For many of the 256 million Americans with a primary care physician, “the doctor” is their chief resource for reliable medical advice. Recent surveys, however, indicate a startling number of doctors concede they simply do not know enough about nutrition to answer basic patient questions about diet.

To qualify for accreditation, every medical school in the United States must instruct and evaluate students on a wide variety of key “competencies,” or knowledge areas, including disease pathology, diagnostic technology, and patient safety. On the list of proficiencies taught and tested, however, diet and nutrition are nowhere to be found.

Professor Emily M. Broad Leib ’08, faculty director of the Harvard Law School Center for Health Law and Policy Innovation, says that discounting the importance of diet and its obvious impact on patient health has magnified the scope and severity of many modern health challenges. “We know in the U.S., roughly 75% of the population is suffering from diet-related diseases,” she says. “Whether it’s obesity, Type 2 diabetes, cardiovascular disease, or certain cancers, dietary challenges are hurting the majority of Americans and better education would significantly improve outcomes.”

A longtime proponent of improving food literacy, Broad Leib aided congressional efforts to encourage medical schools to teach students more about nutrition through a bipartisan resolution passed by the House of Representatives in 2021. Last week, a coalition of advocates — including experts from Harvard Law School, Harvard Medical School, and The T.H. Chan School of Public Health — reached yet another critical milestone when The Journal of the American Medical Association’s JAMA Network Open published their paper demonstrating consensus on doctor-approved nutritional standards for medical schools and residency programs.

In an interview with Harvard Law Today, Broad Leib discussed why doctors need to know more about food and the advocacy strategy she and her colleagues are employing to bring these changes closer to fruition.


Harvard Law Today: Why do medical students need to know more about nutrition?

Emily Broad Leib: What people eat impacts literally everyone, and yet, at the same time, there are no standards in medical schools or residency programs requiring physicians to learn anything about food or nutrition. A growing number of medical schools have begun setting their own requirements, maybe a dozen at the most, but it’s a very small number. As a result, the majority of doctors report that they are not comfortable answering basic questions asked by their patients about diet and nutrition. The majority of patients indicate they trust their doctor and want to trust them on nutrition, yet roughly 86% of physicians report they do not feel adequately trained to answer basic questions on diet or nutrition.

Another issue is that 72% of entering medical students report they believed food is important to health. After graduating, though, less than 50% of medical students reported that they still believed that food is important to health. Aspiring doctors come out on the other end of their medical training having not really talked about food or nutrition. Therefore, their takeaway is, what we as doctors prescribe and how we treat symptoms matters, but what our patients eat does not. Even in highly relevant medical professions, like pediatrics, there is no requirement for residency programs to teach future pediatricians about food or nutrition.

HLT: What does this mean for patients when talking to their doctors?

Broad Leib: When my two children were younger, I remember as a new mom wanting answers to questions about what they should be eating, how much, etc. It was jarring to learn that’s not actually a part of the training. We have also seen data that shows that when doctors are not trained in nutrition, they are highly unlikely to make referrals to nutritionists even when those referrals are medically necessary. A colleague of mine, cardiologist Stephen Devries, who is one of the co-authors of the recent paper, has another study showing that cardiologists with five or more hours of nutrition training were subsequently two times as likely to refer patients to a nutritionist. These are just a few important examples that I think highlight the importance of nutritional requirements for medical students.

HLT: Can you discuss how you first became aware of this gap in nutritional education and your work thus far to help address it?

Broad Leib: The program that I started and built, the Harvard Law School Food Law and Policy Clinic, has a longstanding project with our sister clinic, the Health Law and Policy Clinic, focused on the intersection of food and health policy. I have always been interested in the ‘food is medicine’ perspective and why it seems so difficult for us to really make the hard decisions around food despite its connection to health outcomes. Seven years ago, I had a medical student at Harvard take my food policy course who said, “Isn’t it strange that I had to come from the medical school over to the law school to learn anything about food policy and nutrition?” This student and I started looking into who sets the curriculum for what medical schools teach. Through him, I started engaging with faculty from the public health school and the medical school at Harvard. We started identifying the key decision makers and the accrediting boards. Our coalition ultimately compiled our research into a report published in 2019 called “Doctoring Our Diet: Policy Tools to Include Nutrition in U.S. Medical Training.”

“Roughly 86% of physicians report they do not feel adequately trained to answer basic questions on diet or nutrition.”

We had also begun to learn more about the level of government funding that goes into medical training and how important nutrition is to our economic bottom line. Sixteen billion dollars in funding for residency training comes from the federal government. Most of that comes from Medicare, which serves older patients, many of whom are suffering from diet-related diseases. So, we began working with Representative Jim McGovern (D-Mass.), and his office suggested filing a resolution as a starting point to encourage medical schools to improve nutritional education, and found a bipartisan cosponsor, Representative Michael Burgess (R-TX). The coalition supported congressional efforts through the resolution, which ultimately passed in the House of Representatives.

HLT: Did the resolution’s impact meet your expectations in terms of raising awareness for the issue?

Broad Leib: Yes, the resolution made a huge impact. It helped us demonstrate a broad bipartisan consensus on this issue and stand out from the pack. Since the resolution’s passage, the coalition has participated in the White House Conference on Hunger, Nutrition, and Health, which included nutrition education for doctors in the written strategy released alongside the conference. The U.S. Department of Health and Human Services also responded positively and is now working on a bigger ‘food is medicine’ set of resources and policies including nutrition education for doctors and physicians. Also, the major organizations involved with accrediting medical schools and residency programs agreed to hold a Medical Education Summit on nutrition and medical education.

HLT: Can you describe experiences with these stakeholders and how the new paper came about?

Broad Leib: There were about 100 people at the Medical Education Summit in 2023. I was honored to have been a part of that meeting as one of the only lawyers, or non-healthcare professionals, on the planning committee. About a quarter of the attendees were heavily involved in teaching nutrition and food diet to medical students, but 75 percent of attendees were leaders in medical specialties that have yet to implement more robust nutrition education. One of the things everyone at the summit unanimously acknowledged was the need to do something about the absence of an agreed-upon set of competencies. A lot of people also agreed the lack of competencies was a barrier to treating nutrition as a valuable topic in comparison to recently adopted competency areas like palliative care or prescribing opioids correctly. Within each specialty, there are subjects that doctors need to know, and that schools need to prove that they are teaching, in order to be accredited. So, the idea behind our recent paper was to get a consensus document together on what we think that medical students and medical residents should be learning and should be able to do at the end of their training. And that really was the genesis for this recent article — we used a modified Delphi process to identify consensus on competencies based on three rounds of input from 37 leaders in medical education.

HLT: What other options apart from nutritional competencies have been discussed?

Broad Leib: One option would be to require medical schools and residencies to teach a certain number of hours of nutrition. For instance, a requirement that every medical student needs to receive at least 20 hours of education in nutrition. I think the biggest downside to that is it gives schools the discretion to interpret “nutrition education” loosely. One common thing every medical student learns is you need vitamin C to avoid scurvy. But that is not the level of meaningful nutrition education we are aiming for. We are aiming for doctors knowing the most recent dietary guidance when their patients come in, how to give them information about what they need to eat to be healthy and avoid secondary diseases like Type 2 diabetes, cancer, etc., and when to make referrals to dieticians and other specialists. Competency requirements go beyond ‘hours requirements’ — they are associated with mastery, where students know how to actually implement that training into their practice. One other thing we are seeing more schools do is implement training through teaching kitchens, which my colleague and the lead author of the JAMA study, David Eisenberg, has been deeply involved in supporting.

HLT: So, what’s next?

Broad Leib: The competencies identified in the paper will not automatically become mandatory. Either individual schools need to adopt them or, ideally, the accrediting bodies for medical training will adopt them as actual requirements for accreditation. We already know of a couple of schools interested in adopting these individually into their curriculum. Our coalition partnered on the recent paper with the Accreditation Council of Graduate Medical Education, or ACGME, the group that accredits all residency programs and fellowship programs. But there is still more advocacy on our part and on our partners’ part to be done to turn this into an actual requirement.

HLT: Have you encountered any opposition? And if so, what are their arguments?

Broad Leib: Yes, we have run into some resistance. First, I should explain that there are two accrediting bodies involved. The first, the ACGME, is one we just talked about that oversees residency and fellowship programs. While they have been excellent partners for the recent competencies study, I should also note they have yet to commit to implementing any of the changes identified within it. There’s also a separate body known as the American Association of Medical Colleges, or AAMC, which is the body that really covers what is taught in the medical school classroom. Unfortunately, they were not involved in the recent study.

Overall, the groups we are urging to make medical training require nutrition are also grappling with concerns about implementing nutrition into an already-crowded curriculum. While on one hand I understand changing the status quo isn’t easy, on the other hand nutrition affects everyone and is already impacting a large majority of their students’ future patients via primary or secondary diet-related disease. The other pushback we get sometimes questions whether the science around nutrition is concrete enough to require doctors to study it.

“If doctors understand nutrition and its importance better, they can also be better advocates for better policies, better ingredients in the food supply, and better policies our food creation supply chain.”

HLT: How do you respond to those concerns?

Broad Leib: My response is that every field involves new information, especially the ones we have historically discounted. We have a process where every five years, USDA and HHS collaborate on Dietary Guidelines for Americans through an expert committee that reviews all the science and recommends updated guidelines. At the very least, having education about what those are would seem like a good place to start. There are plenty of areas where experts do unanimously agree. One of my family members had his colon removed several years ago and the doctors gave him a list of like foods he should be eating: bananas, rice, peanut butter, etc. One of the items that they suggested he eat was marshmallows. It made no sense. So, I do think the bar is set low enough right now that having basic knowledge and understanding of what people need to be healthy would be extremely valuable.

HLT: Getting your nutritional competencies paper published in JAMA seems like a major milestone, but what comes next in the process of turning that list of expert recommendations into actual requirements?

Broad Leib: ACGME, which was a partner on our study, does a big update of their residency competencies every ten years and the next update is coming up soon. So, over the next year, they will be deciding on what changes to make to their general competencies. My hope is that this paper gives them somewhere to start when it comes to increasing their requirements for nutrition. And then we can work our way backward to integrate these into competencies for medical schools as well.

HLT: What is the end vision for this effort? At the end of the day, what do you hope the end result of this advocacy process will be?

Broad Leib: The vision is that health professionals will be part of the solution rather than part of the problem. My hope is that doctors will better understand the importance of food, and will be better at giving accurate advice to patients, and more comfortable delivering that advice. That is because, if they are conveying that importance, then patients more often get connected with the resources they need. I would also like to eventually see better health coverage for people to see nutritionists. It’s only covered in certain places and under certain insurance and for certain diseases. That is a bigger issue, but it is not covered at all unless you get referred by a doctor. As a result, doctors are often the gatekeeper to these resources.

HLT: Any final thoughts?

Broad Leib: If doctors understand nutrition and its importance better, they can also be better advocates for better policies, better ingredients in the food supply, and better policies our food creation supply chain. Doctors have the power to help patients and are amazing advocates in their own right because they can speak eloquently about what their patients need. I just want people to be able to get this information and access the resources they need, and I want to improve the policies in place overall so we can have a healthier American population.


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