Even as lawmakers, medical professionals and his own kin call on secretary of health and human services Robert F. Kennedy Jr. to resign for spreading misinformation, medical education organizations are on the hook to give Kennedy their plan for expanding nutrition education requirements by Wednesday.

It’s one of the latest public health directives Kennedy has put forth to advance his so-called Make America Healthy Again agenda, which is heavily focused on addressing chronic illness through diet and lifestyle choices. 

“The chronic disease epidemic is the most urgent and costly health crisis in America today. We can’t afford another decade of delay,” Kennedy wrote in an editorial published in The Wall Street Journal last month. “Reforming medical education to put nutrition at its core will equip the next generation of doctors with the tools to restore the health of our nation—to make America healthy again.”

While nutrition education experts say updating physician training requirements alone won’t lower chronic disease rates, they’re hopeful that the government’s nutrition education push will spur changes advocates have wanted for years.

“It’s best when accrediting bodies and medical institutions make changes to medical training on their own based on public need and the very best scientific evidence,” said Stephen Devries, executive director of the Gaples Institute, which uses education and advocacy to advance the role of nutrition and lifestyle in medicine. “That said, the government does have a stake in the preparedness of physicians to deal with major public health issues like this current burden of diet-related disease.”

In June, Kennedy—who has made false or misleading claims about vaccines, raw milk and food dyes—mentioned in passing that he was considering withholding federal funding for medical schools that don’t offer nutrition education. But that threat wasn’t included in the official Aug. 27 directive he issued with Education Secretary Linda McMahon, which demanded that premed programs, medical schools, residencies, medical licensing exams, board certifications and continuing education organizations all formulate nutrition education reform strategies within two weeks.

While data from the Association of American Medical Colleges shows that all medical schools in the United States already require some form of nutrition education, Kennedy and McMahon said it’s not enough. They cited data from the peer-reviewed Journal of Wellness that said medical students reported receiving an average of 1.2 hours of formal nutrition education per year.

“Medical schools talk about nutrition but fail to teach it,” Kennedy said. “We demand immediate, measurable reforms to embed nutrition education across every stage of medical training, hold institutions accountable for progress, and equip every future physician with the tools to prevent disease—not just treat it.”

Nutrition Education Deficiency

Kennedy is far from the first person to advocate for more robust nutrition education for future and practicing physicians.

“The deficiency of nutrition education in medical training is a real problem and it has been for many years,” said Devries, who is also an adjunct associate professor of nutrition at Harvard University’s T. H. Chan School of Public Health. While many programs offer nutrition electives, “very little has been done in an organized and consistent way.”

In 1985, the Food and Nutrition Board of the National Research Council recommended that preclinical medical students receive 25 to 30 classroom hours in nutrition. At that time, more than half the medical schools in the country taught fewer than 20 hours of nutrition. Forty years later, as medical education has become more complex, numerous newer studies suggest there’s even less of an emphasis on nutrition education.

“One of the barriers to adding more nutrition content in medical schools is that there isn’t enough time in the curriculum to pack everything in,” said Devries, who has developed short nutrition education courses for medical students and doctors. “In order to make this a realistic option, it has to be condensed and also impactful.”

Without proper nutrition education, physicians rarely address patients’ diet or exercise choices until they develop chronic illnesses such as type 2 diabetes, fatty liver disease, hypertension or stroke, said Nate Wood, director of culinary medicine at the Yale School of Medicine. And even after patients are diagnosed with those and other chronic conditions, most physicians choose to treat them with pharmaceuticals over dietary counseling, which can drive up health-care costs.

According to the Centers for Disease Control and Prevention, 90 percent of the nation’s $4.9 trillion health care costs are attributable to a chronic illness; some studies say more investment in preventive care could help lower those costs by billions.

“We jump straight to prescribing medications because we have good data to say they’re effective and it’s much easier to get a patient to take medication every day than to make big changes to their lifestyle,” Wood said. “Even if physicians did want to counsel on diets, they don’t know what to say because they weren’t really taught what specific dietary changes should be enacted to treat certain conditions.”

Combating Misinformation?

A lack of nutrition education also makes it difficult for doctors to accurately answer patients’ dietary questions.

“Physicians get questions all the time from patients about food trends on social media and supplements, and they’re really not prepared to address that,” Wood said. “Even physicians are susceptible to misinformation because they don’t have nutrition knowledge and they’re not adequately trained on how to evaluate the nutrition literature … So, physicians may end up falling for nutrition misinformation and dispensing that to their patients.”

Although Wood is encouraged by the government’s attempt to emphasize nutrition education, he’s concerned that HHS and the Education Department may follow up by mandating the teaching of specific nutritional claims that aren’t supported by scientific evidence, such as Kennedy’s unsubstantiated belief that beef tallow is healthier than seed oils for cooking.

Though neither Kennedy nor McMahon has suggested they plan to do that, “I’m a little worried that some of these talking points they’ve been hammering on for the past year will end up being mandates for medical schools,” Wood said. “That would be really bad.”

But beefing up nutrition education for physicians is only one part of addressing the chronic disease epidemic Kennedy is crusading against.

“Our food environment is also set up to make unhealthy choices the default,” Wood said, noting that highly processed foods are often cheaper and more accessible than fresh, healthier options. “On top of that, doctors don’t really have time to talk about nutrition in the clinic as much as would be needed to dramatically impact people’s diets.”

That’s why he and other nutrition education experts also want Congress to pass the stalled Medical Nutrition Therapy Act, which would expand Medicare coverage of medical nutrition therapy services.

“While doctors need baseline nutrition education, they also need to be able to refer patients to experts in the field—dietitians, who are vastly underutilized,” said Leah Sarris, a registered dietitian and culinary medicine consultant. “After medical students have gone through culinary medicine training, they tend to respect the role of registered dietitians and refer patients to them more.”

In 2022, a study in the International Journal of Disease Reversal and Prevention found that 71 percent of cardiologists referred 10 percent or fewer of their patients to dietitians or nutritionists. However, those who participated in nutrition-focused continuing medical education were almost twice as likely to refer patients to a dietitian or nutritionist compared to those who had not completed such training.

The need for more dietitians is one of the many factors that’s missing from Kennedy’s plan to address chronic diseases, said Sarris, who developed the interdisciplinary culinary medicine program at Tulane University School of Medicine. It also ignores the implications of the government’s recent and proposed cuts to programs that help people access medical care and nutritious food, such as the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children.

“I love that RFK Jr. has brought attention to the fact that we need to improve nutrition education within the medical sector,” she said. “But no matter what we teach people, if they can’t afford healthy food, they won’t improve their health.”