University of Alabama Educational Endeavor
Title: Nutritional Cooking Classes in a Rural Alabama County
Authors: Courtney M. Rentas BS, BA, August Anderson BS, Fellows with the University of Alabama -Pickens County Partnership; John Higginbotham PhD, MPH and Richard Streiffer MD
Contact info: [email protected]
Introduction:: Project funded by state of Alabama as part of a Rural Health Care Management Project which involved a community in rural Alabama. Faculty and students from University Alabama participated in an effort to address high prevalence of obesity and chronic associated diseases.
Studies note that 13.9% HS students in USA are obese, and in Alabama, obesity runs as high as 16.1%. Obese adolescents at increased risk of obesity related disorders including CV disease, DM2, asthma, OSA, psychological stress and depression and behavioral problems
Description: HS students in rural Alabama (25 students from each of 3 different schools) were enrolled in a nutritional cooking course. They were taught nutrition education and basic cooking skills biweekly over a 4 month period. Curriculum covered major macronutrients i.e. protein, carbohydrates and fats, and how to read and interpret nutritional labels. During cooking component students successfully prepared 5 healthy meals.
Summary: All students reported increased knowledge of reading and understanding labels and healthy eating concepts. Course currently being repeated with another 75 students.
Future goals: Make nutritional cooking classes available to all HS students in county, and complete an assessment of behavioral changes
University of Southern Alabama Educational Endeavor
Title: University South Alabama Culinary Medicine: A Community Model with Inter-professional Student Integration
Authors: Austin Cadden MBA, MPH (Sr. Manager, Cancer Control and Prevention), Rebecca Graves PhD, NP-C, Assistant Prof; Adult Health Nursing) and Nancy Brumfield RDN Dietician/Nutritionist)
Contact author info: [email protected]
Introduction: Univ So Ala Mitchell Cancer Institute USA-MCI) and College of Nursing have teamed up to provide Culinary Medicine classes to medical, nursing and physical therapy students, engaged community leaders and underinsured high risk women. Recently completed one year pilot study.
Description: Univ So Ala MCI purchased the Tulane Culinary Medicine Curriculum to provide culinary and medical education to our cancer patients, Univ. So. Alabama Health System patients and community members. After multiple pilot classes, including classes with USA College of nursing, MCI was able to secure funding to provide the full 6 course module to an underserved population of WISEWOMAN ladies. The college of nursing secured funding to conduct inter-professional culinary medicine classes, bringing disciplines together to learn about food and chronic medical diseases.
Summary: Since March 2016, MCI and the College of Nursing have made great strides in establishing the Univ. of South Ala Culinary Medicine Program. Many students and community members have been educated. Survey results show from majority participants show an increase in culinary nutrition skills as well as a commitment to improving the quality of their life through sustained culinary behavioral change.
Future Goals: Follow culinary behavioral change to improved health outcomes in community setting, as well as improved inter-professional team work and increased knowledge in the inter-professional classes
Hawaii – School System Educational Endeavor
Title: School Farm to the School Table – Mala’ai, The Culinary garden of Waimea Middle School, Hawaii County, Hawaii
Authors: Tami Mac Aller MPH, MCHES (Culinary degree Hawaii Public Health Institute); Alethea Lai- Director of the Culinary Garden of Waimea Middle School
Introduction: Mala’ai: The Culinary Garden of Waimea Middle School cultivates the relationship between students and the land through growing and sharing nourishing food in our outdoor living classroom. Our work reaches beyond the boundaries of our garden connecting land stewardship, culture, health and pleasure with lifelong learning. Dr. Michelle Suber, a physician serving the Waimea community since 1998, was concerned with the prevalence of diet- and nutrition-related illness among her patients. Looking for a long term solution aimed at prevention, her inquiries led her to laying the groundwork for a school garden program, targeting middle school adolescents as the ideal age to introduce garden classes and improve awareness of food origins and production. Working in the garden during science, PE and health classes, middle school children are engaged in outdoor physical and academic activities such as planning, measuring garden plots, digging, composting, planting, building a tool shed, harvesting and tasting. Student response to the program is enthusiastic and teachers report improved attendance and class engagement.
Description: Mala’ai’s outdoor classroom held 297 classes, 113 of which were science classes. Facilitated by volunteer hours, the students grew, prepared and packaged foods from the garden. Teachers came with their students to work in the garden. Nutrition education is blended in during the work and learning about how food is grown, prepared, cooked and served- learning fundamentals of healthy eating.
Summary: This past year, the garden produced a yield of over 850 lbs of fresh vegetables and 890 fresh eggs. The products were either consumed by the students and/or given away to the community. Practical skills learned will hopefully follow he students forever.
Kansas City University of Medicine and Bioscience Educational Endeavor
Title: CHAMPS (Coaching Health and Movement Program with Students)
Authors: Marina Giovannini MS2, Jessica Ruikka MS2
Author contact information: [email protected]
Abstract:CHAMPS is a program that helps address the need for lifestyle change by children with elevated BMIs in the underserved Kansas City communities through coaching and mentoring provided by medical students.
Introduction: According to the Centers for Disease Control (CDC), more than one third of U.S. children and adolescents were overweight or obese in 2012. Childhood obesity is causing a broad range of chronic health problems for children that previously were not seen until adulthood. These include high blood pressure, type 2 diabetes, fatty liver disease, and elevated blood cholesterol levels. Additionally, obese children are more prone to low self-esteem, bullying, negative body image and depression. Obesity is a complex problem in the United States. This is an issue that is necessary for the medical community to address, therefore it is important to explore the methods of treatment available.
Description: There are two main components to the CHAMPS program. First children in the population with elevated BMIs are identified. The children are referred from Score 1 Health, a screening program for the Kansas City public school system. Secondly, medical students are recruited and educated by a dietician in lifestyle treatment and effective methods of engaging and interacting with children. This training is essential to help medical students understand the proper methods of engaging with a young population and how to effectively motivate this age group. Medical student coaches have face-to-face, 30-45 minute sessions with enrolled kids and their parent/guardian. The sessions occur every 1-2 weeks for a total of 6-8 visits over a two-to-three-month time frame. Individual sessions are held throughout the community in the family’s neighborhood, specifically where the family is comfortable. Allowing a family to meet in a convenient location is key to the program’s success by eliminating any barriers of transportation.
During the sessions, behavior change goals and nutrition topics are targeted to each family’s needs and their individual readiness to make change. Behavior change topics include: physical activity, screen time, increasing consumption of fruits and vegetables, limiting sugar sweetened drinks while increasing water intake, cooking and meal planning on a budget, and decreasing portion size. Children are encouraged to record their progress on ‘star chart’ goal sheet, during the program as they highlight the success and difficulty of completing each goal. All materials are bilingual and an interpreter is present when there are language barriers between the medical student and the family.
In addition to the individual CHAMPS program, there is also a CHAMPS club that takes place at two elementary schools. Each school hosts a monthly nutrition/activity challenge that complements the CHAMPS Club. CHAMPS Club .meets for 8 sessions during the school year. The CHAMPS coaches, with staff support, lead the monthly sessions and invite community experts to complement the topic of the month.
Summary: Overall, the CHAMPS program has trained 59 coaches and has reached 126 children through CHAMPS individual and group sessions since its start date in 2015. Although no hard data has been collected from this study the response from families and their children has been positive. It is clear children who have participated are starting to have a better understanding of what it means to live a healthy life, in regard to food choices and staying active. Providing children with this education is the first step in preventative medicine treatment and management. In “Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review with Meta-Analysis”, it was found that “lifestyle interventions incorporating a dietary component led to significant weight loss when compared with no treatment” and a “frequent feature of effective studies is involvement of a structured exercise training component.” This research stresses that the focus of promoting a healthy diet and increased movement to CHAMPS participants mirrors the main components of past successful lifestyle change programs. Further, an example of a local similarly structured program is Children’s Mercy in Kansas City’s pediatric weight management programs. Like Children’s Mercy’s weight management programs, CHAMPS also has a team of clinical and academic experts working together to promote sustainable, healthy lifestyle changes by identifying healthy food choices, increased physical activing, and educating our pediatric participants.
Future Goals: The CHAMPS program is an initiative that could grow to many other medical institutions. In order to successfully develop a similar program there are a number of factors to consider. (1) A particular population needs to be considered based on the surroundings of the medical school, and there needs to be an established relationship between this population and the program. For CHAMPS this connection is Score 1 for Health. (2) Medical student training should be provided by a dietician and/or a physician to ensure students are trained from both a nutritional and social standpoint. (3) The barrier of the population the program is working to reach needs to be assessed to understand what obstacles the population faces and how those obstacles can be overcome.
Developing programs similar to CHAMPS is a feasible goal and it can provide an innovative opportunity for medical students to be trained as mobile health coaches. These programs have the potential to shape a new generation of physicians who will be better equipped to address social determinants around childhood obesity. The collaboration between medical students and the community has provided an opportunity to help reduce the incidence of childhood obesity in the underserved Kansas City population, and also provides medical students with the opportunity to develop skills in working with and treating childhood obesity through lifestyle intervention.
Moncrief Cancer Institute, Fort Worth, Texas Educational Endeavor
Title: An Overview of Culinary Medicine at Moncrief Cancer Institute
Name: Keith Argenbright, MD, MMM (Director), Benjamin Barkley, MBA (Assistant Director of Operations), June D’Souza, MS, RD, CSO, LD (Clinical Supervisor), Milette Siler, RD, LD (Community Dietitian)
Contact author: Milette Siler [email protected]
Introduction: In 2014, Academic Medicine found that less than one-third of the nation’s medical schools met the minimum requirement of 25 hours of nutrition education established by the National Academy of Sciences in 1985. Similarly, less than one-quarter of practicing physicians report feeling adequately trained to dispense nutrition advice to their patients1. The link between physician behaviors and their patient outcomes is increasingly evident2, and improvement for these outcomes is sorely needed. According to a 2015 CDC report, two-thirds of American adults are overweight or obese, and nearly 200 billion dollars are spent every year treating conditions that are linked to diet and lifestyle3. Research demonstrating increased cooking competency and cooking from home results in the increased likelihood for patients to maintain a healthy BMI and reduce the risk of developing chronic disease4.
Description: In an effort to address these issues, UT Southwestern Moncrief Cancer Institute developed a hands on teaching kitchen. Piloting curriculum from the Goldring Center for Culinary Medicine at Tulane University in collaboration with faculty and students from the Department of Nutrition at Texas Christian University, the dietitians at Moncrief aim to improve the culinary and nutrition therapy knowledge-base for medical residents in the Dallas/Fort Worth area. Similarly, the team also teaches basic kitchen and healthy eating skills to cancer survivors as an extension of the Survivorship program. This unique patient population encompasses any patient with a diagnosis of cancer, and targets the uninsured and underinsured. Hands on classes are led by oncology certified and community-based dietitians, as well as physician partners at John Peter Smith hospital and UNT Health Science Center.
Summary: Moncrief is uniquely situated to offer a culinary medicine program. Piloting this program has required new relationships within the community be established to identify and recruit class participants. These efforts include marketing Culinary Medicine to medical students and residents, as well as other members of the healthcare community, while also adapting a community curriculum specific for cancer survivors currently involved in the Survivorship program at MCI.
To best provide programming at a professional level, garnering top level administrative support is crucial. This include cultivating relationships with frontline administrative staff responsible for managing and scheduling the training of residents, while procuring physician partners for teaching the curriculum. Establishing and sustaining these relationships is a core component to implementing the Culinary Medicine program.
The community component of Culinary Medicine, however targets an established patient population, engaging survivors currently enrolled in the Community Survivorship program. Moncrief collaborates with Texas Christian University for teaching these courses.
Future Goals: For Culinary Medicine, plan includes submitting the piloted protocol to the UT Southwestern IRB for approval, before expanding partnerships and exploring opportunities with additional partners. These efforts include courses for practicing physicians and other medical professionals.
Oregon State Educational endeavor/Research Opportunity
Title: LEAP: 30-Day Lifestyle Intervention Lowers Risk Factors for Chronic Disease
Author: Stephanie Polizzi RD
Author contact information: [email protected]
Introduction: According to the CDC, 47% of adults have at least one form of chronic disease known to be preventable through a healthy lifestyle. Lifestyle medicine programs like LEAP (Lifestyle Eating Activity and Progress) are immersion programs that teach adults how to adopt healthy behaviors. Programs like this that provide active learning opportunities are most effective at achieving long-term results.
Description: LEAP is a 30-day lifestyle medicine program modeled after the gold standard, CHIP (Complete Health Improvement Program) which has been used to lower risk factors for disease for more than 30 years. Like CHIP, LEAP participants received pre and post health screenings including blood labs, nutrition presentations and fitness demos. LEAP differs from CHIP in that it includes experiential, hands-on activities including case studies and guided activities. Most notably, class participants prepared the plant-based meals for nightly classes and present food demos. Not only did LEAP participants lower risk factors significantly, but they built their skills in selecting and preparing healthy meals.
Summary: Participants in LEAP were empowered to improve their health through a combination of nutritional science and practicing plant-based food preparation in a social environment. Their pre to post health screening results were comparable to those achieved through the gold standard, CHIP. Participants noted in evaluations that the food preparation was the key to adopting these behaviors long-term.
7-Oregon State Research Endeavor
Title: LEAP: 30-Day Lifestyle Intervention Lowers Risk Factors for Chronic Disease
Purpose: Lifestyle medicine programs like CHIP, developed by Dr Hans Diehl of Loma LInda Lifestyle Medicine Institute show consistent reductions in risk factors for chronic disease. CHIP has been studied extensively for at least 25 years and published results in more than 25 peer-reviewed journals. The purpose of this study was to determine if a lifestyle intervention modeled after CHIP but with materials created by OSU Extension can achieve similar results to the gold standard.
Methods/design: CHIP and LEAP both include pre and post health screens, plant-based meals and nutrition education sessions. Where LEAP differs is that it includes a series of hands-on activities to help participants practice skills that will help them adopt healthy behaviors. Where CHIP sessions are pre-recorded, LEAP sessions are live and interactive. Participants engaged in nightly meal preparation, and food demonstrations as well as interactive games, group discussions and fitness activities.
Outcome Measures: Each participant was screened for height, weight, BMI, waist circumference, blood pressure and fasting blood labs (total cholesterol, LDL, VLDL, HDL, Triglycerides and blood sugars)
Study setting: Class met 3 nights per week for 3 hours in the local community center which has a beautiful, newly renovated kitchen. Meals were prepared by the students.
Participants: Adults age 50 with one or more chronic disease
Summary: Every one of the 19 participants showed significant improvement in at least one risk factor from pre to post health screenings. The greatest results were seen in those with the highest risk. LEAP results were comparable to CHIP expectations in weight loss, BMI reduction, drops in systolic and diastolic BP, drops in cholesterol, triglycerides and blood sugars. Long term results have included decrease or elimination of medications needed to treat blood pressure, high cholesterol and diabetes.
LEAP, a program created by a Registered Dietitian was able to achieve similar results to CHIP, the gold standard lifestyle medicine program. LEAP enhanced participant learning by asking students to prepare plant-based meals and food demos, helping them to build skills necessary for adopting of healthy eating habits long term.
Rutgers- Robert Wood Johnson Medical School- Research Endeavor
Title: Evaluation of Inter-professional Culinary Medicine Curriculum within Patient-Centered Medicine Course
Authors: Alyse Van Liew, Emine Ercikan Abali, Lee Ann Schein, Liesel Copeland, Barbara Tangel, Joshua Miller, Barbara Durta, Jane Hand, Annie Truss, Vanpat Pensuwan.
Contact: Information: [email protected]
Purpose: To address complex dietary issues such as obesity, a hands-on nutrition approach with an emphasis on inter-professional (IP) curriculum with nutrition and medical students has been researched at Rutgers University. The efficacy of healthcare and patient compliance improves when a team of professionals work in synchronicity. While the physician is the first to initiate patient discussions about diet, the role of the Registered Dietitian (RD) includes educating patients and administering nutrition therapy. Physicians and RDs must be able to understand each other’s roles and strengthen this teamwork early in their respective careers to optimize patient education and treatment. RWJMS collaborated with the Nutritional Sciences Department to introduce a unique educational experience in the Patient Centered Medicine (PCM) course by combining IP and culinary education.
Methods: Teams of 1 Nutritional Sciences and 2 First year medical students completed theCul inary Medicine session as part of the PCM course (N=152). All students were given surveys before and after completion of the session. Pre- and post- surveys measured inter-professional teamwork, awareness of nutritional habits, and level of comfort discussing nutrition with patients on a Likert scale. The Rutgers Nutritional Sciences students signed up for the course whereas all first year medical students at RWJMS were required to take the Culinary Medicine session and signed up for one of the nine dates that the sessions were being offered. The teams were randomly put together. Quantitative data was analyzed using descriptive statistics and paired ttest. Student comments were analyzed qualitatively assessing emergent themes. Inter-rater reliability was 100%.
Results: Students’ confidence in changing their own diet (t=3.66, p<.001) and being able to guide patients with their own diet changes (t=5.19, p<.001) significantly improved pre- to postsurvey. The inter-professional teamwork measure did not significantly change pre- to postsurvey. Emerging topics from the reflections on IP were: developing mutual respect; increased benefits of collaboration; appreciating different perspectives relating to patients. Students recognized that by improving their own nutrition, they can identify with patients in order to educate and enhance health through better nutrition. Students valued making small, inexpensive food substitutions to patients’ diets to help facilitate compliance.
Conclusion: Overall, students were more confident in their ability to improve their diet and counsel patients. Discrepancy between qualitative and quantitative data may be explained by the ceiling effect (Likert scale mean=4 in both pre/post surveys). Our results demonstrated that IP improves communication skills, awareness of healthcare roles in patient care, and development of positive attitudes towards teamwork.
University of Minnesota
Title: Nourishing Relationships and Resilience; Lessons from Health Professional Students in a Food Hub Teaching Kitchen
Authors: Jenny Breen Chef, Chef/MPH, MEd; Kate Shafto, MD; Emily Paul, Chef/Food Hub Manager
Contact author: [email protected]
Introduction: In the face of rising burnout among physicians, trainees and healthcare providers, the tide of lifestyle-related chronic diseases also rises. Healthcare providers from all disciplines need to understand and embody behaviors that foster well-being. These include mindfulness/mindful eating practices, an understanding of the food system and our role within it, and building of inter-professional relationships. Both internal (personal) and external (system) factors have been identified in the literature as contributing forces to these critical issues for both patients, and practitioners in our healthcare system. Through study of a pilot hands-on 6-week cooking course (Food Matters for Doctors) designed to educate medical students in whole-food, plant-forward nutrition, we found that participants reported improved wellbeing, self-care and mindful awareness of their own overall health, in addition to grasping application of the material for patient care. The course was held in the teaching kitchen of (The Good Acre), a local agricultural food hub, offering a direct connection to the source of the food we eat and the role of food systems in both human and environmental health. This pilot course gave way to an inter-professional model, at the same location, offered by the University of Minnesota’s Center for Spirituality and Healing.
Description: The inter-professional course for graduate students, ‘Food Matters for Health Professionals’, is co-taught by a chef/MPH and a physician, in The Good Acre’s teaching kitchen. The class combines hands-on cooking, whole food-based nutrition and accompanying clinical application, mindful eating, self-reflection and self-care strategies, all set in the context of a sustainable food system. Students from medicine, nursing, health-coaching, pharmacy and public health engage in discussions around one’s personal “food story”, current nutrition literature, comparison of different styles of eating, as well as experiential culinary skill development, working collaboratively in interprofessional teams. Additionally, mindful eating and self-reflection are taught and practiced both as a group and as home assignments, all of these to help students develop tools for both self- and patient care. This model and our course has caught the attention of several local medical practices and will be adapted for use with practicing providers and staff in the coming months.
Summary: We believe our course is unique in that it empowers students to apply self, and patient care strategies from a whole foods, and sustainable food system perspective, recognizing the connections between personal, community and environmental health. We are in the process of studying this model of interprofessional, agriculturally-conscious, clinically-relevant cooking and nutrition education around outcomes of wellbeing, self-care, and eventual application to team based patient care.
Texas Christian University Research Endeavor
Title: Culinary Medicine and a Multi-site Longitudinal Study: Cooking for Health Optimization with Patients (CHOP)
Authors: Lyn Dart, PhD, RD, LD; Anne VanBeber, PhD, RD, LD; Jada Stevenson, PhD, RDN, LD
Contact author: [email protected]
Introduction: Nutrition plays a vital role in disease prevention and health promotion. However, few medical school curriculums provide adequate practical integration of the effects of nutrition and eating behavior on chronic disease management and quality of life.
Purpose: The purpose of this study was to pilot an innovative nutrition curriculum with hands-on training in the culinary arts for medical students.
Description: The Culinary Medicine program developed at the Tulane University Goldring Center for Culinary Medicine (GCCM) in 2012 trains medical students about nutrition and healthy eating practices. Students participate in lecture, journal readings, chef demonstrations, and hands-on culinary activities. Currently, 22 institutions nationwide provide this program and participate in a 10-year longitudinal study (Cooking for Health Optimization with Patients, CHOP) to assess training outcomes. The GCCM curriculum was first piloted in Fort Worth, TX in 2014 as a collaborative inter-professional program taught by dietetics and medical faculty from University of North Texas Health Science Center (UNTHSC), Texas College of Osteopathic Medicine (TCOM), Texas Christian University (TCU) and Moncrief Cancer Institute.
During 2014-2015, 66 health professions students who participated in the course were assessed following course participation using a 4-part survey including demographics, attitudes, dietary habits, and degree of proficiency in professional competencies related to clinical nutrition knowledge. Student responses were compared with 554 non-CM students from seven partner institutions. Study procedures were approved by Tulane and TCU IRB, and participant informed consent was obtained. Data was analyzed to meet study objectives (SPSS, P<0.05).
Results: Compared to non-CM students, UNTHSC/TCOM students who participated in the CM course reported greater proficiency and confidence in their understanding and ability to inform patients about the following clinical nutrition competencies: (1) health effects of the Mediterranean, Dash, and low fat diets, (2) dietary patterns for type 2 diabetes, celiac disease, and food allergies, (3) weight loss strategies, (4) recognizing warning signs/symptoms for eating disorders, and (5) role of fiber and omega-3 fatty acids in disease prevention and heart health (P<0.05).
Summary: Study results underline the value of dietetics and medical educators providing inter-professional learning opportunities that integrate nutrition into medical training for health professions students. As a result of successful outcomes during that first year, the Culinary Medicine course continues to be offered to TCOM medical students each year.
West Virginia University Research Endeavor
Title: Evaluation of a Pilot Program in Metabolic Syndrome Innovation
Authors: Kailey Yancey MS4; Natalie Moffett MS4; Alaina Thiel MS3, Yanhan Huang MS3, Lauren Rover MS3, Rosie Cannarella Lorenzetti MD, MPH
Contact author info: [email protected]
Introduction: Metabolic syndrome is a major risk factor for developing cardiovascular disease and diabetes. In the US, nearly 35% of adults and 50% of those aged 60 years or older were estimated to have metabolic syndrome in 2011-2012. The health benefits of a Mediterranean diet have been well studied and documented in numerous cohort and case-control studies.
Purpose: This is a pilot study to evaluate an educational program for patients who are at risk for diabetes. Study participants will consist of patient volunteers who meet the criteria for metabolic syndrome. Participants will meet in a group visit setting seven times to learn about pre-diabetes and healthy food choices with an emphasis on the Mediterranean diet. Patients will also discuss strategies to reduce their identified barriers to healthy living. The goal is to give the participants initial skills to delay the progression of the metabolic syndrome state to diabetes. By working with this small group we will be able to gather the information that patients with pre-diabetes desire to learn about the condition and nutrition, as well as the manner in which they would like to receive this information. Using this knowledge we will be able to plan a larger scale educational intervention in the outpatient clinic setting.
Methods: IRB approval was sought and obtained for this clinical study. This first cohort of 6 patients was recruited from a Family Medicine practice. These were patients who met criteria for Metabolic Syndrome. They were invited to attend a group visit for one hour every other week for total of 7 visits to learn about metabolic syndrome and good nutrition to prevent progression to frank diabetes. Body parameters of height, weight, blood pressure, BMI and abdominal circumference were to be recorded at every visit. Each group visit had a theme and a lesson; patients were given workbooks and recipes and food preparation lessons. The physiology of pre-diabetes is explained; the end results of untreated diabetes discussed. Topics such as mindfulness while eating, label reading and grocery shopping were addressed. Improving taste of foods without added sugar and salt covered, as well as the actual food preparation lesson, recipes distribution and tasting of new foods each week. There was no charge for these group visits. The medical students were asked to make contact with their assigned patients several times a week, answering questions and offering encouragement. Quantitative data of bodyweights, BMI, A1c, BP and waist circumference was collected. Qualitative data sets including semi-scripted interviews with both the students and the patients were also examined.
Results: Three of the 6 patients made at least half the sessions. All three of these patients had lost inches from the waist and decreased their BMI. The one patient that attended all 7 sessions saw the greatest improvement – she lost 33 lbs and 4 inches off her waist. Those patient interviewed thought the videos explanation of insulin syndrome was excellent and for the first time they felt they understood why it was important to keep sugar intake low. They really enjoyed the new food tastings and recipes. They felt their student mentor gave them accountability. Discussions of barriers to staying on a low sugar/processed carbohydrates diet were busy lifestyle, finding delicious foods that the whole family could eat, so we worked on that. Qualitative results of the student interviews shows students gained confidence in patient interviewing and counseling for positive dietary changes. Also, gathering qualitative remarks from the patients which can be used to recruit more patients for the next series.
Summary: The first pilot in Fall 2016 started with 6 patients and ended up with only patient who attended every session. That patient lost 4 inches off her waist and 33 lbs in 12 weeks. Three others who made several of the sessions still saw positive result sin decreased BMI and decreased waist circumference. We were surprised at the attrition of several of the patient and the difficulty in keeping them engaged. The value of the regular support from the medical students seems to be an important advantage to keep the patients coming. We decided we would need to refine the lessons to make them more interactive, and find ways to encourage attendance and looking at incentives such as a gift card to local food store for completion of the program.
West Virginia University Research Endeavor
Title: Metabolic Syndrome Group Visits: Opportunity for Nutrition and Culinary Skills Education
Authors: Natalie Moffet MD, Kailey Yancey MD, Kathryn Baker MS2, Victoria Konrad, Rosie Lorenzetti MD
Contact Author: [email protected]
Introduction: Metabolic syndrome is a common condition in West Virginia which merits more attention for diet intervention so as to reduce progression to frank diabetes. This program was an outreach of our culinary medicine curriculum to give opportunity for students to identify these patients and have them make dietary changes for maximum benefit. Students led the sessions, prepared the lessons, and demonstrated food prep and shared recipes and foods created in class.
Purpose: This was a second pilot study was done to assess the effectiveness and feasibility of the use of a group visit format run by medical students (with faculty oversight) to inform and teach patients identified who have metabolic syndrome (aka – prediabetes) and create healthy nutritional habits. The focus was on good nutrition, using an approach of a diet program focusing on whole foods; lots of vegetables and good quality protein and healthy fats, and obtaining their carbohydrates from fruits and vegetables (not processed foods). The ultimate goals are to develop a model for successfully treating metabolic syndrome without pharmaceutical intervention and to simultaneously elevate the level of medical student comfort and effectiveness with providing lifestyle-modification-based care.
Methods: This was phase 2 of a pilot project for school year 2016-2017. IRB approval was sought and obtained for this clinical study. This second cohort of patients began First week in February 2017 and will be completed the program in late April 2017. Eleven patients who met the criteria for metabolic syndrome were recruited from the local Family Medicine group practice. These individuals expected to attend group visits every other week for three months to receive education in nutrition focusing on understanding syndrome pre-diabetes and following a healthy natural foods diet. Topics include mindfulness while eating, label reading, grocery shopping , flavoring foods with spices, especially those spices with health benefits, and using less sugar and salt in preparing foods. Patients, students and faculty shared recipes and taste of new foods each week. Each patient is each assigned to a medical student whose responsibilities include conducting weekly check-ins by phone or email (method preferred by the patient) to provide additional support outside of the group visits. Quantitative data being gathered pre- and post our educational intervention includes weight, waist circumference, HgA1C, blood pressure and cholesterol labs. Qualitative data sets including semi-scripted interviews with both the students and the patients are analyzed.
Results: Eleven patients were initially enrolled, with 7 patients completing all 7 sessions. All patients saw improvement in at least one parameter of risk for metabolic syndrome. Parameters being monitored include: BP; Weight; BMI; Waist circumference. Laboratory data include beginning and ending A1c and lipid profiles (mainly interested in triglyceride reduction), 3 months apart. Those with consistent attendance show the most improvement in their numbers. Average weight loss: 10.43 lbs and Average BMI decrease: 1.75. Attendees saw an Average Waist Circumference Decrease 4.5 in. One patient lost 18 pounds, most lost at least 8 lbs. We saw an average decrease in HbA1c of 0.68%; one patient down by 2.7% in three months and stopped taking metformin. Qualitative results will include surveying the students involved, to assess gained confidence and ability to do nutritional counseling in the office setting. Also, qualitative remarks from the patients are recorded.
Summary: Starting with 11 patients, 7 patients were continuously engaged with the sessions. The value of using the medical student as a personal health coach was an important advantage for success for the patients. All patients remarked that they had more energy and physically felt better. Other remarks are listed.
Future Goals: Refine ways to encourage attendance and looking at incentives such as a gift card to local food store for completion of the program. Full results will be available by the conference in June 2017.