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Research Letters |

Enhancing Medical Education to Address Obesity: “See One. Taste One. Cook One. Teach One.” FREE

David M. Eisenberg, MD; Amy Myrdal Miller, RD; Kathy McManus, RD; Jonathan Burgess, BA; Adam M. Bernstein, MD, ScD
[+] Author Affiliations

Author Affiliations: Harvard Medical School (Dr Eisenberg and Mr Burgess) and Harvard School of Public Health (Drs Eisenberg and Bernstein), Boston, Massachusetts; The Culinary Institute of America, St Helena, California (Ms Myrdal Miller); and Nutrition Services Brigham and Women's Hospital, Boston (Ms McManus). Dr Eisenberg is now with the Department of Nutrition, Harvard School of Public Health, and the Samueli Institute, Alexandria, Virginia. Mr Burgess is now with The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr Bernstein is now with the Wellness Institute, Cleveland Clinic, Cleveland, Ohio.


JAMA Intern Med. 2013;173(6):470-472. doi:10.1001/jamainternmed.2013.2517.
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Since 1960, US expenditures have shifted from spending 2.7 times more on food than health care ($74 billion vs $27 billion) to spending 2 times more on health care than food ($2.5 trillion vs $1.25 trillion).1,2 Despite significant increases in health care spending, obesity and diabetes mellitus rates have increased dramatically.3

Schools of medicine, nursing, and allied health train health care practitioners to diagnose, treat, and manage disease. Schools of culinary arts train chefs to feed the public or to advise the food industry. Rarely, however, do medical and culinary experts share information, skills, and ideas about how these 2 professional communities might partner to diminish rates of obesity and diseases related to dietary and lifestyle choices.

A desire to establish partnerships between the medical and culinary communities led to the creation of the continuing education conference, “Healthy Kitchens, Healthy Lives–Caring for Our Patients and Ourselves” (www.healthykitchens.org).4 This 4-day conference has been copresented by Harvard University and The Culinary Institute of America 8 times and includes presentations by nutritional epidemiologists, registered dietitians, chef educators, exercise physiologists, and behavioral experts. Registrants attend didactic and interactive (ie, hands-on cooking) plenary sessions and workshops. (See eAppendix for additional details.)

The conceptual model for this program was influenced by the observation that for health care professionals, practicing a healthful behavior oneself (eg, exercise, wearing a seat belt) is a powerful predictor of counseling patients about these same behaviors.5 We explored the possibility that inclusion of “culinary education” in the form of cooking demonstrations and participatory hands-on cooking workshops, combined with more traditional didactic, nutrition-related presentations, would result in changes in behavior among participants' personal habits and their perceived ability to advise overweight or obese patients. Herein, we describe changes in personal and professional nutrition-related behaviors reported by participants (n = 387) before and 3 months after this educational experience.

We conducted an anonymous survey of registrants' self-reported nutrition-related behaviors at the start of the conference, March 2010, and 12 weeks later (eAppendix). Educational components included didactic presentations relating to nutritional epidemiology and physiology, science of exercise and mindfulness, and culinary demonstrations, hands-on cooking, and tastings.

Responses (at baseline and 12 weeks later) were not matched for participants, as these were anonymous. To test for the equality of 2 proportions, we used the χ2 test for 2 × 2 tables.6 Since we could not take into account paired data given the anonymity of the responses, the P values reported herein are conservative. We also investigated the relationship between personal nutrition behaviors and professional counseling behaviors with Spearman rank correlations (eAppendix).

Of 387 registrants, 219 (57%) completed the survey at baseline and 192 (50%) completed the follow-up survey (Table). A total of 265 (66%) were physicians. Respondents reported significant positive changes in frequency of cooking their own meals (pretest, 58%; posttest, 74%; P < .001); personal awareness of calorie consumption (pretest, 54%; posttest, 64%; P ≤ .05); frequency of vegetable consumption (pretest, 69%; posttest, 85%; P ≤ .04), nut consumption (pretest, 53%; posttest, 63%; P ≤ .04), and whole grain consumption (pretest, 67%; posttest, 84%; P < .001); ability to assess a patient's nutrition status (pretest, 46%; posttest, 81%; P < .001); and ability to successfully advise overweight or obese patients regarding nutritional and lifestyle habits (pretest, 40%; posttest, 81%; P < .001). At the 3-month follow-up, there were significant, modest correlations between clinicians' self-reported diet quality and their ability to advise overweight and obese patients on nutrition and lifestyle changes (correlations, 0.35-0.44; P < .001) (eAppendix).

Table Graphic Jump LocationTable. Personal and Professional Nutrition-Related Behaviors Among Attendees of the “Healthy Kitchens, Healthy Lives” Continuing Education Conferencea

We explored the possibility that the inclusion of “culinary education” in the form of cooking demonstrations and hands-on cooking, as adjuncts to traditional didactic, nutrition presentations, would result in measurable positive changes in both personal and professional nutrition-related behaviors among participating health care professionals. Comparing survey results from baseline to follow-up at 3 months suggest these changes occurred.

Limitations to this study include its modest sample size, response rates, and the anonymous nature of the survey. In addition, outcomes were based on self-report and were limited to a 3-month follow-up. The sustainability of the observed changes remains unstudied, and, the impact of physicians' changes on their patients' behaviors and clinical outcomes over time were beyond the scope of this initial study (eAppendix).

Many health care professionals aspire to advise their patients about dietary habits and to serve as role models. However, they, like the patients they serve, often lack the knowledge and practical experience to proactively advise their patients. Many medical students and physicians feel ill-equipped to counsel overweight or obese patients.79 As such, we need enhanced educational efforts aimed at translating decades of nutrition science into practical strategies whereby healthy, affordable, easily prepared and delicious foods become the predominant elements of a person's dietary lifestyle. The multidisciplinary interactive educational program described herein may be worthy of further investigation in this regard.

Perhaps in this era of scientific advancement regarding nutrition science, it is now time to “teach the teachers” ways to access, prepare, and enjoy healthy, delicious foods, so that they, in turn, can advise their patients to do the same.

Correspondence: Dr Eisenberg, Department of Nutrition, Harvard School of Public Health, SPH-2 Room 337, 665 Huntington Ave, Boston, MA 02115 (Deisenbe@hsph.harvard.edu).

Published Online: February 18, 2013. doi:10.1001/jamainternmed.2013.2517

Author Contributions: Dr Eisenberg had full access to all the data and had the final responsibility for the decision to submit the manuscript for publication. Study concept and design: Eisenberg and Myrdal Miller. Acquisition of data: Eisenberg, Myrdal Miller, and Burgess. Analysis and interpretation of data: Eisenberg, McManus, Burgess, and Bernstein. Drafting of the manuscript: Eisenberg and Burgess. Critical revision of the manuscript for important intellectual content: Eisenberg, Myrdal Miller, McManus, Burgess, and Bernstein. Statistical analysis: Burgess and Bernstein. Obtained funding: Eisenberg. Administrative, technical, and material support: Eisenberg, Myrdal Miller, McManus, and Burgess. Study supervision: Eisenberg.

Conflict of Interest Disclosures: Dr Eisenberg serves as a member of the scientific advisory committee and consultant to The Culinary Institute of America and as a scientific consultant to LKK Health Products Group Ltd and SPE US Development Inc. Ms Myrdal Miller is a full-time employee of The Culinary Institute of America, which copresents and profits from Healthy Kitchens, Healthy Lives.

Funding/Support: This study was made possible, in part, by an unrestricted academic grant from the Bernard Osher Foundation.

Role of the Sponsor: The Bernard Osher Foundation had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Previous Presentations: A summary of the data from this Research Letter was presented at the International Research Congress on Integrative Medicine and Health; May 16, 2012; Portland, Oregon.

Additional Contributions: The following individuals are coauthors of this research letter; however, owing to the limited number of coauthors that can be named in the byline, their names appear here: Mark Erickson, CMC; Bernard Rosner, PhD; Eric B. Rimm, ScD [received honoraria for education presentations at Harvard and Culinary Institute of America events]; and Walter C. Willett, MD, DrPH.

Centers for Medicare and Medicaid Services of the US Department of Health and Human Services.  National Health Expenditure Fact Sheet. http://www.cms./gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/tables.pdf. Accessed August 8, 2011
Economic Research Service of the US Department of Agriculture.  Food Consumer Price Index and Expenditures: Table 1. http://www.ers.usda.gov/Briefing/CPIFoodAndExpenditures/Data/Expenditures_tables/table1.htm. Accessed August 8, 2011
Centers for Disease Control and Prevention.  Long-term trends in diabetes, 2010. http://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf. Accessed October 17, 2011
Myrdal A. Healthy Kitchens, Healthy Lives: caring for our patients and ourselves.  Diabetes Spectrum. 2010;23(3):183-187
Link to Article
Frank E. STUDENTJAMA: Physician health and patient care.  JAMA. 2004;291(5):637
PubMed   |  Link to Article
Rosner B. Fundamentals of Biostatistics. 7th ed. Boston, MA: Cengage Publishers; 2010
Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What do resident physicians know about nutrition? an evaluation of attitudes, self-perceived proficiency and knowledge.  J Am Coll Nutr. 2008;27(2):287-298
PubMed
Buttriss JL. Food and nutrition: attitudes, beliefs, and knowledge in the United Kingdom.  Am J Clin Nutr. 1997;65(6):(Suppl)  1985S-1995S
PubMed
Spencer EH, Frank E, Elon LK, Hertzberg VS, Serdula MK, Galuska DA. Predictors of nutrition counseling behaviors and attitudes in US medical students.  Am J Clin Nutr. 2006;84(3):655-662
PubMed

Figures

Tables

Table Graphic Jump LocationTable. Personal and Professional Nutrition-Related Behaviors Among Attendees of the “Healthy Kitchens, Healthy Lives” Continuing Education Conferencea

References

Centers for Medicare and Medicaid Services of the US Department of Health and Human Services.  National Health Expenditure Fact Sheet. http://www.cms./gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/tables.pdf. Accessed August 8, 2011
Economic Research Service of the US Department of Agriculture.  Food Consumer Price Index and Expenditures: Table 1. http://www.ers.usda.gov/Briefing/CPIFoodAndExpenditures/Data/Expenditures_tables/table1.htm. Accessed August 8, 2011
Centers for Disease Control and Prevention.  Long-term trends in diabetes, 2010. http://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf. Accessed October 17, 2011
Myrdal A. Healthy Kitchens, Healthy Lives: caring for our patients and ourselves.  Diabetes Spectrum. 2010;23(3):183-187
Link to Article
Frank E. STUDENTJAMA: Physician health and patient care.  JAMA. 2004;291(5):637
PubMed   |  Link to Article
Rosner B. Fundamentals of Biostatistics. 7th ed. Boston, MA: Cengage Publishers; 2010
Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What do resident physicians know about nutrition? an evaluation of attitudes, self-perceived proficiency and knowledge.  J Am Coll Nutr. 2008;27(2):287-298
PubMed
Buttriss JL. Food and nutrition: attitudes, beliefs, and knowledge in the United Kingdom.  Am J Clin Nutr. 1997;65(6):(Suppl)  1985S-1995S
PubMed
Spencer EH, Frank E, Elon LK, Hertzberg VS, Serdula MK, Galuska DA. Predictors of nutrition counseling behaviors and attitudes in US medical students.  Am J Clin Nutr. 2006;84(3):655-662
PubMed

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Eisenberg DM, Miller AM, McManus K, Burgess J, Bernstein AM. Enhancing medical education to address obesity: “See One. Taste One. Cook One. Teach One.” JAMA Internal Med. Published online February 18, 2013. doi:10.1001/jamainternmed.2013.2517

eMethods. Supplemental methods and comments

eReferences

eTable. Correlation between personal habits and professional activities among 174 physicians, registered dieticians, and nurse practitioners

eFigure. Healthy Kitchens, Healthy Lives program schedule, March 2010

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