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Health Homework: Leveraging Community Teaching Kitchens to Improve Nutrition and Disease Prevention

Author: Timothy McAuliffe


Editor/Reviewer: Professor Sumantra (Shumone) Ray


Acknowledgements: Thank you to the NNEdPro 2022 Summer School Team (Breanna Lepre, Sarah Armes, Pauline Douglas, Eleanor Beck and Matheus Abrantes) for the opportunity to share this reflection based on the winning essay for 2022. I am grateful to Rima Al-Nimr, Dr Auden McClure, Dr Larry Myers, and Dr Steve Bensen at the Geisel School of Medicine at Dartmouth College (New Hampshire, USA) for introducing me to teaching kitchens during my medical education. Further acknowledgement to Tecla Coleman (NNEdPro US Regional Network Co-Lead) for facilitating the Dartmouth-NNEdPro Summer School scholarship scheme 2022.



Barriers to Nutritious Eating



A healthy eating pattern is a central part of nutrition and overall well-being. However, many individuals encounter challenges maintaining a nutritious diet. Fifty-eight percent of US adults indicated that they should probably be eating healthier.(1) Providing foundational information about healthy foods is a core component, and lack of information is a frequently cited challenge for patients (2) (3) (4). A more nuanced mix of personal circumstances and structural barriers highlights a consistent set of challenges encountered across many populations.


A lack of time or motivation to cook healthy foods poses a frequently cited barrier (4) (5) (6) (7). Furthermore, higher relative costs of nutritious foods and equipment necessary for food preparation generate challenges in preparing healthy meals (3) (4) (7). Many note that special dietary needs, preferences, and cultural eating traditions may generate barriers in making dietary changes (3) (4) (7). Finally, factors related to social or community eating habits contribute as well (2) (4) (6).



Teaching Kitchen Model


In the face of barriers to healthy eating and personal meal preparation among community members, teaching kitchens have emerged to address these challenges. Teaching kitchens leverage nutrition and culinary education to improve patient culinary skills to strengthen healthy eating patterns. These sessions, which can occur in a community or health centre kitchen, generally include interactive cooking instruction to teach culinary skills, improve confidence in cooking, and build knowledge on healthy meal preparation and eating (8) (9) (10).


The central aim of the teaching kitchen model is to educate and engage a diverse audience (including patients with obesity or managing chronic disease) in eating and cooking in thoughtful ways to improve their health and cooking capabilities. Specific objectives include [1] improving familiarity with different eating patterns (e.g., plant-based diet, Mediterranean diet), [2] promoting cooking skill capabilities and confidence, [3] providing recipes that can be applied to at-home cooking, [4] encouraging mindful eating habits, and finally [5] promoting an environment where individuals can engage in their food preparation.



Teaching Kitchen Impacts on Health


In addition to improving general eating habits and cooking skills, teaching kitchens have tangible benefits for patient health. First, they can act as primary prevention strategies for diseases. Surveys from a teaching kitchen programme showed participants increased the frequency of eating fruits and vegetables and reduced the likelihood of eating fast food (10). Families participating in a kitchen-based nutrition programme were about three times as likely to follow a Mediterranean dietary pattern and saved approximately $20 per week on food costs due to home-prepared meals (11). Another teaching kitchen programme, combined with lifestyle and exercise guidance, was associated with reduced participant weight, BMI, waist circumference, blood pressure, and total cholesterol (8). A diet rich in fruits and vegetables and the Mediterranean diet have shown reductions in risks of cardiovascular disease, gestational diabetes, and breast cancer (12) (13) (14).


Once patients are managing a chronic condition, nutrition-focused teaching kitchens can further improve outcomes. A Mediterranean diet-focused cooking and nutrition programme for patients with type 2 diabetes was associated with reductions in diastolic blood pressure and total cholesterol (15). A culinary education programme for individuals with cancer resulted in increased knowledge and confidence in preparation skills for plant-based diets and reduction in processed meat intake (16). Overall, evidence highlights that teaching kitchens can generate meaningful improvements for patients in primary and tertiary disease prevention.



Implementation and Evaluation of Teaching Kitchens


Implementation of teaching kitchens has already started gaining meaningful traction. The Teaching Kitchen Collaborative, founded in 2016, has a network of 45 teaching kitchens worldwide (17). Furthermore, culinary teaching has been incorporated into medical education, such as implementation in curricula at medical schools at Geisel (Dartmouth), Stanford, and Tulane (18). This mirrors culinary medicine programmes available through broader academic medical centers across the United States (9) (19). Nutrition professionals, instructors, and medical students have highlighted the meaningful impact of teaching kitchens on patient health and training:


"With poor nutrition consistently cited as a major cause of morbidity and mortality, hands-on culinary medicine training in a teaching kitchen as a formal part of medical education has been shown to improve future physician confidence in comprehensive patient lifestyle counseling, as well as their own self-care. Evidence-based, technique-driven culinary training is an innovative and effective way to both teach and cement nutrition in medical education."

– Rima Itani Al-Nimr, MS, RDN, LD, Lecturer in Medical Education & Medicine, Nutrition in Medicine Curriculum Director; The Geisel School of Medicine at Dartmouth


“Our session in the teaching kitchen was a truly valuable opportunity for students to gain first-hand knowledge surrounding nutritious choices, food accessibility, and technical culinary skills. This experience will allow us to better provide informed care and resources to our patients.”

– Adriana Radosavljevic, Medical Student at The Geisel School of Medicine at Dartmouth


The core resources required to establish new teaching kitchens include a kitchen location, cooking equipment and food, and a course instructor and/or clinician to lead the programme. Furthermore, connections with community organisations or healthcare settings will enable more community members to be engaged with teaching kitchen programmes. The primary measurement is how many individuals are able to access teaching kitchen culinary education programmes. Beyond this, secondary evaluations should focus on impact and outcomes. These include patient-reported confidence in cooking skills, comfort and readiness in preparing meals, and interest in eating healthy foods and avoiding processed food. Outcome evaluation of major health measurements – such as weight, HbA1c, blood pressure, and cholesterol – can connect teaching kitchen instruction with concrete health outcomes.


Conclusion and Call to Action


Teaching kitchens provide an engaging and supportive environment for patients to learn fundamental culinary skills, new recipes, and healthy habits and offer an innovative new pedagogy for impactful nutrition education. In addition to improving general eating habits, studies have found culinary education significantly improves patient health outcomes. Academic and community organisations have shown how successful models can be developed and integrated into the community. With appropriate funding, stakeholder engagement, community involvement, and focused measurement, teaching kitchens can personalize healthy eating and equip patients with the skills and tools necessary to improve their well-being.


Medical providers and researchers in patient care and nutrition should advocate local medical organisations to establish and sponsor the development of community-based teaching kitchens. Providing tailored and hands-on nutrition-based culinary training for all patients can improve population health, reduce medical care costs, and build robust community connections. By investing in teaching kitchens, professionals focused on improving nutrition can provide more comprehensive health support for patients.


NOTE: Please refer to the award-winning NNEdPro Mobile Teaching Kitchens initiative as well as its successful adaptation in Mexico. In July 2022, the MTK initiative has won the Society for Nutrition Education and Behavior Program Impact Award and is poised and really for adaptation to the US context in collaboration with prime movers in the field across US partner organisations.



References


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2. Beck AL, Iturralde E, Haya-Fisher J, Kim S, Keeton V, Fernandez A. Barriers and facilitators to healthy eating among low-income Latino adolescents. Appetite. 2019Apr4;138:215–22.

3. Oliver TL, McKeever A, Shenkman R, Diewald L. Barriers to healthy eating in a community that relies on an emergency food pantry. Journal of Nutrition Education and Behavior. 2020Nov8;52(3):299–306.

4. Munt AE, Partridge SR, Allman-Farinelli M. The barriers and enablers of healthy eating among young adults: A missing piece of the Obesity Puzzle: A Scoping Review. Obesity Reviews. 2016Oct20;18(1):1–17.

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7. de Mestral C, Stringhini S, Marques-Vidal P. Barriers to healthy eating in Switzerland: A nationwide study. Clinical Nutrition. 2016Apr7;35(6):1490–8.

8. Eisenberg DM, Righter AC, Matthews B, Zhang W, Willett WC, Massa J. Feasibility pilot study of a teaching kitchen and self-care curriculum in a workplace setting. American Journal of Lifestyle Medicine. 2017May23;13(3):319–30.

9. Polak R, Phillips EM, Nordgren J, La Puma J, La Barba J, Cucuzzella M, et al. Health-related culinary education: A summary of representative emerging programmes for health professionals and patients. Global Advances in Health and Medicine. 2016Jan1;5(1):61–8.

10. Black M, LaCroix R, Hoerster K, Chen S, Ritchey K, Souza M, et al. Healthy Teaching Kitchen Programmes: Experiential Nutrition Education Across Veterans Health Administration, 2018. American Journal of Public Health. 2019Oct17;109(12):1718–21.

11. Razavi AC, Sapin A, Monlezun DJ, McCormack IG, Latoff A, Pedroza K, et al. Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: A randomised controlled trial. Public Health Nutrition. 2020Aug3;:1–7.

12. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018Jun21;378(25).

13. Assaf-Balut C, García de la Torre N, Durán A, Fuentes M, Bordiú E, del Valle L, et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM Prevention Study. PLOS ONE. 2017Oct19;12(10).

14. Toledo E, Salas-Salvadó J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, et al. Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the predimed trial. JAMA Internal Medicine. 2015Nov1;175(11):1752.

15. Monlezun DJ, Kasprowicz E, Tosh KW, Nix J, Urday P, Tice D, et al. Medical School-based teaching kitchen improves hba1c, blood pressure, and cholesterol for patients with type 2 diabetes: Results from a novel randomized controlled trial. Diabetes Research and Clinical Practice. 2015Aug;109(2):420–6.

16. Miller MF, Li Z, Habedank M. A randomized controlled trial testing the effectiveness of coping with cancer in the kitchen, a nutrition education programme for cancer survivors. Nutrients. 2020Oct15;12(10):3144.

17. History & leadership [Internet]. Teaching Kitchen Collaborative. Teaching Kitchen Collaborative, Inc.; 2022 [cited 2022Jun1]. Available from: https://teachingkitchens.org/history-leadership/

18. Green S. Food as medicine: Integrating Nutrition Education into the Medical Education Curriculum [Internet]. Geisel News. Trustees of Dartmouth College; 2018 [cited 2022Jun1]. Available from: https://geiselmed.dartmouth.edu/news/2018/food-as-medicine-integrating-nutrition-education-into-the-medical-education-curriculum/

19. Culinary Medicine Programme [Internet]. DHMC and Clinics. Dartmouth Hitchcock Medical Center and Clinics; [cited 2022Jun1]. Available from: https://www.dartmouth-hitchcock.org/weight-welln

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