How learning to cook is helping doctors give nutritional advice
■ Programs in a handful of medical settings are teaching how healthy foods actually can be tasty and how to get patients to change their eating habits.
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Lynn Li, MD, once had many of the same misconceptions about eating healthy that she hears from patients. She thought healthy cooking was difficult and time-consuming, and that meals rich in vegetables often lacked taste or weren't filling enough.
"I thought it's so much work and it tastes so awful," she said. "I always thought that vegetarian food tastes like cardboard."
Cooking classes helped Dr. Li open her eyes and expand her palate -- but they weren't taught at a cooking school or culinary institute. Dr. Li, who specializes in geriatrics, learned to cook healthy concoctions such as salmon burgers and tofu chocolate pie at the University of Massachusetts Medical School.
The school is one of a few that offer physicians the chance to test their skills in the kitchen, with cooking classes geared toward them. The goal is to give doctors the practical skills to prepare healthy meals so they can better advise patients about improving their diets, said Barbara Olendzki, RD, MPH, assistant professor and director of nutrition at UMass Medical School.
"One of the biggest barriers we have is taste, and physicians are no exception," Olendzki said. "When physicians are recommending a dietary change to a patient, often it is seen as something that is depriving. Rather than seeing it as a punishment, we want to get them excited and to see it as an opportunity."
Teaching physicians to cook also makes them more likely to eat healthy foods themselves and be more proactive in advising patients, said David Eisenberg, MD, Bernard Osher Distinguished associate professor of medicine at Harvard Medical School.
Dr. Eisenberg helped found "Healthy Kitchens, Healthy Lives," a continuing medical education collaboration between the Harvard School of Public Health and The Culinary Institute of America, or CIA. Each spring, the program attracts more than 400 physicians and other health professionals who spend four days learning about nutrition and health, watching cooking demonstrations by professional chefs, and getting hands-on instruction in the kitchens of the CIA facility in California's Napa Valley.
"We show them how to hold a knife, how to prepare a vegetable," said Dr. Eisenberg, also associate professor of nutrition at Harvard School of Public Health. "We show them that it's literally not brain surgery to prepare delicious and healthy meals."
Such skills are vital with heart disease and diabetes on the rise, said Robert Graham, MD, MPH, assistant professor of medicine at New York University Langone Medical Center. About 17% of U.S. children and adolescents and one-third of adults are obese, says the Centers for Disease Control and Prevention.
Dr. Graham attended the Harvard-CIA program and was inspired to start a cooking class for physicians at New York's Lenox Hill Hospital, where he is director of resident research. Residents there take one nutrition class per month. Once a year they head to the kitchen, where they have the mammoth task of preparing a nine-course meal.
The latest class, on Aug. 24, made an elaborate meal including arugula salad, escarole and bean soup, and black sea bass in umbido, Dr. Graham said. Then the students sat down to enjoy it.
"Many of us talk the talk when it comes to eating right, but we don't walk the walk," he said.
In her classes at UMass Medical School, Dr. Li learned how to shop for food. She learned that something labeled "multigrain" isn't necessarily healthy. Whole grain products are a better choice. She also learned proper meal portions with each plate ideally having a quarter protein, a quarter grains and one-half vegetables.
"We're helping people understand how to eat, where to go and how to cook at home," said Ira Ockene, MD, David and Barbara Milliken Professor of Preventive Cardiology and director of preventive cardiology at UMass Medical School.
The cooking classes for physicians are tailored by specialty, Olendzki said. For example, gastroenterologists are taught to prepare foods that are good for patients on an anti-inflammatory diet, while cardiologists are taught to make heart-healthy recipes.
At the Harvard-CIA program, attendees range from avid cooks to physicians with no experience in the kitchen, said Eric Rimm, ScD, associate professor in Harvard's departments of epidemiology and nutrition.
They learn cooking tips they can pass on to patients, such as making "planned overs" -- components of meals that are made in advance to save time in the kitchen another night, said Mark Erickson, CIA dean of culinary education.
"When I cook I am thinking not only about what I may be having that night, but I am thinking ahead," Erickson said. "The time that it takes to cook dinner doesn't have to be from scratch that evening."
Putting healthy into practice
Internist John Principe, MD, also was inspired by the Harvard-CIA program. After 20 years as a physician, he became frustrated and burned-out by the day-to-day practice of medicine, feeling as if he never had enough time to really help his patients.
He began taking cooking classes with the idea of becoming a chef, but his plans changed after attending the Harvard-CIA program in 2008. "I came back so reinvigorated, so revitalized," he said.
Since then Dr. Principe has transformed his practice in Palos Heights, Ill. He founded WellBeingMD, which offers a comprehensive six-week program that teaches patients about wellness, including how to buy healthy, organic foods and prepare them.
John La Puma, MD, grew up in a household where love was expressed through food. As an adult he learned to blend his love of cooking with medicine. He taught his first cooking class for medical students at the State University of New York Upstate Medical University in Syracuse in 2003, and now teaches seminars nationwide about cooking and nutrition for physicians and other health professionals. He has written several books, hosts television specials on diet and is the founder of ChefMD, a website that offers recipes and nutritional advice. "I think every doctor ought to be able to write a recipe on a prescription," he said.
Advising patients about making positive lifestyle changes is daunting for many physicians because they aren't trained how to do it and often aren't paid for it, Dr. La Puma said. But the "incentives in medicine are beginning to change so that doctors are going to want to, and be paid to, give advice about lifestyle change and disease prevention."
Dr. Li said the cooking classes taught her how to help patients make positive lifestyle changes.
"I can really relate to their reluctance or their saying, 'It doesn't taste good' or 'It's so much work.' There's nothing like experiencing it before you can talk about it," she said.