In recent years, nutrition has become the focus of renewed attention in medical education. Advocates argue that physicians receive too little formal training about diet and that more comprehensive nutrition education is needed to address chronic diseases such as obesity, diabetes, cardiovascular disease, and certain cancers. A greater focus on the “root causes of chronic diseases” is a mantra of the Make America Healthy Again (MAHA) movement.
That concern has now culminated in a proposal from the Department of Health and Human Services for “Comprehensive Nutrition Education Reforms.” Providing details for that proposal, the department issued the Medical Education Nutrition Competency Framework, which suggests 10 domains and 71 competencies intended to provide guidance for a curriculum for undergraduate medical school nutrition education that meets a 40-hour equivalent minimum and for “identifying gaps in covered topics.”
In announcing the framework at a press conference, HHS Secretary Robert F. Kennedy, Jr. said that chronic disease “is overwhelming the country and it is accelerating. …Today, we spend $4.5 trillion a year on healthcare, and 90% of it goes to managing chronic disease, and poor nutrition is often at its core.” He did not present any evidence for those claims.
Easier Said Than Done
The goal — better equipping physicians to advise patients about diet — sounds reasonable, but it raises an important question: Is it realistic for medical schools to incorporate even a fraction of these competencies into already crowded curricula?
Medical education is famously dense. In four short years, students must absorb enormous bodies of knowledge ranging from molecular biology and pharmacology to pathology, clinical diagnosis, and the complexities of patient care. As I did in medical school, some students also spend some rotations doing research in the labs of faculty members. Every discipline, understandably and predictably, believes its subject deserves more time.
The nutrition competency framework illustrates the tension between worthwhile aspirations and practical realities.
The Proposed Framework
The framework organizes nutrition training into 10 domains, encompassing basic science, clinical care, counseling skills, public health, and health-system practice: Within those domains, advocates have proposed 71 specific “competencies” that medical students should be able to demonstrate:
- Foundational Nutrition Knowledge (21 competencies, 48 hours)
- Nutrition Assessment and Diagnosis (8 competencies, 27.5 hours)
- Food and Nutrition-Related Communication Skills (9 competencies, 29.5 hours)
- Collaborative, Interprofessional Referral and Patient Management (5 Competencies, 12.0 hours)
- Public Health Nutrition (6 Competencies, 15.5 hours)
- Experiential Hands-on Learning (Culinary Medicine) (5 Competencies,16.0 hours)
- Medical Interventions in Combination with Lifestyle Practices (6 Competencies, 17.5 hours)
- Personal Food & Lifestyle Behaviors for Health Care Professionals (4 Competencies, 6.0 hours
- Food Systems and Environmental Impacts (6 Competencies, 16.5 hours)
- Billing, Coding, and Reimbursement for Food and Nutrition Services (1 Competency, 3.0 hours)
Domain #9 – “Food Systems and Environmental Impacts” is totally irrelevant to medical students, dealing with such things as “understand[ing] relationship between soil microbiota diversity and mineral/nutrient content of foods” and “participat[ing] in on-site learning at farms including soil sampling, composting, crop rotation”.
Some of the competencies are ridiculously arcane, such as #17: “Epigenetic modulation through nutrition: comprehend how methyl donors, phytochemicals, and feeding rhythms influence gene expression.” Or irrelevant to medical students, such as #71: “Billing for nutrition services, culinary medicine consultations with RDNs.”
A Worthy Goal—But an Already-Overloaded Curriculum
On paper, most of these competencies seem entirely sensible. None of them is unreasonable in isolation (except, perhaps, domain #9 and competency #71, described in the previous section). Physicians should understand the role of nutrition in disease and should be able to counsel patients about diet. But the scale of the proposal is imposing. It reads more like the requirements for certification as a dietician than a minor aspect of training for an MD degree.
Seventy-one competencies — spread across subjects ranging from biochemistry to sustainability policy — represent a significant educational burden. Even if each competency required only modest instruction, the cumulative time required could be substantial. Consider that devoting only an hour of class time to each of the competencies would require 71 hours – about two weeks.
And consider that medical schools already face severe curricular constraints.
Over the past several decades, the volume of biomedical knowledge has expanded dramatically. Students must master genetics, molecular biology, immunology, advanced imaging technologies, complex pharmacology, and increasingly sophisticated diagnostic tools. New topics—from artificial intelligence in medicine to genomic medicine and health-system science—are continually being added.
Every new innovation and requirement competes with existing content. Medical educators often describe the curriculum as “a suitcase that is already overpacked.” Adding something new almost always requires removing or truncating something else.
Are the “Suggestions” Really “Suggestions”?
But the biggest flaw in the HHS prescription is the focus on “functional medicine” competencies for physicians under the guise of nutrition, which, as Kevin Klatt, PhD, RD, has observed, not only risks integrating pseudoscience into medicine but also distracts from real nutrition competencies. It has the distinctive stench of the influence of HHS Secretary RFK, Jr. and the Means grifter twins – Calley, a senior adviser to Kennedy who focuses on food, nutrition policy, and the “Make America Healthy Again” (MAHA) agenda; and Casey, President Trump’s famously unqualified nominee to be U.S. Surgeon General, whose nomination was just abandoned.
It is true that it might not be mandatory for every competency to be included in the curriculum. The federal directive to medical schools states:
After conducting an assessment of your current nutrition curriculum and identifying gaps in covered topics, we recommend schools choose from the competencies” to “design a curriculum for undergraduate medical school nutrition education that meets a 40-hour equivalent minimum.
However, “suggestions” or “proposals” from the federal government about university curricula raise concerns, given the recent history of the Trump administration using federal funding mechanisms as leverage against universities perceived to be politically or culturally oppositional. In several high-profile disputes, universities lost research grants or other federal support after conflicts over issues such as campus speech, diversity policies, or compliance with federal directives. Such punitive measures could be applied to medical schools, which receive more than $30 billion in federal research funding annually, if they did not conform sufficiently to the nutritional domains and competencies.
Nutrition Is Already Embedded in Medical Education
Another problem with the framework is the implicit assumption that nutrition education is inadequate in current medical training. In reality, nutrition already permeates many aspects of medical education, although it may not appear as a separate course labeled “nutrition.”
Medical students encounter nutrition repeatedly during both their classroom and clinical training.
For example:
- Biochemistry courses teach the metabolic pathways that govern carbohydrate, fat, and protein metabolism.
- Physiology courses explain energy balance, hormonal regulation of appetite, and nutrient absorption.
- Pathology and internal medicine address diseases in which diet plays a critical role—diabetes, cardiovascular disease, kidney disease, liver disease, and many others.
- Clinical rotations frequently involve dietary management as part of care of patients with cardiac, endocrinological, genetic, and other diseases.
In hospitals, students also observe and interact with dietitians participating in patient rounds, especially for patients with complex metabolic or nutritional problems. These professionals often provide detailed dietary assessments and recommendations. I found them to be especially valuable, both as a medical student and as an intern and resident.
For patients with specific medical conditions, dietary management is often central to treatment. Examples include:
- sodium restriction in heart failure
- carbohydrate management in diabetes
- low-protein diets in certain kidney diseases
- gluten-free diets for celiac disease
- food allergies
- specialized feeding regimens for premature infants
In such contexts, medical students see firsthand how nutrition becomes integrated into clinical decision-making. An additional educational experience for me occurred during my rotations at a VA hospital: Meals were delivered to the wards even when patients weren’t able to eat them because of an impending procedure, such as a colonoscopy or surgery, so I’d consume the food. (I found “clear liquid,” “full liquid,” “pureed,” “no added salt,” and “kidney disease” diets to be pretty unpalatable, while “high protein” and “high calorie” were pretty good!)
Learning Through Clinical Context
Medical education has long recognized that students learn most effectively when knowledge is connected to real clinical problems. Nutrition is particularly well-suited to this approach.
Consider a student caring for a patient with newly diagnosed diabetes. The management plan naturally includes dietary counseling, glucose monitoring, and lifestyle changes. A dietitian may join the clinical team to explain carbohydrate counting and meal planning.
In this setting, the student learns nutrition in the context of a disease that requires it—an approach that favors retention more than memorizing isolated competencies.
Similarly, during a gastroenterology rotation, a student might encounter patients with inflammatory bowel disease, malabsorption syndromes, or short-bowel syndrome. Each condition involves distinctive nutritional considerations.
These experiences already teach many of the competencies listed in the framework.
The Risk of Competency Inflation
The nutrition competency proposal reflects a broader trend in modern education: the proliferation of competency frameworks.
Competency-based education can be valuable when it emphasizes essential skills. But frameworks can also expand endlessly as advocates add more goals and sub-goals.
In some cases, the result is a long checklist of aspirations rather than a realistic curriculum. Seventy-one “core nutrition” competencies risk becoming exactly that.
Moreover, some competencies in the framework extend well beyond clinical nutrition into areas such as food systems, sustainability, and public policy. These topics may be intellectually interesting (to some), but their relevance to day-to-day medical practice varies.
Medical students must above all become competent clinicians. Time spent on peripheral topics inevitably displaces training in core medical knowledge.
The Importance of Collaboration
Another reason the framework may be overly ambitious is that physicians do not practice nutrition care in isolation. Modern medicine relies heavily on multidisciplinary teams. Dieticians, nurses, and other specialists possess extensive training and experience in nutritional science and counseling. In many cases, they are better equipped than physicians to provide detailed dietary guidance, and AI has become an increasingly useful adjunct.
The physician’s role is often to identify when nutrition is relevant and involve the appropriate specialists.
Several competencies in the framework acknowledge this reality by emphasizing collaboration with dietitians. But if collaboration is central to effective care, then expecting physicians to master an exhaustive list of nutrition competencies is, arguably, unnecessary.
A More Practical Approach
None of this means that nutrition education should be neglected. Physicians should certainly understand basic nutritional principles and should be able to recognize when diet plays a role in disease and its treatment. But rather than attempting to teach dozens of discrete competencies, medical education might focus on a smaller number of core concepts, reinforced through clinical experience.
For example:
- understanding the basic physiology of metabolism
- recognizing the role of diet in major chronic diseases
- querying AI for information and suggestions about patients’ diseases
- knowing when to refer patients for specialized nutritional counseling
- communicating clearly with patients about diet and lifestyle
These goals can be achieved through existing courses and clinical rotations without dramatically expanding the curriculum.
The Real Challenge: A Sensible Balance
The nutrition competency framework highlights an important issue: The role of diet in health is substantial, and physicians should not ignore it. But the proposed list of 71 competencies illustrates the risk of trying to solve every supposed educational shortcoming by piling on more requirements.
As discussed above, medical students already encounter nutrition in numerous contexts—from biochemistry lectures to hospital rounds with dietitians—and, as in my case, by consuming the various kinds of customized meals prepared for hospitalized patients. These experiences provide a practical understanding of how diet influences health.
The challenge is not necessarily a lack of nutrition course content but rather ensuring that students appreciate its clinical relevance. Achieving that goal does not require an encyclopedic checklist of competencies. Instead, it must integrate nutrition thoughtfully into the broader fabric of medical education.
In the end, the most effective nutrition training may come not from endlessly expanding the curriculum, but from teaching students how to recognize when nutrition matters—and how to work with experts who specialize in it.
Can Medical Schools Really Teach 71 Nutrition ‘Competencies’? Should They?