Abstract
Rani Polak, MD, MBA, a Le Cordon Bleu trained chef and Lifestyle Medicine physician, combined his unique knowledge and skills to start a CHEF Coaching program at the Institute of Lifestyle Medicine (ILM), Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts. Observing that patients are often unable to put clinician recommendations into practice, Polak developed this program to empower clinicians and patients in their abilities to cook at home and improve their health and particularly to empower clinicians to educate their patients better about the tenets of healthy nutrition and cooking.
One is with patients, and we call this Patient CHEF Coaching. In this application, we help patients improve their home cooking and overall health. We also have a program that we call Clinicians' CHEF Coaching. The goal of this program is to train clinicians to use the culinary coaching approach, for example in one-minute segments in their regular conversation with patients and/or in developing their own 12-meeting culinary coaching program for patients. The third application is Trainees' CHEF Coaching, and in this program we train medical residents with these principles. The fourth application is Community CHEF Coaching, in which we help people improve the nutrition of their community by coaching the local cafeterias' and kitchens' leadership.
Most of what we accomplish through CHEF Coaching is offered remotely, so that we can reach the broadest population with low-cost interventions. We also hold an annual meeting LIVE in Boston, which was recently approved for Harvard Medical School Continuing Medical Education (CME) credits. People that come to the Boston conference have the opportunity to stay an extra day for a hands-on component where we cook together, which is an enjoyable education experience.
As a lifestyle medicine physician, I believe the course is important for all types of clinicians. Our main audience today includes physicians, health coaches, nurses, and registered dieticians (RDs), and a smaller group of educators and health policy and public health experts. Within the medical world, family physicians, internists, and pediatricians are particularly interested, but we have had physicians from many different specialties, including plastic surgeons.
During my chef training, I learned so many things and thought, “Hey, wait a minute. Bringing my new culinary knowledge to medicine would make it much more patient-focused, fun, and delicious.” My journey in culinary school convinced me to go back to medical school, and I completed my degree. My MD thesis was to develop a culinary medicine program for people with inflammatory bowel disease (IBD). I asked one of the RDs to join me, and she taught the basic nutrition for IBD, and I taught people how to implement this nutrition in a delicious way. This was a huge success, and I won a prestigious innovation award from the Hebrew University for this program. In fact, the hospital decided to launch a healthy cooking and lifestyle center. After serving with the hospital for a few years, I then came to Boston to pursue a Lifestyle Medicine Fellowship at the ILM.
At that time, Edward M. Phillips, MD, the director of the ILM, shared with me the benefits of health coaching, and I completed a health coaching certification as part of my fellowship. Through this program, I realized that coaching is a powerful tool to impact home cooking, because if a person would like to implement healthy nutrition, they need to set culinary goals. People cannot eat unless they cook food, eat all processed foods, or eat out all of the time. All of these pieces came together, and I developed a program that would not need a teaching kitchen and would be based on coaching approaches and delivered online. That is the CHEF Coaching program that exists today at the ILM.
Every week, I hear about new programs that are being developed or starting. In fact, last week, I was in Columbus, Indiana, and we filmed a culinary medicine module for a national curriculum developed by the American College of Preventive Medicine and the American College of Lifestyle Medicine—Lifestyle Medicine Core Competencies Program. Last year, these organizations decided that the nutrition component should include a culinary medicine module, and I am now the faculty that provides this.
Interestingly, we filmed the video clips in a teaching kitchen that belongs to a big corporation. Their medical staff is very advanced, and they convinced corporate management to develop a lifestyle center for the employees. The heart of this lifestyle medicine is the teaching kitchen. So even in the corporate setting, people are learning how to cook in order to improve their nutrition.
CHEF Coaching, however, is a unique program among programs today because of its remote offering. In our study, we found that our program, CHEF Coaching, is much less expensive as an online program. I strongly believe that to develop a program that will be sustainable and implemented in a nationwide scope, it has to include a remote delivery mode.
The knowledge that is transferred from the nutritional experts to the public is sometime confusing, and even those who understand the nutritional recommendations often do not know how to implement it practically or apply these recommendations in their life. There are different levels of knowledge and skill. Culinary medicine translates nutrition science into tangible tools.
Even if a person understands what to buy at the grocery store, he or she still needs to know how to make meals. There is literature showing that in the United States, home cooking decreased by 25% in the last 40 years, which is significant. Eating out increased in a very similar amount, so people are losing the ability to cook.
One of my patients was diagnosed with type 2 diabetes, and this patient understood that changes in lifestyle were needed and thought that cooking might be helpful. This patient wanted to improve the quality of the lunchtime meal. Instead of always eating out, making lunch would become a priority. The patient had confidence to make sandwiches, but did not have time to buy fresh food frequently. We discussed the option to freeze and defrost bread. The patient was so excited to know that fresh bread could be frozen and defrosted. This knowledge was lacking, and this is not unusual. I meet people like this every day. Try to imagine the gap between the recommendations provided for patients and their ability to implement them. How can we expect patients to eat legumes if they do not know how to cook them or how to share this teaching with patients? Basic knowledge is needed in so many areas of cooking.
In terms of CHEF Coaching specifically, we have a significant research component of our program. Recently, a new manuscript was accepted, which shows significant change in patients' confidence to cook at home. This study included a very small group of people and was without a control group. Our program has been in existence only three years, which is comparable to one day in the science world. Therefore, things are still evolving in our program as well.
Clinically and observationally speaking, people who participate in our program have shared that they are improving their nutrition, losing weight, and improving their health. Many people come to a culinary medicine program because they believe they will enjoy the program, and this is very important for a lifestyle change. The patient I mentioned previously needed to make changes in several lifestyle behaviors and chose to focus on cooking because it sounded attractive. This was this patient's gateway to lifestyle medicine. After accomplishing a few culinary goals, the patient tried other goals.
Spaulding Rehabilitation Hospital
Research Associate, PM&R Department
Harvard Medical School
Boston, MA 02129
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We know as clinicians that confidence is needed to change behaviors. What I have seen is that if one improves their confidence to cook, confidence in general will also improve. A patient might think, “Well, if I can make dinner, then I can probably walk 20 minutes too.”
I truly believe that in order to maintain healthy behaviors, people need to find behaviors that they like to do. It took me a long time to find a type of exercise that I like to do. However, I found that I really like rowing. During the warmer seasons, I row four times a week, 90 minutes at a time. If you enjoy doing something, you might do it. I think this is also a benefit of culinary medicine because it brings joy to cooking and food.
Perhaps most importantly, however, I believe the nutritional messages that we, as clinicians, share with our patients has to change to positive ones. Our clinical approach has often been to tell patients what not to do. A clinician might say, “Okay, you need to decrease your sugar, decrease your salt, decrease fat” etc. However, telling patients to decrease ingredients does not sound very delicious to the individual; it does not provide a positive message that motivates a change! Messages such as, “Let us do more home cooking and add more fruit and nuts to your diet” are more appealing to individuals. Instead of saying, “Cut back your fat, reduce your salt, and do not eat this or that,” a clinician can say, “Hey, let us spice things up a bit and increase the flavor in your food, and make healthier choices.”
Many physicians are not aware that home cooking matters and is very important for a person's health. Home cooking is very important. This is an essential message. A clinician who graduates from our program, in addition to discussing these issues, will be able to provide patients with several links to video clips and recipes that they can use.
We know that people who walk or bike to work are healthier than people who drive to work. The same is true for people who cook at home, and perhaps we can help encourage our patients to adapt these lifestyle behaviors from previous eras, which are healthier. ■