Nutrition was established as a science during the 20th century, based on the biochemical definition of nutrients and their various interactions with branches of genetics, immunology, sociology and pharmacology, which are mainly based on the understanding of various biological mechanisms. Social scientists and historians of food have identified how, at key moments of nutrition research, varying definitions of nutrition – especially good nutrition – have shaped dietary recommendations as well as eating habits.[1]

Despite conditions such as heart disease, certain types of cancer and the epidemic of obesity and diabetes being clearly of metabolic origins, medical education has historically marginalised nutrition science, relegating it to a peripheral topic.[2] However, since nutrition plays a critical role in the development and management of these conditions, healthcare professionals need to be adequately trained in this domain.[3]

Medical school nutrition education is widely recognised as inadequate, with the majority of institutions providing less than 25 hours – most commonly equating to less than four hours of training – across the entire medical curriculum. This creates a significant gap, leaving many graduating physicians lacking the confidence or knowledge to provide effective dietary advice for chronic diseases.[4]

This educational deficiency is rooted in the mid-20th century, since the Flexner Report of 1910, when medical education heavily prioritised acute pathology, laboratory microbiology and pharmacotherapeutic interventions.[5] In 1954, even controversial nutritionist Adelle Davis championed the idea that most diseases are rooted in faulty diet, in line with the concept of “you are what you eat.”[6] Among the various interpretations of that popular quote, there is one that outlines how diet is one of the major factors triggering the establishment of a healthy microbiota, in contrast with gut bacterial dysbiosis, which influences metabolic disorders, such as obesity, type 2 diabetes and hyperlipidemia.[7] However, decades of training that largely ignore the importance of what a patient eats have led to a lack of nutritional competence in physicians and the broad “eat what you want” suggestion when treating patients.

In 1985, the US National Academy of Sciences (NAS) recommended a minimum of 25 hours of nutrition education for medical students.[8] Rather than meeting this goal, over the years there has been a regression, with an average of 22.3 hours in US medical schools in 2004, which fell to 19.6 hours by 2009. Recent surveys suggest the situation has declined further, with trainees receiving an average of only 1.2 hours of formal nutrition education per year.[9] Hence, the current state of medical education reveals a significant and persistent gap in nutrition knowledge, leaving future physicians unequipped to address a key driver of chronic disease.[10]

Despite widespread recognition of nutrition’s importance, between 2015 and 2018, significant gaps in medical education have become evident. Medical students report globally low confidence in applying nutritional knowledge, limited formal training and inadequate familiarity with diet models and guidelines, emphasising the need for curriculum reform and collaborative efforts with other healthcare professionals.[11]

WHO identifies nutrition as a key element of primary health care and emphasises the need for its integration into professional training.[12] In a 2023 survey, the majority (93.3%) of students either somewhat or strongly agreed that understanding the effects of nutrition/eating decisions on the human body is critical to maximising patient care.[10]

Nevertheless, nutrition still appears to be partially, if not totally, absent from medical education programs, not only in the US but also in Europe. According to a recent study published in The Lancet Planetary Health, nutrition is insufficiently incorporated into medical training regardless of the country or year of education. In the UK, 56% of medical students receive fewer than four hours of nutrition training throughout their entire education.[13] While 72% of entering students believe nutrition is highly relevant, this view often drops to below 50% by graduation as the curriculum focuses more on acute pathology and pharmacotherapy.[14] This may underline inadequate doctor-patient discussions, suggesting a need for further evaluation of nutrition-related competencies in postgraduate training.[15] Overall, this lack of training has direct and detrimental effects on patient care and long-term health outcomes, and therefore needs to be adequately addressed.

The lack of commitment to nutrition education is problematic. On one hand, the wider public still considers physicians to be among the most trusted sources for nutrition-related information, before even reaching out to registered dietitians and nutritionists.[16] On the other hand, physicians often lack the confidence and competencies to properly advise their patients about nutrition and diet-related disease[17]​

Michael Pollan’s book, In Defence of Food, states that food can be used as an instrument of disease prevention, which starts with establishing healthy eating habits. However, this important role of food and its ambivalence, which also reflects in the development and diagnosis of diseases, is still too often ignored by doctors. The common, and dismissive, medical suggestion to “eat what you like” creates an “iatrogenic effect”: it puts the patient in a damaging position as it takes away the individual will to put effort into contributing to therapies’ success. It also omits any possible encouragement that could motivate a change in their eating habits.[18] This profoundly dissonates with the famous statement, widely attributed to Hippocrates: “Food can become medicine, but it can also generate disease. Let food be your medicine.”[19]

Moreover, dietary risks now compete with, and in many ways outpace, the detrimental effects of tobacco, physical inactivity and other historically substantial health risks.[20] Because the development of clinical and public health nutrition has long relied on dietary clinical trials (DCTs), which investigate the causal relationship between diet and multiple risk factors of non-communicable and chronic diseases, DCTs are of critical importance for establishing dietary requirements and translating them into public health strategies that promote overall nutritional health among the population. However, DCTs have several limitations and challenges for study design, implementation and interpretation of findings, such as collinearity between diet components, length and multi-target effects of the interventions, diverse dietary behaviours and food culture.[21]

Conversely, medical training relies on the “gold standard” of randomised controlled trials (RCTs), which are effective for evaluating single-molecule drugs but are poorly suited to capture the complex and multifactorial aspects of human health, including diverse genetics, nutrient status and environmental factors. In addition, human beings cannot be blinded to dietary interventions. As a result, physicians are biased toward drug treatments and against dietary interventions for the management of chronic disease.[22]

To overcome behavioural and systemic barriers, such as limited physician training, time constraints and socioeconomic disparities, interprofessional healthcare teams should work together to apply nutrition science and develop patient-centred care plans. Only then will it be possible to provide individualised and culturally tailored dietary guidance that overcomes psychological and physiological barriers to adherence.[23]

In terms of overcoming challenges and identifying opportunities for nutrition education in medical school training, the integration of approaches that are hands-on, system-based, epistemological and multidisciplinary may help forge a robust nutrition education within the medical curriculum. Nutrition knowledge and culinary medicine (CM) can be effective as part of overall interdisciplinary engagements to address current gaps in medical education.[24]

In this context, there is increasing awareness that a shift toward more competency-based frameworks is needed. For example, in the UK, newly qualified physicians have been required to possess the necessary skills to integrate nutrition into clinical practice since 2021, with the aim of embedding nutrition across all clinical areas and demonstrating how nutrition interrelates with all physiological systems.[25] Similarly, in the US, 53 of the nation’s top medical schools across 31 states have voluntarily committed to require at least 40 hours of nutrition education (or implement a 40-hour competency equivalent) for students, starting in autumn 2026.[26]

Furthermore, the expansion of experiential learning models in recent years might help to fill the nutrition training gap. Accordingly, elective CM courses have emerged as an alternative to curriculum reform for medical and health professional students. By combining nutrition science with hands-on cooking, these CM courses significantly improve participants’ confidence in patient dietary counselling, personal health behaviours and interprofessional communication.[27]

There is a need for a standardised approach to nutrition education to ensure that all physicians feel equipped to support patients to achieve or maintain a healthy diet and weight in an effective, informed and sensitive way. This can only be achieved by emphasising nutrition-related education and by expanding models of experiential learning in postgraduate medical curricula.[28] Offering practical sessions led by registered nutritionists or dietitians and using active education methods, like case-based learning, can strengthen clinical nutrition training. Such sessions equip future medical doctors with the skills needed to manage nutrition-related conditions and promote public health.[29]

The persistent marginalisation of nutrition in medical education remains a critical systemic failure, leaving physicians unequipped to manage the metabolic drivers of chronic disease. Rooted in a historical focus on acute pathology and due to the limitations of the DCTs, this gap often creates “iatrogenic effects” where dismissive dietary advice undermines patient motivation and therapeutic success. However, an integrated shift toward competency-based frameworks and experiential models like culinary medicine represents a necessary evolution. By fostering multidisciplinary collaborations with registered nutritionists and dietitians, in tandem with the prioritisation of practical, system-based learning, the medical establishment can finally bridge this deficit. Standardising nutrition education is essential to transitioning from reactive symptom management to a proactive healthcare model centred on long-term disease prevention.