Author: Joshua Clamp / Editors: Shane McAuliffe and Sumantra Ray
A recent announcement from the US Congress has set in motion a move towards improved nutrition education for health care professionals. Representatives James McGovern and Michael Burgess have secured a bipartisan resolution calling for this long-awaited and well-needed transformation. With momentum building, the potential for nutrition-trained healthcare professionals to mitigate the health and economic implications of unhealthy diets is growing, mirrored by an increased prominence of nutrition among the public and professionals. NNEdPro firmly aligns with this mission and supports these bold policy changes and calls to action.
Nutrition plays a central role in maintaining good health. Unhealthy diets can increase the risk of obesity, type II diabetes, cardiovascular disease and cancer, bearing physical, emotional and financial costs for individuals and those around them. Furthermore, with public health spending related to diabetes exceeding $200 billion each year, and $90 billion in reduced productivity, there are significant economic and societal costs [1]. All the while, inequities in the food and healthcare systems result in more extreme food insecurity and health complications for individuals from minority ethnic and low-income backgrounds.
Overcoming the health and economic challenges of unhealthy diets demands changes to the policy landscape, a reimagining of the food environment, and an array of strategies to support individual behaviour change. Whilst this process of change requires a complex, systems-level, and multidimensional approach, key strategies with the potential to have potent, positive impacts have been identified.
Health care professionals are perfectly positioned to provide education and counselling on nutrition to patients, facilitate behavioural change in nutrition and lifestyle, and in turn drive positive health outcomes. Providing such staff with the knowledge, skills, tools, and capacity to include nutrition in their practice is therefore essential.
Despite this, a well-recognised evidence-practice gap exists between the knowledge required for effective nutrition care and the nutrition education provided to medical students and other health professionals during training [2]. Medical staff receive little to no education on the relationships between diet, food and health, and are not provided with the skills necessary to counsel patients. One systematic review found that nutrition was insufficiently incorporated into medical education, regardless of country, setting, or year of medical education. Some reports have identified that medical students receive less than two hours of nutrition training throughout their time studying [3]. Consequently, much medical staff lack the capacity, and in many cases confidence, to deliver quality nutritional advice.
The historical lack of nutrition education in medical training is a double-edged sword. Not only does a lack of training limit one’s ability to learn, understand, and share nutrition advice, but its very absence is suggestive of insignificance in health and health outcomes. Health professionals may therefore be left not only without the tools to deliver effective nutrition counselling but without the motivation to do so.
Growing awareness of this evidence-practice gap has spurred research into how nutrition training may be effectively implemented into medical curricula. This issue has been a focus of NNEdPro, and its international network of nutrition professionals has contributed to numerous publications in this space across a 13-year journey advocating for the important role of nutrition education across the globe [4].
In the USA in particular, over the years NNEdPro has highlighted the need to advance nutrition education in the training of health care professionals [5,6,7].
Further NNEdPro publications:
Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps
Reports, interviews, and surveys were analysed and used to generate recommendations for building global nutrition capacity. Read the full publication here. Read our blog on this review here.
Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis
A review of directories found that nutrition content or instruction on nutrition education is missing from important accreditation and formal curriculum guidance for medical education internationally, with only 45% including nutrition. Read the full publication here.
Hidden curriculum within nutrition education in medical schools
Interviews with medical students highlight the important context in effective nutrition education and the limitations of merely mapping nutrition content. Read the full publication here.
Time for nutrition in medical education
Analyses of surveys of medical students and doctors confirm the desire and necessity for more nutrition within medical education in the UK, as well as a need for greater clarity of a doctor’s role in nutrition care. Read the full publication here.
A 13-year journey towards implementing improved medical nutrition education in the UK and beyond
Read the full publication here.
The combined efforts of organisations and institutions have built momentum, bridging the historical evidence-practice gap. The growing body of peer-reviewed research now provides a strong enough foundation on which policy changes can be brought about. The US Congress's announcement to support nutrition education within medical schools, residency, and fellowship programmes represents a huge step forward in this movement. The resolution encourages action in several key areas:
Physician and health professional training programmes to provide meaningful nutrition education.
It urges federal agencies to provide oversight, to ensure federal funding goes to the programmes that prioritise nutrition education.
Asks agencies to find research and support the development and dissemination of curricular resources.
Calls upon government and private institutions to raise awareness of the critical role of diet and nutrition in health, and the responsibility of health care practitioners to promote healthy diets.
Importantly, this announcement raises the importance of nutrition education in medical training to a level of national concern, and will likely be a key topic at the long-awaited relaunch of the White House Conference on Nutrition, Hunger, and Health happening in late 2022.
Thanks to the hard work and collaboration of individuals, organisations and institutions, nutrition education is being implemented in medical curricula. As a result, the health workforce is becoming better equipped with the knowledge and skills to help patients with diet and behaviour change, leading to improved health outcomes and a reduced economic burden of diet-related diseases. NNEdPro will continue to support this transformation and is excited to learn about future developments in this exciting space.
NOTE: NNEdPro will contribute to a conference on malnutrition in September 2022, organised by the National Institutes of Health (NIH) in the USA. On this occasion, we will draw from this body of knowledge.
Key references
1. American Diabetes Association (2018) Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41 (5): 917–928, doi.org/10.2337/dci18-0007
2. Bassin S, Al-Nimr R, Allen K, Ogrinc G (2020) The state of nutrition in medical education in the United States, Nutrition Reviews, 78(9): 764–780, doi.org/10.1093/nutrit/nuz100
3. Crowley J, Ball L, Hiddink GJ (2019) Nutrition in medical education: a systematic review, The Lancet Planetary Health, 3(9): E379-E389, doi.org/10.1016/S2542-5196(19)30171-8
4. Elaine MacAninach and Prof Sumantra Ray. A 13-year journey towards implementing improved medical nutrition education in the UK and beyond. https://www.nnedpro.org.uk/post/a-13-year-journey-towards-implementing-improved-medical-nutrition-education-in-the-uk-and-beyond
5. Kris-Etherton PM, Akabas SR, Bales CW, et al. (2014) The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr, 99(5 Suppl):1153S-66S, doi:10.3945/ajcn.113.073502
6. Kris-Etherton PM, Akabas SR, Douglas P, et al. (2015) Nutrition competencies in health professionals' education and training: a new paradigm. Adv Nutr, 6(1):83-87, doi:10.3945/an.114.006734
7. Van Horn L, Lenders CM, Pratt CA, et al. (2019) Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination. Adv Nutr, 10(6):1181-1200, doi:10.1093/advances/nmz083
NNEdPro publications
Lepre B, Trigueiro H, Johnsen JT, et al. (2022) Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutrition, Prevention & Health, e000354, doi: 10.1136/bmjnph-2021-000354
Lepre B, Mansfield KJ, Ray S, et al. (2021) Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis. BMJ Nutrition, Prevention & Health, 4, doi: 10.1136/bmjnph-2021-000234
Martin S, Sturgiss E, Douglas K, et al. (2020) Hidden curriculum within nutrition education in medical schools. BMJ Nutrition, Prevention & Health, 3, doi: 10.1136/bmjnph-2019-000059
Macaninch E, Buckner L, Amin P, et al. (2020) Time for nutrition in medical education. BMJ Nutrition, Prevention & Health, 3, doi: 10.1136/bmjnph