If you lived in Macon, Georgia, and were lucky enough to survive a heart attack, you’d probably end up in the Acute Recovery Unit of the Atrium Health Navicent Heart and Vascular Program. It’s “a national leader in state-of-the-art cardiovascular care,” according to their website, offering “prevention, diagnosis, and treatment of cardiac disease.” Their board-certified cardiologists “are committed to providing the best possible care.”
And to celebrate your good fortune as you rehabilitated, your visiting family members could stop by the on-site hospital restaurant and bring you a couple of meals. You could treat your recovering heart muscle and arteries to a Bacon, Egg, & Cheese McGriddle for breakfast; a Big Mac, large fries, and Coke for lunch; and Chicken McNuggets and a chocolate shake for dinner. That’s right — for years, a McDonald’s was renting space inside this medical center.
That was the reality at Atrium Health Navicent until June 2019, when a long campaign by the Physicians’ Committee for Responsible Medicine (PCRM) finally bore fruit, convincing the medical center’s leaders not to renew the fast-food chain’s lease.
There are many morals to this story.
The first is that it’s a win worth celebrating. Three cheers to American College of Lifestyle Medicine Trailblazer Award Winner Neal Barnard, MD, and the rest of the PCRM team for their persistence and political savvy. And hats off to the courage of the Atrium Health Navicent board of directors for cutting off a lucrative revenue stream in favor of patient health.
The second moral is to spare a thought for the often economically stressed patients, visitors, and staff who had come to rely on McDonald’s as a tasty, cheap, and convenient source of calories. Where could they eat cheaply and quickly now?
A third moral is, to put it bluntly, what was a McDonald’s doing in a medical center in the first place?
Can you imagine a liquor store housed in an alcohol abuse rehab center? A demolition derby track as part of an auto body shop? A gun shop located on the grounds of a trauma center?
The Irony of Fast Food in a Hospital
If you stop and think about it for even two seconds, you’ll see that these analogies are spot-on. The food served at McDonald’s, beyond a shadow of a doubt, causes the diseases and conditions that the Atrium Health Navicent Heart and Vascular Program is treating.
Yes, it’s comfort food at a tough time. But there’s no comfort in a second heart attack. No comfort in a continual downward spiral of health and vitality. No comfort in more and more time, money, and energy devoted to managing a slow decline into disability and premature death.
If you wanted to be really cynical about it, you could see the two branches of the operation as feeding each other. The hospital provided customers for McDonald’s, and McDonald’s, in turn, provided more customers for the hospital.
Of course, no cardiologist wants to see more heart disease. No hospital is rooting for the rising incidence of angina, myocardial infarction, a-fib, stroke, and congestive heart failure. It wasn’t a conscious conspiracy. The Atrium Health Navicent McDonald’s — and the dozens of other fast-food restaurants that still operate inside medical centers across the country — are symptoms of a profound blind spot in medical practice and education.
The blind spot, so obvious to those of us outside the profession, is that the food we eat is the number one determinant of human health.
Diet Is the Leading Cause of Preventable Death
A 2019 report published in The Lancet affirms that poor diet is responsible for more deaths than any other risk factor. How many deaths? In 2017 alone, unhealthy diets killed around 11 million adults worldwide, through heart disease, several cancers, type 2 diabetes, and other illnesses. The leading risk factors were high salt intake, low whole grain intake, and low fruit intake.
Not that this is cutting-edge knowledge. Humans have known that food affects health long before epidemiological research, or science, or — most probably — language itself.
The Disappearance of Food as Medicine
Humans didn’t need peer-reviewed studies to sense that food and health were connected — that intuition predates written history. But it took modern science, especially over the past several decades, to move that intuition from folk wisdom to documented mechanism.
My late father, John Robbins, put it simply: “A doctor who doesn’t know about food is like a firefighter who doesn’t know about water.” That was true when he said it. It remains true today. Most doctors still graduate from medical school with little or no training in the foundation of health.
Medical education has long focused on pathology and treatment — what goes wrong with the human body, and the interventions research has produced to address it. Pills, procedures, and protocols.
What’s been missing, of course, is human health before disease or injury. What keeps us well? What can return us to health? Medical education has largely ignored these questions, and so medical practice has pretended they’re irrelevant to its mission.
Meanwhile, healthcare leadership built a system in which fast food could colonize medical centers and shuttle customers onto a conveyor belt of chronic disease.
A Disconnect Between Symptoms and Cause
The modern disease epidemic has hit us faster than anyone might have imagined. It’s been more than 4 decades since we had the first signs that type 2 diabetes, known then as “adult-onset diabetes,” was affecting youth. Between 2001 and 2017, the prevalence of type 2 diabetes among U.S. adolescents ages 10 to 19 rose from 0.34 to 0.67 cases per 1,000 youth — a 95% increase, according to the CDC-funded SEARCH for Diabetes in Youth study, the largest population-based surveillance project tracking pediatric diabetes in the U.S. Over roughly the same period, the annual rate of new type 2 diagnoses in youth climbed by about 4.8% a year — nearly three times the growth rate of new type 1 diagnoses. By 2017–2018, type 2 diabetes was being newly diagnosed in adolescents at a rate of nearly 18 per 100,000 each year, closing in on the rate for type 1 diabetes at about 22 per 100,000 — a gap that would have seemed unthinkable a generation ago, when type 2 diabetes in children was rarely diagnosed at all.
If there were a vaccine that protected against type 2 diabetes, public health authorities would recommend it for every child in the United States. But because the disease is foodborne, vectored by Big Macs, Whoppers, and Baconators, we’ve acted as if prevention were impossible. That abdication of medical responsibility has sentenced our young people to shortened lives full of avoidable pain and suffering.
We’ve graduated healthcare providers with a gap at the foundation of their education. We’ve built an acute care system to handle the flood of after-effects, and forgotten that we had the means to turn off the faucet. The result, decade after decade, has been epidemic obesity, heart disease, diabetes, depression, and cancer, in a culture that fosters the continuation of our poor habits. And every year that we’ve waited, the costs — measured in lives, dollars, and human suffering — have compounded.
Meanwhile, patients whose lives are on the line are told nothing about nutrition by doctors who, despite all their best intentions, were never taught it.
Leading the Charge for Nutrition in Medical Education
The movement that finally got McDonald’s out of Macon’s Atrium Health Navicent campus is still fighting to remove unhealthy food from health care facilities. A 2024 survey by PCRM found that nearly 70% of U.S. medical school hospitals still host a fast-food restaurant on-site.
At the same time, we’ve opened a new front: pushing to get nutrition taught in medical schools themselves.
Some of this work happens one lecture hall at a time. My dear friend Michael Klaper, MD, spent a long career in clinical practice before concluding that the hardest problem wasn’t what he could do for the patient in front of him. It was what he had never been taught to do in the first place. He now brings that reckoning straight to medical students, traveling to schools across North America and internationally to teach how a patient’s diet can either cause disease or reverse it. His initiative, Moving Medicine Forward, backs those visits with Nutrition Interest Groups on campus, toolkits for student leaders, and a CME-accredited masterclass in plant-based clinical nutrition built in partnership with the Rochester Lifestyle Medicine Institute. His book, Moving Medicine Forward, traces his own path from country GP to advocate for reversing chronic disease through plant-strong nutrition. Neal Barnard has called it vitally important and overdue. I agree, and I’d add that it’s the book I wish every physician graduating this year would read.
One key lever is medical education. Like most academic institutions, medical schools teach to the test. So here’s a question: Out of the thousands of questions on the certification exam for physicians, how many were about nutrition? For years, the answer was: almost none.
And if you’re a medical school recruiting the best students, how much energy will you put into teaching a topic that doesn’t show up on the exam that determines your graduates’ careers? Right again: almost none.
Recognizing this, Food Revolution Network partnered with Bright Line Eating and the American College of Lifestyle Medicine in 2019 to fund the Lifestyle Medicine Question Bank. The campaign set out to raise $250,000 to fund 1,000 multiple-choice questions designed for use on categorical assessment tests and licensing exams — the goal being to motivate medical schools to include lifestyle medicine subjects in their curricula, and to eventually get some of these questions folded into official testing. The campaign hit its funding goal on December 22, 2019, and ACLM faculty now use the resulting question bank to teach and test medical students on lifestyle medicine. That kind of grassroots pressure, alongside years of advocacy from clinicians and researchers, has helped keep nutrition on the table as institutions like the National Board of Medical Examiners have moved to expand nutrition-focused content across all three U.S. medical licensing exams, with nutrition performance now appearing in score reporting.
The underlying principle is straightforward: What gets tested gets taught. If nutrition and lifestyle medicine are meaningfully represented on high-stakes exams, educators will be far more likely to prioritize them in the curriculum. These efforts represent important progress. These are steps on a long path, but at least we appear to be moving in the right direction.
A Turning Point: 40 Hours, Finally
Then, in March of 2026, something shifted, and I was in the room when it happened.
For years, advocates had been reciting the same dismal baseline to anyone who would listen: Only 14% of U.S. residency programs had a required nutrition curriculum. Three-quarters of U.S. medical schools had no required clinical nutrition classes. Medical students reported an average of 1.2 hours of formal nutrition education per year, less than the time most of them spend in a single pharmacology lecture.
In 2025, HHS issued a public call for medical schools to change this, and in March 2026, HHS and the U.S. Department of Education announced that 53 of the nation’s medical schools, across 31 states, had committed to require at least 40 hours of nutrition education — or a 40-hour competency equivalent — beginning in fall 2026. That number has kept growing: by June 2026, 19 more schools signed on, bringing the total to 73, and more may have joined since.
I watched HHS Secretary Kennedy, Education Secretary McMahon, CMS Administrator Dr. Oz, and AMA President Dr. Mukkamala take the stage together to mark the occasion. That lineup represented federal health policy, federal education policy, Medicare and Medicaid, and organized medicine. Whatever you think of any one of them, seeing those voices united around a single message was something I hadn’t seen before: Nutrition belongs at the center of medicine.
AMA President Bobby Mukkamala didn’t cite his own credentials as expertise — he offered them as an admission of a gap. After 25 years in practice, he recently earned board certification in Lifestyle Medicine specifically because he felt his own medical training had left him without enough grounding in how food and daily habits affect disease. As he put it: “For too long, nutrition has been treated as an elective in medical education — a few hours here and there. Considering how important what we eat is for our health, it should be a basic foundational training.“
He’s right. And on that day, at least, the people with the power to act agreed.
Now, more than 30,000 physicians will graduate each year with at least a foundational understanding of nutrition — and that number will only grow as more schools sign on beyond the original cohort.. These are doctors who will spend decades in practice, each one having tens of thousands of conversations with patients about their health.
This is a genuine breakthrough. It’s also, to be clear, a set of voluntary commitments from roughly a third of U.S. medical schools. Getting nutrition into some curricula is not the same as getting it onto licensing exams, into residency training, or into the daily habits of the millions of physicians already in practice. We still need mandatory continuing medical education on nutrition, so that doctors who graduated without this knowledge can fill in the gaps. And we need the remaining two-thirds of medical schools to follow.
But the movement that clinicians, researchers, and advocates have been building for decades, from Michael Greger to Neal Barnard to Senator Cory Booker to thousands of unnamed patients and practitioners, is finally reaching institutional weight. The Question Bank, the 40-hour commitments, the eviction of McDonald’s from hospital lobbies: These are all part of the same story.
Dr. Martin Luther King, Jr. reminded us that “the arc of the moral universe is long, but it bends toward justice.” Sometimes that arc feels very long indeed.
But one thing is clear: It won’t bend all by itself. We all have a part to play.
It’s tempting to read a headline like “53 medical schools commit to 40 hours of nutrition” and feel like the work is done. It isn’t. The children being diagnosed with type 2 diabetes today won’t benefit from a curriculum reform that reaches them in their 40s. The patients in cardiac wards this year deserve doctors who already know what to tell them about food.
The work ahead is to translate institutional commitments into practitioner habits — classroom hours into residency training, residency training into hospital protocols, and hospital protocols into the conversations that doctors actually have with patients. That last mile — the exam room conversation, the discharge instructions, the follow-up call — is where decades of advocacy will either land or fail to land.
This is one of the most consequential public health opportunities of our generation. Hundreds of millions of people stand to live longer, better lives if we get this right. And whether we get it right doesn’t depend only on what medical schools, regulators, and advocacy groups do next. It depends, in large part, on the choices each of us makes — about what we eat, what we ask of our doctors, what we expect from our hospitals, and what we’re willing to push for in the systems that shape all of our lives.
Here are three ways you can add your weight to the movement to put food back at the center of medicine:
- Eat like food matters. The most direct way to shift the food-as-medicine landscape is to live it. Lean into more whole, plant-based foods. There are abundant resources right here on this site to help you make that shift, one meal at a time.
- Bring food into the exam room. Ask your doctor how much nutrition training they received in medical school. Ask what role they think food plays in your specific health concerns. And if they seem interested in going deeper, let them know that lifestyle medicine offers excellent CME credits and even a board certification. These conversations, multiplied across millions of appointments, shape what physicians prioritize and what their hospitals and medical schools take seriously.
- Use your voice. Share articles like this one. Talk with friends, family, and colleagues about why nutrition belongs at the center of medicine. Support the organizations doing this work — including PCRM, ACLM, and Food Revolution Network — and make clear, with your time and your dollars, that this is the kind of healthcare you want.
Each of us has a choice. We can be passive patients or empowered participants in our own health and in the health of our communities. We can be complicit in the status quo, or we can be everyday revolutionaries.
And maybe one day soon, the most common order at the hospital restaurant will be kale salad with sweet potatoes and fresh fruit — with the same goal as the cardiologists down the hall.
Tell us in the comments:
- What is your experience with hospital food?
- Do you think medical education should focus more on nutrition and prevention?
Featured Image: iStock.com/AlessandroPhoto
