If you haven’t decided on what you’re eating today, look no further than the nearest social media app. Scroll long enough and in addition to recipes, restaurant reviews, and advertisements, you may also come across reasons why everything you’ve been eating is “wrong.” Such is the social media landscape that we are regularly exposed to, and that our patients are too. With the rise in popularity of GLP-1 receptor agonists and their weight-loss effects, it can feel that our eating behaviors are being held up for discussion — and scrutiny — now more than ever.
Meanwhile, cardiovascular disease continues to lead the way as the major cause of death in the U.S., as rates of diabetes, metabolic syndrome, and liver disease climb higher. It’s no secret that chronic disease is a major burden on the health care system and in the lives of patients. Likewise, the role of diet in causing or exacerbating disease is hardly a mystery, but implementing diet-based prevention and treatment of disease has proven to be a challenge. Is it any wonder why patients reach for this information online, when most physicians do not receive adequate training to be able to provide it?
Physicians have a role to play in counseling their patients on preventable, diet-related diseases. However, the nutrition content in medical education is sparse, if present at all. I am fortunate to be in a program that does include nutrition content within its medical curriculum. And yet, I too have had to seek additional opportunities outside of my classes to learn from practitioners of whole-person care.
For many medical students, lifestyle medicine interest groups are among their first exposure to how diet is discussed in the medical setting. I joined my school’s interest group as soon as my first semester started, grateful for the chance to learn options for healthy eating that I could someday offer to my patients. It seemed fitting that our first event was a chef-led cooking demonstration that would teach attendees how to prepare healthy plant-based meals.
The cooking demo was held in a small room of our hospital’s primary care building. Our group was seated in front of a kitchen stovetop, and as the chef brought together several different types of vegetables and spices, an inviting aroma soon filled the room. He narrated as he went, explaining the techniques and ingredient substitutions he used to create a “healthier” version of the recipes for chili and noodles.
Tempeh and ground sesame seeds were used in place of beef and sesame oil to bolster the nutrient level and add plant-based protein, and soba noodles were used as a gluten-free alternative to wheat noodles. He also chose to keep the fat content low by foregoing oil, instead adding water little by little throughout his cooking. In many ways, the chef was correct — these ingredients did offer many benefits. Data overwhelmingly shows that a healthy diet, particularly one that is low in processed red meat, salt, and sugar, contributes to better health outcomes.
However, I couldn’t help but feel a growing disconnect as the demo continued. We were given a variety of handouts epitomizing an organic, vegan diet as the ultimate goal for good health. Many of the dietary modifications seemed aspirational, if not unrealistic, particularly in food-insecure areas that don’t have access to grocery stores or fresh produce. And, when the chef shared a serious personal story about finding self-forgiveness after breaking his vegan diet to enjoy a single slice of pizza that year, I couldn’t help but feel something was missing. The experience began to strike me as painfully out of touch with the underserved communities that we would be serving as future physicians — people who didn’t have the privilege of knowing when their next meal would be, let alone if it would align with their values or dietary preferences.
Some of the recommendations also clashed with principles I had learned during my years helping deliver a cooking and nutrition education program that was trauma-informed, culturally competent, and grounded in food justice. Our focus was on encouraging the addition of healthy foods aligned with the unique preferences and health goals of each individual, rather than the restriction of “unhealthy” foods. While I respected the chef’s important work in promoting a healthy diet to prevent chronic disease, I realized the need to reframe our programming to better represent the realities of Chicago’s underserved communities. I made sure the next speaker we invited could attest to these realities.
A month later, a chef who had personally led classes in food-insecure neighborhoods came to talk about an empathetic approach to teaching healthy cooking and dietary practices. They made the powerful acknowledgement that healthy diets do not only look one way; rather, they vary based on a variety of factors such as cultural background and socioeconomic barriers. They focused on sensitive topics such as the obstacles patients face to healthy eating and how to help them make the most of their available options. Dinner in one neighborhood can be made from farmer’s market produce or cut right from the stem in their own backyard. In another neighborhood, canned beans from the local food pantry may be their best source of plant-based protein, because it is their only one. In a third, dinner might look like a trip to McDonald’s.
In their perspective, what ultimately matters most in defining healthy practices is not the single meal, but the pattern over time. And patterns are changed not by enforcing guidelines, but by sharing empathy and compassion. There can be an impulse to prescribe a diet like medication, with exact quantity and quality. However, much like how drugs require thoughtful counsel, so too does dietary guidance. Effective nutrition counseling accounts for the complexities of individual lives, including the cultural, economic, and emotional contexts that shape eating behaviors.
If we are serious about advancing health equity through education on dietary and lifestyle changes, we must adopt approaches that are accessible, culturally relevant, and inclusive. In failing to connect with our patients and give advice that fits their needs, we fail to provide the individualized care they deserve.
Changing the future of our country’s health starts with educating the next generation of doctors through conversations about daily dietary habits. By addressing the broader context of how and why people eat the way they do, we can better equip ourselves to help people achieve healthier lives — based on their own terms and their own unique taste
Sara Temelkova is a first-year medical student at Rush Medical College in Chicago, where she is involved in her school's lifestyle medicine student organization and Health Equity and Social Justice Leadership program. She is passionate about food justice, the gut microbiome, and the role of nutrition in health. She loves spending time in small bookstores, being on the badminton court, and admiring Lake Michigan. Sara is a 2024-2025 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz
