Abstract
“The emphasis on nutrition education this past year by the government and other national organizations is encouraging.”
The American College of Lifestyle Medicine has been a champion of food as medicine since its inception in 2004. Almost 20 years later, ACLM is still working to fill the void for lifestyle medicine—and especially food as medicine—across the continuum of medical and other health education and training.
In 1985, the National Academy of Sciences recommended 25 hours minimum of nutrition education in medical school, but by 2015, only 29% of medical schools in the U.S. reported meeting that minimum. Thirty-six percent provided less than half of that.
A 2019 systematic review published in The Lancet concluded that nutrition is still insufficiently incorporated into medical education, regardless of country, setting, or year of medical education. Deficits in nutrition education affect students’ knowledge, skills, and confidence to implement nutrition care into patient care.
That same year, a study concluded nutrition education in medical school is rudimentary, at best, and limited for the duration of graduate medical education for many specialties. Requirements for meaningful nutrition education in all phases of medical training are long overdue.
At this same time in 2019, ACLM began its advocacy work introducing lifestyle medicine, food as medicine and ACLM to potential influencers and champions on Capitol Hill. Of its top advocacy priorities since then, focus has been on emphasizing nutrition education in medical and other health profession training.
In these past 3 years, we have seen the visibility of diet-related chronic disease and the need for nutrition in medical education expand and the topic take root in the highest levels of political, industry, and academic landscapes.
History
In the Fall of 2019, the Food Law and Policy Clinic at Harvard Law School released a report that identified a range of national policy options to increase food and nutrition in medical education.
In November 2021, Massachusetts Senator Jim McGovern introduced H.Res.784, a bipartisan Sense of Congress resolution, expressing the sense of the House of Representatives that the United States recognized the mounting personal and financial burden of diet-related disease in the United States and called on medical schools, graduate medical education programs, and other health professional training programs to provide meaningful physician and health professional education on nutrition and diet.
This resolution, which unanimously passed the House as H.Res.1118, highlights the critical role that medical schools, health professional training programs and the federal government should play in fostering nutrition education and thus ensuring better health outcomes for Americans. It called upon the medical academy to provide meaningful nutrition education, and urged federal agencies to support such curricular changes by disseminating best practices and curricular resources on diet and nutrition to academic programs and ensuring that federal funds go to those academic programs that provide basic competency in diet and nutrition. The resolution also called upon both public and private sectors to raise awareness of the critical role of diet in health and the responsibility of doctors and healthcare professionals to promote healthy diets.
Hence came the Biden Administration’s call for the first White House Conference on Hunger, Nutrition, and Health in 52 years, which subsequently took place in the Fall of 2022. This was a watershed moment for raising the visibility of the need for education on what has been shown to be the cause of most chronic illness—diet-related disease—and a call upon the whole of government and the private sector to end hunger in the U.S. by 2030. At the event, the White House’s National Strategy to End Hunger and Build Healthy Communities was announced, with its second pillar to integrate nutrition and health through regular food insecurity screenings and education for health professionals.
It was in support of the White House Conference that ACLM committed to provide 5.5 hours of free CME/CE-accredited coursework to 100,000 clinicians and provide matching funds to train and certify 1 physician at each of the nation’s 1400 Federally Qualified Health Centers (FQHCs). Our $24.1 million commitment was highlighted at the event and since then has provided an unprecedented opportunity to continue the conversation and establish training partnerships across other medical professional associations, insurers such as Humana and Blue Cross Blue Shield of Vermont, health systems, academic medical centers such as University Hospitals in Indiana, and even local governments such as New York City and community initiatives such as Rooted Santa Barbara County. At this writing more than 23,000 people have registered to take the course.
Further Conversations
Since the White House Conference, we have been active in events and meetings to discuss next steps in nutrition education across the medical education continuum: • The March 12-14 AAMC/AACOM/ACGME Summit on Nutrition, an event commitment of those accrediting bodies at the White House Conference held in Chicago at the ACGME Headquarters. • The April 26 The Friedman School of Nutrition Science and Policy at Tufts “Food Is Medicine: Transforming Healthcare” National Summit in Boston. • The Bipartisan Policy Center’s virtual Food as Medicine Roundtable on May 24th. • The June 20 “Advancing Food is Medicine Approaches in Support of the National Strategy on Hunger, Nutrition, and Health” event sponsored by the White House, Tufts University and Food Tank in Boston held at the Friedman School of Nutrition and Policy.
Growing Student Interest
An undergraduate study in 2021 showed that 92% percent of all allopathic and osteopathic medical students wanted to learn more about lifestyle medicine, while 95.2% believed they would provide more effective counseling if they were trained sufficiently to serve as a healthy lifestyle role model for their patient. Another 2022 study showed that medical students entering their clinical years understood the value of lifestyle medicine in patient care (100%) and wanted to learn the skills and knowledge involved (98.2%).
At this writing, student-led lifestyle medicine interest groups exist at 123 U.S. medical school and health professions campuses.
The academic tide is turning. The Wall Street Journal reported recently that more medical schools are teaching students lifestyle medicine to tackle chronic conditions in this feature highlighting ACLM and 2 of ACLM’s partners, the University of South Carolina Greenville School of Medicine and Howard University.
Residencies are also integrating lifestyle medicine, with more than 230 lifestyle medicine residency programs at this writing, using the ACLM Lifestyle Medicine Residency Curriculum at 125 sites, with more than 5700 enrollees.
Next Steps
There are more nutrition education events planned and more are needed. Meanwhile, the number of electives that are being offered in medical schools on the topic of nutrition is increasing; the main goal is to have nutrition included in the core curriculum and meet the National Academy of Sciences recommendation of 25 hours minimum of nutrition education in medical school, which as mentioned was put forward almost 40 years ago. Moreover, when the National Board of Medical Examiners (NBME) changes the questions on the board exam to include more questions on nutrition as it relates to chronic condition prevention, treatment, and reversal, medical school deans and faculty will need to incorporate material in their curriculum so that the students can pass the test.
A step in the right direction was to make the Step 1 United States Medical Licensing Examination (USMLE) pass/fail. This change, which occurred on January 26, 2022, has lowered the stress level on the pre-clinical students who take the Step 1 after completing their pre-clinical studies. In addition, this pass/fail change may help faculty to ease up on the curriculum and perhaps allow for some flexibility with the pre-clinical courses. Some schools are working to incorporate themes like nutrition and lifestyle medicine into all 4 years by weaving in threads of the topics throughout traditional core courses including anatomy, pathology, histology, and endocrine units through the use of case-based learning that addresses lifestyle factors.
The emphasis on nutrition education this past year by the government and other national organizations is encouraging. We know in lifestyle medicine that there is more to address if we want to tackle chronic conditions and empower patients to adopt and sustain healthy lifestyle patterns for a lifetime. The pillars of routine physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substances or harm reduction are important to address as well. The American College of Lifestyle Medicine is uniquely positioned to play a leading role in the inclusion of all 6 pillars in medical education. The progress with nutrition this past year is inspiring, and the fact that ACLM has been included in the invitation-only events demonstrates that others are appreciating and acknowledging our value and our willingness to serve as leaders.
We look forward to a future where lifestyle medicine is the foundation of all health and healthcare, starting with medical education. We’re on our way!
Beth Frates, MD, FACLM, DipABLM
President of the American College of Lifestyle Medicine and use the website for ACLM