Resources Exist to Integrate Nutrition into Graduate Medical Education

The February 11 article “The Time is Ripe: The Case for Nutrition in Graduate Medical Education in the United States” effectively captured the poor state of nutrition education for physicians-in-training as well as the urgency to alter our unsustainable trajectory of chronic disease, much of which is diet-related. Fortunately, there are proven resources already available and in use nationwide to help programs integrate nutrition education into their curricula.

One of them is the Lifestyle Medicine Residency Curriculum (LMRC), launched in 2018 by the American College of Lifestyle Medicine (ACLM) to fill the gap in lifestyle medicine and nutrition education in graduate medical education. Lifestyle medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions, such as type 2 diabetes, cardiovascular diseases, and obesity. Lifestyle medicine-certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often put these conditions into remission.

Since it was piloted, the LMRC has evolved and expanded significantly and has now been adopted by 304 residency programs. Residents who complete the LMRC qualify for the American Board of Lifestyle Medicine (ABLM) certification exam. Because LMRC competencies align with ABLM exam competencies, 26% (26 h) of the 100-h educational curricula (didactics and application activities) focus specifically on nutrition and food as medicine. The practicum components of the LMRC include 400 lifestyle medicine-related patient encounters with 10% (40) of those encounters consisting of nutritional assessments and interventions. As a result, resident physicians gain valuable patient experience with nutrition assessment, education, referral, follow-up, and support. Extensive evaluation of the LMRC is currently underway which will report on the number of LMRC enrollees who successfully complete the program and the percentage who pass the Boards. One program, the Occupational Medicine Residency at the Harvard TH Chan School of Public Health and Harvard Medical School, conducted their own anonymous survey of the residents which demonstrated all residents in the program found the lifestyle medicine offerings including the LMRC to be educational, evidence-based, enjoyable, and value-add with all survey participants reporting they felt the program would positively impact their career. ¹

Interest in graduate medical education programs that integrate nutrition and lifestyle medicine continues to grow as more medical students are exposed to the concepts in medical school. Since the first Lifestyle Medicine Interest Group (LMIG) was started at Harvard Medical School in the 2008-2009 academic year, the number of medical schools with LMIGS has grown to 95, or nearly half of all U.S. medical schools. An LMIG is free and provides a parallel curriculum for teaching nutrition that does not disrupt the flow of the core courses. ² An analysis of data from 1062 LMIG events at 127 unique institutions involving almost 30,000 attendees determined that 36% of those events focused on nutrition. ³ Additionally, LMIG members gain access to a national virtual lecture series, that houses content from world-renowned experts such as Dr Walter Willett, professor of medicine at Harvard TH Chan School of Public Health. ACLM also offers the free evidence-based Lifestyle Medicine LM 101 Curriculum supplying a set of 13 PowerPoint presentations (150-200 slides each) for the 13 modules in the course that have been downloaded by 1400 individuals, including about 900 physicians and faculty members. The LM101 curriculum includes a teacher's manual for faculty and follows the Lifestyle Medicine Handbook's 13 chapters created in collaboration with ACLM. The slides have been used in LMIG lectures and in medical school electives. The nutrition module and the 2 behavior change modules are easily accessible and ready for use by faculty at any medical school. The goal is to successfully incorporate nutrition into the core curriculum of medical school.

Resources to assist medical schools in formally integrating lifestyle medicine and nutrition are also now available. A recent Delphi study establishing consensus on nutrition competencies is available to provide guidance, and the authors recommend that nutrition education be vertically integrated into medical education and training, highlight interprofessional teamwork, and incorporate sociocultural frameworks to ensure a person-centered approach. ⁴ The University of South Carolina at Greenville School of Medicine provides LMEd, an open-access collection of evidence-based curricular resources to train future physicians in the treatment and prevention of lifestyle-related chronic diseases. A free culinary medicine curriculum based on the foundational work of Michelle Hauser, MD, of the Stanford University School of Medicine, has been accessed nearly 10,000 times ⁵ and the Stanford elective course demonstrated success in improving the attitudes, knowledge, and behavior around healthy cooking and eating of medical students who completed it. ⁶ More than 30 U.S. medical schools have implemented culinary medicine programs. ⁷ For interested clinicians who did not have exposure to culinary medicine in their medical education or training, there is also a hybrid 60-credit curriculum to become a certified culinary medicine specialist (CCMS®).

Teaching nutrition through the lens of lifestyle medicine has the additional benefit of preparing physicians to not just understand the science behind nutrition and health, but also develop health coaching skills to help patients make sustainable lifestyle behavior changes. Lifestyle medicine-trained physicians consider each patient’s unique circumstances and other interconnected lifestyle behaviors that may affect their eating patterns, such as physical activity, sleep, stress management, social connection, and use of risky substances. That's why when we discuss the implementation of food is medicine services, such as produce prescriptions and medically tailored meals, the clinical training component must be part of the conversation if we are to achieve optimal success.

As the article noted, the winds of change are blowing. Policymakers are now recognizing the burden of diet-related chronic disease both on human suffering and healthcare spending. Our traditional costly but ineffective model of health care has reached an inflection point. Now is the time for institutions that educate and train the next generation of physicians throughout the education continuum to integrate nutrition and lifestyle medicine by utilizing the many resources that are there, ready and waiting.