Health Meets Food: Bridging the Gap in Nutrition Education

America’s food and work culture have led to the doubling of obesity since the 1980s, like yeast making bread rise, with no rest in sight. For those on a weight loss journey, or for those in the pre-contemplation stage, success often relies on guidance and support of the journey goer’s physician. A multitude of studies have concluded that most physicians feel unprepared to provide nutrition-related advice and treatment plans to patients. We can trace this dearth of nutrition education back to medical school, where, on average, medical students receive just three-quarters of the recommended twenty-five hours of nutrition education. Not all medical schools even require nutrition education. For those schools with nutrition education requirements, most do not provide a dedicated nutrition course. Furthermore, diet-related preventable diseases are among the leading causes of mortality in America, including cancer, cardiovascular disease, and diabetes mellitus.

Before seeking solutions, we must acknowledge the challenge that accompanies any lifestyle change - particularly in patients with habits so ingrained that they have led, or contributed, to a disease state. As any physician would agree, getting one’s patients to actively engage in lifestyle changes is a major feat. Nutrition knowledge should be ubiquitous among physicians to allow them to best serve their patients. In some settings, such as inpatient and urban settings, we rely less on a physician’s nutrition knowledge in treating patients. However, the ability of any physician to participate in nutrition-related treatment plans sets their patients up for greater success by reinforcing the importance of and plan for dietary changes and fielding patient questions. The question now remains; how do we ever hope to lose the cumulative pounds we have gained as a country?

The most important place to start is by fortifying medical school nutrition education. This would serve as an investment in a future filled with nutritionally-minded physicians more adept at treating diet-related disease and better equipped for participating in interdisciplinary treatment management.

Various educational models have been studied to ascertain the most effective nutrition education model in medical schools. The multiyear prospective observational cohort study, Cooking for Health Optimization with Patients (CHOP), conducted by researchers at Tulane University, showed superiority of hands-on cooking and nutrition education compared to the traditional medical school curriculum in a sample of 627 medical students. This research was the first step in the creation of the replicable, hands-on nutrition education program, Health Meets Food. In their more recent multisite cohort study, hands-on cooking and nutrition education, as compared to traditional medical school curricula, improved 3,248 medical students’ nutritional counseling competencies as well as improved student’s diets.

Dr. Beth Dollinger is a well-known Orthopedic Surgeon at Arnot Ogden Medical Center, located upstate in Elmira, NY. This hospital is affiliated with Lake Erie College of Osteopathic Medicine (LECOM). Six years ago, Dr. Beth Dollinger brought the Health Meets Food program to Arnot Ogden Medical Center and has since been the Elmira program’s director. Her foray into nutrition education started with the idea of preventative medicine. Her patients needed to lose weight as part of their orthopedic treatment plan. Simultaneously, she came across article after article about the success of the Health Meets Food program. It occurred to her that there was a confluence of ideas - her patients’ orthopedic treatment plans could be facilitated, in part, by nutrition education. The legacy of her work will be furthered by medical student program participants who subsequently implement their knowledge into practice and seed additional nutrition education programs.

Since being brought to Elmira, the Health Meets Food program’s mediterranean-diet based recipes are fortifying LECOM’s nutrition education as well as the health of Elmira’s community. The program centers around hands-on, in-the-kitchen learning where participants are challenged to bring nutritious recipes to fruition and to enjoy the tasteful meal they have made together, all the while listening to nutrition education inspired by the meal. One could even call this program a “sim-lab” for nutrition education. Health Meets Food is offered to medical students rotating at Arnot Ogden, as well as to adults and children within the Elmira community. As it is often said that the best way to learn is to teach, we rely on LECOM medical students to coordinate and teach the hands-on cooking modules during our community program. In total, we offer 3 Health Meets Food programs throughout the year: a fall program for medical students, a winter program for adults in the Elmira community, and a summer program for children in the Elmira community. As we prepare for and engage in each cooking module, participants are challenged to further their knowledge in nutrition, medicine, sustainability, and public health policy. Health Meets Food regularly invites guests from Arnot Ogden Medical Center to teach as well as to work alongside us in the kitchen.

The success of our program lies heavily in interdisciplinary collaboration and interdisciplinary education. This year, Health Meets Food-Elmira hosted a hospital dietitian as a guest speaker to a class. She spoke about the communication strategies needed to traverse the different stages and types of nutrition-related conversations with patients. These skills will help physicians-in-training gain the confidence and knowledge to discuss nutrition plans and recommendations with patients. Various culinary experts, including commercial and hospital chefs, have come in to teach Elmira program classes as well. Their skill and expertise helped participants hone their culinary skills while highlighting the importance of meal presentation and appearance.

Such a hands-on program in nutrition education not only provides education, but also creates time and space for students, community members, and teachers to come together to learn and have fun. Due to the demanding nature of medical school, medical students’ time to cook at home is often limited. Community members may also face food insecurity or struggle to cook at home. Through this program, students and community members can rely on a weekly homemade nutritious meal- at least for the duration of the program. The leftovers the participants get to take home are a notable, and tasty, bonus.

Through this interdisciplinary approach, we can all help to change the course of health in our country. For example, Wegmans, a New York-based grocery store, coordinates with dietitians to better serve their community. The Cellar, a local Corning restaurant, centers its menu around locally sourced ingredients turned into farm fresh healthy meals. The Food Bank of the Southern Tier is fighting food insecurity by coordinating with local businesses to provide healthy and nutritious food. Recently, medical student volunteers, who are also Health Meets Food participants, have volunteered to help the food bank reach people needing help during the COVID-19 pandemic. By working together to learn, make meals, and create partnerships, we are able to satisfy both mind and stomach.

We look forward to the continued success of the Health Meets Food program and to its expansion to include the new first-year medical students beginning their medical education journey at LECOM’s new campus in Elmira. We are also delighted to continue building interdisciplinary healthcare worker camaraderie over the breaking (and toasting) of whole grain bread. Over sixty medical schools have already adopted and implemented this comprehensive nutrition education program. For those seeking to start, please reach out through https://culinarymedicine.org/.

About the Guest Author

Jen Lenchner is a rising 4th year medical student at the Lake Erie College of Osteopathic

Medicine – Seton Hill. She became interested in the Health Meets Food program at Elmira

during her clinical rotations, eventually rising to the role of research coordinator. Jen plans on going into psychiatry and is excited to implement nutrition into her practice.

Sources

1. Kahan S & Manson JE (2017) Nutrition counseling in clinical practice: how clinicians can do better. JAMA 318: 1101–2.

2. Frantz, David J., et al. "Cross-sectional study of US interns’ perceptions of clinical nutrition education." Journal of Parenteral and Enteral Nutrition 40.4 (2016): 529-535.

3. Vetter, Marion L et al. “What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge.” Journal of the American College of Nutrition vol. 27,2 (2008): 287-98. doi:10.1080/07315724.2008.10719702