It is no secret that physicians spend countless hours studying a wide variety of disease processes and treatments. We all know that sub-optimal dietary choices and habits can lead to chronic diseases such as obesity, cardiovascular disease, diabetes, and cancer. The burden of these diseases is rising astronomically. According to the USDA 2015-2020 guidelines, in 2008, the medical cost related to the chronic disease of obesity was estimated to be 147 billion. In 2012, the estimated cost of diagnosed diabetes was 245 million. This burden has come to light even further in our current pandemic as patients with obesity or diabetes have greater morbidity and mortality when they contract COVID-19. Despite knowing this, why do most physicians feel inadequately trained to provide themselves, their patients, and their community with practical nutrition education?
Nutrition education in medical schools is lacking, with most spending less than 25 hours on nutrition education over the course of four years. This limited education does not answer the basic question of “Doctor, what and how should I eat for my medical condition?” Most physicians have not been trained in culinary skills or preparation, behavioral nutrition, or healthful eating patterns. These factors influence patient adherence, quality, quantity, and consumption of healthier foods. When physicians model healthy lifestyle changes, we know that they are more likely to counsel their patients on these exact changes; it’s a win-win situation. This lack of knowledge and training could lead to patients feeling discouraged or lost when a health care provider or physician tells them to “eat more fruits and vegetables” but cannot explain how to do this successfully. A simple recommendation to eat healthy and exercise is inadequate.
Dr. Patel, an internal medicine hospitalist, recalls while in residency, when a “patient first asked me what they should eat for their medical conditions, all I said was “it is essential to eat fruits and vegetables.” We know blanket statements like this don’t change behavior, but I didn’t feel equipped to tell them more. It wasn’t until after I finished training that I realized I needed to make changes as poor dietary habits were taking a on toll my own health. Unfortunately, the internet is fraught with misinformation that is not evidence-based when it comes to nutrition, but thankfully I found the field of culinary medicine.”
Dr. Narang, an endocrinologist with a clinical emphasis on diabetes, weight management, and culinary medicine, spends day in and day out talking about food. Patients who come in for diabetes or weight management are often disheartened by prior recommendations to eat right and exercise. “People don’t know what that means, particularly when they have been raised in a certain culture, or within various family traditions, or when they have eaten in a certain way their whole lives. It’s a very tall order to expect someone to make changes without understanding where they are coming from.”
So what is culinary medicine, and why do we need it?
Culinary medicine adds to existing nutrition interventions by integrating the concept of the pleasurable qualities of healthful food and culinary technique with the scientific knowledge of how food and dietary choices influence human health. Culinary medicine aims to help a person achieve a healthful eating pattern by teaching patients how to choose, shop for, and prepare meals with healthful cooking habits and working within the confines of what resources are available to them. It also considers the behavioral aspect of food choices and consumption while understanding that our personal eating behaviors’ external influences play a significant role (culture, religion, social circle, and environment). Patients don’t want to be judged for their food choices, and we must understand this to create a collaborative framework for change. It’s important to work with patients to develop attainable goals that they are willing to meet.
The list of medical schools adopting a formal culinary medicine curriculum is growing, but this does not address the very important need to educate practicing physicians. Thankfully, a handful of programs fill this need, such as the Certified Culinary Medicine Specialist via Health Meets Food. As physicians, we want to help our patients lead healthier lives at the end of the day, but it starts with the need to understand the important role that dietary habits contribute to this. We hope that culinary medicine programs expand for physicians out of training. One day, this practical nutrition knowledge becomes second nature and an integral part of our day to day care for our patients.
Disha Narang is an endocrinologist. Nisha Patel is an internal medicine physician.
Image credit: Shutterstock.com
