“Why am I not being taught this?”
It’s a question Amardeep Mangat says medical learners frequently ask after rotating through his Lifestyle Medicine clinic, where they witness patients improving their chronic disease management through nutrition, exercise, sleep optimization and behavioural interventions – and sometimes deprescribing medications altogether.
Despite decades of evidence linking diet to chronic disease, nutrition education remains surprisingly limited in most North American medical schools. Despite some attempts at introducing nutrition into medical education, concerns about insufficient nutrition education in medical training have been raised by Canadian students and researchers for decades.
In the U.S., Health Secretary Robert F. Kennedy Jr. recently announced his effort for American medical schools to increase their nutrition education to meet a 40-hour minimum requirement or risk facing cuts to their federal funding. The U.S. Department of Health and Human Services and the U.S. Department of Education have already received voluntary commitments from 53 medical schools. Rather than mandating a standardized curriculum, the proposal provides schools with a set of nutrition competencies and flexibility to determine how the content is delivered, with the goal of integrating approximately 40 hours of nutrition education throughout the four years of medical training.
Mangat, medical director at Aroga Lifestyle Medicine in Ontario, argues that nutrition education can no longer be optional, especially given the rise in chronic disease. The clinic operates using a mixed public-private funding model. Physician consultations, specialist assessments and medically necessary investigations are covered through provincial insurance plans. However, many of the clinic’s additional lifestyle-based supports – including nutrition counselling and exercise programming – are paid out-of-pocket or through extended health insurance benefits.
Mangat is currently working with Toronto Metropolitan University (TMU) medical school to establish a clinical rotation for medical learners through his clinic. The relationship is still in its early stages, but it is intended to extend beyond clinical exposure alone. TMU has already begun introducing lifestyle medicine concepts into the pre-clerkship curriculum, including a “Food as Medicine” lecture and a hands-on cooking demonstration.
The experience at TMU offers a glimpse of what nutrition education can look like when a curriculum is built from the ground up. As Canada’s newest medical school, TMU had the rare opportunity to reconsider what today’s physicians need to learn before established curricula becomes entrenched.
Through focus groups and community engagement, the school identified preventative medicine as a priority. Rather than treating nutrition and lifestyle medicine as optional additions, TMU embedded them into its undergraduate curriculum. This approach was driven by the belief that prevention should be a cornerstone of modern medical practice. Theresa Chan, the Dean of TMU’s School of Medicine, said the guiding question was: “How do we prevent disease, and how do we make sure people see that not as a nice-to-have, but as a must-have?”
Few would argue against teaching future physicians more about nutrition. The more difficult question is why this has proven so challenging in practice. Although major organizations such as the Canadian Medical Association and Royal College of Physicians and Surgeons emphasize prevention and health promotion, neither currently mandates specific nutrition education requirements.
Mangat says a barrier to broader implementation is a lack of awareness among many current medical educators who were not formally trained in nutrition or lifestyle medicine.
Still, enthusiasm alone does not easily translate into curriculum reform. While the importance of nutrition may seem self-evident, integrating mandatory content into medical education is far more complicated in practice.
The issue is often not disagreement about importance but determining where it can fit. Both undergraduate and postgraduate medical curricula are dense, and the addition of new competencies involves a systematic and lengthy process.
Batya Grundland, associate program director of curriculum at the University of Toronto’s Department of Family and Community Medicine, says implementing new educational priorities across large training systems is inherently complex.
It starts with identifying a true educational gap, having evidence to support the change and then finding enough people with the expertise to teach it.
At the University of Toronto alone, family medicine training occurs across 18 different teaching sites, ranging from downtown academic centres to rural community programs. Integrating new curriculum consistently across all of them presents major logistical and financial challenges.
“The devil is always in the details of the logistics,” says Grundland.
Nutrition education itself presents additional complications. Schools must determine not only what should be taught, but how. Whether through standalone lectures, integrated case-based teaching, culinary medicine programs or longitudinal clinical exposure, each approach requires faculty expertise, protected teaching time and institutional resources that many programs already struggle to provide.
There is also the challenge of defining what nutrition education should include. Physicians are not expected to function as registered dietitians, yet they increasingly encounter patients seeking guidance on diet, supplements and chronic disease prevention. Determining the appropriate depth and scope of training remains an ongoing debate among the residency curriculum committee at the University of Toronto.
The university explored integrating a formal nutrition curriculum about a decade ago, but the initiative ultimately proved difficult to implement because of fiscal and resource-related barriers. When asked whether the program may revisit the idea, Grundland described medical education as “an evolving landscape,” shaped by available funding, faculty expertise and competing priorities. At present, nutrition curriculum integration is not considered a leading priority, but this doesn’t negate its recognized importance. With limited curricular space, the program is currently focused on several higher-priority initiatives, including the integration of digital health content and other emerging areas of medical education.
A review of the 36 nutrition competencies recently endorsed by the U.S. Department of Health and Human Services shows a framework that extends beyond basic nutritional science to include competencies such as motivational interviewing and dietary counselling. However, much of the proposal remains focused on competency lists and hour requirements and provides limited guidance on how medical schools should meaningfully implement and assess these practical clinical skills across diverse training environments.
Therefore, while calls for more nutrition education are often framed as obvious solutions to rising chronic disease, some educators caution against oversimplifying the issue. Mandating a minimum number of hours alone does not guarantee meaningful integration.
Without clear learning objectives, trained faculty and opportunities for practical clinical application, nutrition education risks becoming another checkbox in an already overcrowded curriculum.
In my med school era of the 1980s, my very, very full weeks were taken by learning biochemistry, physiology, pharmacology, anatomy, etc. We had some nutrition teaching, but I remember little about it.
Experience has taught me that eating habits are ingrained way before a patient ever sees a doctor, My few minutes with a patient can change little.
The greatest effect on diet would be in the primary schools, much like physical education. Solidify the messages and habits early and regularly. And tax the hell out of junk food.