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

With its ambitious plans for improving 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.

While long overdue, healthcare professionals like me are heartened that the Biden administration has put this issue on its plate. They have set a noble goal of ending hunger and increasing healthy eating and physical activity in the U.S. by 2030 so that fewer Americans experience diet-related diseases, such as diabetes, obesity and hypertension. This is not only a nationwide problem but also one that hits close to the nation’s capital: More than half of all adults in Washington, D.C. are affected by obesity.

Though some are skeptical of meeting such ambitious goals in under eight years, it can be done with the right commitment from Congress to our communities. There are concrete steps that — just like diet and physical activity — will put us on the right path to better nutrition and health. Major, systemic changes can be made if our lawmakers are willing to seize the moment.

This begins by passing new legislation requiring providers to incorporate nutritional education into healthcare.

Nutrition is the foundation of health. According to the U.S. Government Accountability Office, the leading causes of death nationally are directly linked to poor diet and nutrition. Although healthcare providers — not to mention the public — recognize that diet is the primary treatment for many chronic diseases, most of us do not have ready access to nutrition counseling, primarily because our healthcare providers lack nutrition training. This lack of training makes beginning the conversation all but impossible and limits referrals to specialized services such as registered dietitian nutritionists and certified nutrition specialists. A further barrier to involving nutrition specialists is poor insurance coverage, which may be surmounted by a referring clinician with sufficient nutrition training.

Fortunately, the U.S. House of Representatives passed a bipartisan bill (H.Res.784) in May to facilitate federal oversight and require “substantive training in nutrition and diet sufficient for physicians and health professionals to meaningfully incorporate nutrition interventions and dietary referrals into medical practice.” If this becomes law, it will help embed nutrition training into the required medical curriculum nationally, ensuring future physicians have the nutrition knowledge to better serve their patients.

Yet, even if the bill passes the Senate and is signed into law by the president, implementing nutrition training will take significant time, investment, and coordination nationwide.

To this end, we must also work from the ground up.

It’s 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-based organizations working to improve food security and nutrition the resources they need to scale up their efforts.

According to the most recent data from the U.S. Department of Agriculture, more than 38 million people — over 10 percent of the nation — live in food insecure households. In the nation’s capital, 1 out of 10 residents — one-third of which are children — experience food insecurity.

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

Thankfully, many community-based organizations embedded in both urban and rural communities are working diligently to combat hunger and provide culturally appropriate nutrition guidance that is effective for and well-received by their communities. Rather than reinvent the wheel with new organizations or programs, the government at all levels should support the growth of already successful organizations. 

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

If people can get good food cheaper, they will buy it. While disincentives may be effective and appropriate in certain instances, subsidizing healthy food — in local grocery and convenience stores, as well as farmers’ and mobile produce markets — can eliminate cost barriers for people searching for healthier options while simultaneously taking aim at nutrition insecurity and diet-related chronic diseases.

Though systemic change often takes time, there are systems-level changes we can make right now. Ultimately, 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 will all be healthier for it.

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