We Can Treat Patients and Medical Students with Culinary Medicine

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Back when I was in culinary school, I never would have imagined that one day I would be suturing skin instead of breaking down whole hogs. When I decided to pursue a career in medicine, I assumed my culinary training had been a waste of time an energy; nothing more than a “fun fact” about myself that I could share during ice-breakers. I could not have been more wrong. As I have progressed through my medical education, I have come to realize my background in cooking is almost more of an asset for promoting patient wellness than my knowledge of the Krebs cycle. This is because the ability to cook is directly related to the ability to control your nutrition on a budget — something almost all patients can benefit from. Unfortunately, it’s incredibly difficult to counsel patients on how they feed themselves if you don’t know how to feed yourself beyond prepared food.

At a time when more than one-third of American adults are obese [1], less than one-third of American medical schools provide students the minimum 25 hours of recommended nutrition instruction as recommended by a landmark study published in 1985 [2,3]. Many of those that do, simply provide passive lectures on the biochemistry of nutrition that students aren’t tested on (read: not paying attention to), my institution included. Although students sit for necessary examinations on rare genetic disorders and obscure syndromes, medical curriculum largely fails to include appropriate hands-on education on the most important factor that predicts premature death: diet [4]. This is demonstrated by the majority of graduating seniors from medical schools reporting that their nutrition education is inadequate [3], and is carried into clinical practice where most physicians report they do not have enough training to confidently counsel patients on nutrition [5–8], and will often defer to expensive or unavailable specialists instead of giving nutrition and dietary counseling themselves [9].

Medical school provides the perfect medium for culinary and nutrition education. A rare period when theory and concepts are emphasized prior to practice. Students are required to master the biochemical pathways and anatomical landmarks that comprise human anatomy and physiology prior to being able to prescribe medications and perform procedures that are based on these basic concepts. So, why shouldn’t the basics of cooking and nutrition be taught during medical school to ensure new medical graduates are comfortable counseling patients about their dietary habits?

Recently, the disconnect between nutritional and dietary education and medical education has been bridged by the development of curricula termed “culinary medicine.” First pioneered in medical education by Tulane University School of Medicine in 2012 through the creation of the Goldring Center for Culinary Medicine [10], culinary medicine is a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine by counseling patients on personal medical decisions about accessing and eating high-quality meals that help prevent and treat disease and promote well-being [11]. Culinary medicine offers systematic ways to help clinicians understand and appreciate the patient’s understanding of food and cooking as part of their care, and allows clinicians to help apply that understanding to the patient’s health care goals in a complementary manner to traditional, reactive medicine.

Longitudinal outcomes since the implementation of the culinary medicine curricula at Tulane have been promising. Medical students who completed this curriculum were three times more likely to understand that specific nutrition information can improve patients’ diets, three times as likely to understand diabetic dietary patterns, four times as likely to understand the benefits and downsides of a vegetarian diet, and four times as likely to understand the role of fiber in disease prevention [12]. Unfortunately, since 2012, only seventeen medical schools have adopted some form of culinary education for their medical students [13].

In addition to the good that learning the basics of cooking and nutrition can do for our future patients, these skills can also improve medical student wellness. Learning to integrate cooking and nutrition in the kitchen are real-world skills that medical students can practice at home, and even utilize as a stress outlet and tool to improve mental and physical wellness in an environment that is known for high stress and burnout.

Unfortunately, many medical schools simply do not have the resources or priorities to integrate culinary and nutrition education into their curriculum. Setting up a culinary medicine program requires both money and personnel — both of which many medical schools find in short supply. In addition, many schools seem to be more concerned with building curricula around LCME recommendations which are not always congruent with real-world skills.

Ultimately, culinary medicine education in medical school is not the silver bullet for the obesity epidemic. Even with improved nutrition and culinary education, providers still need to be incentivized to spend the time counseling patients rigorously on nutrition and basic food preparation skills. To do so, this intervention needs to be linked to reimbursements and providers must be allowed to spend more time with patients per visit. However, expanded culinary medicine training in medical school is a small and reasonable improvement in medical education that has the potential to outfit the modern practitioner with the practical skills to improve patient and physician wellness alike.

Alexander Diaz Bode is a fourth-year medical student at the University of Miami Leonard M. Miller School of Medicine. He completed his culinary training at Kishwaukee College and undergraduate degree at the University of Arizona.

References

1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief [Internet] 2015;(219):1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26633046

2. Council NR. Nutrition Education in U.S. Medical Schools [Internet]. Washington, DC: The National Academies Press; 1985. Available from: https://www.nap.edu/catalog/597/nutrition-education-in-us-medical-schools

3. Adams KM, Kohlmeier M, Zeisel SH. Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey. Acad Med [Internet] 2010;85(9):1537–42. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042309/

4. Murray CJL. The State of US Health, 1990–2010. Jama [Internet] 2013;310(6):591. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2013.13805

5. Darer JD, Hwang W, Pham HH, Bass EB, Anderson G. More training needed in chronic care: a survey of US physicians. Acad Med 2004;79(6):541–8.

6. Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med (Baltim) 1995;24(6):546–52.

7. Levine BS, Wigren MM, Chapman DS, Kerner JF, Bergman RL, Rivlin RS. A national survey of attitudes and practices of primary-care physicians relating to nutrition: strategies for enhancing the use of clinical nutrition in medical practice. Am J Clin Nutr 1993;57(2):115–9.

8. Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. J Am Coll Nutr 2008;27(2):287–98.

9. Chen PW. Teaching Doctors About Nutrition and Diet [Internet]. New York Times. 2010 [cited 2017 Oct 16];Available from: http://www.nytimes.com/2010/09/16/health/16chen.html

10. Medicine TUS of. The Goldring Center for Culinary Medicine [Internet]. [cited 2017 Jan 1];Available from: https://culinarymedicine.org

11. La Puma J. What Is Culinary Medicine and What Does It Do? Popul Health Manag [Internet] 2016;19(1):1–3. Available from: http://online.liebertpub.com/doi/10.1089/pop.2015.0003

12. Monlezun DJ, Leong B, Joo E, Birkhead AG, Sarris L, Harlan TS. Novel Longitudinal and Propensity Score Matched Analysis of Hands-On Cooking and Nutrition Education versus Traditional Clinical Education among 627 Medical Students. Adv Prev Med [Internet] 2015;2015:1–8. Available from: http://www.hindawi.com/journals/apm/2015/656780/

13. Rogers K. Why Medical Schools Are Starting to Teach Doctors How to Cook [Internet]. Vice. 2015 [cited 2017 Oct 16];Available from: https://motherboard.vice.com/en_us/article/kb7eb9/why-medical-schools-are-starting-to-teach-doctors-how-to-cook

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