On television shows like “Grey’s Anatomy,” “The Resident” and “Chicago Med,” physicians seem to always have the right answer.
But when it comes to nutrition and dietary advice, that may not be the case.
One of us is an assistant professor of nutrition and dietetics; the other is a medical student with a master’s degree in nutrition.
Both of us understand the powerful effects that food has on your health and longevity. A poor diet may lead to cardiovascular disease, diabetes, obesity and even psychological conditions like depression and anxiety. Diet-related diseases are the leading causes of death in the U.S., and a poor diet is responsible for more deaths than smoking.
These health problems are not only common and debilitating, but expensive. Treating high blood pressure, diabetes and high cholesterol costs about $400 billion per year. Within 25 years, those costs are expected to triple, to $1.3 trillion.
These facts support the need for physicians to give accurate advice about diet to help prevent these diseases. But how much does a typical physician 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 received no formal nutrition education while in medical school for four years. Those who did averaged about three hours of nutrition education per year.
That is woefully short of the goals set by the U.S. Committee on Nutrition in Medical Education back in 1985: that med students should receive a total of 25 hours of nutrition education while in school – a little more than six hours per year.
But a 2015 study showed only 29% of medical schools met this goal, and a 2023 study suggests the problem has become even worse – only 7.8% of med students reported 20 or more hours of nutrition education across all four years of med school. If this is representative of medical schools throughout the country, it has happened despite efforts to bolster nutrition education through numerous government initiatives.
Not surprisingly, the lack of education has had a direct impact on physicians’ nutrition knowledge. In a study of 257 first- and second-year osteopathic medical students taking a nutrition knowledge quiz, more than half flunked the test. Prior to the test, more than half the students – 55% – felt comfortable counseling patients on nutrition.
Unfortunately, this problem is not limited to U.S. medical schools. A 2018 global study concluded that no matter the country, nutrition education of med students is insufficient throughout the world.
Bringing nutrition education back
Even though evidence suggests that nutrition education can be effective, there are many reasons why it’s lacking. Medical students and physicians are some of the busiest people in society. The amount of information taught in medical curricula is often described as overwhelming – like drinking out of a fire hose.
First- and second-year medical students focus on dense topics, including biochemistry, molecular biology and genetics, while they learn clinical skills such as interviewing patients and understanding heart and lung sounds. Third- and fourth-year students are practicing in clinics and hospitals as they learn from physicians and patients.
As a result, their schedules are already jammed. There is no room for nutrition. And once they are physicians, it gets no better. Providing preventive care including nutrition counseling to patients would take them more than seven hours per week – and that’s not counting the time they would have to spend on continuing education to keep up with new findings in nutrition science.
On top of that, the lack of nutrition education in medical schools has been attributed to a dearth of qualified instructors for nutrition courses, as most physicians do not understand nutrition well enough to teach it.
Ironically, many medical schools are part of universities that have nutrition departments with Ph.D.-trained professors; those academicians could fill this gap by teaching nutrition to medical students. But those classes are often taught by physicians who may not have adequate nutrition training – which means 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, whether for medical students or the general public, is a registered dietitian, certified nutrition specialist or some other type of nutrition professional with multiple degrees and certification. They study for years and record many practice hours in order to give dietary advice.
Although anyone can make an appointment with a nutrition professional for dietary counseling, typically a referral from a health care provider like a physician is needed for the appointment to be covered by insurance. So seeing a physician or other primary care provider is often a step before meeting with a nutrition professional.
This extra step might be one reason why many people look elsewhere, such as on their phones, for nutrition advice. However, the worst place to look for accurate nutrition information is social media. There, about 94% of posts about nutrition and diet are of low value – either inaccurate or lacking adequate data to back up the claim.
Keep in mind that anyone can post nutrition advice on social media, regardless of their qualifications. Good dietary advice is individualized and takes into account one’s age, sex, goals, body weight, goals and personal preferences. This complexity is tough to capture in a brief social media post.
The good news is that nutrition education, when it occurs, is effective, and most medical students and physicians acknowledge the critical role nutrition plays in health. In fact, close to 90% of med students say nutrition education should be a mandatory part of medical school.
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 its history and current status, this seems unlikely to happen anytime soon.
In the meantime, those who want to learn more about a healthy diet should meet with a nutrition professional, or at the very least read the 2020-2025 Dietary Guidelines for Americans or the World Health Organization’s healthy diet recommendations.
Nathaniel Johnson is an Assistant Professor of Nutrition and Dietetics, University of North Dakota. Madeline Comeau is a medical student, University of North Dakota.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The Conversation
26 Comments
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Raw Beer
Once again, they confirmed something that the "conspiracy theorists" have been saying.
Most doctors just repeat a narrative that is determined by agencies that primarily concerned with profits.
virusrex
Nonsense, the "conspiracy theorists" pretend doctors give nutritional advice without preparation, in reality doctors can simply take proper accreditation on nutrition when their practice justifies it, or direct the patients to a nutritionist or Dietitian when it does not.
False, they are regulated to provide attention based on the best available evidence as it should be, just because you don't want to accept the evidence that does nothing to refute it. The global medical consensus on nutrition is not moved primarily by profits as you try to misrepresent. You just like to make this baseless claim without proving it ever and specially without refuting the clear evidence that supports the consensus.
Bad Haircut
How did this article slip through?
In saying that, it's one thing to increase the amount of education on nutrition that doctors receive. It's another to ensure they're getting information free of tainting by industry players that have plenty of money to "donate" to medical schools so that doctors get the "right" message.
virusrex
Fortunately this is just an imaginary situation antiscientific propaganda groups like to promote when the scientific consensus don't support their favorite diet, there is no realistic possibility every institution in the world is in this supposed global conspiracy, much less when the proponents are just nameless people on the internet that show zero evidence of it being the case.
Raw Beer
Indeed. I often mentioned how the American Diabetes Association fired an experienced dietician because she refused to promote Splenda, which is manufactured by a major donor of the ADA.
There is also the American Heart Association, who soon after accepting a large donation from the maker of Crisco Oil started recommending that everyone replace butter with "heart healthy" alternatives like vegetable oil or Crisco Oil.
There are many more similar examples. So all these doctors who have no or little understanding of nutrition are recommending their patients based on the "recommendations" of these tainted associations.
Interestingly, they took if offline right after I posted my comment yesterday. I don't know what happened, honest mistake perhaps...
Raw Beer
I guess you missed where I wrote "honest mistake perhaps"
How do you know?
Except that animal fats (including butter) are much healthier than seed oils...
Moonraker
The rich tobacco industry attempted to subvert health science and the insanely rich oil and gas industry subverts planet health science so it stands to reason that rich food and drinks and pharma industries will try to subvert health science too in their own interest. So will insurance industries. It's the nature of capitalism. Can we trust those driven by profit at all when their interests don't align with the people? They have contributed mightily to this post-truth era.
Raw Beer
This part of the article is very informative:
"In a 2023 survey of more than 1,000 U.S. medical students, about 58% of respondents said they received no formal nutrition education while in medical school for four years. Those who did averaged about three hours of nutrition education per year."
So it's even worst than what the title says: "yet many doctors receive little to no nutrition education in med school".
Most doctors receive no nutrition education in med school. Those who do, receive very little...
The Ripper!
Thankfully the medical experts advise maintaining a healthy by limiting calroic intake along with exercising as the best approach ti a healthy weight.
Weight loss drugs have many dangerous side effects so the natural route is the safest when achieving the desired result.
Zaphod
Ah, the "experts" and "all in institutions in the world strike again". Me, I am looking Rachel Levine (expert) and Joe Rogan (non-expert) and I wonder who to take nutrition advice from. Choices choices...
konjo4u
Nutritionists are not usually physicians, and they are paid a fraction of a physician's salary. They might work in hospital cafeterias or nursing homes, but not work with the general public like a physician would. Schools? I doubt many have them.
fallaffel
This is what I took from the article.
Zaphod
fallaffel
Hmmm... I wonder who has looked at all posts about nutrition on all social media? That sounds like a very tall order. And then I wonder who is the arbiter of low and high "value"..... perhaps our often cited but never defined "experts" and "all institutions in the world"?
fallaffel
Well, sampling is a thing.
You're right that we don't know how they determined the accuracy of each post; they didn't cite the actual study that made this claim. _
Raw Beer
Yeah, that might be true if you just randomly pick any source, but who does that? There are a number of good sources online that are far superior to the 2020-2025 Dietary Guidelines for Americans. I had a quick look at the guidelines, it is of low value.
kohakuebisu
It is probably this way by design.
As in if you pose the question "does American want interventionist doctors telling obese patients which products they must stop eating for the sake of their health?", the answer is probably going to be "no".
What American wants is free markets in which cooperations can make money in any way they wish. If this includes selling unhealthy food, super additive opiate-like painkillers, supersized cars that are 10 times more likely to kill pedestrians, housing developments with no routes for children to walk to school, .... then so be it. The greater good does not matter.
virusrex
The problem with those examples is that they do not reflect the current understanding and consensus, the fact that scientific knowledge continuously corrects and improve the recommendations actually disprove what you tried to defend with them, instead you proved that anything that is not actually supported by evidence is eventually corrected as this is the purpose of the method. When your examples are not even global in scale it becomes even clearer how this is not a valid criticism of the global consensus.
The current consensus still contradicts your original clam and no, animal fats are not considered healthier than seed oils, no recognized institution have this conclusion as valid.
There is no need for any trust, the thing your examples have in common is that a tiny fraction of fringe "experts" try to contradict the consensus without the necessary evidence for that purpose, in this case this applies to the science denialists that try to convince others the experts of the whole world are wrong but you have to trust them because the evidence is on the other side.
Not really, because the same reply to the original comment you made still applies, people don't get much preparation in nutrition in medical school, but neither in environmental medicine, palliative care or gerontology, and that is not a problem because that can be done after graduating as an MD, the problem as the article helpfully describes is that people are not covered for costs of visiting a dietitian if they are not directed first by a general practitioner, this (and not the lack of specific training in medical school) is one difference that the US have with the rest of the world, and therefore a much more likely explanation of the obesity problem when compared with countries like Japan, where the medical students receive very low (if any) preparation in nutrition on medical school but patients are covered by insurance if they decide to go to a dietitian directly.
The Ripper!
Yet, you have no reference to support this opinion.
virusrex
This is mistaken, the same as when you misunderstood the comment and thought it made a claim nobody has made.
That science is based on improving and correcting itself is not an opinion either, it is the whole purpose of the method and anybody with common sense knows this, I assumed people would have basic knowledge of this but if this is not the case it is terribly easy to correct this.
https://www.npr.org/sections/13.7/2017/01/30/512402110/what-makes-science-science
First, the body of scientific knowledge is continually evolving. Scientists don't simply add more facts to our scientific repository; they question new evidence as it comes in, and they repeatedly reexamine prior conclusions. That means that the body of scientific knowledge isn't just growing, it's also changing.
https://www.ncbi.nlm.nih.gov/books/NBK547541/
Scientific progress is made when the drive to understand and control the world is guided by a set of core principles and scientific methods. While challenges to previous scientific results may force researchers to examine their own practices and methods, the core principles and assumptions underlying scientific inquiry remain unchanged. In this context, the consideration of reproducibility and replicability in science is intended to maintain and enhance the integrity of scientific knowledge.
Raw Beer
No, what you call consensus is just the official narrative. And why bring up "current understanding" when the above article is about how most doctors do not understand nutrition, they just parrot what they are told.
Actually, our scientific understanding is increasing and it is telling us that those initial "recommendations" are wrong.
A very few are major shareholders globally of most food producers, drug manufacturers, MSM, scientific journal publishers...
virusrex
No, it is the consensus, easy to prove the moment you are unable to find any recognized institution that refutes this consensus nor evidence that even indicates their conclusions are wrong. In fact you just proved the recommendations improve over time without problem even when they contradict what you call "official narrative".
No, they don't, once again having preparation after finishing medical school is trivially easy for those interested, and for those that are not they can simply refer the patient to the specialist. You are making an invalid assumption here, that doctors that don't get one subject in medical school don't get preparation later on and still treat the patients on that specialty, which is as invalid as thinking Family Practice doctors are doing laminectomies.
No they are not, there is no evidence of this being the case, just claims (that without evidence can be ignored).
Yet there are many countries that don't have problems with obesity (specially to the degree that happens in the US). If your argument was real then the "wrong" recommendations would affect all countries the same. Instead we have countries with a food culture much closer to what the experts recommend that have a very healthy population (like Japan). According to this evidence you would be proving that the supposed conspiracy can be very good for the public health since the recommendations are working.
Wick's pencil
Diet-related diseases are No. 1 cause of death in U.S. BECAUSE many doctors receive little to no nutrition education in med school?
Zaphod
virusrex
"Institutions" represent their sponsors and political interests as much as actual science. To form an opinion, one should listen to actual researchers and not bureaucratic "Institutions" with their own agendas. And "recognized" by whom? By their governments and the industries that finance them?
But I agree, the words sound big and are a great appeal to authority.
virusrex
That would be an invalid correlation, doctors in many other countries also receive very little nutritional training during medical school, but (the same as in the US) that is solved by getting that training after medical school during their specialty, or by directing their patients to a dietician for specialized care and guidance.
A huge difference that applies to the US and not to other countries? that patients are required to visit first a primary care doctor to be send to the dietitian or else it is not covered by insurance. Once again this is a completely unnecessary complication from the US healthcare system that can be part of the causes of the problem (as the article explains).
Unless you provide proof that anything they say contradicts the evidence this is not a valid argument. Specially when the consensus is global and includes instuttions that are "sponsored" by their governments, non-profit organization, private universities, etc. etc. without any problem in reaching a consensus.
The fallacy of rejecting institutions is more than anything else an excuse to pretend unprofessional individuals that push false, debunked, unsubstantiated claims are as likely to be correct as huge institutions. This of course is not valid since it would also "prove" microbes don't exist, the DNA is made of radiowaves or that prayer improves 100% of the time the health of people even at the other side of the planet (all examples of things "actual researchers" defend but obviously rejected by all institutions of the globe).
A valid appeal to authority, which is precisely the function it has, when the whole scientific and medical community of the world agrees on something to the point of it becoming a consensus then it is simply astronomically more likely to be correct than what people without evidence try to push to mislead people.
Wick's pencil
But most other countries have very strong culinary traditions, more difficult to get them to accept the new agenda-driven recommendations.
virusrex
Healthy countries are much more closer to what the expert recommend, they are put as example of balanced diets that correspond to what people should be eating according to the experts.
Mediterranean countries, Japan, etc. are already inside of the recommendations, the US on the other hand have such a problem because people do NOT follow what the recommendations say people should eat.
Of course these are agenda-driven recommendations, the agenda being having a healthier population with a good lifestyle and diet.