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Journal of Graduate Medical Education logoLink to Journal of Graduate Medical Education
. 2024 Dec 13;16(6 Suppl):40–44. doi: 10.4300/JGME-D-23-00913.1

Plant-Based Diets: A Vital Component of Graduate Medical Education Programs on Climate and Health

Shirley Kalwaney 1,, Elizabeth Cerceo 2
PMCID: PMC11644602  PMID: 39677890

Introduction

Extreme weather and wildfires create undeniable health impacts, long noted by the medical community, with the World Health Organization naming climate change the century’s top health threat.1 Major health organizations urge graduate medical education (GME) leaders to incorporate climate change and health into ongoing education curricula.2,3 Increasingly, residents report eco-anxiety and climate grief, leading to some policy and curricular changes within institutions’ clinical learning environments, though implementation is not uniform.4,5 In addition, residents across medical specialties will face an unabating US epidemic of noncommunicable diseases linked to poor-quality diet alongside climate change–associated diseases.6 Population dietary patterns connect both cardiometabolic diseases and the climate crisis,7 and potential solutions require a shift in the GME approach to preparing residents and fellows. This perspective intends to alert program directors that the benefits of a plant-based diet should be part of any curriculum dealing with climate change and health.

Planetary Health, Patient Health, and Diet

While popular media focuses on the effects of burning fossil fuels on climate, dietary choices have a substantial impact.8,9 Evidence supports that a shift toward plant-based foods and away from animal products reduces greenhouse gas emissions, land and water use, biodiversity loss, and environmental pollution.10,11 Moreover, consumption of plant-predominant diets may result in 75% less climate-heating emissions compared with diets with over 100g of meat daily.10-12 Shifting consumption to more plant-based foods would improve personal health while reducing worldwide food insecurity, pollution, and climate change, thereby improving planetary health.13

Confronting the dual crises of the intensifying effects of global climate change14 and deteriorating metabolic health15 will require residents and fellows to be aware of several important facts. First, half the global health burden comes from modifiable risk factors, with poor diets causing over 11 million premature deaths,16 accounting for more global deaths than tobacco. Second, the nutrient and fiber-rich diet of mainly whole plant foods is associated with a lower risk of cardiovascular disease, diabetes, hypertension, dyslipidemia, chronic kidney disease, obesity, and some cancers.17-19 Third, plant-based diets are recommended in the current US Department of Agriculture dietary guidelines and by national medical societies and nutrition scientists.20-22 Despite a broad consensus on the importance of a plant-based diet on health, current health care strategies aimed at adopting better diets have yet to successfully curb the rise of cardiometabolic disease.

Patients are increasingly aware of climate change and its health effects and seek information about contributors and solutions.23 As a trusted source of health information for the public, physicians have an essential role in addressing false health claims and dispelling dietary and nutrition myths.24 Therefore, residents could learn to concisely communicate the evidence on diet and health to their patients. Residents might be encouraged to adopt a healthy diet, emphasizing sustainable protein sources, and limiting red meat and dairy. This action may improve their own health and wellness and may translate into promotion of healthy behaviors for their patients.25

A Call to Action: Nutrition and Dietary Education for Patient and Planetary Health

The EAT-Lancet Commission suggests that achieving healthy and sustainable diets by 2050 will necessitate a reduction of more than half in worldwide red meat consumption and doubling the consumption of plant-based foods.9 The Congressional Food Is Medicine Working Group and the White House National Strategy on Hunger, Nutrition, and Health26,27 urged health care leaders to include nutrition in GME training. This led to the first Accreditation Council for Graduate Medical Education (ACGME)-sponsored Summit on Medical Education in Nutrition,28 discussing integrating nutrition and food insecurity education into curricula. Extending these efforts to support sustainable food systems and promote plant-based diets would be beneficial. However, inadequate nutritional training hampers residents’ ability to guide patients toward healthy dietary behaviors,29 despite recommendations made by the National Academy of Sciences and the American Society for Nutrition over 30 years ago.30 Therefore, an excellent place to start the needed change is by combining comprehensive nutrition and dietary education with culinary training.31,32 Residency training could incorporate instruction on food systems sustainability and culturally sensitive dietary counseling strategies. In clinical settings, residents can address both cardiometabolic disease and climate change mitigation by communicating the benefits of plant-rich, locally purchased, low-waste food options.

In any curriculum, trainees should be educated on social determinants of health (SDOH) and approach patient recommendations with cultural humility.33 Integrating plant-forward diets into diverse cultural contexts requires sensitivity, especially in regions traditionally reliant on animal-based foods. The climate crisis threatens vulnerable populations by altering animal availability and migration patterns, highlighting the universal need for dietary adaptability. Addressing economic barriers to food access is crucial, particularly for vulnerable groups disproportionately affected by these barriers. The curriculum for residents may encompass strategies to navigate financial and cultural obstacles, emphasizing meal planning, culinary education, and supplemental food programs. By framing plant-based diets within the context of preventive health and economic reform, future physicians can advocate for policies supporting equitable access to nutritious foods. This approach prepares them to promote health and sustainability, recognizing the interconnectedness of diet, health, and sustainability.

Incorporating Nutrition Into a Curriculum for Climate Change and Health

To achieve the goal of better patient and planetary health, it is essential for trainees to recognize the role of diet in health and climate change. Furthermore, trainees must recognize their own impact on patient behavior and be confident to counsel patients effectively. Nutrition education might be interweaved into existing educational structures whenever possible (eg, during educational sessions related to lifestyle-related diseases such as nonalcoholic fatty liver disease and type 2 diabetes mellitus). Working with nutritionists and dietitians in educational sessions can distribute the workload and promote interprofessional teams. The Table outlines topic areas, goals, associated core competencies, and examples of educational strategies.

Table.

Proposed Framework for Nutrition and Food Sustainability Education in GME

Topic Goal/Objectives Competencies Educational Strategies
Lifestyle and preventative medicine
  1. Describe the relationship between diet quality and cardiometabolic health.

  2. List ways plant-based diets are sustainable compared with animal-based diets.

  3. Learn how to obtain a dietary history.

  4. Demonstrate effective dietary counseling, considering patient goals and SDOH.

Medical Knowledge
Interpersonal and Communication Skills
Practice-Based Learning and Improvement
  • Lecture series on nutrition and dietary patterns

  • Interprofessional team workshops (registered dietitian, health coach): practice dietary history

  • Nutrition content integrated into existing disease-based curriculum (eg, cardiovascular disease, obesity, diabetes)

  • Motivational interviewing training focused on dietary behaviors (role-play)

Environmental determinants of health
(EDOH)
  1. Recognize food accessibility challenges (ie, food deserts).

  2. Examine the cost-effectiveness of plant-based dietary patterns in disease prevention.

  3. Discuss environmental safety on lifestyle behaviors.


 
Practice-Based Learning and Improvement
Systems-Based Practice
  • Ethics discussions

  • Design QI projects to address EDOH challenges (ie, patient tools that provide grocery cost comparison of healthy sustainable food options)

Social determinants of health (SDOH)
  1. Understand the social and economic factors that play an outsized role in health and behavior adoption.

  2. Practice communication strategies for health literacy, empathy, and cultural humility.

  3. Screen and refer (ie, WIC, SNAP) for food insecurity.

  4. Employ “food is medicine” interventions (ie, medically tailored meals and groceries, produce prescriptions).

  5. Recognize dietary behaviors in context of cultural significance and personal values. 

Interpersonal and Communication Skills
Professionalism
System-Based Practice
  • Ethics discussions

  • Conferences in “food is medicine” interventions

  • Longitudinal experiential training in behavioral counseling (eg, simulated patients, role-play, and in clinical settings), tools to review plant-based cultural foods/menus

  • OSCE: food insecurity screening

  • Visiting food pantries may be impactful experiences

  • Culinary: medicine/teaching kitchens

Food systems and sustainability
  1. Explore the science behind food systems, agriculture, and climate change.

  2. Describe how dietary shifts can optimize personal and planetary health.

  3. Discuss the environmental impact of local food purchasing and waste reduction.

  4. Adopt sustainable practices: buy seasonal foods from local farmers and sustainable producers.

System-Based Practice
Practice-Based Learning and Improvement
  • Reading assignments, expert lectures

  • Visiting local farms may be impactful experiences

  • Design QI projects to increase resident, fellow, and faculty adoption of sustainable food practices


 
Climate change advocacy
  1. Describe the intersection between government policy and climate change solutions.

  2. Explain how government food subsidies effects food affordability.

  3. Discuss health-related elements of the Farm Bill.34

Interpersonal and Communication Skills
System-Based Practice
  • Participation on national and state health care sustainability committees

  • Attend state climate and health “advocacy day”

  • Organize sustainable diet education during community health campaigns

Health care sustainability
  1. Examine how hospital food waste reduction and composting programs influence sustainability.

  2. Discuss how hospital purchases from local growers and producers promote sustainability.

Interpersonal and Communication Skills
System-Based Practice
  • Hospital sustainability committees/green teams membership

  • Participate in hospital sustainability initiatives (ie, Earth Day educational events)

Abbreviations: GME, graduate medical education; SDOH, social determinants of health; QI, quality improvement; EDOH, environmental determinants of health; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children; SNAP, Supplemental Nutrition Assistance Program; OSCE, objective structured clinical examination.

Residency programs can integrate the principles of plant-based diets into discussions for specific diseases.35 It is essential that Food Is Medicine initiatives, such as medically tailored meals and groceries, produce prescriptions, and food security programs, are familiar to all residents.27,36 Moreover, standardized interpersonal and communication competencies and milestones promoting nutrition and lifestyle behaviors should be implemented across all residencies and fellowships. Advocacy training is also helpful in addressing health disparities and SDOH factors affecting patient outcomes.37 Program directors, residents, and fellows can organize healthy and sustainable diet education around disease prevention campaigns targeting patients and their families. Evidence-based resources and tools from organizations, such as the American College of Lifestyle Medicine, American Heart Association, and American Medical Association, can support these efforts.38-40

System-Level Changes

Beyond curricular changes at individual institutions, system-level changes are needed at multiple levels. At the national level, the ACGME must integrate nutrition education and dietary counseling into the Common Program Requirements as part of the Medical Knowledge and Interpersonal and Communication Skills competencies. At the regional or local level, hospitals and hospital systems can transform clinical work environments by providing healthy menu options in cafeterias, vending machines, and during conferences. GME leaders across these systems can support interprofessional teams that promote medical guideline–recommended patient meals and minimize food waste at their institutions.

Conclusion

Integrating plant-based diet education into GME programs is crucial in addressing chronic disease and climate change. Equipping future physicians with knowledge and skills to promote nutritious and sustainable diets can lead to healthier outcomes for patients and the planet.

References

  • 1.World Health Organization WHO calls on countries to protect health from climate change. Published November 17, 2015. Accessed October 12, 2023. https://www.who.int/news/item/17-11-2015-who-calls-on-countries-to-protect-health-from-climate-change.
  • 2.Philipsborn RP, Sheffield P, White A, Osta A, Anderson MS, Bernstein A. Climate change and the practice of medicine: essentials for resident education. Acad Med . 2021;96(3):355–367. doi: 10.1097/ACM.0000000000003719. [DOI] [PubMed] [Google Scholar]
  • 3.Crowley R, Mathew S, Hilden D, Health and Public Policy Committee of the American College of Physicians Environmental health: a position paper from the American College of Physicians. Ann Intern Med . 2022;175(11):1591–1593. doi: 10.7326/M22-1864. [DOI] [PubMed] [Google Scholar]
  • 4.Kremer M, Chiang S. A department wellness initiative for coping with climate distress in 2030. J Grad Med Educ . 2020;12(3):365–366. doi: 10.4300/JGME-D-19-00816.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Kuczmarski TM, Fox J, Katznelson E, et al. Climatizing the internal medicine residency curriculum: a practical guide for integrating the topic of climate and health into resident education. J Climate Change Health . 2021;4:2667–2782. doi: 10.1016/j.joclim.2021.100067. [DOI] [Google Scholar]
  • 6.US Burden of Disease Collaborators , Mokdad AH, Ballestros K, et al. The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states. JAMA . 2018;319(14):1444–1472. doi: 10.1001/jama.2018.0158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Shah UA, Merlo G. Personal and planetary health—the connection with dietary choices. JAMA . 2023;329(21):1823–1824. doi: 10.1001/jama.2023.6118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Gelles D. Fossil fuels aren’t going anywhere. New York Times . Published October 12, 2023. Accessed June 27, 2024. https://www.nytimes.com/2023/10/12/climate/fossil-fuels-arent-going-anywhere.html?smid=url-share. [Google Scholar]
  • 9.Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT—Lancet Commission on healthy diets from sustainable food systems. Lancet . 2019;393(10170):447–492. doi: 10.1016/S0140-6736(18)31788-4. [DOI] [PubMed] [Google Scholar]
  • 10.Scarborough P, Clark M, Cobiac L, et al. Vegans, vegetarians, fish-eaters and meat-eaters in the UK show discrepant environmental impacts. Nat Food . 2023;4(7):565–574. doi: 10.1038/s43016-023-00795-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Ivanovich CC, Sun T, Gordon DR, Ocko IB. Future warming from global food consumption. Nat Climate Change . 2023;13:297–302. doi: 10.1038/s41558-023-01605-8. [DOI] [Google Scholar]
  • 12.Godfray HCJ, Aveyard P, Garnett T, et al. Meat consumption, health, and the environment. Science . 2018;361(6399):eaam5324. doi: 10.1126/science.aam5324. [DOI] [PubMed] [Google Scholar]
  • 13.Springmann M, Van Dingenen R, Vandyck T, Latka C, Witzke P, Leip A. The global and regional air quality impacts of dietary change. Nat Commun . 2023;14(1):6227. doi: 10.1038/s41467-023-41789-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Agudelo Higuita NI, LaRoque R, McGushin A. Climate change, industrial animal agriculture, and the role of physicians—time to act. J Climate Change Health . 2023;13(9):100260. doi: 10.1016/j.joclim.2023.100260. [DOI] [Google Scholar]
  • 15.Murphy SL, Kochanek KD, Xu J, Arias E. Centers for Disease Control and Prevention; 2020. Mortality in the United States. Published December 2021. Accessed October 17, 2023. https://www.cdc.gov/nchs/data/databriefs/db427.pdf. [Google Scholar]
  • 16.Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study [published correction appears in J Am Coll Cardiol. 2021;77(15):1958-1959] J Am Coll Cardiol . 2020;76(25):2982–3021. doi: 10.1016/j.jacc.2020.11.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Shan Z, Wang F, Li Y, et al. Healthy eating patterns and risk of total and cause-specific mortality [published correction appears in JAMA Intern Med. 2023;183(6):627] JAMA Intern Med . 2023;183(2):142–153. doi: 10.1001/jamainternmed.2022.6117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol . 2017;14(5):342–354. doi: 10.11909/j.issn.1671-5411.2017.05.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. Association between plant-based dietary patterns and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA Intern Med . 2019;179(10):1335–1344. doi: 10.1001/jamainternmed.2019.2195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.American Diabetes Association Prevention or delay of type 2 diabetes: standards of medical care in diabetes—2021. Diabetes Care . 2021;44(suppl 1):34–39. doi: 10.2337/dc21-S003. [DOI] [Google Scholar]
  • 21.Shah UA, Iyengar NM. Plant-based and ketogenic diets as diverging paths to address cancer: a review. JAMA Oncol . 2022;8(8):1201–1208. doi: 10.1001/jamaoncol.2022.1769. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Dietary Guidelines for Americans Accessed June 26, 2024. DietaryGuidelines.gov.
  • 23.Salas RN. The growing link between climate change and health. NEJM Catal Innov Care Deliv . 2022;3(3) doi: 10.1056/CAT.22.0052. [DOI] [Google Scholar]
  • 24.Katz DL. How to improve clinical practice and medical education about nutrition. AMA J Ethics . 2018;20(10):e994–e1000. doi: 10.1001/amajethics.2018.994. [DOI] [PubMed] [Google Scholar]
  • 25.Oberg EB, Frank E. Physicians’ health practices strongly influence patient health practices. J R Coll Physicians Edinb . 2009;39(4):290–291. doi: 10.4997/JRCPE.2009.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.US House of Representatives H.Res.1118. 117th Congress (2021-2022) Accessed October 4, 2024. https://www.congress.gov/bill/117th-congress/house-resolution/1118.
  • 27.The White House Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health. Published September 2022. Accessed November 1, 2023. https://www.whitehouse.gov/wp-content/uploads/2022/09/White-House-National-Strategy-on-Hunger-Nutrition-and-Health-FINAL.pdf.
  • 28.Accreditation Council for Graduate Medical Education Proceedings of the Summit on Medical Education in Nutrition. Accessed June 24, 2024. https://www.acgme.org/globalassets/pdfs/nutritionsummit/nutrition-summit-proceedings.pdf.
  • 29.Devries S, Willett W, Bonow RO. Nutrition education in medical school, residency training, and practice. JAMA . 2019;321(14):1351–1352. doi: 10.1001/jama.2019.1581. [DOI] [PubMed] [Google Scholar]
  • 30.Eisenberg DM. Nutrition education in 2040—an imagined retrospective. J Grad Med Educ . 2015;7(3):489–491. doi: 10.4300/JGME-D-15-00235.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Agusala B, Broad Leib E, Albin J. The time is ripe: the case for nutrition in graduate medical education in the United States. J Med Educ Curric Dev . 2024;11:23821205241228651. doi: 10.1177/23821205241228651. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Shannahan AB, Ring MR, Stephens J, Wright KM, Clements DS, Grote V. Cooking up health: academic-community collaboration to teach nutrition education. J Grad Med Educ . 2023;15(3):391–392. doi: 10.4300/JGME-D-22-00774.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Co JPT, Weiss KB;, CLER Evaluation Committee CLER Pathways to Excellence, Version 2.0: executive summary. J Grad Med Educ . 2019;11(6):739–741. doi: 10.4300/JGME-D-19-00724.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.U.S. Department of Agriculture Farm Bill Home. Accessed September 24, 2024. https://www.fsa.usda.gov/programs-and-services/farm-bill/index.
  • 35.Joshi S, McMacken M, Kalantar-Zadeh K. Plant-based diets for kidney disease: a guide for clinicians. Am J Kidney Dis . 2021;77(2):287–296. doi: 10.1053/j.ajkd.2020.10.003. [DOI] [PubMed] [Google Scholar]
  • 36.Tufts University What is “food is medicine?”. Accessed March 1, 2023. https://tuftsfoodismedicine.org/
  • 37.Coutinho AJ, Nguyen BM, Kelly C, et al. Formal advocacy curricula in family medicine residencies: a CERA survey of program directors. Fam Med . 2020;52(4):255–261. doi: 10.22454/FamMed.2020.591430. [DOI] [PubMed] [Google Scholar]
  • 38.American College of Lifestyle Medicine Part of the Lifestyle Medicine Core Competencies program (LMCC) Accessed November 1, 2023. https://lifestylemedicine.org/project/nutrition-core-competencies/
  • 39.Health Care by Food Accessed November 1, 2023. https://healthcarexfood.org/
  • 40.Gaples Institute Nutrition science for health and longevity: what every physician needs to know. Accessed November 1, 2023. https://edhub.ama-assn.org/gaples-institute-ed.

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