Most US medical schools do not require medical students to learn basic nutrition theory, even though poor diet is the leading preventable risk factor for disability or early death in the United States.[1,2]

"It takes at least 25-30 hours of medical school instruction to achieve just basic nutrition competencies," according to an expert committee of the Nutrition Academic Award Program of the National Institutes of Health,[3] Martin Kohlmeier, MD, professor in the Department of Nutrition at the University of North Carolina (UNC) at Chapel Hill and researcher at the UNC Nutrition Research Institute, told Medscape.

However, from 2000 to 2012, medical students only received a median of 16-20 hours of nutrition education, on the basis of surveys conducted by Kohlmeier's team every 4 years since 2000.[1,4] Partial data from the 2016 survey show that "nothing has changed," Dr Kohlmeier said. "Nutrition education in medical school continues to be inadequate."

The US Burden of Disease Collaboration group identified that a poor-quality diet is "an even bigger problem than physical inactivity or obesity itself,"[2] Stephen Devries, MD, a cardiologist at Northwestern University in Chicago, Illinois, and executive director of the nonprofit Gaples Institute for Integrative Cardiology, told Medscape. "Poor-quality diet trumps all of those, including tobacco."

Part of the problem is that "each medical school is free to address the issue [of nutrition education] as they wish," according to Dr Kohlmeier. "Some are doing a much better job, and some are doing a poor job." Medical students are not required to obtain a basic knowledge of nutrition, unlike anatomy, for example. "That's the problem," he said.

However, Dr Devries is cautiously optimistic. Some med schools now offer online nutrition courses or "healthy kitchen" programs, and stakeholders are working to bring about changes in accreditation.

'Minimal' Nutrition Education in Most MD, DO Programs

The survey of the 133 US medical schools with 4-year MD programs in 2012 showed that medical students received a median of 16 hours of nutritional education that year—roughly the same as in 2000, 2004, and 2008.[1] Meanwhile, the percentage of US medical schools that do not require medical students to receive any instruction about nutrition increased from 5% in 2000 to 10% in 2012. Only around 1 in 4 medical schools have a required nutrition course.

Typically, in the first 2 years of med school, students learn about the molecular structures of vitamins and metabolites, Dr Kohlmeier said. However, teaching students about "the structure of Krebs-cycle metabolites," for example, "doesn't teach them anything about diabetes."

"Fewer than one half of all US medical schools offer any kind of clinical focus on nutrition—no rounds, no clinics—which reflects the reality in a lot of these teaching hospitals," Dr Kohlmeier observed. "Even in those that offer something, the average is in the range of 5 hours at most, which is not enough."

Students are not getting practice in "making patient assessments or understanding which patients are at risk from malnutrition before or after surgery," nor are they learning how to help motivate patients to lose weight.

Nutrition education in schools of osteopathic medicine is not any better. An analysis of data from 2012 from 30 US colleges with a 4-year osteopathic medicine (DO) program revealed that most osteopathic colleges (87%) did not provide 25 hours of nutrition education, and close to one third only provided one half of the recommended minimum amount of nutrition education.[5] Only about 1 in 4 schools provided clinical training in nutrition; even then, it was for only about 4.1 hours.