As the U.S. expands nutrition training, where does the UK stand?

“Just cut out all the rubbish.” That is the advice my dad was given by his GP when he was first diagnosed with pre-diabetes. There was no real explanation of what the diagnosis meant, no leaflet to take home, not a single question asked about his diet or lifestyle, and no referral to an education programme.

He left that appointment without a clear understanding of what he needed to do. And with that, an opportunity was lost not only to prevent progression to type 2 diabetes, but also to reduce the likelihood of future treatment and healthcare costs.

That was more than ten years ago but in my role as a specialist dietitian working in the NHS Diabetes Remission Programme, I heard similar stories often, with many people describing feeling under‑informed and confused at the point of diagnosis. They were unsure what it meant for their health, unclear about what needed to change, and some were uncertain even about the basics.

This is not because support doesn’t exist. Guidance from the National Institute for Health and Care Excellence recommends that people with type 2 diabetes are offered structured education at diagnosis, and national programmes have been developed to provide exactly that. 

But in practice, that support doesn’t always reach people at the point it’s needed most. Long waiting times, variation in local services, and low uptake mean that many patients still leave their initial appointment with only brief or vague advice. By the time they do access more structured support (if they access it at all), the moment for early intervention may already have passed. 

This is not every patient’s story. There are lots of GPs who provide clear explanations and thoughtful support, often under significant time pressure. But for my dad and for many others it still feels like there are missed opportunities for clear, confident nutrition guidance at the point of diagnosis.

The nutrition training gap in medicine

These experiences reflect wider pressures within primary care: limited consultation time, overstretched services, and increasingly complex patient needs. This is not about blaming individuals, but about whether the system equips them with the training and support needed to discuss nutrition confidently.

A 2020 UK study published in BMJ Nutrition, Prevention & Health found that over 70% of doctors and medical students reported receiving fewer than two hours of nutrition education in medical school. The study added that around a quarter reported feeling adequately prepared or confident.

It is not just the volume of teaching that is limited; nutrition is also rarely assessed in medical degrees. One observational cross-sectional study found that only a small proportion of exam questions related to nutrition, and these focused largely on basic science rather than practical skills. Without meaningful assessment, there is little accountability for ensuring doctors can apply this knowledge in practice.

GPs handle the high-pressure diagnostics but for patients like my dad, the GP is usually the first (and sometimes only)  point of contact for lifestyle advice. Even when knowledge is present, limited time can make these conversations difficult. 

A global push to teach doctors more about nutrition

Increasingly, this gap in medical education is being recognised internationally. In the United States, several medical schools have recently committed to expanding nutrition education, with initiatives encouraging institutions to provide at least 40 hours of nutrition training.

For many public health advocates, this shift is long overdue. Doctors are often on the frontline of an epidemic of diet-related disease, including obesity, cardiovascular disease and type 2 diabetes.

However, increased teaching hours do not automatically translate into better patient outcomes, particularly when initiatives are voluntary. The U.S. healthcare system also faces well-documented challenges around access and inequality, which shape how such changes are experienced in practice.

What the UK is doing (and still needs to do)

The UK has already taken some steps to address this gap. In 2021, a national undergraduate nutrition curriculum for medical doctors was published by the Association for Nutrition, outlining the core nutrition knowledge and skills medical students should develop during training. However, implementation across medical schools remains uneven. 

But of course, education alone is not enough. Digital tools, group education, and the way GP contracts reward lifestyle interventions all influence whether nutrition gets the time and attention it deserves in practice.

Doctors and dietitians need to work together

I’m all for nutrition being included more naturally in medical training. For example, when doctors learn about cancer, it makes sense to also discuss how diets high in processed and red meat have been linked to increased risk of colorectal cancer. But let’s not forget the importance of scope of practice. We cannot expect doctors to be experts in everything. 

Dietitians are trained to translate nutrition science into practical, personalised advice that supports lasting change. The title “dietitian” is legally protected, unlike terms such as “nutritionist” or “health coach.” They are regulated and qualified to work with complex conditions, including diabetes and malnutrition. 

Strengthening nutrition education should go hand in hand with better integration of dietitians into primary care teams.

Many practices already rely on nurses and other allied health professionals for long-term condition management. With appropriate training, these roles can support basic nutrition care and reinforce advice over time. Adding dietitians into that mix would help complete the picture.

Doctors are experts in diagnosis and prescribing, while dietitians bring specialist knowledge in translating nutrition science into practical advice. Working together ensures patients get both perspectives.

There is already evidence that this approach works. In UK primary care pilots, dietitians embedded within GP practices have managed cases such as malnutrition and obesity directly, improving patient satisfaction, reducing prescriptions and freeing up doctors’ time. 

One British Dietetic Association project reported that dietitians served as first contact for 94% of 63 frailty/malnutrition cases. In a GP practice pilot in Devon, a dietitian acted as the first point of contact for nearly a third of nutrition-related consultations while also educating the wider clinical team.

Why doesn’t every GP practice have a dietitian? 

It’s a fair question. The NHS’s long-term workforce plan points to a move towards more diverse, multidisciplinary teams. Over the next few years, the plan proposes more training opportunities for healthcare professionals and a broader role for them in primary and community care.

NHS funding has also supported the expansion of healthcare professionals in primary care teams since 2020, including a growing number of dietitians, with early evaluations suggesting improvements in patient satisfaction and outcomes.

However, dietitians remain less widely employed in primary care compared to roles such as physiotherapists or pharmacists. Contributing factors include workforce limitations, financial constraints and competing priorities.

Part of the answer may also lie in a challenge the profession has faced for years: dietitians are often misunderstood. Many decision-makers, GPs and patients still associate dietitians primarily with weight loss or meal plans, rather than recognising their broader role in managing chronic disease, malnutrition and complex medical conditions. As a result, the profession’s potential to improve patient outcomes and reduce long-term healthcare costs may sometimes be overlooked.

Conclusion

The principles are clear, even if translating them into everyday practice will take time. Medical schools must treat nutrition as a core clinical skill, not a nice‑to‑have, and GP practices need to view dietitians as essential members of the team rather than as optional extras. Of course, workforce and funding realities will shape how quickly this can happen, but it is equally as important that they are supported to be aware of, and make use of, the educational pathways and patient support resources that already exist.

Patients also have more power than they sometimes realise. After a new diagnosis like type 2 diabetes, they can ask their GP or practice nurse: “Can you explain what this means for my health?”, “Is there an education programme you can refer me to?” or “Will I be referred to a registered dietitian to help me work out what to eat day to day?”. If they are looking for support online, they can check whether someone is a registered dietitian on the HCPC register, and ask any nutrition coach or nutritionist what qualifications they have, and whether their title is regulated in the same way as “dietitian”.

These may seem like small questions, but they can change the feel of a consultation. When patients feel empowered to ask for clearer explanations, structured education and support from regulated professionals, nutrition is more likely to be treated as a routine part of managing long‑term conditions, rather than something that’s squeezed into the last few seconds of an appointment.

If my dad were diagnosed today, my hope is that he wouldn’t just be told to “cut out the rubbish”, but would leave with a clear explanation of his diagnosis, a realistic plan, and someone qualified to walk him through the changes. That shouldn’t be reserved for the few who happen to live in the right area, have the time, are digitally literate, or can afford to seek out extra help; it should be the norm.