The Harvard Law School Food Law and Policy Clinic (FLPC) released two issue briefs today identifying state and local policy approaches to increasing the nutrition competency of Massachusetts and New York-trained physicians. These issue briefs, Nutrition Education for Physicians and Health Professionals: Policy Opportunities for Massachusetts and Nutrition Education for Physicians and Health Professionals: Policy Opportunities for New York, map the potential opportunities that the governments of Massachusetts, New York State, and New York City could take to ensure that physicians trained and practicing in their jurisdictions are able to prevent, address, and treat diet-related diseases.
Diet is the most significant risk factor for disability and premature death in the United States. Heart disease, cancer, stroke, and diabetes—all highly correlated to diet—are among the leading causes of death. In the midst of the COVID-19 pandemic, the impact of diet-related diseases has become even more severe, as individuals with diet-related conditions have been especially impacted by the coronavirus. Although many people consider physicians to be a trusted source of information on the prevention and management of diet-related conditions, in actuality most physicians receive little to no formal education on nutrition. Classes on nutrition account for less than one percent of lecture hours offered by U.S. medical schools, and 73% of physicians report that they have received no or minimal instruction on nutrition. As a result, 86% of practicing physicians report feeling unqualified to offer nutritional advice to their patients. This gap in medical education is a glaring missed opportunity to invest in better population health, as doctors who are trained in diet and nutrition are more likely to include nutrition assessments during patient exams, communicate accurate basic nutrition advice, and provide referrals to dieticians as needed.
The issue briefs provide specific policy solutions that can make Massachusetts and New York leaders in the movement to ensure that physicians receive adequate nutrition education. The issue briefs lay out a variety of methods by which policymakers can encourage schools to increase their nutrition education offerings, such as by leveraging funding and financial incentives, offering recognition incentives such as recognition awards, and providing technical assistance. As one example, the New York issue brief recommends that the New York State Department of Health create an incentive structure that gives in-state teaching hospitals higher Medicaid reimbursements if their residency programs have met designated nutrition education-related benchmarks.
In light of the constraints on the healthcare system and state budgets imposed by the COVID-19 pandemic, both issue briefs contain an Executive Summary that highlights the policy recommendations that are most likely to be feasible in the near term. A key recommendation highlighted in the Massachusetts issue brief Executive Summary, for example, suggests that the Massachusetts Board of Registration in Medicine, the state regulatory body that licenses Massachusetts physicians, amend its regulations to create nutrition education requirements as a part of Massachusetts physicians’ continuing medical education (CME) requirements.
The issue briefs build upon FLPC’s September 2019 report, Doctoring Our Diet: Policy Tools to Include Nutrition in U.S. Medical Training. Doctoring Our Diet highlighted the lack of education on diet-related diseases and nutrition that doctors receive over the course of their medical careers and provided recommendations for policymakers to tackle this issue on a nationwide scale. The New York issue brief was prepared at the request of the Office of Brooklyn Borough President Eric Adams, and the Massachusetts issue brief was inspired by conversations about Doctoring Our Diet with the Food is Medicine Massachusetts (FIMMA) Coalition’s Provider Nutrition Education and Referral Task Force, which similarly aims to build capacity to better prepare health professionals in Massachusetts to address questions related to food, diet, and nutrition.
Since 2017, FLPC has collaborated with the Nutrition Education Working Group (a group of medical and public health faculty at Harvard, Northwestern, the Cleveland Clinic, and the Gaples Institute) and partners across the country to raise awareness about the lack of nutrition education provided in medical training by presenting the issue to policymakers, writing comments to the Accreditation Council for Graduate Medical Education (ACGME), and working with various medical boards to add nutrition-focused questions to exams. The issue briefs are the latest effort in FLPC’s ongoing commitment to policy development at the intersection of food and medicine.