This post was written by former FLPC student, Suzanne Donahue.
Representatives Jim McGovern (D-MA) and Michael Burgess (R-TX) recently introduced to the House of Representatives a resolution that encourages medical schools, graduate medical education (GME) programs, and other health professional training programs to provide education on nutrition and diet. Although resolutions do not create binding law, they express the sentiment of the House of Representatives and often signal interest in the possibility of future lawmaking. The Harvard Law School Food Law and Policy Clinic (FLPC) enthusiastically supports this resolution, which recognizes key policy issues that are an ongoing and vital part of FLPC’s work; our 2019 Doctoring Our Diet report discusses national policy opportunities to increase nutrition education for physicians and two of our issue briefs analyze state level policy opportunities in Massachusetts and New York.
Diet is one of the most significant risk factors for disability and premature death in the United States. Many of the leading causes of death nationwide, such as heart disease, cancer, stroke, and diabetes, have a strong correlation to poor diet and nutrition. During the COVID-19 pandemic, the toll of malnutrition has become even more clear: a CDC study found that SARS-CoV-2 patients with a B.M.I. of 45 or higher—which corresponds to severe obesity—were 33% more likely to be hospitalized and 61% more likely to die than those at a healthy weight. Diet-related diseases also impose significant economic costs on the federal government by increasing spending on healthcare programs. Medicare spending totaled $776 billion in 2020, accounting for 12% of all federal spending as the second largest program in the federal budget. 5 of the 8 most common conditions for Medicare beneficiaries are diet-related—including diabetes, which itself accounts for one-third of all Medicare spending. According to 2018 federal data, government spending, including Medicare and Medicaid, to treat three major diet-related chronic diseases—cardiovascular disease, cancer, and diabetes—accounted for 54% of the $383.6 billion in health care spending to treat these conditions.
While the federal government faces increasing healthcare costs, it simultaneously finances much of the cost of training health professionals. For example, in 2015 the federal government spent over $14.5 billion to support GME programs, $10 billion of which came directly from the Medicare program. These expenditures, however, do not translate into training on preventing diet-related diseases. Doctors receive little to no nutrition education at any stage of their medical training, which means that physicians are ill-equipped to recognize the importance of nutrition and dietor offer basic nutrition advice, or even provide necessary referrals to dietitians.
The resolution recognizes the incongruity of funding medical education programs and then paying the costs of the programs’ reluctance to provide nutrition education. As such, it urges health professional training programs to provide meaningful nutrition education that demonstrates the connection between diet and disease and develops the skills necessary to initiate successful nutrition interventions. The resolution also suggests that the federal government provide oversight to ensure that federal funding of health professional training programs, such as Medicare spending on GME programs, goes to programs that offer such nutrition education.
Further, the resolution calls upon the relevant federal agencies to conduct or fund research that assesses the status of nutrition education in healthcare professionals’ training, evaluates the impact that increased nutrition education would have on healthcare quality and outcomes, and aids in developing curricula that ensure nutrition competency. The resolution suggests that, building from this research, the relevant government agencies should support the development and dissemination of curricular resources among health professional training programs, so as to reduce the burdens of introducing new curricula. Lastly, the resolution calls upon the government to raise awareness of the critical role of diet and nutrition in health, and the responsibility of healthcare professionals to promote healthy diets. This awareness will be key in encouraging health professional training program administrators to invest in making important changes to their curriculum.
Although the resolution introduced by Representative Jim McGovern (D-MA) and Michael Burgess (R-TX) does not make mandatory changes to healthcare training, it represents a step forward in responding to the growing burden of diet-related disease by raising awareness and encouraging future action. Investments in nutrition training for health professionals can significantly improve patient outcomes, provide for better population health, and contain costs associated with the most prevalent and preventable diet-related diseases. FLPC is pleased to support this resolution, and it commends the leadership of Representatives McGovern and Burgess on this pressing issue.