RFK, Jr. has gone full publicity blitzkrieg about his success enlisting U.S. medical schools to teach more about nutrition. The Health and Human Services Department is selling it as a great victory for Kennedy’s Make America Healthy Again Movement. However, the omission of a very important item from Kennedy’s proposed nutrition curriculum topics for doctors has hit a very sensitive nerve with me today.
First, the background.
As Eating in America reported last fall, the Trump administration and the USDA have killed the annual U.S. Food Security Report. After thirty years of continual monitoring of American household food security, the final report was quietly issued, two months late, on December 30.
Over the decades, the Food Security Report has been crucial to guide food assistance programs like SNAP and to measure our progress, or lack of it, in reducing hunger in America. Most of us have never had to worry about hunger or food security, but in 2024 one in seven households, 41 million Americans, experienced food insecurity. That was measured at 13.7% of households, a little more than in 2023, but not statistically different.
In 2024, 5.4% of households had very low food security compared to 5.1% in 2023, but still not statistically different. Very low food security means sometimes being hungry, skipping a meal, or not eating for a whole day because of lack of money for food.
Children experienced food insecurity in 3.3 million households and very low food security in 318,000 households.
Why does Trump want to let the fact that hunger is still found in America be hidden? Does he not want to address it? Is he aware that his policies and actions are likely to increase food insecurity and hunger, and he would rather not see statistics proving the rise of food insecurity and hunger in adults and children?
Trump’s lack of support for SNAP benefits during last fall’s federal shutdown and his tightening of eligibility requirements make it highly likely that food security, if it were still being measured, would show a downturn and hunger an upturn in the first year of his administration.
This masking of hunger in America reminds me how rich coffee plantation owners in Central America, where the use of enslaved people was forbidden, essentially created a system of slavery by maintaining a state of food deprivation on their plantations in order to force the indigenous people to work (Coffeeland, Sedgewick, 2020). Families were tied to the plantation. There were no other source of work and no other source of food. The indigenous laborers were nominally free – there was nothing to rebel against - but because they and their families were hungry, they were subdued, controlled, and subservient.
When I see the prevalence of hunger in Americans and the fact that hunger will be officially hidden by our government going forward, I cannot help but see hunger as a device of repression against poor Americans in the hands of Trump and his minions. And in recent months outside of America, Trump has weaponized the hunger of civilians in Gaza and Cuba.
So what has this to do with the addition of nutrition to a medical education?
I’m getting there.
There are two kinds of malnutrition in America, and increasingly around the world: undernutrition and overnutrition.
I have only heard RFK, Jr. talk about overnutrition. Overnutrition as expressed in unhealthy weight is all around all of us. Kennedy, Trump, and MAHA advocates and siblings Calley and Casey Means, the latter Trump’s nominee for Surgeon General, all grew up in privilege, moving in elite circles and with exposure mainly to people like themselves, many of whom had issues of overnutrition. Maybe I am wrong, but meaningful exposure to the real lives of Americans with food insecurity and, worse, undernutrition, might never have been part of Kennedy, Trump, and the Means’ real-world education.
However, real doctors and health experts, not unqualified people like Casey Means or Kennedy, should be, need to be, attentive to the fact that some of their patients and constituents may be experiencing food insecurity.
Doctors in training need to learn that there are quick food security screeners that can be administered in the doctor’s office. The best known is the simple Hunger Vital Sign tool: a two-question validated screener developed by Children’s Health Watch in Boston. It is based on the Trump-killed U.S. Food Security Survey. The doctor or professional simply asks for an “often” or “sometimes true” versus “never true” response to two statements: First, “Within the past 12 months we worried whether our food would run out before we got money to buy more.” Second, “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” A response other than “never true” flags the need for a doctor to assist in assuring that the patient’s food security is addressed.
So why would teaching the use of a food security screening tool like the Hunger Vital Sign not be at the very top of the list of things about nutrition that a doctor should be taught? It boggles my mind, but food security screening is not explicitly on the list of 71 nutrition competencies Kennedy recommends be addressed in medical education.
Kennedy’s list is billed as being based on an expert list of 36 competencies published in the Journal of the American Medical Association in 2024, but it bears little resemblance. The JAMA list puts food security screening as the #2 item, behind #1 “Provides evidence-based, culturally sensitive nutrition and food recommendations to patients for the prevention and treatment of disease.” In general, the JAMA list is written to make doctors-to-be aware and sensitive to nutritional issues and competent to address nutrition in partnership with dedicated nutrition professionals. I like the JAMA list a lot.
The Kennedy list is, on the other hand, more like a curriculum for doctors who want to become social media influencers and snake oil peddlers, like our unlicensed-doctor-waiting-to-be-Surgeon-General, Casey Means. For example, recommended core competency #58 is learning how to recommend a wide range of “nutraceuticals” or food and herb-derived supplements like Means sells. And then there are bizarre recommendations for the training of a doctor, like competency #67: “Regenerative agriculture immersion: participate in on-site learning at farms including soil sampling, composting, crop rotation.”
The single competency on Kennedy’s list that pops out as a genuinely valuable addition to JAMA’s list of two years ago is #55: “GLP-1 agonists counseling with diet and lifestyle guidance.” In other words, doctors should be familiar with the growing arsenal of GLP-1 and related medicines, how they work, their powerful intended and side effects, real world food needs stemming from taking GLP-1s, effects - real or feared - on muscle mass, and that there should be no stigma attached to taking GLP-1s. Well, of course, yes.
There has long been a push for more nutrition training in medical school. As doctors watched the obesity epidemic explode and attendant chronic diseases increase in America, the nutrition training gap in medical school became undeniable. More awareness and understanding in the medical profession were required, even if effective treatment tools to curb the symptoms of the disease of obesity were not yet widely available.
I didn’t understand until I read JAMA’s 2024 recommended nutritional competencies that the need was not for doctors to learn more facts about fats and carbohydrates but to learn how to treat people with respect, understanding, and thoughtful guidance when those people are just coping with the effects of living in a terrible food environment that is allowed to prey on their biology.
Fifty-three out of the approximately160 medical schools in the U.S. have capitulated to Kennedy’s somewhat extortionate push to incorporate more nutrition training. The use of any of Kennedy’s 71 competencies is, fortunately, not required by the medical school agreements with Kennedy, and it might be embarrassing to see any medical school work from a list grounded in Kennedy’s personal bias and not in science. However, the list is described by Kennedy as “recommended”, not merely “suggested.”
So despite my long-held belief and advocacy for more nutrition training for doctors, I stand with those who are upset by Kennedy forcing the issue on medical schools. Our federal government does not place science and the health of its people above all else. Opening any door to future federal dictates for medical training is scary, given the current administration.
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