Heart disease, cancer, obesity, diabetes and Alzheimer’s are the most expensive disease burdens in the United States, reports the Centers for Disease Control and Prevention (CDC). According to Modern Healthcare heart disease is estimated to cost $351 billion a year. Cancer care costs between $115 billion and $136 billion, but these estimates were made before the advent of recent cancer drugs costing $100,000 a year. The Milken Institute put the cost of diabetes second only to heart disease and claims obesity ($481 billion a year) amounts to nearly half of all chronic diseases. Alzheimer’s costs nearly $200 billion a year, mostly because patients require institutional care at the end of their lives.
What do all these diseases have in common? They are either directly or, in the case of Alzheimer’s, partly related to diet and lifestyle. Yet, many doctors receive little to no education on nutrition in medical school.
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 US$400 billion per year. Within 25 years, those costs are expected to triple, to $1.3 trillion.
Medical schools teach students how to treat chronic diseases but not much on how to prevent them through nutrition and behavioral modification. Medical students report that nutrition is not a significant part of their curriculum.
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.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.
There are probably numerous reasons why diet and nutrition are not thoroughly taught in medical school. First and second year medical students’ schedules are filled with dense medical science – biochemistry, molecular biology and genetics – while third- and fourth-year medical students are busy with clinics and clinical rotation. Furthermore, many medical schools lack qualified professors who can teach nutrition. Health insurance, Medicare, Medicaid, employer plans and patients themselves are unlikely to be willing to pay for physicians’ time to counsel them on diet. Moreover, it does not require a medical degree to talk to people about nutrition. Registered dietitians deal with nutrition; it’s not considered the practice of medicine, like brain surgery. Indeed, many physicians are abandoning the age-old practice of weighing their patients at the start of an office visit.
Activists and advocates have a variety of additional courses they would like to be tacked onto medical education. Nutrition is just one of many ideas being promoted. Critics claim that identity politics and diversity, equity and inclusion activism on medical school campuses has diverted attention away from the rigorous education needed to train physicians. Medical students have little extra time to take on more educational requirements. To the extent that their training needs expanded, nutrition is a better candidate than many of the other ideas advocates want to indoctrinate students with.
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