Teaching Kitchen Collaborative Research Day February 7,2018

Editor's Note : In the earliest days of integrative health and medicine, I had the opportunity to deliver a paper for an October 1996 small meeting through which I first met the author of this invited commentary. The workshop was jointly hosted by what was the NIH Office of Alternative Medicine, the then Agency for Health Care Policy and Research and the nascent Program in Integrative Medicine—now Center for Integrative Medicine—founded by Andrew Weil, MD at the University of Arizona School of Medicine. The day-long workshop focused on the practical challenges in integration. Dr. Weil put the issues with then utterly unconventional practices like acupuncture and chiropractic in perspective by sharing an anecdote about his yet unsuccessful long labor in merely getting healthy food into his institution's cafeteria.

Now, two decades later, Dr. Eisenberg, whose surveys of public use of unconventional medicine jumpstarted the integrative era, ^1,2 has convened with colleagues the first Research Day for the rapidly growing Teaching Kitchen Collaborative. The TKC, as Dr. Eisenberg shares, is a data-driven, taste-driven, whole system, experiential, full-court press transformative campaign to put food, nutrition and lifestyle front and center in transitioning our medical industry toward what might appropriately be called a healthcare system. JACM is honored to partner with TKC in publishing the abstracts from this initial Research Day, together with this commentary from Dr. Eisenberg to guide you into this important initiative. For JACM, this collaboration is closely aligned with our mission to explore the paradigm, practice, and policy advancing integrative health. Consider engaging your own institution in the expansive value of the TKC work. —John Weeks, Editor-in-Chief

OPEN IN VIEWER

David M. Eisenberg, MD

Department of Nutrition

Harvard T.H. Chan School of Public Health,

Boston, MA

The term “teaching kitchen” may bring to mind an image of chefs demonstrating knife skills and culinary techniques to engaged participants. However, if reimagined far beyond a traditional cooking class, teaching kitchens can be viewed as “learning laboratories” for life skills—incorporating nutrition education, mindfulness training, movement and exercise, personalized health coaching, and more.

Inspired by this vision, thought leaders around the world are experimenting with the design, implementation, and evaluation of teaching kitchen programs for participants in a range of settings, including universities, hospitals, corporate worksites, K-12 schools, and community organizations. ^{3 –7} In February 2018, over 125 of these pioneering individuals from 24 states as well as Japan and The United Arab Emirates gathered for the inaugural Teaching Kitchen Collaborative Research Day to share scientific findings and experiences in this growing movement.

The Teaching Kitchen Collaborative (TKC), launched in 2016 by the Harvard T.H. Chan School of Public Health (Harvard Chan) and The Culinary Institute of America (CIA), is an invitational network of over 30 organizations using teaching kitchen facilities as catalysts of enhanced personal and public health. The TKC's mission is to enable early adopters to learn about one another's facilities and educational programs, to develop best practices for reproducing and scaling emerging models, and to document the clinical, behavioral, and financial impact of teaching kitchens for a broad range of populations. The idea behind hosting a research conference was proposed at the group's initial meeting in February 2016 with the intention of demonstrating the capacity of the TKC to pursue these shared aspirational goals among a public audience.

The inaugural TKC Research Day, made possible by a National Institutes of Health (NIH) grant and a few generous supporters, highlighted 17 oral abstract presentations, 40 poster presentations, and four plenary lectures by Dr. Eisenberg, Director of the TKC; Dr. Frank Hu, Chair of the Department of Nutrition at Harvard Chan; Michiel Bakker, Director of Food at Google, and Wendy Weber, ND, PhD, MPH, Acting Deputy Director of the National Center for Complimentary and Integrative Health at the NIH. Twenty-seven of the current TKC member organizations participated with formal scientific presentations. Fifteen percent of attendees were students or trainees, and nearly half of those present were new to the TKC, thereby affirming the extent to which national and international interest in this emerging line of inquiry is growing rapidly.

Dr. Eisenberg's opening presentation ⁸ delved into the impetus for the TKC, beginning with his personal observations from 20 years ago: few practicing physicians knew anything about the science of nutrition, and most health professionals knew even less about cooking healthy, delicious, affordable meals for themselves, let alone for their patients. He described the partnership between Harvard Chan and the CIA as the vehicle whereby the medical and culinary communities could join together to create a united front in an effort to address the burden of diet and lifestyle related chronic disease. Dr. Eisenberg summarized the evolution of the annual Healthy Kitchens, Healthy Lives ^® (HKHL) conference (www.healthykitchens.org), which has been successfully offered each year since 2006, providing science-based and practical advice to more than 6,000 health professionals. Survey data in 2015 indicating that more than a third of HKHL attendees had built or would soon build teaching kitchens provided the unequivocal spark to create the TKC.

Dr. Frank Hu spoke on the topic of “Teaching kitchens as essential elements of translational nutrition research.” ⁹ He discussed teaching kitchens as virtual clinical research labs to evaluate novel curricula, outcomes, assessment tools and technologies. As envisioned by Dr. Hu, teaching kitchens may serve as instructional classrooms to help translate, in very practical terms, the Dietary Guidelines for Americans and make them relevant and accessible to all audiences. Similarly, they can provide current health professionals with practical healthy eating knowledge and skills to pass on to their patients, and serve as venues for hands-on educational opportunities for the next generation of chefs, graduate students, dietetic students, medical and nursing students, etc. In the emerging field of “precision nutrition,” Dr. Hu believes that teaching kitchens could be used as laboratories to explore the potential of tailoring dietary recommendations to an individual's microbiome, genetic and metabolic profile. In closing, Dr. Hu envisioned a network of global teaching kitchens which would bring together the best in cooking with the most up-to-date science to benefit individuals, populations and the global environment.

Michiel Bakker's plenary presentation described Google's extensive experience building and refining teaching kitchens across its global campuses. Google constructed its first teaching kitchen in Mountain View, CA in 2013 and now has seven functioning teaching kitchens worldwide that engaged more than 11,000 employees in 2017 alone. ¹⁰ Additionally, Google now has plans to build 17 new teaching kitchens over the coming year. Mr. Bakker shared several important guiding principles and lessons learned, including: (1) learn by acting, launching and iterating; (2) keep it simple; (3) consider all aspects such as pre-, during, and post-buildout of the teaching kitchens; and (4) not everything can or should be measured. Importantly, Mr. Bakker conveyed Google's continued commitment to work with the TKC to validate health outcomes, develop enhanced surveys and questionnaires, meaningful types of teaching kitchen curricula and interventions, and a shared path towards certification standards and careers for those who will lead and serve as instructors in future teaching kitchens.

Dr. Weber delivered the final plenary talk of the day, entitled, Possibilities for the Future of Teaching Kitchen Research: Perspectives from the NIH. ¹¹ She summarized previous nutrition research across the NIH as well as the many challenges in this important aspect of scientific inquiry. She then rhetorically asked, “How does nutrition research go from the laboratory or research setting to making a large impact on public health that is sustainable?” This was followed by a rhetorical answer, namely: “Could the teaching kitchen model be a way to achieve this goal?” Dr. Weber shared the view that teaching kitchens can provide an effective way to teach cooking skills and nutrition information: (1) to individuals who are not learning these skills elsewhere; and (2) in a manner which provides fundamental knowledge necessary to promote health and wellness. Dr. Weber believes that teaching kitchen programs may have broad-based reach in the public if delivered in enough locations or through online and/or mobile delivery; and if multiple locations collect similar baseline and follow-up data, thereby allowing the NIH to look at the impact of teaching kitchens across various populations.