Nutrition education is health care—let’s make it official

With its ambitious plans to improve the nation’s health and food security, this month the White House will host a Conference on Hunger, Nutrition and Health—the first of its kind in more than 50 years.

Although long overdue, health professionals like me are encouraged that the Biden administration has put this issue on its plate. They have set a noble goal to end hunger and increase healthy eating and physical activity in the US by 2030 so that fewer Americans suffer from diet-related diseases such as diabetes, obesity and hypertension. It’s a problem not only across the country, but also near the nation’s capital: More than half of all adults in Washington are affected by obesity.

While some are skeptical about achieving such ambitious goals in less than eight years, it can be done with the right commitment from Congress to our communities. There are concrete steps that—just like diet and exercise—will get us on the right path to better nutrition and health. Big, systemic changes can be made if our lawmakers are ready to seize the moment.

This begins with the passage of new legislation that requires providers to include nutrition education in health care.

Nutrition is the basis of health. According to the US Government Accountability Office, the leading causes of death nationally are directly related to poor diet and nutrition. Although health care providers—not to mention the public—recognize that diet is the primary treatment for many chronic diseases, most of us do not have easy access to nutritional counseling, primarily because our health care providers lack nutrition education. This lack of training makes starting a conversation nearly impossible and limits referrals to specialized services such as registered dietitians, registered dietitians and certified nutritionists. Another barrier to nutritionist involvement is poor insurance coverage, which can be overcome by a referring clinician with adequate nutrition training.

Fortunately, the US House of Representatives passed a bipartisan bill (H.Res.784) in May to ease federal oversight and require “substantial training in nutrition and dietetics sufficient for physicians and health professionals to meaningfully incorporate nutritional interventions and dietary recommendations in medical practice.” If it becomes law, it will help embed nutrition education into the required medical curriculum nationally, ensuring future doctors have the nutrition knowledge they need to better serve their patients.

Still, even if the bill passes the Senate and is signed by the president, implementing nutrition education will take significant time, investment, and coordination across the country.

For this purpose we also have to work from scratch.

It is vital that healthcare professionals discuss nutrition with their patients; however, all the training in the world won’t matter if people don’t have access to healthy food. One of the best ways to provide our communities with healthy food is to give the many existing community organizations working to improve food security and nutrition the resources they need to scale up their efforts.

More than 38 million people — more than 10 percent of the nation — live in food-insecure households, according to the latest figures from the USDA. In the nation’s capital, 1 in 10 residents – a third of whom are children – experience food insecurity.

How is this possible in an obesity epidemic? Obesity is a lack of food security, manifested as cheap, high-calorie foods largely devoid of vitamins and minerals. To be nutritionally secure, foods that promote well-being and prevent and treat disease must be readily available.

Fortunately, many community-based organizations involved in both urban and rural communities are working hard to fight hunger and provide culturally appropriate nutrition guidelines that are effective and well-received by their communities. Instead of reinventing the wheel with new organizations or programs, government at all levels should support the growth of already successful organizations.

Another step we can take is to encourage healthy choices for companies and consumers. Too often we focus solely on demotivating unhealthy food choices, e.g. through sin taxes on junk food and soda instead of incentivizing healthy food choices. Why not subsidize healthy foods instead of, say, corn being turned into high fructose corn syrup and added to ultra-processed foods that lead to weight gain and contribute to chronic disease and health care costs?

If people can get good food cheaper, they will buy it. While deterrents may be effective and appropriate in certain cases, subsidizing healthy food — at local grocery and convenience stores, as well as farmers’ and mobile markets — can eliminate cost barriers for people seeking more healthy options while addressing food insecurity and diet-related chronic diseases.

Although systemic change often takes time, there are systemic-level changes we can make right now. After all, millions of lives are at stake. Whether individually or collectively, life-changing health goals require great effort, investment, persistence and patience. They can be accomplished, and we’ll all be healthier for it.

Leigh A. Frame, Ph.D., MHS, CERT’20, is executive director of the Office of Integrative Medicine and Health, co-founder and associate director of the GW Resiliency & Well-being Center, and professor of medicine at George Washington University.

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