articles in nutrition education

Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Healthy Eating Learning Opportunities and Nutrition Education

Healthy eating learning opportunities includes nutrition education  and other activities integrated into the school day that can give children knowledge and skills to help choose and consume healthy foods and beverages. 1 Nutrition education is a vital part of a comprehensive health education program and empowers children with knowledge and skills to make healthy food and beverage choices. 2-8 

US students receive less than 8 hours of required nutrition education each school year, 9  far below the 40 to 50 hours that are needed to affect behavior change. 10,11  Additionally, the percentage of schools providing required instruction on nutrition and dietary behaviors decreased from 84.6% to 74.1% between 2000 and 2014. 9

Given the important role that diet plays in preventing chronic diseases and supporting good health, schools would ideally provide students with more hours of nutrition education instruction and engage teachers and parents in nutrition education activities. 5, 12  Research shows that nutrition education can teach students to recognize how healthy diet influences emotional well-being  and how emotions may influence eating habits. However, because schools face many demands, school staff can consider ways to add nutrition education into the existing schedule. 11

Nutrition education can be incorporated throughout the school day and in various locations within a school. This provides flexibility allowing schools to use strategies that work with their settings, daily schedule, and resources.

In the Classroom

Nutrition education can take place in the classroom, either through a stand-alone health education class or combined into other subjects including 2,5 :

• Counting with pictures of fruits and vegetables.
• Learning fractions by measuring ingredients for a recipe.
• Examining how plants grow.
• Learning about cultural food traditions.

Nutrition education should align with the National Health Education Standards and incorporate the characteristics of an effective health education curriculum .

Farm to School

Farm-to-school programs vary in each school or district, but often include one or more of the following strategies:

• Purchasing and serving local or regionally produced foods in the school meal programs.
• Educating students about agriculture, food, health, and nutrition.
• Engaging students in hands-on learning opportunities through gardening, cooking lessons, or farm field trips.

Students who participate in farm-to-school activities have increased knowledge about nutrition and agriculture, are more willing to try new foods, and consume more fruits and vegetables. 14-17

School Gardens

School garden programs can increase students’ nutrition knowledge, willingness to try fruit and vegetables, and positive attitudes about fruits and vegetables. 18-22 School gardens vary in size and purpose. Schools may have window sill gardens, raised beds, greenhouses, or planted fields.

Students can prepare the soil for the garden, plant seeds, harvest the fruits and vegetables, and taste the food from the garden. Produce from school gardens can be incorporated into school meals or taste tests. Classroom teachers can teach lessons in math, science, history, and language arts using the school garden.

In the Cafeteria

Cafeterias are learning labs where students are exposed to new foods through the school meal program, see what balanced meals look like, and may be encouraged to try new foods through verbal prompts from school nutrition staff, 23 or taste tests. 24-25 Cafeterias may also be decorated with nutrition promotion posters or student artwork promoting healthy eating. 24

Other Opportunities

Schools can add messages about nutrition and healthy eating into the following:

• Morning announcements.
• School assemblies.
• Materials sent home to parents and guardians. 24
• Staff meetings.
• Parent-teacher group meetings.

These strategies can help reinforce messages about good nutrition and help ensure that students see and hear consistent information about healthy eating across the school campus and at home. 2 

Shared use agreements can extend healthy eating learning opportunities. As an example, an after-school STEM club  could gain access to school gardens as learning labs.

CDC Parents for Healthy Schools: Ideas for Parents

Nutrition: Gardening Interventions | The Community Guide

Dietary Guidelines for Americans, 2020–2025

Introduction to School Gardens

Learning Through the Garden

National Farm-to-School Network

National Farm to School Network Resource Database

National Health Education Standards

Team Nutrition Curricula

USDA Farm to School

USDA Team Nutrition

• Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. MMWR Morb Mortal Wkly Rep . 2011;60(RR-5):1–76.
• Joint Committee on National Health Education Standards. National Health Education Standards: Achieving Excellence. 2nd ed. Atlanta, GA: American Cancer Society; 2007.
• Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2012, Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2012. Available at http://www.cdc.gov/healthyyouth/hecat/index.htm. Accessed April 9, 2019.
• Price C, Cohen D, Pribis P, Cerami J. Nutrition education and body mass index in grades K–12: a systematic review. J Sch Health. 2017;87:715–720.
• Meiklejohn S, Ryan L, Palermo C. A systematic review of the impact of multi-strategy nutrition education programs on health and nutrition of adolescents. J Nutr Educ Behav . 2016;48:631–646.
• Silveira JA, Taddei JA, Guerra PH, Nobre MR. The effect of participation in school-based nutrition education interventions on body mass index: A meta-analysis of randomized controlled community trials. Prev Med . 2013;56:237–243.
• County Health Rankings and Roadmaps. School-based Nutrition Education Programs website. http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/school-based-nutrition-education-programs . Accessed on April 9, 2019.
• Results from the School Health Policies and Practices Study 2014 . Atlanta, GA: Centers for Disease Control and Prevention; 2014.
• Connell DB, Turner RR, Mason EF. Results of the school health education evaluation: health promotion effectiveness, implementation, and costs . J Sch Health . 1985;55(8):316–321.
• Institute of Medicine. Nutrition Education in the K–12 Curriculum: The Role of National Standards: Workshop Summary. Washington, DC: The National Academies Press; 2014.
• Murimi MW, Moyeda-Carabaza AF, Nguyen B, Saha S, Amin R, Njike V. Factors that contribute to effective nutrition education interventions in children: a systematic review. Nutr Rev . 2018;76(8):553–580.
• Hayes D, Contento IR, Weekly C. Position of the American Dietetic Association, School Nutrition Association, and Society for Nutrition Education: comprehensive school nutrition services. J Acad Nutr Diet . 2018; 118:913–919.
• Joshi A, Misako Azuma A, Feenstra G. Do farm-to-school programs make a difference? Findings and future research needs . J Hunger Environ Nutr . 2008;3:229–246.
• Moss A, Smith S, Null D, Long Roth S, Tragoudas U. Farm to school and nutrition education: Positively affecting elementary school-aged children’s nutrition knowledge and consumption behavior. Child Obes . 2013;9(1):51–6.
• Bontrager Yoder AB, Liebhart JL, McCarty DJ, Meinen A, Schoeller D, Vargas C, LaRowe T. Farm to elementary school programming increases access to fruits and vegetables and increases their consumption among those with low intake . J Nutr Educ Behav . 2014;46(5):341–9.
• The National Farm to School Network. The Benefits of Farm to School website. http://www.farmtoschool.org/Resources/BenefitsFactSheet.pdf . Accessed on June 14, 2019.
• Berezowitz CK, Bontrager Yoder AB, Schoeller DA. School gardens enhance academic performance and dietary outcomes in children. J Sch Health . 2015;85:508–518.
• Davis JN, Spaniol MR, Somerset S. Sustenance and sustainability: maximizing the impact of school gardens on health outcomes. Public Health Nutr . 2014;18(13):2358–2367.
• Langellotto GA, Gupta A. Gardening increases vegetable consumption in school-aged children: A meta-analytical synthesis. Horttechnology . 2012;22(4):430–445.
• Community Preventative Services Task Force. Nutrition: Gardening Interventions to Increase Fruit and Vegetable Consumption Among Children. Finding and Rationale Statement .. https://www.thecommunityguide.org/sites/default/files/assets/Nutrition-Gardening-Fruit-Vegetable-Consumption-Children-508.pdf . Accessed on May 16, 2019.
• Savoie-Roskos MR, Wengreen H, Durward C. Increasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review. Journal of the Academy of Nutrition and Dietetics 2017;11(2):240–50.
• Schwartz M. The influence of a verbal prompt on school lunch fruit consumption: a pilot study. Int J Behav Nutr Phys Act. 2007;4:6.
• Fulkerson JA, French SA, Story M, Nelson H, Hannan PJ. Promotions to increase lower-fat food choices among students in secondary schools: description and outcomes of TACOS (Trying Alternative Cafeteria Options in Schools). Public Health Nutr. 2003 ;7(5):665–674.
• Action for Healthy Kids. Tips for Hosting a Successful Taste Test website. http://www.actionforhealthykids.org/tools-for-schools/find-challenges/classroom-challenges/701-tips-for-hosting-a-successful-taste-test . Accessed on May 19, 2019.

Healthy Youth

To receive email updates about this page, enter your email address:

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Original Communication
• Published: 28 August 2003

Nutrition education in schools: experiences and challenges

• C Pérez-Rodrigo 1 &
• J Aranceta 1  

European Journal of Clinical Nutrition volume  57 ,  pages S82–S85 ( 2003 ) Cite this article

29k Accesses

93 Citations

2 Altmetric

Metrics details

Health promotion from the early stages in life by fostering healthy eating practices and regular physical activity has the potential for a major impact on health and well-being during childhood and later stages in life.

School-based nutrition education should consider the needs and interests of students, teachers and the school. Educational strategies include efforts to increase health awareness, communication and skill building.

Previous literature reviews identified educational strategies directly relevant to a behavioural focus and theory-driven strategies among the elements conducive to successful programmes. Other features that contribute to gain effectiveness are the provision of adequate time and intensity for the intervention, involvement of families, particularly for younger children, and incorporation of self-assessment and feedback in interventions for older children. School meals provide a valuable opportunity for nutrition education. The emphasis on environmental and behavioural factors in successful school-based physical activity and nutrition interventions highlights the importance of involving parents and other community members.

This is a preview of subscription content, access via your institution

Access options

Subscribe to this journal

Receive 12 print issues and online access

251,40 € per year

only 20,95 € per issue

Buy this article

• Purchase on SpringerLink
• Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

The effect of physical activity intervention and nutritional habits on anthropometric measures in elementary school children: the health oriented pedagogical project (HOPP)

Effect of a peer-led education intervention on dietary behaviour and physical activity among adolescents in ho chi minh city, vietnam: a pilot study, evaluation of health intervention: a case of preschool children in egypt.

ADA (1999): Statement. Promoting Healthy Eating Behaviors: The Role of School Environments . Washington, DC: USDA, Food, Nutrition and Consumer Services.

Aldinger CE & Jones JT (1998): Healthy Nutrition: An Essential Element of a Health-promoting School . WHO Information Series on School Health. Document four. Geneva: WHO.

Google Scholar  

Aranceta J (2001): Nutrición Comunitaria , 2 a edición, pp. 1–284. Barcelona: Masson.

Baranowski T & Stables G (2000): Process evaluations of the 5-a-day projects. Health Educ. Behav. 27 , 157–166.

Article   CAS   Google Scholar  

Birch LL & Fisher JO (1998): Development of eating behaviors among children and adolescents. Pediatrics 101 (Suppl), 539–549.

CAS   Google Scholar  

Birnbaum AS, Lytle LA, Story M, Perry CL & Murray DM (2002): Are differences in exposure to a multicomponent school-based intervention associated with varying dietary outcomes in adolescents? Health Educ. Behav. 29 , 427–443.

Article   Google Scholar  

Brug J, Steenhuis I, van Assema P, Glanz K & de Vries H (1999): Computer-tailored nutrition education differences between two interventions. Health Educ. Res. 14 , 249–256.

Centers for Disease Control and Prevention (CDC) (1996): Guidelines for School Health Programs to Promote Lifelong Healthy Eating. MMWR , 45 , 1–33.

Contento IR (ed) (1995): The effectiveness of nutrition education and implications for nutrition education policy, programs and research —a review of research. J. Nutr. Educ. 27 , 279–418.

DiSogra L & Glanz K (2000): The 5 a day virtual classroom: an on-line strategy to promote healthful eating. J. Am. Diet. Assoc. 1000 , 349–352.

Dixey R, Heindl I, Loureiro I, Pérez-Rodrigo C, Snel J & Warnking P (1999): Healthy Eating for Young People in Europe. A School-based Nutrition Education Guide . Copenhague: European Network of Health Promotiong Schools.

Eriksen K, Haraldsdöttir J, Pederson R & Flyger HV (2003): Effect of a fruit and vegetable subscription in Danish schools. Public Health Nutr. 6 , 57–63.

Fulkerson JA, French SA, Story M, Snyder P & Paddock M (2002): Foodservice staff perceptions of their influence on student food choices. J. Am. Diet. Assoc. 102 , 97–99.

Gortmaker SL, Cheung LW, Peterson KE, Chomitz G, Cradle JH, Dart H, Fox MK, Bullock RB, Sobol AM, Colditz G, Field AE & Laird N (1999): Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving. Arch Pediatr. Adolesc. Med. 153 , 975–983.

Hoelscher DM, Evans A, Parcel GS & Kelder SH (2002): Designing effective nutrition interventions for adolescents. J. Am. Diet. Assoc. 102 (Suppl), S52–S63.

Kelder SH, Perry CL, Klepp KI & Lytle LL (1994): Longitudinal tracking of adolescent smoking, physical activity and food choice behaviors. Am. J. Public Health 84 , 1121–1126.

Kealey KA, Peterson Jr AV, Gaul MA & Dinh KT (2000): Teacher training as a behavior change process: principles and results from a longitudinal study. Health Educ. Behav. 27 , 64–81.

Matheson D & Spranger K (2001): Content analysis of the use of fantasy, challenge and curiosity in school-based nutrition education programs. J. Nutr. Educ. 33 , 10–16.

Morris JL & Zidenberg-Cherr S (2002): Garden-enhanced nutrition curriculum improves fourth-grade school children's knowledge of nutrition and preferences for some vegetables. J. Am. Diet. Assoc. 102 , 91–93.

Nader PR, Sellers DE, Johnson CC, Perry CL, Stone EJ, Cook KC, Bebchuk J & Luepker RV (1996): The effect of adult participation in a school-based family intervention to improve children's diet and physical activity: the Child and Adolescent Trial for Cardiovascular Health. Prev. Med. 25 , 455–464.

Nicklas TA & O'Neil CE (2000): Process of conducting a 5-a day intervention with high school students: Gimme 5 (Louisiana). Health Educ. Behav. 27 , 201–212.

Nicklas TA, Webber LS, Srinivasan SR & Berenson GS (1993): Secular trends in dietary intakes and cardiovascular risk factors of 10-year-old children: the Bogalusa Heart Study (1973–1988). Am. J. Clin. Nutr. 57 , 930–937.

Nicklas TA, Johnson CC, Myers L, Farris RP & Cunningham A (1998): Outcomes of a high school program to increase fruit and vegetable consumption: Gimme 5-A fresh nutrition concept for students. J. Sch. Health 68 , 248–253.

Pérez-Rodrigo C & Aranceta J (1997): Nutrition education for schoolchildren living in a low-income urban area in Spain. J. Nutr. Educ. 29 , 267–273.

Pérez-Rodrigo C & Aranceta J (2001): School-based nutrition education: lessons learned and new perspectives. Pub. Health Nutr. 4 , 131–139.

Pérez-Rodrigo C, Klepp KI, Yngve A, Sjöstrom M, Stockley L & Aranceta J (2001a): The school setting: an opportunity for the implementation of dietary guidelines. Public Health Nutr. 4 , 717–724.

PubMed   Google Scholar  

Pérez-Rodrigo C, Luna F, Tejedor F & Armentia A (2001b): Programa: Alimentación, nutrición y dieta equilibrada. Comisión mixta sanidad-educación. Gobierno Vasco.

Perry CL, Zauner M, Oakes JM, Taylor G & Bishop DB (2002): Evaluation of a theater production about eating behavior of children. J. Sch. Health . 72 , 256–261.

Raizman DJ, Montgomery DH, Osganian SK, Ebzery MK, Evans MA, Nicklas TA, Zive MM, Hann BJ, Snyder MP & Clesi AL (1994): CATCH: food service program process evaluation in a multicenter trial. Health Educ. Q. 2 (Suppl), S51–S71.

Renaud L, Chevalier S, Dufour R, O'Loughlin J, Beaudet N, Bourgeois A & Ouellet D (1997): Evaluation of the implementation of an educational curriculum: optimal interventions for the adoption of an educational program of health in elementary schools. Can. J. Public Health . 88 , 351–353.

CAS   PubMed   Google Scholar  

Reynolds KD, Franklin FA, Binkley D, Raczynski JM, Harrington KF, Kirk KA & Person S (2000): Increasing the fruit and vegetable consumption of fourth-graders: results from the High 5 project. Prev. Med. 30 , 309–319.

Roe L, Hunt P, Bradshaw H & Rayner M (1997): Health Promotion Interventions to Promote Healthy Eating in the General Population: A Review . London: HEA.

Story M, Mays RW, Bishop DB, Perry CL, Taylor G, Smyth M & Gray C (2000): 5-a-day power plus: process evaluation of a multicomponent elementary school program to increase fruit and vegetable consumption. Health Educ. Behav. 27 , 187–200.

Story M, Neumark-Sztainer D & French S (2002): Individual and environmental influences on adolescent eating behaviors. J. Am. Diet. Assoc. 102 (Suppl), S40–S51.

US Department of Health & Human Services. Centers for Disease Control and Prevention, CDC (2000): SHI. School Health Index for physical activity and healthy eating. A self-assessment and planning guide. Elementary school. CDC, Atlanta.

Download references

Author information

Authors and affiliations.

Department of Public Health, Community Nutrition Unit, Bilbao, Spain

C Pérez-Rodrigo & J Aranceta

You can also search for this author in PubMed   Google Scholar

Contributions

Guarantor : C Pérez-Rodrigo.

Contributors: CP-R and JA have both contributed to the literature review, conceptualize paper structure and further development.

Corresponding author

Correspondence to C Pérez-Rodrigo .

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Pérez-Rodrigo, C., Aranceta, J. Nutrition education in schools: experiences and challenges. Eur J Clin Nutr 57 (Suppl 1), S82–S85 (2003). https://doi.org/10.1038/sj.ejcn.1601824

Download citation

Published : 28 August 2003

Issue Date : 01 September 2003

DOI : https://doi.org/10.1038/sj.ejcn.1601824

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• nutrition education
• healthy eating practices
• educational strategies
• intervention

This article is cited by

Integrating nutrition into the mathematics curriculum in australian primary schools: protocol for a randomised controlled trial.

• Berit M. Follong
• Elena Prieto-Rodriguez
• Tamara Bucher

Nutrition Journal (2020)

Behaviorally oriented nutrition education at a Russian summer camp improves children’s dietary choices: a quasi-experimental study

• Richard R. Rosenkranz
• Natalia Rodicheva
• David A. Dzewaltowski

Nutrire (2017)

Nutrition education in European medical schools: results of an international survey

• V J van Buul
• F J P H Brouns

European Journal of Clinical Nutrition (2014)

The Boost study: design of a school- and community-based randomised trial to promote fruit and vegetable consumption among teenagers

• Rikke Krølner
• Thea Suldrup Jørgensen
• Pernille Due

BMC Public Health (2012)

Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

European Journal of Clinical Nutrition (2012)

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Nutrition education: linking research, theory, and practice

Affiliation.

• 1 Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY 10027, USA. [email protected]
• PMID: 18296331

The increase in obesity and chronic diseases such as diabetes and heart disease worldwide reflects the complex interactions of biology, personal behaviour and environment. Consequently there has been a greater recognition of the importance of nutrition education. An analysis of the evidence from 300+ studies shows that nutrition education is more likely to be effective when it focuses on behaviour/ action (rather than knowledge only) and systematically links theory, research and practice. There are three essential components to nutrition education: 1. A motivational component, where the goal is to increase awareness and enhance motivation by addressing beliefs, attitudes through effective communication strategies. 2. An action component, where the goal is to facilitate people's ability to take action through goal setting and cognitive self-regulation skills. 3. An environmental component, where nutrition educators work with policymakers and others to promote environmental supports for action. Each component needs to be based on appropriate theory and research. The procedure for program design can use the logic model: Inputs are the resources needed as well as the needs analysis process. The outputs are the activities within the three components of nutrition education described above. Here the behavioural focus is selected and theory and research are used to design appropriate educational strategies to achieve the targeted behaviours. The outcomes are the short, medium or long-term impacts of the nutrition program. These are evaluated through the use of appropriate designs and instruments. Nutrition education programs that link research, theory, and practice are more likely to be effective.

PubMed Disclaimer

Similar articles

• Nutrition communication in the Pacific. White L, Saweri W. White L, et al. Pac Health Dialog. 2007 Sep;14(2):71-5. Pac Health Dialog. 2007. PMID: 19588610
• Nutrition knowledge, attitudes and dietary restriction behaviour of Taiwanese elderly. Lin W, Lee YW. Lin W, et al. Asia Pac J Clin Nutr. 2005;14(3):221-9. Asia Pac J Clin Nutr. 2005. PMID: 16169832
• Improvement in knowledge, social cognitive theory variables, and movement through stages of change after a community-based diabetes education program. Chapman-Novakofski K, Karduck J. Chapman-Novakofski K, et al. J Am Diet Assoc. 2005 Oct;105(10):1613-6. doi: 10.1016/j.jada.2005.07.010. J Am Diet Assoc. 2005. PMID: 16183364
• Using goal setting as a strategy for dietary behavior change. Cullen KW, Baranowski T, Smith SP. Cullen KW, et al. J Am Diet Assoc. 2001 May;101(5):562-6. doi: 10.1016/S0002-8223(01)00140-7. J Am Diet Assoc. 2001. PMID: 11374350 Review.
• [Self-efficacy among health learners/self-efficacy among health educators]. Chikamoto Y. Chikamoto Y. Kango Kenkyu. 1998 Jan-Feb;31(1):3-12. Kango Kenkyu. 1998. PMID: 10437454 Review. Japanese.
• Feeding practices of caregivers with children attending early childhood development centres in Xhariep, South Africa. Carson-Porter AC, van den Berg VL, Meko NL. Carson-Porter AC, et al. Health SA. 2024 Jul 2;29:2575. doi: 10.4102/hsag.v29i0.2575. eCollection 2024. Health SA. 2024. PMID: 39114339 Free PMC article.
• Influence of health food literacy on willingness to pay for healthier foods: focus on food insecurity. Nam SJ, Suk J. Nam SJ, et al. Int J Equity Health. 2024 Apr 22;23(1):80. doi: 10.1186/s12939-024-02135-1. Int J Equity Health. 2024. PMID: 38649971 Free PMC article.
• Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial. Hansen MC, Uhrenfeldt L, Ingstad K, Pedersen PU. Hansen MC, et al. Trials. 2024 Apr 15;25(1):262. doi: 10.1186/s13063-024-08096-8. Trials. 2024. PMID: 38622729 Free PMC article.
• Nutrition-Related Knowledge, Attitudes, Practices, and Anemia Status of Lactating Mothers in Bukavu, Democratic Republic of the Congo-A Cross-Sectional Analysis. Beitze DE, Kavira Malengera C, Barhwamire Kabesha T, Scherbaum V. Beitze DE, et al. Nutrients. 2024 Mar 17;16(6):870. doi: 10.3390/nu16060870. Nutrients. 2024. PMID: 38542781 Free PMC article.
• Effectiveness of Sports Nutrition Education Based on Self-Determination Theory for Male University Rowing Athletes: A Randomized Controlled Trial. Enatsu N, Seino J, Tsuji T, Ogata M. Enatsu N, et al. Nutrients. 2024 Mar 11;16(6):799. doi: 10.3390/nu16060799. Nutrients. 2024. PMID: 38542710 Free PMC article. Clinical Trial.

Publication types

• Search in MeSH

LinkOut - more resources

Full text sources.

• HEC Press, Healthy Eating Club PTY LTD
• MedlinePlus Health Information

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

10 September 2024: Due to technical disruption, we are experiencing some delays to publication. We are working to restore services and apologise for the inconvenience. For further updates please visit our website: https://www.cambridge.org/universitypress/about-us/news-and-blogs/cambridge-university-press-publishing-update-following-technical-disruption

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > Journals
• > Public Health Nutrition
• > Volume 4 Issue 1a
• > School-based nutrition education: lessons learned and...

Article contents

School-based nutrition education: lessons learned and new perspectives.

Published online by Cambridge University Press:  01 February 2001

Nutrition is a major environmental influence on physical and mental growth and development in early life. Food habits during infancy can influence preferences and practices in later life and some evidence suggests fair to moderate tracking of food habits from childhood to adolescence 1–4 . Studies support that good nutrition contributes to improving the wellbeing of children and their potential learning ability, thus contributing to better school performance 5–7 . Children and young people who learn healthy eating habits, are encouraged to be physically active, to avoid smoking and to learn to manage stress, have the potential for reduced impact of chronic diseases in adulthood 4–8 . Nutrition education is a key element to promoting lifelong healthy eating and exercise behaviours and should start from the early stages of life 8–11 ; it should also address the specific nutritional needs associated with pregnancy, including reinforcing breastfeeding 12 .

Food habits are complex in nature and multiple conditioning factors interact in their development 13 . Young children do not choose what they eat, but their parents decide and prepare the food for them. During infancy and early childhood the family is a key environment for children to learn and develop food preferences and eating habits. As they grow and start school, teachers, peers and other people at school, together with the media and social leaders, become more important. Progressively children become more independent and start making their own food choices. The peer group is very important for adolescents and has a major influence in developing both food habits and lifestyles 13 .

Community trials suggest that nutrition education is an accessible effective tool in health promotion programmes with a focus on the development of healthy eating practices 14, 15 .

This article has been cited by the following publications. This list is generated based on data provided by Crossref .

• Google Scholar

View all Google Scholar citations for this article.

Save article to Kindle

To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

• Volume 4, Issue 1a
• Carmen Pérez-Rodrigo (a1) and Javier Aranceta (a1)
• DOI: https://doi.org/10.1079/PHN2000108

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox .

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive .

Reply to: Submit a response

- No HTML tags allowed - Web page URLs will display as text only - Lines and paragraphs break automatically - Attachments, images or tables are not permitted

Your details

Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly.

You have entered the maximum number of contributors

Conflicting interests.

Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. This pertains to all the authors of the piece, their spouses or partners.

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Journal Menu

• Nutrients Home
• Aims & Scope
• Editorial Board
• Reviewer Board
• Topical Advisory Panel
• Instructions for Authors
• Special Issues
• Sections & Collections
• Article Processing Charge
• Indexing & Archiving
• Editor’s Choice Articles
• Most Cited & Viewed
• Journal Statistics
• Journal History
• Journal Awards
• Society Collaborations
• Conferences
• Editorial Office

Journal Browser

• arrow_forward_ios Forthcoming issue arrow_forward_ios Current issue
• Vol. 16 (2024)
• Vol. 15 (2023)
• Vol. 14 (2022)
• Vol. 13 (2021)
• Vol. 12 (2020)
• Vol. 11 (2019)
• Vol. 10 (2018)
• Vol. 9 (2017)
• Vol. 8 (2016)
• Vol. 7 (2015)
• Vol. 6 (2014)
• Vol. 5 (2013)
• Vol. 4 (2012)
• Vol. 3 (2011)
• Vol. 2 (2010)
• Vol. 1 (2009)

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

Implications of Nutrition Education for Health, Behavior and Lifestyle

Special issue editors, special issue information, benefits of publishing in a special issue.

• Published Papers

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section " Nutritional Policies and Education for Health Promotion ".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 69895

Share This Special Issue

Dear Colleagues,

According to the World Health Organization, nutrition is defined as “the intake of food in relation to the body’s dietary needs”. Malnutrition is an umbrella term used for over- and under-nutrition to reflect macronutrient intake, but recently the term “hidden hunger” has emerged to underline the importance of micronutrients in the diet. An adequate, well-balanced diet is a cornerstone of good health, has a great impact on wellbeing, and is reflected by dietary intake and behavior. Diet and behavior are highly modifiable factors that can help to prevent the emergence of new cases or ameliorate their progression. Nutrition education represents the main means for training individuals and groups on the principles of good nutrition, based on their needs, making nutrition information digestible and usable in everyday life.

Currently, a wide discrepancy exists in nutrition-related advice that originates from a wide range of different sources, many of which are unreliable and scientifically invalid, further underlining the need for fitting nutrition education.

Although health professionals play a different role in educating an individual in the clinic, the community, or a long-term healthcare facility, nutrition education is not fully integrated in the training programs of most healthcare professions. This partly explains the public’s considerable confusion on what is correct nutritional advice, which is exacerbated by the discrepancy.

The aim of this Special Issue is to publish original research articles and systematic reviews that report the design and implementation of nutrition education intervention programs and their effectiveness in terms of lifestyle, health, and wellbeing. More specifically, this Special Issue aims to bring together a selection of original research articles and reviews that showcase the latest evidence on the design of nutrition education programs that target individuals or groups at different life stages and of different health statuses and their effectiveness in promoting sustainable changes in diet, lifestyle, health, and wellbeing.

We welcome the submission of design and intervention studies as well as systematic reviews and meta-analyses from a wide range of related disciplines (e.g., human nutrition and dietetics, public health, epidemiology, health promotion, and non-communicable chronic diseases).

Prof. Dr. Antonis Zampelas Dr. George Moschonis Dr. Emmanuella Magriplis Guest Editors

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website . Once you are registered, click here to go to the submission form . Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• nutrition education
• dietary behavior
• dietary intervention
• healthy eating
• behavioral changes
• prevention of chronic diseases
• Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
• Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
• Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
• External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
• e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue polices can be found here .

Published Papers (15 papers)

Jump to: Research , Review

Jump to: Editorial , Review

Graphical abstract

Jump to: Editorial , Research

Further Information

Mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

• Skip to main content
• Skip to FDA Search
• Skip to in this section menu
• Skip to footer links

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

U.S. Food and Drug Administration

•   Search
•   Menu
• Food Labeling & Nutrition

Nutrition Education Resources & Materials

Resources on the importance of good nutrition.

The Nutrition Facts Label

The Nutrition Facts label reflects current scientific information, including the link between diet and chronic diseases such as obesity and heart disease. The label makes it easier for you and your audience to make more informed food choices.

Learn about What’s on the Nutrition Facts Label , including details on: Calories, Serving Sizes, Added Sugars, and Percent Daily Value.

Industry members, read more about the changes to the Nutrition Facts label requirements .

More on the Nutrition Facts Label

How to Understand and Use the Nutrition Facts Label Learn how to use this information more effectively and easily.  

Interactive Nutrition Facts Label An interactive way to learn about the Nutrition Facts label and discover the wealth of information it contains.

For Educators

Health Educator’s Nutrition Toolkit Teach your audience how to use the Nutrition Facts label and to make informed choices.  

"Behind the Label” with FDA Information for Educators View this video for health educators that explains the changes to the Nutrition Facts label.

For Youth & Youth Educators

Read the Label Use these hands-on materials to challenge kids and families to look for and use the Nutrition Facts label.  

Science and Our Food Supply | Curriculum for Middle/High School Teachers Introduce students to the fundamentals of informed food choices with this nutrition-based curriculum.  

Whyville Snack Shack Games Kids can play two fun games that test their knowledge about using the Nutrition Facts label to make healthy snack choices.

For Older Adults

A How-To Guide for Older Adults Good nutrition can help older adults feel their best and stay strong. It can also help lower the risk of developing some health conditions that are common among older adults.

For Physicians & Healthcare Professionals

Physicians' Continuing Medical Education Program Resources for talking to patients about using the Nutrition Facts label to make healthy food choices.

Pediatricians' Continuing Medical Education Program Resources for talking to parents and patients about using the Nutrition Facts label to make healthy food choices.

More on Labeling

Gluten-Free Labeling Learn how gluten-free labeling can help your audience manage health and dietary intake — especially those with celiac disease.

Calories on the Menu | Menu Labeling Information Find out how calorie labeling on menus can help your community make informed and healthful decisions about meals and snacks.

Sodium | Look at the Label Learn the basics on sodium’s health effects, how-to’s for using the Nutrition Facts label to reduce sodium intake, and more.

Using the Nutrition Facts Label to Choose Milk and Plant-Based Beverages Use the Nutrition Facts Label to compare the nutrient content of different products to help you make the best choices for you and your family when choosing milk and plant-based beverages.

CFSAN Education Resource Library

FDA's Center for Food Safety and Applied Nutrition (CFSAN) has a wealth of nutrition education materials.

Consumers, educators, teachers, dietitians, and health professionals are invited to explore CFSAN’s Education Resource Library – a catalog of downloadable and printable materials and videos on nutrition (including labeling and dietary supplements), food safety, and cosmetics.

Education Newsletter

Get regular FDA email updates delivered on this topic to your inbox.

Advertisement

Quantifying Turbulence: Introducing a Multi-crises Impact Index for Lebanon

• Original Research
• Published: 11 September 2024

Cite this article

• Oussama Abi Younes 1 ,
• Leila Dagher 2 ,
• Ibrahim Jamali 3 &
• Paul Makdissi   ORCID: orcid.org/0000-0001-6594-8706 4  

2 Altmetric

This paper provides an in-depth analysis of Lebanon’s severe economic crisis, a situation aggravated by the collapse of Banque du Liban’s financial strategies, delayed reforms by the government, the COVID-19 pandemic, and the devastating Beirut Port explosion. These events have precipitated a sharp decline in disposable income, soaring inflation rates, and an alarming increase in unemployment and multidimensional poverty. Central to this study is a comprehensive field survey that examines eighteen coping mechanisms adopted by workers in various economic sectors of Lebanon. From this survey, we introduce a new index designed to systematically categorize and evaluate these coping strategies across four critical dimensions of well-being: nutrition, healthcare, education, and financial issues. We use this index to quantify and understand the extent to which workers have relied on these coping mechanisms, offering novel insights into the socio-economic repercussions of the crisis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

The term redistributive kleptocracy was coined by Ghassan Salamé, an ex-Lebanese Minister of Culture. The interested reader can refer to https://www.lorientlejour.com/article/1296329/ghassan-salame-le-liban-est-arrive-a-un-point-ou-un-regime-radicalement-different-doit-etre-envisage.html.

For more details, visit the World Bank Open Data website: https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG. , Lebanon recorded a 171.2% inflation rate, the highest among all countries with available estimates for that year. Furthermore, the World Bank ( 2023 ) also reports that Lebanon experienced the highest food price inflation, reaching 352% year-on-year. Food insecurity thus became a very likely threat (Abou Zaki et al., 2022 ).

See https://www.worldbank.org/en/programs/statistical-performance-indicators .

For further details, refer to: Education in Lebanon - World Education News + Reviews( https://wenr.wes.org/2017/05/education-in-lebanon ).

For a comprehensive report, see: Rebuilding of the Lebanese health care system: health sector reforms( https://www.emro.who.int/emhj-volume-12-2006/volume-12-issue-3-4/report-rebuilding-of-the-lebanese-health-care-system-health-sector-reforms.html ).

See: https://www.reuters.com/world/middle-east/before-lebanons-current-financial-crisis-central-bank-faced-47-billion-hole-2021-10-28/ .

The index’s asymptotic properties are dictated by a ten-dimensional cumulative distribution function. While inherently Gaussian, the associated complexity is computationally demanding, prompting us to utilize bootstrapping, a standard recourse in such scenarios. This is reminiscent of the so-called Durbin problem.

See https://apnews.com/article/lebanon-smuggling-financial-markets-business-middle-east-b012ed557365d98bd1c39d7aa57285ae .

Abou Zaki S., Dagher L., & Salam A. (2022), Addressing Food Insecurity in Crisis-Stricken Lebanon , LCPS Policy Brief number 69.

Abu-Ismail, K., & Hlásny, V. (2020). Wealth distribution and poverty impact of COVID-19 in Lebanon . ESCWA Technical Paper 8, E/ESCWA/CL3.SEP/2020/TP.8.

Alkire, S. (2002). Dimensions of human development. World Development, 30 , 181–205.

Article   Google Scholar  

Alkire, S., & Foster, J. (2011). Counting and multidimensional poverty measurement. Journal of Public Economics, 95 , 476–487.

Alkire, S., & Fang, Y. (2019). Dynamics of Multidimensional Poverty and Unidimensional Income Poverty: An Evidence of Stability Analysis from China. Social Indicators Research, 142 , 25–64.

Assouad, L. (2023). Rethinking the Lebanese economic miracle: The extreme concentration of income and wealth in Lebanon, 2005–2014. Journal of Development Economics, 161 , 103003.

Atamanov, A., Tandon, S.A., Lopez-Acevedo, G.C., & Vergara Bahena, M.A. (2020), Measuring monetary poverty in the Middle East and North Africa (MENA) region: Data gaps and different options to address them, In: Policy Research Working Paper Series 9259, The World Bank.

Claessens, M. S., & Kose, M. A. (2013). Financial crises: Explanations, types, and implications In Financial Crises: Causes, consequences and policy responses . International Monetary Fund.

Google Scholar  

Dagher, L., Abboud, A., Sidani, O., & Abi Younes, O. (2022), For Inclusive and Fair COVID-19 Socio-Economic Recovery Measures in Lebanon: Focus Group Discussions Report of Findings , Munich Personal RePec Archive Paper No. 116134.

Dagher, L., Jamali, I., & Abi Younes, O. (2023). Extreme energy poverty: The aftermath of Lebanon’s economic collapse. Energy Policy, 183 , 113783.

Dagher, L., & Nehme, R. (2021). Can Lebanon’s economy be saved? A Plan for Revival, Middle East Policy, 28 (1), 123–134.

Duclos, J.-Y., Makdissi, P., & Wodon, Q. (2008). Socially-improving tax reforms. International Economic Review, 49 , 1507–1539.

Duclos, J.-Y., Makdissi, P., & Wodon, Q. (2005). Poverty-dominant transfer programs: the role of targeting and allocation rules. Journal of Development Economics, 77 , 53–73.

Eijffinger, S. C., & Karataş, B. (2023). Three sisters: The interlinkage between sovereign debt, currency, and banking crises. Journal of International Money and Finance, 131 , 102798.

Fakih, A., Makdissi, P., Marrouch, W., Tabri, R., & Yazbeck, M. (2022). A stochastic dominance test under survey nonresponse with an application to comparing trust levels in Lebanese public institutions. Journal of Econometrics, 228 , 342–358.

Fitch Solutions (2022), Lebanon Set for Second Highest Inflation Rate Globally In 2022 , retrieved from https://www.fitchsolutions.com/country-risk/lebanon-set-second-highest-inflation-rate-globally-2022-10-08-2022

Harb, N. (2022). Earnings function in Lebanon: Does religion matter? Applied Economics, 54 (7), 821–840.

Harb, N., & Rouhana, T. (2020). Earnings and gender wage gap in Lebanon: The role of the human and social capital. Applied Economics, 52 (44), 4834–4849.

Laeven, M. L., & Valencia, M. F. (2018). Systemic banking crises revisited . International Monetary Fund.

Book   Google Scholar  

Lerman, R. I., & Yitzhaki, S. (1985). Income inequality effects by income source: A new approach and applications to the United States. Review of Economics and Statistics, 67 , 151–156.

Makdissi, P., Marrouch, W., & Yazbeck, M. (2024). Monitoring poverty in a data deprived environment: The case of Lebanon. Forthcoming in Review of Income and Wealth . https://doi.org/10.1111/roiw.12708

Makdissi, P., & Mussard, S. (2008). Analyzing the impact of indirect tax reforms on rank-dependent social welfare functions: a positional dominance approach. Social Choice and Welfare, 30 , 385–399.

Makdissi, P., & Wodon, Q. (2002). Consumption dominance curves: Testing for the impact of indirect tax reforms on poverty. Economics Letters, 75 , 227–235.

Makdissi, P., & Yazbeck, M. (2014). Measuring socioeconomic health inequalities in presence of multiple categorical information. Journal of Health Economics, 34 , 84–95.

Ministry of Planning (1960), Needs and Developing Possibilities in Lebanon: Preliminary Study. In Besoins et possibilités de développement du Liban: étude préliminaire , Mission Irfed, URL https://books.google.fr/books?id=emcaAAAAMAAJ.

Pyatt, G., Chen, C. N., & Fei, J. (1980). The distribution of income by factor components. Quarterly Journal of Economics, 95 (3), 451–473.

Sen, A. K. (1993). Capability and Well-Being. In M. Nussbaum & A. K. Sen (Eds.), Quality of Life (pp. 30–53). Clarendon Press.

Chapter   Google Scholar  

Shorrocks, A. F. (1982). Inequality decomposition by factor components. Econometrica, 50 (1), 193–211.

World Bank. (2016). Lebanon economic monitor (Fall 2016): The big swap: Dollars for trust . World Bank.

World Bank. (2020). Lebanon economic monitor (Fall 2020): The deliberate depression . World Bank.

World Bank. (2021). Lebanon economic monitor (Spring 2021): Lebanon sinking (to the top three) . World Bank.

World Bank. (2021). Lebanon economic monitor (Spring 2021): The great denial . World Bank.

World Bank. (2022). Lebanon economic monitor (Fall 2022): Time for an equitable banking resolution . World Bank.

World Bank (2023). Food security update , May 4, 2023.

Yitzhaki, S., & Slemrod, J. (1991). Welfare dominance: An application to commodity taxation. American Economic Review, 81 , 480–496.

Yitzhaki, S., & Thirsk, W. (1990). Welfare dominance and the design of excise taxation in the Côte d’Ivoire. Journal of Development Econonomics, 33 , 1–18.

Download references

Author information

Authors and affiliations.

American University of Beirut, Beirut, Lebanon

Oussama Abi Younes

Department of Economics, Lebanese American University, Beirut, Lebanon

Leila Dagher

Department of Finance, Accounting and Managerial Economics, American University of Beirut, Beirut, Lebanon

Ibrahim Jamali

Department of Economics, University of Ottawa, Ottawa, Canada

Paul Makdissi

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Paul Makdissi .

Ethics declarations

Conflict of interest.

The authors declare that there is no conflict of interest regarding the publication of this paper.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors gratefully acknowledge financial support from the National Endowment for Democracy (NED). A special thanks is due to Ola Sidani, Maya Fattal, Elie Sayegh, and Souhad Abou Zaki for excellent research assistance. AUB IRB approval was granted on March 15, 2022 under number SBS-2021–0394. The views expressed in this article are those of the authors and do not necessarily represent the views of the American University of Beirut, the Lebanese American University, the University of Ottawa or the National Endowment for Democracy.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Abi Younes, O., Dagher, L., Jamali, I. et al. Quantifying Turbulence: Introducing a Multi-crises Impact Index for Lebanon. Soc Indic Res (2024). https://doi.org/10.1007/s11205-024-03426-4

Download citation

Accepted : 22 August 2024

Published : 11 September 2024

DOI : https://doi.org/10.1007/s11205-024-03426-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Multiple crises

JEL Classification

• Find a journal
• Publish with us
• Track your research

Thursday, 12 September

WATCH | Education minister scraps R10bn food tender after 'applying her mind'

• Agriculture Minister John Steenhuisen asks Roman Cabanac to step down as chief of staff
• WATCH | 'Pravin, please hang in there': Candlelight vigils held in Joburg, Durban for Gordhan in hospital
• Ramaphosa not moved by Steenhuisen's threat that signing the BELA Bill could endanger the GNU
• 'We have to implement BELA if Ramaphosa signs it,' says Gwarube as conflict looms
• Here are your Lotto and Lotto Plus results

Free to listen for subscribers

News24's September audiobook that’s free to listen to for subscribers is The Super Cadres: ANC Misrule in the Age of Deployment by Pieter du Toit.

Indulge in the finer things

News24's new magazine is curated for those who understand luxury and want to celebrate the richness of life.

Can you ace them all?

Today’s crossword, wordflower, sudoku and weekly news quiz

Friday Briefing - weekly

Insight and analysis on the big political story of the week, plus a roundup of top columns and reader favourites.

Use your voice to deepen the dialogue and engage with stories of courage, endurance, community, triumph, and the pursuit of truth in SA.

Contact the public editor with feedback for our journalists, complaints, queries or suggestions about articles on News24.

Advertisement

Supported by

Trump Wants to Shut Down the Department of Education? Is That Possible?

Donald Trump has argued he would use the department to further his priorities — or close it. But the agency has relatively limited power, and any plan to shutter it would face major hurdles.

• Share full article

By Dana Goldstein

On the campaign trail, Donald J. Trump has depicted the nation’s public schools as purveyors of an extreme ideology on gender and race. One of his proposed remedies is to revive a Reagan-era call to shut down the federal Department of Education, founded in 1979.

“We will move everything back to the states, where it belongs” he said in one speech. “They can individualize education and do it with the love for their children.”

On the Democratic side, vows to resist that effort have become a frequent applause-line in speeches.

“We are not going to let him eliminate the Department of Education that funds our public schools,” Vice President Kamala Harris said at the Democratic National Convention.

Lost in the back and forth over this relatively small federal agency is any discussion of what the department — affectionately known in Washington policy circles as “Ed” — actually does, and what the practical impact would be of shuttering it (if that is even possible).

How much power does it have?

Perhaps paradoxically, even as Mr. Trump has vowed to close Ed, he has implied that he would use the agency’s investigatory powers to peer into local school practices around gender and race.

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and  log into  your Times account, or  subscribe  for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber?  Log in .

Want all of The Times?  Subscribe .

Login to your account

If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password

If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password

• Submit       Member Login

Access provided by

Nourishing Knowledge: Food Education Joins the Core Subjects in Schools

Download started

• Download PDF Download PDF
• Add to Mendeley

Article metrics

Related articles.

• Download Hi-res image
• Download .PPT
• Access for Developing Countries
• Articles & Issues
• Articles In Press
• Current Issue
• List of Issues
• Supplements
• For Authors
• Author Guidelines
• Submit Your Manuscript
• Statistical Methods
• Guidelines for Authors of Educational Material Reviews
• Permission to Reuse
• About Open Access
• Researcher Academy
• For Reviewers
• General Guidelines
• Methods Paper Guidelines
• Qualitative Guidelines
• Quantitative Guidelines
• Questionnaire Methods Guidelines
• Statistical Methods Guidelines
• Systematic Review Guidelines
• Perspective Guidelines
• GEM Reviewing Guidelines
• Journal Info
• About the Journal
• Disclosures
• Abstracting/Indexing
• Impact/Metrics
• Contact Information
• Editorial Staff and Board
• Info for Advertisers
• Member Access Instructions
• New Content Alerts
• Sponsored Supplements
• Statistical Reviewers
• Reviewer Appreciation
• New Resources
• New Resources for Nutrition Educators
• Submit New Resources for Review
• Guidelines for Writing Reviews of New Resources for Nutrition Educators
• Podcast/Webinars
• New Resources Podcasts
• Press Release & Other Podcasts
• Collections
• Society News

The content on this site is intended for healthcare professionals.

• Privacy Policy   
• Terms and Conditions   
• Accessibility   
• Help & Contact

South Africa’s DA Says Education Bill Poses Threat to Coalition

• President Ramaphosa plans to sign changes into law on Friday
• Dispute is first sign of cracks in three-month old coalition

South Africa’s second-biggest political party warned that President Cyril Ramaphosa ’s plan to approve changes to education legislation poses a threat to the nation’s coalition government.

Ramaphosa will sign the Basic Education Laws Amendment Bill into law on Friday, the presidency said in a statement on Wednesday. The Democratic Alliance said that if he proceeds, it will violate the “letter and spirit” of the joint statement that formed the basis of the government of national unity.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Am J Clin Nutr

The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness 1, 2, 3, 4

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.

INTRODUCTION

The science of nutrition has evolved rapidly over the past 50 y. In an era that requires the practice of evidence-based medicine, there is now compelling evidence that lifestyle practices, including nutrition and physical activity behaviors, influence health and disease and contribute to the leading causes of death in the United States ( 1 – 5 ). Experimental, observational, and controlled clinical trials have contributed to the development of national policies that emphasize dietary recommendations for the prevention and treatment of diseases, especially chronic diseases such as cardiovascular disease, diabetes, cancer, and obesity ( 6 – 8 ). Furthermore, diet and physical activity interventions that were once considered limited in their potential impact for the prevention and treatment of chronic diseases have increasingly shown improvement and benefits that equal if not surpass those of pharmacologic intervention, often with less risk, reduced side effects, and lower costs ( 9 – 12 ). For example, there are many dietary interventions that have been shown to reduce the incidence, severity, and associated morbidity of hypertension ( 10 ), dyslipidemia ( 13 , 14 ), type 2 diabetes ( 15 ), breast and colorectal cancers ( 16 , 17 ), and obesity ( 18 , 19 ). Furthermore, there are numerous examples of beneficial patient outcomes resulting from nutrition practices in inpatient, outpatient, and community settings. In acute care settings, best nutrition practices have been shown to improve patient outcomes and reduce health care costs ( 20 ). Moreover, Rosen et al ( 20 ) underscored the value of nutrition care before, during, and after hospitalization to help prevent and treat malnutrition, avert hospital-acquired conditions, reduce hospital readmissions, lower infection and complications rates, and shorten hospital stays. Finally, the Patient Protection and Affordable Care Act (ACA 5 ; 21 ) mandates modernization of the disease prevention and public health systems. This law will shift health care away from a fee-for-service model to one that is focused on preventive care and wellness ( 22 ). In this new paradigm, nutrition is expected to be a central focus of health care in the future.

The importance of including nutrition in the training of health care professionals, as well as in the continuing education of practicing clinicians, remains a low priority. The absence of required medical nutrition education within medical and other health care curricula, and the lack of curricular coordination between health professions, bears witness to this problem. The current status of nutrition education for health care professionals in the United States and for physicians in other countries such as the United Kingdom is summarized in this supplement issue ( 23 – 26 ). There is a need for strategies to be developed and integrated into the education and training programs of health care professionals to attain a translational impact on disease prevention, treatment outcomes, and population health. Physician nutrition education is paramount because physicians typically drive the health care system in this country; and by generating greater awareness for the importance of nutrition in the prevention and treatment of disease, they can become greater proponents and sources of referral to other relevant health care professionals. There are cross-cutting and similar nutrition competencies for all health care professionals, and these could be updated and strategically aligned across disciplines to better provide a more standardized nutrition message to patients. These competencies are applicable to medical students, residents and fellows, nurses, advanced practice nurses, dietitians/nutritionists, pharmacists, physician assistants, dentists/dental hygienists, and exercise physiologists. Having common nutrition competencies across the health care disciplines can achieve a new paradigm for improving interdisciplinary, team-based health care that provides health care benefits.

THE EVOLUTION OF NUTRITION EDUCATION IN MEDICINE

The history of nutrition education for medical professionals is depicted in Table 1 . Highlights of this history are briefly presented below. In addition, discussions of medical education ( 23 ) and graduate medical education and subspecialty training ( 25 ) are presented elsewhere in this supplement issue.

History of nutrition in the medical education of physicians 1

Medical education

In 1985, the Institute of Medicine (IOM) issued a report entitled “Nutrition Education in Medical Schools” ( 29 ). The committee recommended integration of a minimum of 25–30 h of nutrition into the 4-y medical school curriculum. Early leaders in the field of medical nutrition education, including Young et al ( 27 ), Weinsier et al ( 28 ), and Winick ( 50 ), proposed core nutrition topic areas for medical students and other physicians. The core topics were built on those outlined in the 1985 IOM Committee report: energy balance, the role of specific nutrients, nutrition through the life cycle, protein and energy needs, malnutrition, the role of nutrition in disease prevention and treatment, possible risks from poor dietary practices, and social and cultural factors that influence dietary practices ( 29 ). Feldman ( 51 ) and Kushner et al ( 52 ) were among early pioneers who addressed the need to teach nutrition in a manner that could be integrated throughout the medical school curriculum, including the development of clinical practice skills. In the 1990s, the American Medical Student Association established the Nutrition Curriculum Project and later published a national consensus report on the essentials of nutrition education in medical schools ( 32 ).

Notable by its creation and commitment to this cause, the Nutrition Academic Award (NAA) was developed and funded from 1998 through 2005 by the National Heart, Lung and Blood Institute (NHLBI), along with support from the National Institute of Diabetes and Digestive and Kidney Diseases ( 53 ). Modeled after the Preventive Cardiology Awards of the 1980s when the field was rapidly advancing and needed standardized, formalized training, 21 medical schools participated in the NAA to collaborate on medical nutrition education ( 54 ). The aims of the NAA ( Table 2 ) provided the foundation for initiating a formalized approach, starting with agreement about the content of the nutrition curriculum for medical education. The NAA program achieved success through the development of new tools, syllabi, and practice guidelines that helped to facilitate nutrition education in this setting ( http://www.nhlbi.nih.gov/funding/training/naa/products.htm ). The contributions and advances made by the NAA were considerable; however, the lack of sustained funding, absence of a coordinating center, and competition for local resources slowed and, in some schools, eventually halted progress.

Aims of the NAA program 1

As part of the NAA, unprecedented discussions with the National Board of Medical Examiners, which provides licensure examinations for physicians (the US Medical Licensing Examination), occurred in an attempt to formally assess the newly developed curricula, educational materials, and, where possible, integrate more relevant nutrition questions into board examinations. In 2003, a nutrition subscore was added to step 1 of the US Medical Licensing Examination, which supported the imperative that nutrition be recognized as a scientific discipline within the medical curriculum by both medical educators and students.

In August 2007, the Association of American Medical Colleges published a report as part of the Medical School Objective Project entitled “Contemporary Issues in Medicine: Prevention and Treatment of Overweight and Obesity,” which called on medical schools to educate medical students on obesity prevention and treatment ( 55 ).

Traditionally, the 4-y medical school curriculum has been composed of 2 preclinical years, which consist primarily of lectures in the biological sciences, followed by 2 clinical years during which clerkships are the venue for clinical training. Nutrition has been taught both in preclinical and clinical settings. The current movement toward merging classroom and clinical education will facilitate learning basic nutrition science and clinical application. Qualified faculty with nutrition expertise are needed to teach nutrition in the preclinical and clinical settings. Didactic education is frequently provided by nonclinical faculty who have little or no nutrition expertise (clinical or research) and have competing demands such as obtaining grant funding and conducting research. Moreover, there needs to be a concerted effort to raise the interest level in nutrition and advocate for its importance in patient care.

A survey conducted in 2010 reported that the percentage of medical schools offering a dedicated nutrition course had declined from 35% in 2000 to 25% in 2008 ( 36 ). In 2008, an average of only 19.6 medical school hours was devoted to nutrition education and skill building, which was less than the IOM-recommended minimum contact time of 25 h ( 29 ). Institutions that used online learning modules provided significantly more hours of nutrition instruction (24.1 compared with 13.7 h) across the 4-y curriculum than did those that did not use online learning ( 56 ). The available evidence ( 57 , 58 ) indicates that few residents, fellows, and other clinicians are comfortable with managing nutrition problems of their patients. This could be because existing education is either inadequate or ineffective, both of which provide an argument for greater attention to nutrition.

Additional survey data showed that most information about nutrition continues to be taught in the basic science courses and therefore may not be specifically identified with the discipline of nutrition in clinical practice ( 36 ). In this survey, only 26 of the 127 accredited US medical schools had a separate course dedicated to nutrition; most nutrition instruction did not occur in nutrition courses. Although most medical schools did not have dedicated didactic courses in nutrition, a small number of medical schools have well-developed longitudinal approaches that span all 4 y ( 59 ) (eg, see Figure 1 ). However, the task of instituting well-integrated longitudinal approaches has been limited by the absence of national standards for a nutrition knowledge base or for competencies, as well as limited recognition of best practices in nutrition.

An example of nutrition integration throughout 4 y of medical school in basic science courses, problem-based nutrition, and clinical clerkships. B12, vitamin B-12; IF, intrinsic factor.

Graduate medical education

Knowledge and skills are synthesized into the practice of medicine during residency and fellowship training. Graduate medical education is accredited by the Accreditation Council for Graduate Medical Education (ACGME). As discussed by Lenders et al ( 25 ), ACGME standards require little nutrition training for most specialties. Not surprisingly, the majority of graduate trainees feel unprepared to address nutrition issues in patients ( 25 ), which is striking when considering the benefits of nutrition interventions or practices in many acute or chronic conditions. This leads to the identification of the most important nutrition topics in residency and fellowship training, especially those areas where tangible benefits are realized. One salient example is nutrition care in the intensive care unit where early (within 24–48 h) adequate nutrition is known to decrease morbidity and mortality ( 60 ). However, there are controversies about nutrition support for critically ill patients because there is some evidence that hypocaloric feedings provide benefits ( 61 , 62 ). These examples show the complexity of medical nutrition therapy for critically ill patients and reinforce the importance of nutrition training in medical education. This evidence-based training generally falls far short of goals and must be emphasized in the future ( 63 ). Furthermore, obesity, which has been shown to be well managed by surgical techniques if severe [BMI (in kg/m 2 ) >40] ( 64 ) and with medical treatment when less severe ( 65 ), requires specialized knowledge in nutrition.

Specialty training in nutrition

Beginning in 2000, the Intersociety Professional Nutrition Education Consortium was established to oversee the physician nutrition specialist (PNS) training. The primary aims of the Consortium were to establish educational standards for fellowship training of PNSs and to create a mechanism for certifying physicians trained in nutrition. As the pool of PNSs increased, the goal was to enable every US medical school to have at least one PNS on the faculty who could overcome barriers to the incorporation of nutrition into the medical curriculum and residency programs ( 66 ). However, there are a few nutrition certification boards in medicine, including the American Board of Physician Nutrition Specialists (ABPNS), which certifies only physicians; the ACN, which is available for MDs and PhDs; and the National Board of Nutrition Support Certification, sponsored by the American Society for Parenteral and Enteral Nutrition, which certifies physicians, pharmacists, registered dietitians (RDs), physician assistants, and nurses. However, none of these certifications is approved by the American Board of Internal Medicine or the American Board of Medical Specialties ( 67 ). An interim proposal by the American Association of Clinical Endocrinologists seeks to develop a staged program of nutrition education and training for clinical endocrinologists that will lead to certification ( 68 ).

As discussed by Lenders et al ( 25 ), in addition to the absence of a recognized specialty board for physicians, several other factors slowed the growth of PNS training, including poor reimbursement for clinical nutrition practice by physicians and the disease-treatment orientation of medicine rather than prevention and inconsistent recognition of nutrition as a specialty unto itself.

Under the auspices of The Obesity Society, a consortium of 14 societies and organizations created a new American Board of Obesity Medicine ( www.abom.org ), which offered its first examination for certification in November 2012. Although not a recognized board specialty, the American Board of Obesity Medicine has had preliminary discussions with the American Board of Medical Specialties with regard to required steps for a focused practice Maintenance of Certification designation.

UK FOCUS: THE NEED FOR A NUTRITION EDUCATION PROGRAM FOR PHYSICIANS

There are initiatives ongoing around the world to improve and enhance nutrition knowledge and training of health care professionals. These global efforts may show promise in helping the ongoing efforts in the United States to improve nutrition education training of health care professionals. By extension, all of the lessons learned from the ongoing efforts globally can stimulate further improvements in nutrition education of health care professionals worldwide. This section discusses the UK program and acknowledges ongoing activities in Australia (for details of the latter, see the Web-Based Nutrition Competency Implementation Tool at http://wncit.weebly.com/ ).

In the United Kingdom, the Need for Nutrition Education Program (NNEdPro; http://www.nnedpro.org.uk/ ) was developed to increase awareness among medical/health care professionals with regard to the importance of clinical and public health nutrition in the prevention of noncommunicable diseases. NNEdPro is an independent educational innovation and evaluation program arising from the work of the Council of Europe Alliance (United Kingdom) on Hospital Food and Nutritional Care. NNEdPro has completed 2 phases of work over 5 y and is beginning a third phase. The objective of phase 1 was to measure the effectiveness of a nutrition education intervention for medical students undertaking clinical training. The objective of phase 2, Nutrition Education and Leadership for Improved Clinical Outcomes, was to assess whether a training intervention incorporating clinical/public health nutrition and change management/leadership strategies could equip junior doctors to improve nutrition awareness in UK hospitals. Phase 3 will focus on nutrition training of medical/health care professionals, research methodology training for nutritionists and dietitians in health care, work in raising awareness of the role of nutrition in noncommunicable disease and cardiovascular disease prevention and management and evaluation of the impact of all NNEdPro work. Collaboration between the University Cambridge School of Clinical Medicine and the NNEdPro group led to the formation of the Nutrition Education Review Group to incorporate nutrition into the medical school curriculum at Cambridge University.

Since 2010, NNEdPro has worked toward vertical integration of nutrition into all clinical years in the curriculum. This began with the introduction of nutrition teaching into the 4th Year, with “carousel-style” multidisciplinary workshops. The teaching incorporates a variety of interactive teaching methods and is evaluated through pre- and post–multiple-choice questionnaires and through collection of qualitative feedback.

The Nutrition Education Review Group currently is working toward integrating teaching into the 6th Year, which will focus on noncommunicable and chronic disease prevention from a nutrition perspective. This teaching will be evaluated in a similar manner to the 4th Year. Nutrition will be integrated into the 5th Year through the creation of podcasts, which will incorporate nutrition into each of the core themes. This will bring in elements of “blended” learning. There continues to be a strong interest among students in integrating nutrition into all 6 y of medical training.

NUTRITION EDUCATION AND COMPETENCIES IN NUTRITION AND DIETETICS PROFESSIONALS’ EDUCATION

Nutrition education for dietitians/nutritionists is discussed in detail by DiMaria-Ghalili et al ( 24 ). The Academy of Nutrition and Dietetics (AND; formerly the American Dietetic Association) has established extensive guidelines, curriculum content, competencies, evaluations, and registration examination criteria that are required of all accredited academic and supervised practice programs in nutrition and dietetics ( 69 ). After completion of an accredited academic program, students complete an accredited supervised practice component, which qualifies them to take the registration examination. Although there is no standard definition of the term “nutritionist,” all RDs are nutritionists, but the reverse is not always true. Many state licensure boards have legislated specific qualifications for using the term nutritionist, but this is not uniformly regulated (AND; Definition of Terms, http//www.eatright.org/scope ).

In 2013, the Academy published competencies defining the scope of practice for the RD including education and credentialing requirements and RD-specific roles, services, and activities ( 70 ). Competencies also were established for the Dietetic Technician, Registered, a distinctly different professional who has met criteria for food and nutrition technical services ( 70 ). In 2013, the Nutrition and Dietetics Associate certification was created to recognize baccalaureate degree graduates from accredited didactic programs ( http://www.eatright.org/ACEND/content.aspx?id=6442480304&terms=baccalaureate%20degree%20credential ).

RDs must successfully complete a minimum of a baccalaureate degree granted by a US regionally accredited university or college or foreign equivalent. The relevant curriculum contributes core knowledge, including courses in the basic sciences, clinical and behavioral sciences, community nutrition, research methodology, administrative topics such as food service management and business theories, and principles of public policy ( 69 ).

The curriculum also must cover the principles of medical nutrition therapy, a specific term that encompasses skills in assessment of nutritional status of patients and provision of specialized diet modification, counseling, and therapies as appropriate ( 71 , 72 ). This was further defined as part of the 2001 Medicare legislation as “nutritional diagnostic therapy and counseling services for the purpose of disease management, which are furnished by the RD or nutrition professional” ( 73 ).

Distinct and yet synergistic with medical nutrition therapy (MNT), in 2003, the American Dietetic Association published the Nutrition Care Process (NCP) ( Figure 2 ), defined as “a systematic problem-solving method that dietetics professionals use to critically think and make decisions to address nutrition related problems and provide safe and effective quality nutrition care” ( 71 ). The 4 steps of the NCP are as follows: 1 ) nutrition assessment, 2 ) nutrition diagnosis, 3 ) nutrition intervention, and 4 ) nutrition monitoring and surveillance.

Academy of Nutrition and Dietetics Nutrition Care Process and model ( 71 ).

Dietetics students must develop effective oral and written communication skills and patient counseling techniques and be proficient with interdisciplinary relationships with other health care professionals to meet the nutritional needs of the patient/client. With respect to the latter, dietitians work closely with nurses in identifying mechanical (ie, chewing, swallowing) problems that need to be addressed with a prescribed diet.

The Commission on Dietetic Registration (CDR) is responsible for ensuring professional accountability and continuing competence of RDs. By 2001 the CDR had implemented the Professional Development Portfolio (PDP) Project, which upheld the CDR's mission to “[administer] rigorous valid and reliable credentialing processes to protect the public and meet the needs of nutrition and dietetics practitioners, employers and consumers” ( 75 ). The PDP process comprises 5 steps: 1 ) professional self-reflection, 2 ) learning needs assessment, 3 ) learning plan, 4 ) activity log, and 5 ) professional development evaluation. The PDP allows RDs to identify their own unique learning needs, to create a plan based on those needs, and to carry out that plan by participating in a wide variety of activity types that cater to many different learning styles. In addition, the steps were designed to meet the Joint Commission (formerly the Joint Commission on Accreditation of Health Care Organizations) Management of Human Resources standards on competence assessment and development.

NUTRITION EDUCATION AND COMPETENCIES IN NURSING EDUCATION

The American Nurses Association describes the profession of nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” ( http://nursingworld.org/EspeciallyForYou/What-is-Nursing ). The Essentials of Baccalaureate Education for Professional Nursing Practice by the American Association of Critical-Care Nurses label Essential VII as “Clinical Prevention and Population Health,” which refers to individually focused interventions aimed at preventing the escalation of diseases and conditions, as well as promoting healthy conditions and behaviors to improve populating health. Nutrition is specifically document as sample content for baccalaureate nursing programs (http://www.aacn.nche.noted in the Essentials edu/education-resources/baccessentials08.pdf). In fact, most baccalaureate nursing programs require a separate nutrition course in the prehealth curriculum and incorporate nutritional concepts throughout clinical nursing courses. While caring for patients in hospital, community, and home settings, nurses are taught to perform nutritional assessments and to collaborate with other health care team members to meet the nutritional needs of patients. In their role in health promotion and disease prevention, nurses provide lifestyle counseling to patients, including diet and physical activity ( 63 , 75 – 80 ).

The Consensus Model for Advanced Practice Registered Nurse (APRN) regulation ( http://www.aacn.nche.edu/education-resources/APRNReport.pdf ) states that APRNs must be educated, certified, and licensed to practice in a specific role (nurse anesthetist, nurse midwife, clinical nurse specialist, nurse practitioner) and with different populations (family/individual across life span, adult-gerontology, neonatal, pediatrics, women's health/sex-related, psychiatric-mental health). Entry-level competencies are delineated for graduates of master's, doctorate of nursing practice, and postgraduate programs. All APRN programs include courses on advanced physiology, pharmacology, and health assessment. As examples of APRN preparation in nutrition-related assessment and intervention skills, Table 3 lists selected competencies for the adult-gerontology primary care and acute care nurse practitioners that relate either directly or indirectly to nutrition ( http://www.aacn.nche.edu/geriatric-nursing/adultgeroprimcareNPcomp.pdf ; http://www.aacn.nche.edu/geriatric-nursing/adult-gero-acnp-competencies.pdf ).

Competencies relevant to nutrition for select advanced practice nursing roles

NUTRITION EDUCATION IN DENTAL AND DENTAL HYGIENE SCHOOLS

There are 64 dental schools and 323 dental hygiene schools in the United States. Canada has 10 dental schools and 39 dental hygiene schools ( 81 ). Nutrition is expected or required in the curriculum of both.

The dental program is a 4-y postbaccalaureate program leading to the Doctor of Dental Medicine (DMD) or Doctor of Dental Surgery (DDS). This nomenclature varies by school, but the curricula are virtually indistinguishable. Dental hygiene programs are usually 2-y, post–high school programs, which are usually combined with an associate degree program, often in community college settings. Because the dentist is the primary care dental provider, they set the standards for the practice but may not be the principal nutrition care provider. That role is usually assigned to the dental hygienist as a component of preventive care (or disease prevention and health promotion). As a result, guidelines or competencies for each provider group vary. The American Dental Education Association sets the standards for dental education and for dental hygiene education ( 83 ).

In an earlier iteration of the accreditation competencies for dental education, nutrition education was specifically identified as a requirement. Currently, the relevant competency is broadened to health promotion but does mention nutrition care. Dental hygiene schools are required to teach nutrition. In each case, the purpose of the nutrition competency is to educate providers to deliver appropriate nutrition care for oral health promotion and disease prevention.

For both of these clinical disciplines, the nutrition curriculum should have a strong clinical component, focusing on diet assessment, patient education, and referral. A major concern in both disciplines is often the lack of faculty with a clinical nutrition background. Past studies have indicated a wide range of expertise of faculty teaching nutrition. Very few faculty are RDs or other nutrition professionals ( 83 ). In dental schools, nutrition education often is the responsibility of biochemistry or the preventive dentistry faculty. In dental hygiene schools, it is often an interested hygiene faculty member who assumes this responsibility ( 83 ). Other barriers are the difficulty of integrating nutrition education into the curriculum (more so in dental than in dental hygiene programs), the lack of resources such as core curricula and models for clinical nutrition implementation, and the lack of faculty who can teach nutrition in the clinical setting ( 84 ). In many schools, nutrition still has not evolved beyond biochemistry. For the past 50 y, schools have been challenged with integrating basic and applied nutrition into the curriculum, and specifically into the clinical curriculum.

Several past studies have shown the number of hours devoted to nutrition has remained fairly consistent and is low compared with other topics in the curriculum ( 85 ). A 2001 survey of US and Canadian dental schools found that only 41% of schools reported that students provided diet counseling for patients and only 28% of schools had an RD on the faculty to provide clinical nutrition education ( 86 ). Another study found that although dentists were motivated to include nutrition in their clinical care, most felt unqualified to provide diet guidance to their patients ( 87 ).

NUTRITION EDUCATION FOR HEALTH CARE PROFESSIONS MUST KEEP PACE

There is evidence that adherence to best nutritional practices alone has not been adequate to promote consistent advancement of nutrition education for health care providers. There now are several additional trends that are the impetus for remodeling nutrition education for health care professionals. The trends include policy and legislative mandates, new pedagogic approaches being adopted in the training of health care professionals, and the emergence and mandate of interprofessional education.

As discussed by Levy et al ( 26 ), the ACA mandates increased knowledge and awareness of disease-prevention strategies across the continuum of medical and health care professions, starting with education in preparation for these career paths. In particular, the ACA Title IV Prevention of Chronic Disease and Improving Public Health should be viewed as a call to action to show that nutrition training for health care professionals can achieve beneficial health outcomes. It also is an opportunity to partner with federal, state, and local agencies that are motivated by ACA mandates.

Trends in medical education

Specific recommendations to reform medical education over the past 2 decades ( 88 , 89 ) have led to substantial changes in the overall organization and structure of the curriculum at an increasing number of medical schools. Changes include greater emphasis on competency-based curricula, interprofessional and team-based education, and information technology–empowered learning ( 89 ). Importantly, there also has been a shift toward earlier integration of clinical applications in the basic sciences. Increased incorporation of nutrition education, especially in the first 2 y, is consistent with the growing demand for more clinically relevant knowledge, especially with respect to the trend of teaching by organ system. The clinical foundations component of the curriculum, now more likely to begin in year 1 rather than being deferred, can readily include nutritionally relevant aspects of the physical examination and dietary assessment ( 90 ). This also sets the stage for introducing resources that can be used by medical students throughout the continuum of postgraduate training and residency. For example, relevant nutrition knowledge, skills, and resources can be appropriately included in the blocks of lectures focused on gastroenterology, endocrinology, hematology, and the cardiovascular and renal systems. This approach accommodates a strong emphasis on nutrition without necessitating a separate nutrition course within an already overcrowded teaching environment.

Problem-based learning and small-group experiences are another hallmark of the new medical education environment ( 91 ), with self-directed learning and evaluation recognized as important across the continuum of undergraduate, graduate, and continuing medical education ( 92 ). Nutrition science and clinical practice issues can be readily integrated into problem-based learning cases and scenarios that are provided, without time being added to the schedule of classes and activities ( 90 ). Longitudinal ambulatory care externships or apprenticeships, another hallmark of medical education reform, involve medical students in clinical experiences beginning at year 1. These ambulatory care assignments provide the opportunities to help students recognize how nutrition knowledge and skills contribute to clinical care and to model appropriate interprofessional approaches.

Interprofessional education

Interprofessional education in the training of health care professionals, as discussed by DiMaria-Ghalili et al ( 24 ) and Kushner et al ( 23 ) in this supplement issue, has become an important approach promoted by the IOM and adopted by the Association of American Medical Colleges, ACGME, American Dental Education Association, AND, and APRN.

Health care is reorganizing around high-functioning teams to address medical problems ( 93 ). One study reported that a multidisciplinary team achieved results similar to specially trained physicians for patients in intensive care units ( 94 ). This approach provides the rationale for interprofessional nutrition education as a potential solution to a shortage of PNSs or other qualified nutrition professionals.

A recent IOM report underscored the importance of a multidisciplinary team-based approach in achieving a more effective health care delivery system ( 95 ). Nutrition education requires a team-based approach involving health care professionals with the requisite nutrition training to develop nutrition competencies needed for practice. The Interprofessional Education Collaborative has provided the rationale and framework for development of interprofessional competencies ( 96 ). To further facilitate this approach, common competency domains across health care professions have been developed recently ( 97 ).

REMODELING NUTRITION EDUCATION FOR HEALTH CARE PROFESSIONALS

The rationale to advance nutrition education of health care professionals is compelling. However, to move forward, a unified interprofessional approach is needed. Lessons learned from the NAA experience were clear. Coordination and sustainability of the nutrition education model is crucial to perpetuate the medical nutrition education agenda going forward. Championing this cause, the NHLBI convened a workshop in the fall of 2012 ( see http://www.nhlbi.nih.gov/meetings/workshops/nutrition.htm ), bringing together a multidisciplinary network composed of some of the NAA faculty, as well as leaders in a broad range of nutrition education efforts and policy development ( 98 ), to consider how best to move forward the nutrition education agenda for health care professionals.

Among the conclusions reached by workshop members was that definition of a core nutrition knowledge base and competencies is needed. Furthermore, it is evident that best nutrition practices are relevant to all venues where health care is practiced. The ACA provides the momentum to link care of the individual with public health, and nutrition training should strive toward this link. Another conclusion from the workshop is that there are opportunities to educate and promote skills at each stage of training or continuing education. Although the focus here has been in early-stage education, mechanisms are needed to advance nutrition awareness, knowledge, and skills of practicing health care providers, as well as improve their referral patterns to other qualified nutrition providers.

At this time, there is a limited number of certified PNSs, many of whom were trained in specialties/subspecialties. This elite group represents a highly valuable resource in offering guidance and training in their academic medical centers. Together with other qualified nutrition faculty, these individuals can take a leadership role in developing and teaching the nutrition topics of relevance to the curriculum.

The workshop provided a valuable opportunity for interprofessional interaction and initiated the process of developing common interprofessional goals and competencies. Additional interprofessional issues discussed included defining the specific roles in nutrition education for each discipline. An interprofessional team approach with the adoption of best practices appears to be a viable solution for the shortage of PNSs and qualified nutrition educators in clinical care. However, because of their inherent knowledge and training in nutrition, qualified dietitians/nutritionists should assume a key role in educating the health care professional team. Dietitians already exist in many health care environments, but their role in the education of other health care professionals is highly variable and often unrecognized. The interprofessional team needs to examine how to systematically incorporate the RD into their education.

Guiding principles for the future

Future efforts to transform the ways in which we integrate nutrition and physical activity into the education and training of health care professionals need to follow a clearly defined set of guiding principles that are built on a multidisciplinary approach. The principles presented below are applicable to all health care professionals and thus are inherently cross-cutting themes for health care professional training:

• 1 ) Health care professionals should implement recommended nutrition practices and promote current dietary guidance issued by federal agencies and professional societies for the prevention and treatment of disease. The practices and principles should be evidence-based, reflect the current state of the science, and be implemented according to best practices.
• 2 ) The fundamentals of the NCP, a systematic approach that currently is used mostly by dietitians/nutritionists for providing high-quality nutrition care that includes nutrition assessment, diagnosis, intervention based on root cause, and monitoring/evaluation ( 71 ) should be adapted as appropriate to other health care providers. This process should define specific roles, such as who refers and when, interactions between the professions, and how multidisciplinary teams work together for the best health outcomes for their patients. Interprofessional nutrition education is critical to instill a team approach to teaching, training, and learning and to patient care.
• 3 ) It is important to recognize and promote the unique role of the RD on the health care team, partnering with physicians in the nutrition assessment, therapeutic recommendations, and joint follow-up of patients as a cornerstone of the NCP. Although strongly endorsing a multidisciplinary approach, the unique and essential role of the dietitian in the care process needs to be underscored. RDs also play a key role in teaching and providing training for other health care professionals.
• 4 ) Nutrition education in medical/professional schools needs to be delivered in the context of the most up-to-date approaches for curriculum design and delivery by using a longitudinal, integrated approach rather than focusing on single courses or a discrete discipline. These approaches move the focus away from rote memorization and toward a more meaningful integration of new constructs with existing knowledge ( 90 ).
• 5 ) Nutrition educational experiences should involve the collaborative effort of multiple stakeholders and the most innovative approaches for effective teaching, such as problem-based learning, case-based learning, behavioral methodologies such as motivational interviewing, simulation, role playing, and other modalities ( 99 ). Resources for providing nutrition content in the context of these approaches should be fully available to the teaching teams.
• 6 ) It is important to understand the application of evidence-based research in the development of diet and nutrition guidelines for public health and to be able to apply that knowledge toward better patient outcomes. The educational experience should include a thorough explanation of how evidence-based guidelines are derived as well as interactive training on the evaluation of future research findings and their application to clinical practice.
• 7 ) There should be an increased emphasis on education research that identifies and validates strategies for providing nutrition education to health care professional students and practicing clinicians. The new nutrition education approaches implemented in the future will require objective assessments for efficacy and effectiveness. There will be a need to study educational approaches throughout the medical/health care professional realm, especially with respect to incorporating nutrition into newly evolving medical/health care professional training curricula.

Health care professionals must be mindful of the population health issues that affect different cohorts. Inherent to this is having an understanding of the social determinants of health to be effective managers of change ( 100 ).

Research recommendations

Based on the reality that nutrition education curricula for health care professionals have not been well integrated in education and training programs, there is a need to conduct research to identify the best education and training models and their effect on health care professionals’ practices, the subsequent benefits on patient outcomes, and the impact on public health and associated costs. A considerable investment in research is needed to develop and implement the most effective nutrition education programs across the continuum of medical and health care professional education and training. These are classified as cross-cutting recommendations for all health care professionals as well as those that are specifically relevant to medical schools, residency and fellowship programs, and other health care professionals ( Table 4 ).

Cross-cutting research recommendations

Ownership of the challenge/solution

The institutes of the NIH are providing strong leadership for a new and enhanced model of biomedical nutrition education that will become an integral part of the training of medical and other health care professionals. With their guidance and support, we are developing innovative new strategies that build on previous initiatives such as the NAA and take this important health care component to the next level of excellence. To ensure that this effort and progress will be sustained, the collaboration of a wide range of stakeholders will be required. Major stakeholders include the following: institutions of higher learning, professional societies, credentialing boards, practicing health care professionals, education specialists, policy makers, health care consumers, public health care professionals, and the health care industry as a whole (both providers and insurers). Efforts to achieve buy-in for this initiative will be enhanced by the establishment of the core competencies, which provide an organized framework for informing stakeholders and bringing them into the discussion ( 101 ). Likewise, collaboration between educators and clinicians will enhance both the development of new educational approaches as well as the crucial research studies needed to provide the scientific evidence of their effectiveness ( 102 ). It is hoped that groups such as the NHLBI and ASN will work together to create common nutrition competencies and curriculum guidelines that are adopted across different disciplines to improve the education and training of health care professionals for the betterment of population health.

Improving the delivery of nutrition care to patients in different settings (ie, from the hospital to the clinic and the community) is essential to improve population health in an era where increasing chronic diseases related to aging, obesity, and lifestyle practices contribute dramatically to public health challenges and associated health care costs. There is an urgent need to better prepare health care professionals to address nutrition-related conditions using best practices. This will require that dietitians and nutrition professionals assume a leadership role in medical education training for health care professionals. There also is a pressing need to conduct research that improves health care professional education and health care practice, patient outcomes and education, and population health. We recommend as a next step that relevant stakeholder groups launch an initiative to tackle these relevant health care professional education and training needs. Implicit to this is the need to evolve (and teach) evidence-based standards for nutritional care. In addition, including nutrition in clinical training at all levels is necessary to maintain a focus on its critical role in patient care. Also, a multidisciplinary team educational approach will be required to realize best practices and patient outcomes. This is a major undertaking that will require coordination among involved stakeholders to accomplish a transformation in the education of health care professionals. Success will be dependent on sustained funding and commitment by the health care delivery infrastructure at all levels in the United States and globally. We are mindful that this is a long-term and multistep process that involves many components, which include establishing a coordinating center to manage all aspects of the nutrition education programs for health care professionals and developing education competencies and curricula for health care professionals. It is time that the health care professionals rise to the demands of society to improve patient care and population health.

Acknowledgments

The authors’ responsibilities were as follows—PMK-E and LVH: described dietetics education; SRA, CWB, BB, MSE, MDL, CLR, ES, and DLS: wrote sections on physician education; BB, CML, ES, and DLS: wrote about nutrition education for medical residents; LB: described nursing education; CA Palmer: described dental education; CL and SR: described medical education in the United Kingdom; CML, CA Pratt, and LVH: described the Nutrition Academic Award; and PMK-E, CA Pratt, ES, and LVH: had oversight for all aspects of the manuscript. All of the authors contributed to writing the manuscript. CML receives research and educational support from the New Balance Foundation, the Boston Nutrition Obesity Research Center (P30DK46200), as well as the National Institute of Diabetes and Digestive and Kidney Diseases (5-K23DK082732). BB is a consultant for Nestlé. DLS receives research and educational support from the Vanderbilt Digestive Disease Research Center (P30DK058404). None of the other authors declared a conflict of interest.

5 Abbreviations used: ACA, Patient Protection and Affordable Care Act; ACGME, Accreditation Council for Graduate Medical Education; AND, Academy of Nutrition and Dietetics; APRN, Advanced Practice Registered Nurse; CDR, Commission on Dietetic Registration; IOM, Institute of Medicine; NAA, Nutrition Academic Award; NCP, Nutrition Care Process; NHLBI, National Heart, Lung, and Blood Institute; NNEdPro, Need for Nutrition Education Program; PDP, Professional Development Portfolio; PNS, physician nutrition specialist; RD, registered dietitian.