Clinicians Need More Training in Nutrition Education and Spotting Hunger, Biden Says

WASHINGTON -- Doctors and other clinicians need more training on how to recognize hunger symptoms and to teach patients about proper nutrition, President Biden said Wednesday.

"In 19 states, more than 35% of adults are obese," Biden said at the White House Conference on Hunger, Nutrition, and Health, which was held at the Ronald Reagan Building here. "For seniors and millions of folks on Medicaid, our national strategy would expand access to nutrition and obesity counseling, so they can get the guidance they need to stay healthy."

"You know, science changes things," he added. "People are realizing not only whether or not they're overweight or obese or not 'healthy,' but certain diseases are affected by what they eat, what they intake, and the more we can spread that word and educate people as to what's at stake, the more we're going to see change. We have to be ready as a government, as a people, to find the elements of change that are going to change things for them."

On the other hand, the president said, "our national strategy also calls for doctors, nurses, dentists to be trained to spot the signs of hunger." The administration's goal in that area is to end hunger in the U.S. by 2030, he said, noting that 1 in 10 American households still don't have access to enough food.

Regarding clinician education, "one of the things that we're hoping to do is to integrate the training to screen for food insecurity and do nutrition and obesity counseling into medical training," a senior administration official told MedPage Today on Tuesday during a call with reporters. "A number of provider groups [are] committing to further embedding hunger and food insecurity as a component of intake and evaluation for not just physicians but nurses, pharmacists, physician assistants, and dentists, and ensuring that nutrition, hunger, and lifestyle medicine-related topics are part of their education or part of their board exams as well. We feel that there is a bigger role that physicians and other medical professionals can play in this, and we hope to see more and more providers screening for food insecurity and then pointing them to resources."

In a fact sheet, the administration also listed actions that clinician groups are taking to further these nutrition education goals:

Offering nutrition insecurity screening. By 2030, the American Academy of Pediatrics (AAP) and the anti-hunger nonprofit Share Our Strength will commit to offering training to all 67,000 AAP member pediatricians on both screening for nutrition insecurity and referring patients to federal and community nutrition resources. AAP will also evaluate its training by tracking its members' comfort discussing food insecurity, members' screening rates for nutrition insecurity, and the outcomes of pediatrician referrals.

Donating CME credits. The American College of Lifestyle Medicine (ACLM) will make an in-kind donation of $24.1 million to improve nutrition training for medical professionals by donating 5.5 hours of CME course credits on nutrition and "food is medicine" topics to 100,000 healthcare providers located in regions with high rates of diet-related disease. ACLM will also coordinate with the American Board of Lifestyle Medicine to cover half the cost of lifestyle medicine training and certification for 1,400 primary care providers – one from each federally qualified health center in the U.S.

Brainstorming educational curricula. The Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education have agreed to organize and host the first-ever Medical Education Summit on Nutrition in Practice in March 2023. This initiative will convene 150 medical education leaders -- across medical schools, residency training, and continuing education programs -- to identify, discuss, and determine the best strategies for integrating nutrition and food insecurity into medical education curricula, with a focus on interprofessional care and health equity, the administration said.

In addition, a variety of provider organizations including the National Medical Association, the National Hispanic Medical Association, the Association of Schools and Programs of Public Health, the National Dental Association, the National Association of Boards of Pharmacy, and the American Association of Colleges of Pharmacy have pledged to strengthen health professionals' education in nutrition, such as by including the use of therapeutic lifestyle interventions in curricula and training on chronic disease; ensuring that professional training programs include at least one educator with formal training in nutrition science; and making sure hunger, nutrition, and lifestyle topics comprise at least 5% of board certification exam questions for both primary and subspecialty professional training programs.

The administration also announced its own actions on Wednesday. For instance, the FDA proposed updated criteria for when foods can be labeled with the nutrient content claim "healthy" on their packaging. This proposed rule would align the definition of the "healthy" claim with current nutrition science, the updated Nutrition Facts label, and the current Dietary Guidelines for Americans, the agency said.

"More than 80% of people in the U.S. aren't eating enough vegetables, fruit and dairy. And most people consume too much added sugars, saturated fat and sodium. The proposed rule is part of the agency's ongoing commitment to helping consumers improve nutrition and dietary patterns to help reduce the burden of chronic disease and advance health equity," FDA wrote in a press release.

HHS announced approval of Medicaid waivers for Massachusetts and Oregon, which allow them to test coverage for evidence-based nutritional assistance and medically tailored meals, housing supports, and other interventions. "This is an historic moment in our nation's fight to end hunger and improve health equity, particularly in states like Oregon and Massachusetts," HHS Secretary Xavier Becerra said in a press release. "Groundbreaking action in each state will ensure children and youth remain connected to healthcare, and that we double down on tackling social needs impacting health, such as nutrition."

And because physical activity is part of a healthy lifestyle and avoiding diet-related diseases, the administration "will work with Congress to increase access to the country's parks ... especially for Americans in low-income communities who need public transit to get there," the president said. "We'll also give more families a chance to hike, to bike, to breathe fresh air." In addition, "the Department of Education and the CDC are going to help schools expand physical education classes in the summer schools and summer programs, so kids get off to a healthy start in life."