Farshad Fani Marvasti, MD, MPH, is part of a growing movement to fundamentally shift medical education to include training on how to cook healthy meals.
The way he sees it, the stakes couldn't be higher. He believes doctors need to see food as medicine to be able to stem the tide of chronic disease.
About 6 in 10 adults in the United States live with chronic diseases, according to the Centers for Disease Control and Prevention, costing $4.1 trillion in annual healthcare costs. Adult obesity rates are rising, as are obesity-related conditions such as heart disease, stroke, type 2 diabetes, and certain types of cancer.
To turn the tide, Marvasti created a culinary medicine program in 2020 in collaboration with the University of Arizona Cooperative Extension and local chefs.
Marvasti, who is board certified in family medicine, graduated from the University of Arizona, Phoenix, where he serves as the director of the medical school's Culinary Medicine Program.
The program offers an elective course for third- and fourth-year medical students, which introduces the evidence-based field of culinary medicine. Marvasti's goal is for the course to teach students how to use this science and the joy of cooking to improve long-term health outcomes for their patients.
As part of Marvasti's program, students learn cooking fundamentals through chef demonstrations and hands-on practice — to teach students how food can be used to prevent and treat many chronic diseases.
One of the dishes students learn to make includes a quinoa salad made with cucumber, onion, bell peppers, corn, cherry tomatoes, beans, garlic, olive oil, and lemon juice. Another recipe includes a healthier take on dessert: Dark chocolate mousse made with three large, ripe avocados, dark chocolate powder, three tablespoons of agave or maple syrup, coconut cream, nondairy milk, salt, and vanilla. Marvasti and his team are set to build out the existing program to develop additional resources for medically underserved and rural communities in Arizona, according to a statement from the university. These plans will be funded by a $750,000 grant from Novo Nordisk, the Danish drug company.
"We're going to develop an open education curriculum to share, so it's open access to everyone," said Marvasti, who is also director of Public Health, Prevention and Health Promotion and an associate professor at the university. "It can be adaptable at the undergraduate, graduate, and postgraduate level."
Marvasti and his colleagues at the University of Arizona aren't alone. In fact, culinary medicine programs are sprouting some serious legs.
Culinary Medicine Programs Catch On
Jaclyn Albin, MD, CCMS, an associate professor in the departments of internal medicine and pediatrics at the University of Texas, Dallas, conducted a scoping review of the literature on culinary medicine programs for medical students. Her purpose was to learn how the programs were structured and how they assessed student knowledge and attitudes regarding nutrition counseling for patients.
Albin and her colleagues performed an initial literature search between June 1 and Aug. 1, 2020, of papers published between Jan. 1, 2012, and Aug. 1, 2020 — excluding some newer programs such as the one at the University of Arizona. The results of their research were published in Academic Medicine.
Ultimately, the authors identified and examined 34 programs offering medical student–focused culinary medicine courses.
Program instructors typically included a team of physicians, dietitians, chefs, and other professionals, the study found.
Most program participants exclusively taught medical students, though the training years of participants varied among programs, and they included first-, second-, third-, and fourth-year students. Some programs allowed students from outside their respective medical school to participate in the trainings.
As for the formats of the program, most included cohorts of 10-20 students attending multiple 2- to 3-hour sessions over the course of several months. The University of Alabama at Birmingham offers one of the longest courses, which spans 4-5 months, according to the paper. In contrast, the University of Rochester (N.Y.) program offers only a 1-day lab divided into four sessions, with each session lasting about 2 hours.
The culinary medicine programs' course sessions tended to include a 10- to 30-minute didactic session involving videos, research articles, culinary theories, and other lectures, a 60- to 90-minute hands-on cooking session, and a 30-minute discussion around nutrition, culture, and patient care.
Most programs used pre- and post-program surveys to evaluate outcomes, though results varied between programs, according to the study. While each program evaluation had different metrics, the surveys generally revealed students felt more confident discussing dietary interventions with patients and in their own cooking skills following completion.
Course Correction
Most of those programs are unfunded or minimally funded, Albin said.
Her own program, which is immensely popular with medical students, is one she teaches on a volunteer basis.
"I do this for free, in the evenings, because I believe in it," she said.
Medical school education real estate is limited, so convincing medical schools to add something to the curriculum is difficult, Albin noted.
But it's worth it, she said, because nutrition is the underpinning of so many diseases.
"Food is the top risk factor for early death in the US," Albin said. "I like to say that five times in a row. People have not digested it."
During her culinary medicine courses, she also asks her medical students: "Who is comfortable in the kitchen?" Some sheepishly raise their hands, she said. Some don't. Many don't know anything about cooking.
Then she teaches students about healthy food and how to make it. As part of her program, medical students are given a pantry starter kit with olive oil and a variety of spices to take home and use.
Some recipes Albin teaches includes mango chili shrimp salad with lime vinaigrette, eggplant sliders, yellow vegetable curry, and strawberry banana chia pudding.
"If you figure out how to do it for your own busy, everyday life, you are now empowered to tell someone else about it," she said.
A Dietitian's Involvement
Milette Siler, RD, LD, CCMS, works with Albin to educate medical students and patients about food as medicine. A significant chunk of her job involves teaching future doctors what dietitians do.
When the class starts, many students don't know two of the five basic things dietitians do, Siler said. By the end of the class, all students know what a dietitian does.
That's important as students go on to become doctors.
"For us to remove barriers to care, we have to acknowledge most patients' entry into healthcare is their physician," she said. "The dietitian is often a referral. Doctors need to know enough to do no harm."
Clinicians are often siloed, she said, and the key to better serving patients is partnership, transparency, and relationships. "I think everybody is at a point where everyone is saying what we're doing isn't working," she said. "The American public deserves better, physicians deserve better, and clinicians deserve better."
Popular With Students
While the old guard has been slow to embrace the shift, her students have helped drive the growth of the culinary medicine field, Albin said.
"They are not settling for the inadequacy that somehow the rest of us did," she continued. "I'm so hopeful for the future of the health system. We have a generation of people who will not stand for neglecting the most vital elements."
Lyndon Bui, a second-year medical student at the University of Arizona, Phoenix, is an example of one of these people.
As a member of a culinary medicine interest group on campus, he said, he has learned a lot about the importance of diet for long-term health. This has given him confidence to talk about food and nutrition.
His group does cooking demos at the Phoenix Farmers Market using food from various local vendors. They usually make a salad from local greens and cook seasonal veggies in a stir fry, he said.
They've previously made salad with microgreens — young seedlings of edible vegetables and herbs — and pomegranate seeds with a honey mustard vinaigrette, eggplant or cucumber, and hummus on pita bread, as well as almond butter and honey sandwiches, according to the university.
The group also talks with people in the community, answers questions, and learns about community needs.
Bui's participation in this group has helped him cultivate a passion for community outreach that he wants to incorporate into his career.
"I feel like I have the knowledge to provide better advice to patients," he said. "Knowing all these things about food, I feel more comfortable talking about it and more inclined to refer to a dietitian when maybe I wouldn't have before."
Family Physician Applauds Culinary Medicine Programs
When Angie Neison, MD, CCMS, went to medical school, she was surprised there wasn't more education on nutrition.
In fact, on average, physicians receive less than 20 hours of nutrition education, according to the University of Arizona.
Now 15 years into her career as a family physician, Neison says nutrition is a huge part of her practice. She spends time working to bust myths about nutrition for her patients — including that healthy food is boring and bland, that making it is time consuming, and that healthy food is expensive. She also spends time teaching aspects of culinary medicine to her colleagues — many of whom are well into their careers — so they can better serve their patients.
It's worth it to spend time learning about nutrition, she said, whether that's as a medical student in a culinary medicine program or a practicing physician taking additional courses.
Nutrition education in medical school hasn't been a priority, she said, maybe because there is so much to learn, or maybe because there is no money to be made in prevention.
"If doctors learn it, they are able to better guide patients," she said.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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Cite this: Kelly Ragan. Medical School Culinary Medicine Programs Grow Despite Limited Funding - Medscape - Nov 18, 2022.
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