Culinary medicine: why doctors have to be skilled with a kitchen knife

By Mardi Chapman

29 Jun 2020

Forget the scalpel and instead get acquainted with a kitchen knife as culinary skills are needed more than ever in medicine to counter an obesogenic world.

The ADA 2020 virtual Scientific Sessions heard from experts – including dual qualified medicos and chefs – on the importance of being able to help patients with practical support around food choices rather than abstract discussion about micronutrients.

Dr David Eisenberg, a physician and director of culinary nutrition at the Harvard T. H. Chan School of Public Health, said improvements in cardiometabolic health will require changes in society and personal behaviour.

Cooking at home was at an all-time low in countries such as the US yet the evidence clearly shows there are correlations between cooking skills and levels of obesity, weekly vegetable consumption and the long term risk of diabetes.

“We as medical professionals are not trained to advise patients about food, diet, exercise and lifestyle. We are not required to prove competence re: diet and exercise on certification exams,” he said.

Yet the translation of nutrition information into practice is failing and innovative ways of demonstrating how patients can succeed with diet and lifestyle are required.

Dr Eisenberg founded the concept of teaching kitchens in which health professionals can learn skills such as meal preparation and planning through to nutrition counselling.

And the model of mobile and pop-up teaching kitchens can become “experiential learning laboratories” to help patients with chronic diseases such as diabetes and prediabetes learn life skills.

Dr Michelle Hauser, a physician and chef, teaches culinary medicine at Stanford

Clinical Associate Professor Michelle Hauser, an internal medicine physician and qualified chef from Stanford University School of Medicine, told the meeting that culinary medicine should be available to health professionals at all levels of their training.

She said culinary medicine was an evidence-based field that brings together nutrition and culinary knowledge and skills, to assist patients in maintaining health and preventing and treating disease by choosing high quality, healthy food in conjunction with appropriate medical care.

It could help bridge the gap between the majority of patients who consider doctors as very credible sources of nutrition information and the majority of doctors who feel inadequately trained to advise patients on food and eating behaviours.

“And last but not least, personal practice matters. Healthy physicians are much more likely to advise patients on the healthy behaviours that they practice themselves,” she said.

According to Dr Hauser, culinary medicine training is now available in some medical schools, during medical residencies and as part of continuing medical education.

For example, Stanford has been offering a teaching kitchen elective The Doctor is In (the Kitchen) for its medical students since 2017, delivered by two chef-MDs, other chefs and medical specialists.

And participants reported that knife skills were one of the most important skills they learned.

“I would say the biggest gap in nutrition for most people is that they are not eating produce, especially vegetables, and part of that is that they just don’t know how to efficiently chop those up,” she said.

A study of students who completed the program versus wait-listed students also showed improvements in basic cooking skills and techniques and confidence in planning balanced meals.

They also felt they were personally eating better and could use their new knowledge in talking to patients about how to enjoy home cooked, healthy food and overcome any potential barriers they faced.

Associate Professor Hauser said her comprehensive culinary medicine curriculum is now freely available online for health professional education.

Dr Linda Shiue, an MD and chef, said the power of culinary medicine when applied in the clinic setting lies in promoting and supporting healthy eating patterns, improving measures such as HbA1c, helping patients achieve weight goals, and delaying or preventing diabetes complications.

She said she would love to see cooking classes in every clinic as it is more effective in changing behaviour than nutrition education alone.

“This is all about seeing it, experiencing it, doing it and sharing a meal together.”

Dr Shiue, director of culinary medicine at the Permanente Medical Group, said providing teaching kitchens in a clinic setting is a low cost, accessible and culturally adaptable intervention.

Having cooking classes delivered in the place patients receive their health care also creates a positive association between food and health, she said.

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