Teaching Kitchens in the Learning and Work Environments: The Future Is Now

Improving Cooking Skills, Lifestyle Behaviors, and Clinical Outcomes for Adults at Risk for Cardiometabolic Disease: Protocol for a Randomized Teaching Kitchen Multisite Trial (TK-MT)

BACKGROUND/OBJECTIVES

This protocol describes a study to investigate the feasibility and preliminary efficacy of a novel Teaching Kitchen Multisite Trial (TK-MT) for adults with cardiometabolic abnormalities. The TK-MT protocol describes a hybrid lifestyle intervention combining in-person and virtual instruction in culinary skills, nutrition education, movement, and mindfulness with community support and behavior change strategies. This 18-month-long randomized controlled trial aims to evaluate the feasibility of implementing a 12-month, 24 class program, assess preliminary study efficacy, and identify barriers and facilitators to implementation.

METHODS

The intervention program includes 16 weeks of intensive hands-on culinary and lifestyle education classes followed by eight monthly virtual classes. Psychometric assessments and biometric data will be collected at baseline, 4, 12, and 18 months. Semi-structured interviews and open-ended surveys will be conducted during the 12-month follow-up assessment.

RESULTS

Feasibility will be assessed through recruitment, attendance, and fidelity data. Secondary outcomes will analyze changes in health behaviors, biometric data, and anthropometric measures using mixed-effects regression models. Qualitative data will undergo thematic analysis.

CONCLUSIONS

As envisioned and described in detail in this manuscript, this study will inform the development and implementation of reproducible, scalable teaching kitchen interventions. The protocol described here is intended to set the stage for future investigations to evaluate evidence for the impact of teaching kitchen interventions on dietary habits, physical activity, and overall health and well-being.

Culinary Medicine and Teaching Kitchens: Dietitians Leading Innovative Nutrition Training for Physicians

The objective of this evaluation was to determine the impact of a pop-up Teaching Kitchen (TK) at a national cardiovascular conference. The 60-minute session was hosted in a hotel conference room and led by two registered dietitians. Participants prepared 12 recipes, enjoyed a family-style meal, and explored nutrition behaviour change strategies for patients. Using Likert-scaled and open-ended questions, pre-/post-online surveys assessed change in perceived nutrition counselling skills, attitudes, and confidence; post-survey also assessed effectiveness of session components and further training needs. Pre-survey response was 72% (18/25). Twenty-one participants attended the event (14 pre-registrants, six from waitlist, and five drop-ins); 81% completed the post-survey. Positive shifts were reported in nutrition competence, particularly attitudes towards using recipes in nutrition counselling, and increased skills and confidence discussing eating on a budget and SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal setting with patients. Components of the TK session that enhanced nutrition competence were key patient messages and the shared meal. Preparing and eating together in a hands-on format was most enjoyable. Promoting healthy eating behaviours requires understanding the complexity of individual and societal food literacy. With high physician interest, dietitians are well positioned to deliver culinary medicine interventions and support physicians' confidence in health promotion and chronic disease prevention and management.

Will a Programmatic Framework Integrating Food Is Medicine Achieve Value on Investment?

Diet-related chronic diseases account for seven out of the ten leading causes of death in the USA. Food is Medicine (FIM) interventions can be effective adjuncts to standard medical care to address this cost burden. While the Food is Medicine Pyramid recommends some culinary skill development when integrating FIM into healthcare, the emphasis is on medically tailored meals and food provision. Hence, there is a practice gap to ensure patients develop the necessary skills to apply nutrition recommendations into improved food behaviors to achieve positive long-term health outcomes. This paper presents a theoretical framework for optimizing existing clinical services to provide FIM interventions, tracking associated improvements in patient outcomes, and identifying healthcare cost saving/revenue generation that can lead to a net value on investment. It describes how these interventions can and have been used in a clinical setting as adjuncts to clinical care. While there is published evidence for each modality individually, the literature lacks evidence of the value of an integrated approach. The framework therefore provides a roadmap to both identify best practices and evaluate outcomes that will inform viable financial models.

Employer Actions in Office Settings and Women's Perception of the Workplace as Supportive of Healthy Eating: A Cross-Sectional Pilot Study

BACKGROUND/OBJECTIVES

This study aimed to evaluate how women working in office environments perceive their workplace as promoting healthy eating behaviors through employer-led actions.

METHODS

This cross-sectional study was conducted among 230 professionally active women employed in office settings in Poland. Data were collected using the Computer-Assisted Web Interview (CAWI) method. Participants were divided into two groups based on their perceived level of workplace support for healthy eating behaviors, as measured by the Workplace Healthy Eating Scale. Group 1 (n = 125; 54.3%; mean score = 15.69, SD = 3.76) and Group 2 (n = 105; 45.7%; mean score = 29.88, SD = 5.15) reflected low and high perceived support, respectively.

RESULTS

A linear regression model was employed to assess the association between the perceived level of support and specific workplace initiatives, including access to fresh fruits and vegetables, meal preparation facilities, cafeteria usage, lectures on nutrition, cooking workshops, and individual dietary consultations. For Group 1, access to fresh fruits and vegetables was the only factor significantly associated with a positive perception of the workplace as promoting healthy eating (p = 0.003), explaining 6.5% of the variance (adjusted R2 = 0.065). In Group 2, both access to fresh produce and participation in cooking workshops were significantly associated with positive workplace perceptions (p < 0.001), explaining 41% of the variance (adjusted R2 = 0.410).

CONCLUSIONS

Access to fresh produce is a key determinant of employees' perceptions of workplace support for healthy eating behaviors, with a notably greater impact observed when combined with additional activities such as cooking workshops. Employer-led initiatives focusing on practical dietary engagement appear to be effective in enhancing workplace perceptions of health promotion.

Behavioral Frameworks and Translational Applications of Culinary Medicine and Culinary Nutrition

Culinary medicine and culinary nutrition programs have emerged as innovative approaches to influencing dietary and lifestyle behavior change. These models vary in reported use of behavioral frameworks for planning purposes and attributing efficacy to current inconsistencies in format and delivery. This report aims to review current practice of behavior change theories in culinary medicine/culinary nutrition, delineate constructs that support positive outcomes, and describe future directions for translational applications in integrating the skills of chefs, nutrition educators, and medical professionals.

Food is Medicine Initiative for Mitigating Food Insecurity in the United States

OBJECTIVES

While several food assistance programs in the United States tackle food insecurity, a relatively new program, "Food is Medicine," (FIM) initiated in some cities not only addresses food insecurity but also targets chronic diseases by customizing the food delivered to its recipients. This review describes federal programs providing food assistance and evaluates the various sub-programs categorized under the FIM initiative.

METHODS

A literature search was conducted from July 7, 2023 to November 9, 2023 using the search term, "Food is Medicine", to identify articles indexed within three major electronic databases, PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligibility criteria for inclusion were: focus on any aspect of the FIM initiative within the United States, and publication as a peer-reviewed journal article in the English language. A total of 180 articles were retrieved; publications outside the eligibility criteria and duplicates were excluded for a final list of 72 publications. Supporting publications related to food insecurity, governmental and organizational websites related to FIM and other programs discussed in this review were also included.

RESULTS

The FIM program includes medically tailored meals, medically tailored groceries, and produce prescriptions. Data suggest that it has lowered food insecurity, promoted better management of health, improved health outcomes, and has, therefore, lowered healthcare costs.

CONCLUSIONS

Overall, this umbrella program is having a positive impact on communities that have been offered and participate in this program. Limitations and challenges that need to be overcome to ensure its success are discussed.

Evaluation of the Effectiveness of a Bilingual Nutrition Education Program in Partnership with a Mobile Health Unit

There are limited reports of community-based nutrition education with culinary instruction that measure biomarkers, particularly in low-income and underrepresented minority populations. Teaching kitchens have been proposed as a strategy to address social determinants of health, combining nutrition education, culinary demonstration, and skill building. The purpose of this paper is to report on the development, implementation, and evaluation of Journey to Health, a program designed for community implementation using the RE-AIM planning and evaluation framework. Reach and effectiveness were the primary outcomes. Regarding reach, 507 individuals registered for the program, 310 participants attended at least one nutrition class, 110 participants completed at least two biometric screens, and 96 participants attended at least two health coaching appointments. Participants who engaged in Journey to Health realized significant improvements in body mass index, blood pressure, and triglycerides. For higher risk participants, we additionally saw significant improvements in total and LDL cholesterol. Regarding dietary intake, we observed a significant increase in cups of fruit and a decrease in sugar sweetened beverages consumed per day. Our findings suggest that Journey to Health may improve selected biometrics and health behaviors in low-income and underrepresented minority participants.

Culinary Medicine or Culinary Nutrition? Defining Terms for Use in Education and Practice

Examination of how terms such as culinary nutrition, culinary nutrition science, culinary medicine, culinary nutrition professional, culinary nutrition intervention, culinary nutrition activity, and culinary nutrition competency are used in practice, and the creation of consensus definitions will promote the consistent use of these terms across work areas and disciplines. Thirty leading practitioners, academics, and researchers in the fields of food and nutrition across Australia, the United States, Canada, United Kingdom, Europe, and Asia were approached by investigators via email to submit definitions of key terms using a Qualtrics survey link. Further participants were reached through snowball recruitment. Initial emails were sent in October and November 2021 with subsequent reminders between November 2021 and March 2022. Two researchers undertook content analysis of the text answers for each of the terms and generated definitions for discussion and consensus. Thirty-seven participants commenced the survey and twenty-three submitted one or more definitions. Agreed definitions fell into two categories: practice concepts and practitioners. Further discussion amongst investigators led to the creation of a visual map to demonstrate the interrelationship of terms. Culinary nutrition science underpins, and interprofessional collaboration characterizes practice in this area, however, further work is needed to define competencies and model best practice.

Effect of the Emory Healthy Kitchen Collaborative on Employee Health Habits and Body Weight: A 12-Month Workplace Wellness Trial

INTRODUCTION

Teaching kitchens are being used to facilitate lifestyle changes with a focus on culinary and nutrition programs to improve health behaviors. Less is known regarding their use as a worksite wellness program and their influence on employees' quality of life, body weight, and adoption of healthy behaviors. We evaluated changes in self-reported healthy behaviors, overall health, and weight during a one-year multidisciplinary teaching kitchen program.

METHODS

Thirty-eight benefits-eligible employees were recruited, screened based on a priori eligibility criteria that prioritized elevated body mass index (BMI), co-morbid conditions, and high levels of motivation to make lifestyle changes, and consented to participate in The Emory Healthy Kitchen Collaborative. This 12-month program included a 10-week didactic and experiential curriculum followed by continued support and access to health coaching implemented in an academic health system university hospital workplace between 2019 and 2020. Comparative statistics, paired t-test, Mcnemar's tests, and Wilcoxon signed-rank tests were used to assess changes at four time points.

RESULTS

Participants improved diet quality (p ≤ 0.0001), increased confidence in tasting new foods (p = 0.03), and increased mindful eating habits (p = 0.00002). Significant changes were seen in physical activity levels; aerobic activities (p = 0.007), strength resistance activities (p = 0.02), and participation in yoga (p = 0.002). Most participants weighed within 5 lbs. of their starting weight at 3 months (p = 0.57).

CONCLUSIONS

A teaching kitchen intervention is an innovative model for improving employee health behaviors and general health self-perception.

Total Force Kitchen: Exploring Active-Duty Service Member Performance Optimization Through Cooking

Introduction: Obesity, overweight, and suboptimal eating habits are threats to U.S. active-duty service member (SM) nutritional fitness. Offering programs that improve diet quality and nutritional status is of high interest to military leaders. Methods: Total force kitchen (TFK) was developed as a performance-focused multicomponent program centered around culinary skills with education and skill building in key areas of nutrition, physical activity, and mindfulness. This pilot study's objectives were to determine the feasibility and acceptability of the TFK program, to make recommendations for program modification, and to determine impact on behavior, self-efficacy, and health-related outcomes. Participants were single or geographically single active-duty SMs (n = 17) who attended the 12-week, 60-h innovative culinary education and performance optimization program at a local United Service Organization facility. A mixed-method approach assessed pre- and post-program metrics, including attrition rates and participant satisfaction. Results: The TFK program retention rate was 76.5%. All participants were "somewhat satisfied" or "very satisfied" with the overall TFK program. The highest satisfaction was with the cooking-related components. Improvements in other behavioral (d = 0.39, 95% confidence interval [CI]: -0.17 to 0.95), self-rated health (d = 0.58, 95% CI: -0.02 to 0.16), and anthropometric measures (e.g., body fat percentage: d = -0.01, 95% CI: -0.12 to 0.10) were smaller than improvements in cooking attitudes (d = 0.66, 95% CI: 0.17 to 1.13) and self-efficacy for techniques (d = 1.80, 95% CI: 0.96 to 2.62). Participants reported positive changes in lifestyle related to what they eat and how they prepare their meals. They also highly valued active learning and instructor knowledge and enthusiasm. Discussion: This multidisciplinary evidence-based program offers ample opportunities for SMs to gain knowledge, build skills, and engage in a supportive community to optimize their performance through cooking. A successful pilot has the potential to leverage resources for the TFK program expanding its reach and impact to the larger military population and nonmilitary communities.

The Time is Ripe: The Case for Nutrition in Graduate Medical Education in the United States

A poor-quality dietary pattern is a leading risk factor for chronic disease and death in the United States, and the costs of medical care continue to unsustainably rise. Despite this reality, nutrition training for physicians fails to adequately prepare for them to address the complex factors that influence diet-related disease. Expanding nutrition education for physicians-in-training is imperative to equip them for the growing demand of food is medicine services and is also supported by recent policy efforts in the United States as well as the governing bodies of graduate and undergraduate medical education. A multisector approach that links graduate medical education, clinical care delivery innovation, and health and food policy experts provides momentum to advance nutrition education as a core strategy for food is medicine expansion globally.

Culinary Medicine: Needs and Strategies for Incorporating Nutrition into Medical Education in the United States

In the past decade, medical education has increasingly incorporated evidence-based lifestyle interventions as primary strategies for preventing and managing noncommunicable diseases. This shift embraces the growing recognition of the significant impact of lifestyle on health outcomes, driving diseases including obesity, diabetes, heart disease, and cancer. Now deemed "food is medicine" (FIM), diet-related interventions witnessed integration into healthcare systems and recognition in the United States' White House Conference on Hunger, Nutrition, and Health in 2023. As FIM gains traction, investigating optimal strategies for team-based education becomes essential. Healthcare teams need the necessary knowledge and tools to effectively administer FIM services and collaborate across disciplines, ultimately enhancing disease prevention, chronic disease management, health quality, value, and overall wellness. Culinary medicine (CM), a vital component of FIM, bridges nutrition education, pragmatic culinary skills, and conventional strategies to improve chronic disease management. CM involves experiential learning, imparts practical skills, and encourages behavior change by addressing food-related determinants of health and promoting equitable access. Teaching kitchens serve as physical or virtual learning spaces and as a didactic and experiential method (skills lab), playing a crucial role by integrating culinary, lifestyle, integrative, and conventional medicine. A growing number of medical schools in the United States and globally offer CM education via diverse methods including interest groups, electives, and specialty tracks, encompassing didactic sessions, hands-on kitchen education, and virtual teaching methods. Given the rising demand for CM programs, this article aims to describe, map, and compare existing CM education types in medical education. It provides actionable recommendations for medical schools to establish and expand CM programs by fostering service-learning partnerships, clinical innovation, and interdisciplinary research. As FIM gains prominence, cultivating a robust foundation of educational strategies is vital to ensure seamless integration into both medical education and collaborative medical practice.

Feasibility pilot study of a Japanese teaching kitchen program

Background

This pilot study examined the feasibility of a new lifestyle modification program involving a "Teaching Kitchen" in Japan. Our goal was to explore (1) feasibility of the program; (2) acceptability for class frequency (weekly vs. bi-weekly); and (3) changes in biometrics, dietary intakes, and lifestyle factors.

Methods

A total of 24 employees with obesity in a Japanese company were recruited. Participants were randomly divided into two groups (weekly or bi-weekly group), each attending the program consisting of four two-hour classes (lectures on nutrition, exercise, mindfulness, and culinary instructions). Participants were observed for changes in dietary intakes, biometrics, and health related quality of life over the subsequent 3 months. We tested the between-group differences in changes using linear mixed-effect models.

Results

The program completion rates were 83.3% in total (91.7% for weekly group and 75.0% for bi-weekly group). From baseline to post-intervention, significant decreases were observed in weight (p < 0.001), body mass index (p < 0.001), diastolic blood pressure (p = 0.03), body fat mass (p < 0.001), and dietary intakes in total fat (p = 0.03) and sodium (p = 0.008) among 17 participants who were available for measurements. Improvements in biometrics remained significant 1 month after the intervention (all p ≤ 0.03 in 14 participants). Participants' health related quality of life was significantly improved in bodily pain, general health, vitality, and mental component score (all p ≤ 0.047).

Conclusions

The new Japanese Teaching Kitchen program is feasible with high program completion rates in Japanese office workers with obesity. While this was a small feasibility study, significant multiple improvements in dietary intakes, biometrics, and health related quality of life suggest that this line of inquiry warrants further exploration to address obesity and obesity-related diseases in Japan.

Comparison of Effectiveness regarding a Culinary Medicine Elective for Medical Students in Germany Delivered Virtually versus In-Person

(1) Background: The Culinary Medicine elective at the German medical schools of the universities of Göttingen, Giessen, and Brandenburg is a teaching kitchen-based elective aimed at training medical students on how to improve patient counselling on nutrition and lifestyle medicine topics. This curriculum was either delivered virtually (2021) or in-person (2022/2023). Changes in teaching effectiveness were evaluated. (2) Methods: The elective included seven modules in the teaching kitchen for 3 h each. It consisted of a short introduction and a hands-on interactive cooking part illustrating important dietary principles in different disease groups. The elective was conducted virtually in 2021 in a fully interactive setup using videoconference tools. Students in this cohort attended from their private kitchens whereas students in the in-person cohort (2022/2023) attended the same classes in the teaching kitchen. Standardized comparative self-assessment questionnaires on counselling competencies, nutrition knowledge, eating habits, and mental well-being (WHO-5) before and after the elective were used to determine teaching effectiveness. Paired and unpaired t-tests were performed to evaluate results. (3) Results: A total of 70 students (mean semester 6.3) were included in the virtual cohort, and 80 students (mean semester 6.3) were in the in-person cohort. In both, counselling competencies on 25 nutrition and lifestyle medicine topics increased significantly. Significant changes also occurred in most nutrition knowledge categories. Subjective well-being as well as personal attitudes towards nutrition counselling in medical practice improved significantly during the elective. Healthy eating habits improved in both groups as students ate significantly less unfavourable foods. There were no significant differences between the two groups apart from minor differences in nutrition knowledge. (4) Conclusions: The elective in Culinary Medicine improved students counselling competencies, nutrition knowledge, attitudes, well-being, and eating habits with no relevant difference between virtual and in-person teaching.

Teaching Kitchens and Culinary Gardens as Integral Components of Healthcare Facilities Providing Whole Person Care: A Commentary

Child and adult obesity continue to be major health concerns in the United States and can contribute to the development of chronic diseases. Culinary medicine, which incorporates teaching kitchens and gardens, may be a useful strategy for preventing and/or treating obesity-related disease by providing the knowledge and skills that encourage consumption of whole plant-based foods prepared at home. Though emerging research describes the benefits of culinary medicine-based programming, examples of teaching kitchens and culinary gardens being integrated into current clinical practice is minimal. Here, we describe the development of innovative, community-centered culinary medicine programming borne from interdisciplinary collaboration at a leading healthcare system. Preliminary outcomes suggest improvements in anthropometrics, cardiometabolic risk factors, and participation in healthy lifestyle behaviors in pediatric weight management patients, as well as improved confidence, knowledge, and likelihood to prepare whole food, plant-based meals in healthcare employees following participation in culinary medicine workshops. Hospitals and culinary medicine partners can support each other through shared knowledge, vision, and resources to provide value-based care to patients in the community. Collaboration among gardeners, chefs, architects, educators, and healthcare professionals can transfer traditional physician-driven care to patients, empowering them with the tools, resources, and confidence to improve health and wellbeing.

"Zoom"ing to the Kitchen: A Novel Approach to Virtual Nutrition Education for Medical Trainees

While nutritional interventions are first-line therapy for many chronic diseases, most medical trainees receive minimal nutrition education, leaving them unprepared to address nutritional issues with patients. An interactive, single-session, virtual nutrition curriculum was taught online to 80 physician assistant (PA) students. Topics included plant-based nutrition, dietary history-taking and counseling, and culinary medicine. Students were surveyed before, immediately after, and four weeks after the curriculum to assess changes to nutrition-related knowledge, attitudes, confidence, and personal dietary behaviors. Seventy-three PA students (91%) completed the pre-survey, 76 (95%) completed the post-survey, and 42 (52.5%) completed the delayed post-survey. Knowledge scores increased immediately post-intervention (48.9% to 78.9%; p < 0.001) and persisted four weeks later (78.9% to 75.8%; p = 0.54). Post-intervention, students felt more confident in dietary history-taking (55% vs. 95%; p = 0.001) and nutrition counseling (53% vs. 84%; p = 0.003) and agreed that dietary changes alone could reverse type 2 diabetes (74% vs. 97%; p = 0.027) and coronary artery disease (66% vs. 92%; p = 0.039). Curricula using virtual teaching kitchens may be a scalable approach to nutrition education for medical trainees.

The Role of Agricultural Systems in Teaching Kitchens: An Integrative Review and Thoughts for the Future

Diet-related chronic disease is a public health epidemic in the United States. Concurrently, conventional agricultural and food production methods deplete the nutritional content of many foods, sever connections between people and the origin of their food, and play a significant role in climate change. Paradoxically, despite an abundance of available food in the US, many households are unable to afford or attain a healthful diet. The linkages between agriculture, health, and nutrition are undeniable, yet conventional agriculture and healthcare systems tend to operate in silos, compounding these pressing challenges. Operating teaching kitchens in collaboration with local agriculture, including farms, community gardens, vertical farms, and urban agriculture, has the potential to catalyze a movement that emphasizes the role of the food system in promoting human and planetary health, building resilient communities, and encouraging cross-disciplinary collaboration. This paper reviews the current state of agricultural systems, food is medicine, consumer behavior, and the roles within these sectors. This is followed by a series of case studies that fill the gaps between TKs and agriculture. The authors summarize opportunities to combine the knowledge and resources of teaching kitchens and agriculture programs, as well as challenges that may arise along the way.

Physician-Chef-Dietitian Partnerships for Evidence-Based Dietary Approaches to Tackling Chronic Disease: The Case for Culinary Medicine in Teaching Kitchens

Since the middle of the 20th century, the American food environment has become increasingly ultra-processed. As a result, the prevalence of chronic, diet-related disease in the United States has skyrocketed. Meanwhile, physicians are still poorly trained in nutrition. A recent innovation that aims to address this is "culinary medicine" programming taught by teams of physicians, chefs, and registered dietitian nutritionists. Culinary medicine is an evidence-based, interprofessional field of medicine that combines culinary arts, nutrition science, and medical education to prevent and treat diet-related disease. It employs hands-on learning through healthy cooking and is typically taught in a teaching kitchen, either in-person or virtually. It can be dosed either as a patient care intervention or as experiential nutrition education for students, medical trainees, and healthcare professionals. Culinary medicine programs are effective, financially feasible, and well-received. As a result, healthcare systems and medical education programs are increasingly incorporating culinary medicine, teaching kitchens, and interprofessional nutrition education into their patient care and training models.

Perspective: Teaching Kitchens: Conceptual Origins, Applications and Potential for Impact within Food Is Medicine Research

There is a need to identify innovative strategies whereby individuals, families, and communities can learn to access and prepare affordable and nutritious foods, in combination with evidence-based guidance about diet and lifestyle. These approaches also need to address issues of equity and sustainability. Teaching Kitchens (TKs) are being created as educational classrooms and translational research laboratories to advance such strategies. Moreover, TKs can be used as revenue-generating research sites in universities and hospitals performing sponsored research, and, potentially, as instruments of cost containment when placed in accountable care settings and self-insured companies. Thus, TKs can be considered for inclusion in future health professional training programs, and the recently published Biden-Harris Administration Strategy on Hunger, Nutrition and Health echoes this directive. Recent innovations in the ability to provide TK classes virtually suggest that their impact may be greater than originally envisioned. Although the impact of TK curricula on behaviors, outcomes and costs of health care is preliminary, it warrants the continued attention of medical and public health thought leaders involved with Food Is Medicine initiatives.

Evaluation of dietary habits and cooking confidence using virtual teaching kitchens for perimenopausal women

BACKGROUND

The transition to menopause is a time when women are at increased risk for chronic and cardiovascular diseases, and weight gain. This study evaluates the efficacy of virtual teaching kitchen (TK) interventions on cooking confidence and consumption of a healthy diet in women over 45.

METHODS

This teaching kitchen intervention is a synchronous online series of classes for perimenopausal women, with 45 min of live cooking and 15 min of nutrition discussion. From September 2020 through January 2022, participants completed online pre- post-intervention surveys addressing weight, eating habits, cooking confidence and self-efficacy. Analysis used paired samples t-test and Wilcoxon signed rank sum test for normally and non-normal distributed data respectively.

RESULTS

Of the 609 unique participants, 269 women completed both pre and post surveys after attending classes. Participants self-reported a statistically significant decreased weight (p < 0.001), increased daily consumption of fruit/vegetables (p < 0.039), fish (p < 0.001) and beans (p < 0.005), and decreased daily consumption of red meat (p < 0.001), sugary beverages (p < 0.029) and white grains (p < 0.039). There was significant improvement in cooking self-efficacy and confidence.

CONCLUSIONS

Virtual teaching kitchens were effective in improving culinary and dietary habits among peri- and post-menopausal women. This early evidence suggests that teaching kitchens can effectively reach larger populations for healthy behavioral modification.

TRIAL REGISTRATION

Study obtained IRB exemption.

Culinary Medicine as Innovative Nutrition Education for Medical Students: A Scoping Review

PURPOSE

Lifestyle-related disease substantially impacts health, but physicians lack adequate nutrition education to discuss behavioral change with patients. Many medical schools have developed culinary medicine programs as a nutrition education strategy, but common elements of success have not been defined.

METHOD

The authors conducted a scoping review of the literature on culinary medicine programs for medical students. They searched PubMed, Ovid MEDLINE, and MedEdPORTAL databases to identify English-language studies published between January 1, 2012, and October 15, 2021. Multiple search terms were used to identify medical student-focused culinary medicine programs. The authors focused inclusion criteria on medical student learners, curricular description, hands-on cooking components, reflection or application to patient care, and assessment. Additionally, the authors reviewed 2 online databases which list programs delivering culinary medicine education for U.S. medical students.

RESULTS

Authors identified 251 studies, of which 12 met inclusion criteria. These studies described programs that used a kitchen or similar space adaptable for food preparation to enable hands-on learning, and some programs provided opportunities for practical application. Most programs administered surveys to assess course impact, but the type of survey and cohort size varied. Culinary medicine programs for medical students varied in learner level, number of participants, course length and structure, and instructor background but consistently improved student knowledge in key areas of nutrition application and changed knowledge and attitudes about food and nutrition. Funding was often noted as a barrier to program sustainability. When funding source was provided, it derived from philanthropic or academic sources. When the authors reviewed the 2 online databases, they identified 34 programs offering medical student-focused culinary medicine courses.

CONCLUSIONS

As culinary education programs emerge across academic centers, standardizing programmatic and curricular elements, best practices, and assessment strategies will be vital for quality control, sustainability, and optimal population health impact.

A Teaching Kitchen Program Improves Employee Micronutrient and Healthy Dietary Consumption

Objective

To measure changes in micronutrient adequacy and diet quality in healthcare and university employees who underwent a 10-week teaching kitchen program.

Methods

Thirty-eight healthcare and university employees participated in a 10-week teaching kitchen program. Twenty-seven completed self-administered, 24-hour dietary recalls to measure dietary intake at baseline and 3-months. Micronutrient adequacy and diet quality was assessed using Dietary Reference Intakes (DRIs) and the Healthy Eating Index (HEI).

Results

Seventy percent of participants were classified as low or moderate micronutrient adequacy at baseline. The proportion of participants with high micronutrient adequacy increased from 30% to 48% at 3-month follow-up. Total HEI and most HEI components increased at follow-up; with a statistically significant increase in seafood/plant protein score (P = .007).

Conclusions and Implications for Practice

Our results suggest an inadequacy in micronutrient intake in university and healthcare employees and that teaching kitchens may help improve micronutrient adequacy and diet quality.

Building Flavor and Confidence in the Kitchen: A Pilot Virtual Cooking Class on Healthy Snacking

Cooking meals at home is associated with more healthful eating and even other healthy behaviors, such as increased physical activity, but for many there are numerous barriers to making this a reality. Healthy teaching kitchen interventions aim to help patients overcome these barriers. Our pilot program worked to address this issue by demonstrating the feasibility and acceptability of a virtual culinary medicine session designed for outpatient clinic patients. Participants were recruited from a single community primary care clinic for a virtual culinary medicine session. Of the 29 subjects who attended the class, 13 (45%) filled out the pre-course survey, and 8 (26%) filled out the post-course survey. Average participant confidence in preparing snacks at home from fresh ingredients increased from 3.62 to 4.38 out of 5 after attending this session, though the results were not statistically (OR .47; P = .172; 95% CI .16 to 1.3). Post-participation comments were overwhelmingly positive. This study showed that a virtual cooking class is feasible in a community clinic setting and is positively received. In addition, a culinary class teaching healthy cooking techniques paired with nutrition training may improve patient's confidence in the kitchen.

Impact of an Interactive Health Corner Using the Culinary Education Approach in Promoting Long-Term Dietary Changes among Patients Who Seek Public Primary Care Services

An unhealthy diet is a major risk factor for chronic diseases. Although nutrition education and cooking demonstrations have resulted in favourable dietary changes, it is unclear whether this is sustainable for longer periods. This study aims to evaluate the long-term impact of a nutrition-led cooking intervention using the culinary education approach on dietary patterns based on My Healthy Plate (MHP). This was a quasi-experimental study involving patients who sought public primary care services in two polyclinics (mean age 59.3 years old). A self-administered survey was done at baseline, 6 months, and 1 year for both the intervention and the comparison groups. Participants in the intervention group were exposed to the health corner, which provided nutrition education and cooking demonstrations using the culinary education approach. A total of 216 participants completed the study at 1 year with a follow-up rate of 86%. Adjusted risk ratios (aRR) were obtained from negative binomial regression. Compared with the comparison group, participants in the intervention group were more likely to report adhering to the requirements of MHP at 6 months (aRR 1.83, 95% CI 1.12-2.99) and 1 year (aRR 1.54, 95% CI 1.10-2.16). Participants in the intervention group were less likely to add salt or sauces to food at 6 months (aRR 0.29, 95% CI 0.12-0.75) and 1 year (aRR 0.21, 95% CI 0.07-0.61) and more likely to remove fat when eating meat at 1 year (aRR 0.30, 95% CI 0.13-0.67) than the comparison group. The interventions at the health corner had a positive impact in helping patients achieve MHP recommendations, not adding salt and sauces to their food, and removing animal fat before eating. There is potential for expanding this initiative to improve healthy eating practices in other polyclinics.

Our Whole Lives for Hypertension and Cardiac Risk Factors (OWL-H)—Combining a Teaching Kitchen Group Visit with an Online Platform: A Feasibility Trial (Preprint)

Background

Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN.

Objective

The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN.

Methods

We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods.

Results

Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income <US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were “very satisfied” with using OWL-H to help manage their HTN. Participants’ blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants’ self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks.

Conclusions

The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN.

Trial Registration

ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334