Culinary Medicine Experiences for Medical Students and Residents in the U.S. and Canada: A Scoping Review

PHENOMENON

Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation.

APPROACH

This scoping review used the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides. Eligible publications described the nature, impact, facilitators, and/or barriers of nutrition and food preparation learning experiences for medical students and/or residents. Additional inclusion criteria were location (U.S. or Canada), allopathic or osteopathic, English, human subjects, and publication year (2002 or later). The search strategy included 4 electronic databases. Two reviewers independently screened titles/abstracts and a third reviewer resolved discrepancies. The full-text review consisted of 2 independent reviews with discrepancies resolved by a third reviewer or by consensus if needed, and the research team extracted data from the included articles based on the nature, impact, barriers, and facilitators of culinary medicine experiences for medical trainees.

FINDINGS

The publication search resulted in 100 publications describing 116 experiences from 70 institutions. Thirty-seven publications described pilot experiences. Elective/extracurricular and medical student experiences were more common than required and resident experiences, respectively. Experiences varied in logistics, instruction, and curricula. Common themes of tailored culinary medicine experiences included community engagement/service-based learning, interprofessional education, attention to social determinants of health, trainee well-being, and cultural considerations. Program evaluations commonly reported the outcome of experiences on participant attitudes, knowledge, skills, confidence, and behaviors. Frequent barriers to implementation included time, faculty, cost/funding, kitchen space, and institutional support while common facilitators of experiences included funding/donations, collaboratives and partnerships, teaching kitchen access, faculty and institutional support, and trainee advocacy.

INSIGHTS

Culinary medicine is an innovative approach to address the need and increased demand for improved nutrition training in medicine. The findings from this review can guide medical education stakeholders interested in developing or modifying culinary medicine experiences. Despite barriers to implementation, culinary medicine experiences can be offered in a variety of ways during undergraduate and graduate medical education and can be creatively designed to fulfill some accreditation standards.

Exploring the effectiveness of virtual and in-person instruction in culinary medicine: a survey-based study

BACKGROUND

Culinary medicine, which has recently increased in popularity in medical education, incorporates food and nutritional interventions with principles of disease prevention and treatment. The ultimate goal is to improve overall health outcomes. The growing prevalence of diet-related chronic diseases indicates the need for physicians to have a deeper understanding of the interplay between nutrition and disease. Incorporating culinary medicine into medical education can equip medical students with the necessary skills and knowledge to promote better patient outcomes. The purpose of this study was to evaluate students' perceptions of their foundational knowledge of a culinary medicine course after completion of the course for first- and second-year medical students at the PCOM (Philadelphia College of Osteopathic Medicine). We will also examine the difference between methods of instruction in relation to constructs discussed of knowledge gained and enjoyment of the course.

METHODS

This retrospective cohort study was conducted using SurveyMonkey by Momentive. Data were collected from osteopathic medical students who enrolled in a culinary medicine course at the PCOM from 2018 to 2022 through the completion of a post-course survey. The methods of instruction included either a virtual or in-person classroom. The statistical analysis for this study was conducted using IBM SPSS Statistics version 28. To compare methods of instruction, the statistical analyses used included descriptive statistics, chi-square analysis, one-way ANOVA, and independent sample one-sided t tests.

RESULTS

A total of 360 out of 430 participants, spanning the years 2018 to 2022, completed the course requirements and participated in the online survey. There was a valid sample size of 249 for the in-person group and 111 for the virtual instruction group. The knowledge gained construct consisted of five survey questions, for a total possible score of 25, while the enjoyment construct consisted of two questions, for a total possible score of 10. A statistically significant difference in knowledge gained was identified by one-way ANOVA, F (4,355) = 3.853, p =.004. Additionally, there was a statistically significant difference in enjoyment of the course between class years, F (4,356) = 11.977, p <.001. Independent sample t-tests revealed a statistically significant difference in enjoyment between the two methods (p <.001) even after accounting for unequal variances, with Cohen's d equal to 0.807, indicating a moderate effect size.

CONCLUSIONS

The findings of this study suggest that overall, students were highly satisfied with the Culinary Medicine course over a five-year period. The study suggested that students who participated in in-person courses benefitted more than did the virtual students in terms of knowledge gained and enjoyment. The 360 students who completed the Culinary Medicine course were highly satisfied with the information and skills they acquired.

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.

Occupational therapy and cooking: A scoping review and future directions

BACKGROUND

Occupational therapy (OT) has historically used cooking as an intervention and assessment approach across settings. Current practices in OT and the emergence of the multidisciplinary field of culinary medicine highlight the relationship between cooking and health.

AIMS/OBJECTIVES

To map the current literature on OT and cooking and to identify key factors that may facilitate collaboration within culinary medicine.

MATERIALS AND METHODS

We conducted a scoping review using the Joanna Briggs Institute methodology to identify primary contexts and clinical settings. Publications were analysed using framework thematic analysis to identify OT themes and roles.

RESULTS

A total of 56 studies met the criteria for inclusion. The majority of studies (n = 29, 53%) represented home/community settings and brain injury was the largest clinical group (n = 15, 27%). Primary themes related to person (n = 47, 43%), occupation (n = 30 (28%), environment (n = 19, 17%), and psychosocial wellbeing (n = 13, 12%). The primary OT role identified was that of interventionist (n = 48, 86%).

CONCLUSIONS/SIGNIFICANCE

OT's holistic practice places cooking within a larger context that can help identify and overcome the barriers to participation. Findings support multiple pathways in which OT can contribute to cooking initiatives for health promotion and potentially expand OT practice in population health.

The Bite of HOPE Small Food Business Development Program: a clinic-based culinary medicine program targeting local business owners

Culinary medicine is a popular approach to health promotion, but most programs focus on patient or provider-facing education. While laudable, these efforts do not represent the full potential for culinary medicine to impact community health. We describe a novel approach to culinary medicine at a federally qualified health center (FQHC), the HOPE Clinic: Bite of HOPE Small Food Business Development (SFBD) program. Describe the design and implementation of the Bite of HOPE SFBD program and examine initial response to the program through interviews and focus groups with past participants. The SFBD program aims to create healthy food outlets by supporting local small businesses with education, resources, and mentorship support. Former participants in the SFBD program were invited to participate in focus groups and interviews exploring their experience and perceived program impact. Three focus groups (n = 10) and nine in-depth interviews were conducted. Most participants were Black or Hispanic and all operated their businesses in the community surrounding HOPE Clinic. Five themes emerged from the data including perceived program purpose, program discovery, motivating factors to participation, perceived program impact, and suggestions for improvement. Participants expressed high satisfaction with the program and positive changes in both business development and personal eating habits. There is an opportunity to leverage the culinary medicine model to support local small food business and improve community health. The Bite of HOPE SFBD program offers an example of how clinic-based resources can expand into the surrounding environment.

Creating Teams of Family Medicine Residents and High School Culinary Students Reduces Some Barriers to Implementing a Culinary Medicine Hands-On Workshop

Background

Barriers to implementation of culinary medicine in resident training include lack of facilities, administrative support, and community engagement.

Activity

Twenty-five family medicine residents were teamed with 17 high school culinary arts students to prepare recipes aligned with the Mediterranean diet (MED) and the USDA low, moderate, and liberal cost food plans.

Results

The workshop took place in the high school teaching kitchens. A pre-survey informed the planning committee's design of a 4-h hands-on workshop that was considered a success.

Discussion

Post-surveys documented improved resident confidence and skills in recommending MED to their patients and interaction with their own peers and high school students, as well as enjoyment by all participants of this hands-on approach.

Interprofessional Students' Perspectives on Culinary Medicine Training: Intentions from Plate to Practice

Purpose

The purpose of this pilot study was to determine the impact a culinary medicine teaching activity had on interprofessional healthcare students' knowledge, confidence, and intent to apply practical dietary principles in practice.

Methods

Thirteen interprofessional students (n = 13) completed a 3-h, hands-on culinary medicine session focused on recipe conversion and nutritional coaching skills to modify a favorite comfort food into a significantly more nutritious, Mediterranean diet-based meal. Participants produced variations of a recipe to gain a deeper understanding of how diet modifications that consider both taste and nutritional value can treat health conditions. Pre- and post-session surveys were administered to evaluate participants' knowledge and intent to apply culinary medicine principles into their respective healthcare practices.

Findings

Students reported an increase in the belief that nutritional counseling should be included in routine appointments, as well as increased confidence in their ability to implement culinary medicine into practice. All students reported the intent to integrate culinary medicine into practice, and a likelihood that they would recommend culinary medicine training to other healthcare professionals.

Conclusion

Interprofessional students reported learning satisfaction throughout the hands-on, chef-led and faculty-facilitated culinary medicine teaching activity and found the nutritional content to be especially transferable to working with patients.

Hungry for more: Australian medical students' competence, attitudes and preferences towards nutrition education

BACKGROUND

Inadequate nutrition education in medical training is a prevailing global challenge. This study assessed Australian medical students' self-perceived competencies in nutrition and preferences regarding nutrition education in medical training.

METHODS

We conducted a national cross-sectional online survey between September 2019 and January 2020. Our survey collected sociodemographic characteristics and assessed nutrition competency according to a validated assessment tool. All Australian medical students aged over 18 were eligible to participate.

RESULTS

One hundred ninety-five medical students representing 20 Australian medical schools completed the survey and reported moderate nutrition knowledge (17·6 ± 4.1 out of 35, 50%) and skills (29.8 ± 7.6 out of 55, 54%). Students demonstrated positive attitudes towards nutrition training/education (35·9 ± 4.0 out of 40, 90%). Most medical students (n = 148, 72%) reported they had sought some form of nutrition education outside of their degree. Students showed preference for practical, evidence-based nutrition education that is integrated in and prioritised throughout medical training.

CONCLUSIONS

Australian medical students express positive attitudes towards nutrition but report only low to moderate nutrition knowledge and skills. There is an opportunity to incorporate practical, regular nutrition learning activities into Australian medical curriculums to equip future doctors to adequately address non-communicable disease. Such initiatives are likely to be well received by students.

Impact of a Brief Culinary Medicine Elective on Medical Students' Nutrition Knowledge, Self-efficacy, and Attitudes

The aim of this study was to determine how a brief culinary medicine curriculum impacted medical students' nutrition knowledge, attitudes, and self-efficacy and to evaluate which parts of the curriculum students found to be most helpful. This preliminary intervention study enrolled participants in a 2-week culinary medicine elective course and measured pre- and post-elective. Students attending an Appalachian medical school (n = 16) participated in this study. Participants were surveyed on their nutrition knowledge, self-efficacy in providing nutrition advice, and attitudes towards use of nutrition in practice pre- and post-elective. Participants also completed elective evaluations following the course. Changes in mean outcome scores were measured pre- and post-elective using signed Wilcoxon tests. Alpha was set at .05. Frequencies of responses were calculated to determine which course components were ranked highest in their efficacy. Nutrition knowledge and self-efficacy increased significantly from pre- to post-elective (p < .0001 and p < .0001, respectively). Students valued the hands-on and culinary components of the course most. Results indicate that a brief culinary medicine curriculum can effectively improve medical students' knowledge and self-efficacy of nutrition counseling and that students prefer hands-on and applied learning when learning about nutrition.

Exploring culinary medicine as a promising method of nutritional education in medical school: a scoping review

BACKGROUND

Dietary modifications are considered a first-line intervention for chronic disease management, yet graduating doctors still report not feeling competent to counsel patients on their diet. Research has focused on methods to address this shortfall in physician competency, including culinary medicine. Culinary medicine is an approach to education that involves hands-on food and cooking learning experiences to equip participants with tools for improving the nutrition behaviour and health of their future patients. Despite positive findings in the efficacy of these interventions, they differ markedly in approach and target, which therefore fails to provide adequate evidence that could serve to guide future culinary medicine interventions.

OBJECTIVE

A scoping review to synthesize the existing literature on culinary medicine interventions that are offered during medical training.

METHODS

Online databases were used to identify literature published prior to April 2022 that involve a hands-on culinary medicine component to nutrition and examine academic impact, feasibility and acceptability.

RESULTS

Twenty-four studies met the eligibility criteria. Despite promising gains in nutrition knowledge, confidence and high acceptability of the programs, large variations exist in delivery method, setting, and course content between programs. There is a lack of program cost reporting and long-term follow up of participants, inconsistent evidence for improved nutrition attitudes amongst participants, as well as geographically limited adoption of such programs.

CONCLUSIONS

The findings of this research demonstrate a clear increase in interest in the use of hands-on culinary medicine programs as educational tools, evidence of feasibility in implementation, and improved student nutritional knowledge, skill and counseling compared to a traditional didactic curriculum. The quality of culinary medicine research studies is increasing and the aims of research are narrowing to focus on how culinary medicine can positively impact medical education. The findings from this review will aid in legitimising culinary medicine as an effective delivery method of nutritional education in medical programs.

Barriers and Facilitators of Implementing a Clinic-Integrated Food Prescription Plus Culinary Medicine Program in a Low-Income Food Insecure Population: A Qualitative Study

BACKGROUND

Food prescription and culinary medicine programs are gaining popularity as tools for decreasing food insecurity, increasing personal agency, promoting healthy eating, and reducing the risk of chronic diseases. However, there is a gap in understanding of how health care professionals can deliver evidence-based how-to nutrition information that is tailored for culturally diverse, low-income populations.

OBJECTIVE

To understand the barriers and facilitators for healthy eating among a low-income, diverse population with diabetes, and the gaps in knowledge and training needed for registered dietitian nutritionists (RDN) to address patient barriers when implementing a food prescription and CM program in a healthcare setting.

DESIGN

A series of nine focus groups were conducted: six focus groups with patients with diabetes (n = 40) (three in English and three in Spanish) and three focus groups with RDN employees (n = 17).

PARTICIPANTS/SETTING

A convenience sample of 40 low-income food insecure patients with diabetes receiving care at a diverse, integrated, safety net health care system in an urban setting in Texas and convenience sample of 17 RDN employees.

STATISTICAL ANALYSIS

All focus group transcripts were examined by independent reviewers and blind catalogued and organized into common themes and subthemes based on constant comparative methodology. Investigator group consensus was reached on emergent themes and subthemes for the respective focus groups.

RESULTS

Patients reported frustration with mixed dietary messages from different health care providers, lack of culturally inclusive recommendations, and a desire for skills to prepare tasty and healthy food. RDNs desired more training and education in cultural humility, culinary nutrition skills, and behavioral change theory.

CONCLUSIONS

Our study describes how cultural humility, practical culinary nutrition skills, and consistent and coordinated messaging can help to improve patient nutrition care. Before implementation of a food prescription and culinary medicine program, efforts should promote training of RDN staff in culinary nutrition and related areas to increase acceptability and adherence of the program for patients.

A Suggested Strategy to Integrate an Elective on Clinical Nutrition with Culinary Medicine

Time allocated to nutrition education in the medical school curriculum stands in contrast to high mortality rates attributable to poor diet in patients. Counseling patients on nutrition-related diseases is a critical skill for physicians, particularly those entering primary care. The crowded medical school curriculum has made adding hours of nutrition instruction difficult. This study evaluates the attitudes of undergraduate medical students at a single institution regarding the need for and relevance of nutrition education and reports on organization of and students' responses to a short experimental elective. Student attitudes regarding nutrition in medicine and a proposed nutrition elective were surveyed. Results helped formulate a short experimental elective. A two-session experimental course was completed, after which the participants were surveyed. Students agreed or strongly agreed with statements regarding the importance of nutrition in clinical practice. Greater than 60% of students surveyed in each class were interested in the proposed elective. All participants found the elective with culinary medicine sessions at least moderately useful to their needs as future healthcare providers. The majority of participants (more than 93%) reported being likely to both take and recommend the elective should it be offered in the future. Medical students consider nutrition an essential aspect of a patient encounter, but do not feel prepared to counsel future patients on dietary changes for management and/or prevention of nutrition linked diseases. There is strong student support for creating an elective in clinical nutrition with culinary medicine sessions to address the gap in their education and improve their confidence.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01346-3.

Culinary Medicine for Family Medicine Residents

BACKGROUND

Physicians are inadequately trained to effectively provide lifestyle counseling to manage the obesity epidemic.

ACTIVITY

Family and community medicine residents participated in a culinary medicine course taught by two Registered Dietitian Nutritionists (RDNs) in University Park, PA, in March 2020.

RESULTS

All residents (n = 13) reported increased knowledge, 92% (n = 12) reported increased confidence, and 84.6% (n = 11) reported they intended to make changes to their practice based on the class. Most participating residents (85%, n = 11) would attend follow-up classes.

DISCUSSION

Residents recognized the importance of nutrition in clinical care and found the information to be applicable to practice.

Nutrition from the kitchen: culinary medicine impacts students' counseling confidence

BACKGROUND

Although a poor diet is the number one risk factor for early death in the United States and globally, physicians receive little to no training in dietary interventions and lack confidence counseling patients about lifestyle modifications. Innovative, interprofessional strategies to address these gaps include the emergence of culinary medicine, a hands-on approach to teaching the role of food in health outcomes. We sought to assess the impact of a culinary medicine elective on counseling confidence, awareness of an evidence-based approach to nutrition, and understanding of the role of interprofessional teamwork in dietary lifestyle change among medical students at one undergraduate medical school.

METHODS

We administered pre- and post-course surveys to two cohorts of medical students (n = 64 at pre-test and n = 60 at post-test) participating in a culinary medicine enrichment elective. Chi-square analysis was used to assess the relationship between participation in the course and a positive response to each survey item.

RESULTS

Compared with the baseline, students participating in culinary medicine were more likely to feel confident discussing nutrition with patients (29% vs 92%; p < 0.001), to feel familiar with the Mediterranean diet (54% vs. 97%; p < 0.001), and to understand the role of dietitians in patient care (37% vs. 93%; p < 0.001).

CONCLUSIONS

Culinary medicine shows promise as an impactful educational strategy among first-year medical students for increasing counseling confidence, promoting familiarity with evidence-based nutrition interventions, and augmenting understanding of the role of interprofessional engagement to address lifestyle-related disease.

Food as Medicine: A Pilot Nutrition and Cooking Curriculum for Children of Participants in a Community-Based Culinary Medicine Class

PURPOSE

Healthy dietary change proves challenging for all families navigating the variable food preferences of children but can be especially burdensome for low-income families with limited resources. Encouragingly, programs that engage children in hands-on nutrition education appear to promote changes that positively impact the entire family. From these observations, we designed a dedicated pediatric cooking and nutrition class concurrent with a community-based culinary medicine class for adult clients of a food pantry.

DESCRIPTION

Through the Food As Medicine (FAME) nutrition education initiative at community pantry sites, we launched culinary medicine classes for pantry clients and offered concurrent culinary medicine classes for their children. Each pediatric class included an interactive lesson, hands-on cooking, and crafts or games to reinforce concepts prior to sharing a meal with parents.

ASSESSMENT

The pilot classes launched at two pantry sites, and the team leading the pediatric classes solicited feedback from participants and stakeholders to enable thematic analysis of the impact. Observations included the ability of children to identify new foods and to report enthusiasm for assisting with food preparation at home. Child participants engaged in the class demonstrated willingness to try new foods when joining their parents for a meal.

CONCLUSION

This pilot intervention details an educational, hands-on nutrition and cooking curriculum for children of low-income families. Through age-appropriate experiential learning, we observed a positive impact of this class in its ability to encourage family participation, to augment nutrition lessons taught to parent participants, and to empower young learners to advocate for healthy dietary change.

A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart

Background

Cooking interventions have increased in popularity in recent years. Evaluation by meta-analyses and systematic reviews show consistent changes in dietary quality reports and cooking confidence, but not of cardiovascular (CVD) biomarkers. Interventions evaluating or reporting behavioral mechanisms as an explanatory factor for these outcomes has been sparse. Moreover, evaluations of cooking interventions among communities with health disparities or food access limitations have received little attention in the literature.

Methods

This study will occur over two phases. Phase 1 will assess acceptability among the target population of African-American adults living within an urban food desert. Phase 2 will consist of a 6-week cooking intervention delivered at a community kitchen setting. Pre and post intervention visits for clinical examinations and biomarker collection will be conducted, as well as dietary and cooking skill assessments. Primary outcomes include cooking behavior and feasibility measures. Secondary outcomes are related to dietary quality, psychosocial factors, CVD biomarkers, and food environment measures.

Discussion

This study seeks to demonstrate feasibility of a community-based cooking intervention and to provide necessary information to plan future interventions that identify cooking behavior as an outcome of participation in cooking interventions among African-American adults, especially in relation to dietary and biomarker outcomes.

Trial registration

This study was registered at ClinicalTrials.gov (NCT04305431) on March 12, 2020.

Experiential Application of a Culinary Medicine Cultural Immersion Program for Health Professionals

Nutrition is a key factor in preventing and treating long-term disease. Patients should be advised to follow evidence-based dietary patterns, such as the Mediterranean diet, which has shown success in preventing or managing a variety of long-term diseases. All health professionals can play a role in providing nutrition advice to patients; however, many have shown an overall low nutrition knowledge and self-efficacy in counseling patients. Because of this, there is a call by health professional organizations for an increase in the applied nutrition education of health professionals. Increasing Culinary Health Opportunities for Professionals is a learn-first, practice second experiential learning program with currently practicing or aspiring health professionals aimed to increase nutrition knowledge, self-efficacy, attitudes, and dietary intake. Currently practicing health professionals (n = 15) and aspiring health professionals (n = 14) were recruited to participate in a 16-week online course on culinary medicine and the Mediterranean diet followed by a 2-week cultural immersion in Tuscany, Italy. Participants were taught the Mediterranean diet and lifestyle, culinary medicine, nutrition counseling, and cultural comparisons in the online course. In Tuscany, participants completed culinary lessons, organic farm tours, food production facility tours, and various tastings of Mediterranean foods. Participants completed a 51-item survey that measured nutrition knowledge, self-efficacy, attitudes, and Mediterranean diet adherence at baseline, post-online education, and post-cultural immersion. Mann-Whitney U tests were used to determine differences in mean scores between cohort 1 (currently practicing) and cohort 2 (aspiring). Results showed that cohort 1 had a greater increase in knowledge (1.07 ± 0.40 vs -0.87 ± 0.40, P = .0069) and self-efficacy (0.74 ± 0.24 vs 0.01 ± 0.24, P = 0.0441) from pre-post course, but at the conclusion of the cultural immersion, there were no significant differences between cohorts in mean changes in attitude, knowledge, self-efficacy, or Mediterranean diet scores from baseline. These results suggest that implementation of this curriculum can be equally effective in increasing nutrition-related attitudes, self-efficacy, and Mediterranean diet adherence for both currently practicing and aspiring health professionals.

Culinary medicine and community partnership: hands-on culinary skills training to empower medical students to provide patient-centered nutrition education

Given the economic burden and numerous morbidities associated with obesity and poor dietary choices, it is increasingly important for medical students to receive education on nutrition and preventive medicine so that they are equipped to advise patients about healthy lifestyle choices. Currently, 71% of US medical schools do not reach the minimum benchmark of 25 hours of nutrition education set by the National Academy of Sciences. In order to improve the quality and quantity of nutrition education at the Keck School of Medicine of USC (KSOM), medical students and faculty have partnered with LA Kitchen (LAK), a local teaching kitchen, and the Wellness Center at LA County Medical Center (LAC+USC). They developed a hands-on preclinical culinary and nutrition course that aims to teach students practical skills and knowledge that they will be able to apply to their own lives and pass onto patients. Following the completion of the first three years of the course (2016-2018), analysis suggests that the class was well-received and has improved students' nutrition knowledge, confidence in lifestyle counseling, and personal culinary skills. Given these highly encouraging observations, the project is currently aimed at incorporating nutrition education more broadly into the required preclinical curriculum at KSOM.

"Eat to Live"-Piloting a Culinary Medicine Program for Head & Neck Radiotherapy Patients

BACKGROUND

Head and neck radiotherapy (H&N RT) patients are at risk for malnutrition following treatment due to dysphagia and alterations in taste quality. This project studied feasibility of a food skills intervention strategy support food preparation, cooking confidence, and individualized dietary choices to support nutritional status in this patient population.

METHODS

We piloted a monthly cooking class (called "Eat to Live") from November 2018 to January 2019. Every class included cooking and nutrition domains, organized around a specific meal of the day (i.e., breakfast, lunch, or dinner). Seven participants (4 patients, 3 caregivers) attended at least one class, with four participants (3 patients, 1 caregiver) completing all three classes. Pre- and post-study measures (self-administered questionnaires) assessed changes in cooking behavior, dietary choices, and taste sensation before and after the intervention.

RESULTS

Healthful eating scores increased modestly from start to finish of the class (1.5 to 1.7 on a 3-point scale), with averaged patient preference scores for healthy foods increasing incrementally. This took place despite physical taste scores declining across the 3-month study. After completing the class, participants were more likely to select fresh fruits and vegetables, grains, lean cuts of meat, and dairy products. Patients also adopted positive behavioral modifications to their diets, such as eating out at restaurants less often and baking/grilling foods instead of frying.

CONCLUSIONS

To our knowledge, this is the first published report on feasibility and patient acceptance of an evidence-based culinary medicine intervention in H&N RT patients. We observed objective improvements in dietary choices and cooking confidence in a small cohort of patient/caregiver dyads. This pilot work justifies follow-on development of a more comprehensive intervention optimized for patient convenience and longitudinal support.

Development and Evaluation of a Nutrition-Centered Lifestyle Medicine Curriculum for Physician Assistant Students

BACKGROUND

US medical schools are increasingly integrating lifestyle medicine competencies into their academic programs. Yet, physician assistant (PA) academic programs have been slower to respond.

METHODS

We developed, implemented, and evaluated a nutrition-centered lifestyle medicine curriculum for 2nd-year PA students (n = 24). The 4-week hybrid, 2-credit hour course activities aligned with the American College of Lifestyle Medicine competencies for primary care providers and reinforced four of the Accreditation Standards for PA Education. We combined didactic lectures with weekly hands-on cooking modules from the "Health meets Food" courseware for medical students. We employed a pre-post evaluation design including a comparison group of 2nd-year PA students in a separate program. We assessed changes in personal nutrition behaviors and knowledge and confidence for counseling in nutrition, exercise/physical activity, weight, smoking, and alcohol, using the modified 5A's framework (assess, advise, agree, assist, and arrange) for lifestyle counseling.

RESULTS

Students receiving the intervention demonstrated significantly higher gains in both knowledge and confidence for the 5A's of nutrition counseling compared to the control group. Self-reported knowledge and confidence for the 5A's of counseling for the other lifestyle behaviors similarly improved among the intervention group compared to the control group, but to a lesser extent.

CONCLUSION

A nutrition-centered lifestyle medicine course can demonstrate PA academic program adherence to accreditation standards, while also introducing students to nutrition and lifestyle medicine competencies. Hands-on experiences that reinforce didactic instruction may maximize student knowledge and self-efficacy for implementing lifestyle medicine into their practice.

Culinary Medicine: Patient Education for Therapeutic Lifestyle Changes

There is a well-established body of evidence that connects particular dietary lifestyle choices to good health. Despite this knowledge, rates of obesity, cardiovascular disease, and metabolic disease continue to rise. Culinary medicine uses what is known about the pharmacologic properties of food to treat, manage, and prevent disease. It fuses medicinal nutrition with culinary knowledge to help individuals adopt a diet that supports good health. Culinary techniques used to change behaviors and improve eating habits is an innovative modality to preserve and promote the health of a nation in need of effective medical interventions.

Preventing Type 2 Diabetes with Home Cooking: Current Evidence and Future Potential

PURPOSE OF REVIEW

Various dietary regimes have proven effective in preventing diabetes, yet its prevalence is growing. This review's goals are to examine the relationship between home cooking and diabetes and to present the literature on home cooking education programs as a novel strategy to improve adherence to healthy nutrition, thus decreasing the risk of diabetes.

RECENT FINDINGS

Consumption of home-cooked food is linked to healthier nutrition and decreased risk of diabetes. Further, home cooking interventions have a short-term positive impact on nutritional intake of both children and adults, and on diabetes prevention. Well-designed randomized controlled studies are needed to rigorously evaluate the long-term impact of home cooking interventions on cooking behavior, dietary intake, diabetes, and healthcare costs. Culinary education is an emerging field that aims to change nutrition education paradigms. Clinicians can empower patients to adopt home cooking by role modeling home cooking themselves, including home cooking content in their medical encounters, and through comprehensive lifestyle medicine interventions.

Impact of culinary medicine elective on medical students' culinary knowledge and skills

Diet has an important role in the treatment and prevention of chronic illnesses. Physicians are regarded as having proficient knowledge about nutrition, but most believe that they lack an understanding of clinical nutrition. In fall 2016, a group of medical students developed a culinary medicine elective for 20 students at Texas Tech University Health Sciences Center School of Medicine in Lubbock that included four didactic sessions and four interactive cooking labs that culminated in a final contest. The elective was meant to educate medical students about nutrition and dietary habits for their own benefit and that of their future patients. Surveys were administered to participants before and after the elective. Results showed a significant increase in confidence in overall culinary skill level, knowledge of ingredients, knowledge of cooking techniques, and ability to use kitchen supplies (P = 0.002, 0.002, 0.0004, and 0.003, respectively). The culinary medicine elective appears to be a valuable addition to the medical school curriculum.

Medical school-based teaching kitchen improves HbA1c, blood pressure, and cholesterol for patients with type 2 diabetes: Results from a novel randomized controlled trial

AIMS

A medical school-based teaching kitchen sought to establish proof-of-principle for its hands-on Mediterranean diet (MD)-based cooking and nutrition curriculum for patients with type 2 diabetes (T2D).

METHODS

This pilot randomized controlled trial (RCT) allocated 27 patients with T2D between the control and GCCM arms. Mixed effects linear regression with repeated measures was used to investigate differences from baseline to 6 months. The primary and secondary endpoints were HbA1c -0.3% (-27 mmol/mol) and diastolic blood pressure (DBP) -10 mmHg and a 25% improved responses in dietary habits and attitudes and competencies in healthy nutrition.

RESULTS

Compared to the control group, the GCCM group had superior HbA1c reduction (-0.4% vs. -0.3%, p = 0.575) that was not statistically significant. There were significantly greater reductions in the GCCM vs. control group for DBP (-4 vs. 7 mmHg, p=0.037) and total cholesterol (-14 vs. 17 mg/dL, p = 0.044). There was a greater proportion increase though not significant of GCCM subjects compared to controls who mostly believed they could eat correct portions (18% vs. -11%, p = 0.124), and who used nutrition panels to make food choices (34% vs. 0%, p = 0.745).

CONCLUSION

This is the first known RCT demonstrating improved biometrics using a novel MD-based hands on cooking and nutrition curriculum for patients with T2D. These results suggest subsequent clinical trials are warranted on the grounds of documented feasibility and clinical efficacy.