 years, these costs are expected to triple to $1.3 trillion.
These facts support the need for doctors to provide accurate nutritional advice to help prevent these diseases. But how much does a typical doctor know about nutrition?
What doctors don't know
In a 2023 survey of more than 1,000 U.S. medical students, about 58% of respondents said they had received no formal nutrition education for four years during their medical training. Those who did received an average of about three hours of nutrition education per year.
That falls woefully short of the goals set by the U.S. Committee on Nutrition in Medical Education in 1985: that medical students should receive a total of 25 hours of nutrition education while in school - just over six hours per year.
But a 2015 study found that only 29% of medical schools met this goal, and a 2023 study suggests the problem has gotten even worse, with only 7.8% of medical students reporting 20 or more hours of nutrition education across all celebrate the years of medical training. If this is representative of medical schools across the country, this has occurred despite efforts to strengthen nutrition education through numerous government initiatives.
Not surprisingly, the lack of training has had a direct impact on physicians' nutritional knowledge. In a study of 257 first- and second-year osteopathic medical students who took a nutritional knowledge quiz, more than half failed the test. Before the test, more than half of the students - 55% - felt comfortable advising patients about nutrition.
Unfortunately, this problem is not limited to American medical schools. A 2018 global study concluded that regardless of country, nutrition education for medical students around the world is inadequate.
Bring back nutrition education
While there is evidence that nutrition education can be effective, there are many reasons why it is lacking. Medical students and physicians are among the busiest people in society. The amount of information taught in medical curricula is often described as overwhelming - like drinking from a fire hose.
First- and second-year medical students focus on complex topics including biochemistry, molecular biology and genetics, while learning clinical skills such as interviewing patients and understanding heart and lung sounds. Third- and fourth-year students practice in clinics and hospitals while learning from doctors and patients.
As a result, their schedules have already stalled. There is no room for food. And once they become doctors, things don't get better. Providing preventive care, including nutritional advice, to patients would take them more than seven hours a week - not to mention the time they would have to spend on continuing education to stay abreast of new findings in nutritional science .
Additionally, the lack of nutrition education in medical schools has been attributed to a shortage of qualified instructors for nutrition courses because most physicians do not understand nutrition well enough to teach it.
Ironically, many medical schools are part of universities that have nutrition departments with doctorate-trained professors; those academics could fill this gap by teaching nutrition to medical students. But these classes are often taught by physicians who may not have adequate nutritional training - meaning truly qualified instructors, within reach of most medical schools, are left out of the process.
Finding the right advice
The best source of nutrition information, for both medical students and the general public, is a registered dietitian, certified nutrition specialist, or other type of nutrition professional with multiple degrees and certifications. They study for years and record many practice hours to provide nutritional advice.
Although anyone can make an appointment with a nutritionist for dietary advice, a referral from a healthcare provider such as a doctor is usually required for the appointment to be reimbursed by insurance. So seeing a doctor or other primary care provider is often one step before meeting a nutritionist.
This extra step may be a reason why many people look for nutritional advice elsewhere, for example on their phone. However, the worst place to look for accurate nutritional information is social media. There, approximately 94% of food and diet messages are of low value - either inaccurate or without adequate data to support the claim.
Keep in mind that anyone can post nutritional advice on social media, regardless of their qualifications. Good nutritional advice is tailor-made and takes into account age, gender, goals, body weight, goals and personal preferences. This complexity is difficult to capture in a short social media post.
The good news is that nutrition education, when provided, is effective, and most medical students and physicians recognize the critical role nutrition plays in health. Nearly 90% of medical students say nutrition education should be a mandatory part of medical training.
We hope that nutrition education, after being devalued or ignored for decades, will soon be an integral part of every medical school's curriculum. But given history and current status, it seems unlikely that this will happen anytime soon.
In the meantime, those who want to learn more about a healthy diet should meet with a nutritionist, or at least read the Dietary Guidelines for Americans 2020-2025 or the World Health Organization's Healthy Eating Recommendations.
Nathaniel Johnson, assistant professor of nutrition and dietetics, University of North Dakota and Madeline Comeau, medical student, University of North Dakota
