2019 Culinary Medicine Conference Research Posters

The research posters below were presented at Health meets Food: the Culinary Medicine Conference in 2019.
View the 2017 Posters | View the 2018 Posters

Goldring Center for Culinary Medicine, Tulane University School of Medicine

Title: The Goldring Center for Culinary Medicine Refresh Kids Summer Class

Authors: Ofure Akhiwu, Brennen Gagen, Maria Santos, Alex Sapin

Contact info: oakhiwu@tulane.edu

Purpose/Hypothesis: The purpose of this study is to showcase the Refresh Kids summer class and also discuss its effectiveness at addressing a lack of knowledge amongst children in the Broad Community of New Orleans regarding the nutritional value of foods and how to prepare foods that promote beneficial health. This summer camp is a one-week intensive plan led by the Broad Communities Connections (BCC) supported by The Goldring Center for Culinary Medicine at Tulane University. The aim of the camp is to enable kids in the board community to obtain knowledge and skill sets so they can make educated decisions about their health and influence individuals in their homes to lead healthy lifestyles.

Methods/Design: The Refresh Kids Summer Camp is held Monday through Friday from 8am to 3 PM. During this time, the participants go through various activities that work to provide education on nutritional and physical health. These activities include, gardening lessons, nutritional education and cooking that incorporate garden harvested and culturally-relevant recipes, physical activity, and an afternoon enrichment activity involving a guest speaker. The gardening lessons teach how to make a compost, recycle, and plant, along with information regarding herbs, while the nutritional education and cooking sessions teach the children about the importance of grains and legumes,good and bad fats, and vegetables. These sessions are in effort to equip the children with the knowledge and resources needed to make health conscious decisions in the diet and lifestyle.

Pre- and post-surveys were distributed to participants to assess the increase in knowledge of the children and the effectiveness of the camp in promoting greater knowledge and understanding of nutrition and health. In addition, a qualitative evaluation was given to garner feedback on the camp and ways that the camp could be improved.

Study Setting: The Camp took place at 300 Broad Street New Orleans, Louisiana. The gardening was held outside at the SPROUT community garden. The cooking classes and physical activities session were held at the Goldring Center for Culinary Medicine Kitchen. The enrichment activities were held in the Refresh community room.

Participants: The individuals targeted in this intervention were children from ages 7-12 living around the Broad community in New Orleans, Louisiana. Recruitment was from the zip codes: 70119, 70113, 70117, 70116, of which the majority of the inhabitants were people of color. A total of 19 children were recruited for the program in 2017 and 19 in 2018.

Results:

68% of the respondents to the pre- and post-survey increased their confidence in making healthy foods.
32% of the respondents improved their attitudes toward vegetables
32% of the respondents improved their attitudes toward growing their own food
21% of respondents improved their understanding of how food sourcing affects the environment
100% of the respondents enjoyed coming to the class

Some examples of qualitative data gotten from the children in their own words include:

What did you learn during your week at camp? “Learning how to cut properly”, “Learning to make salsa”, “How to make hummus”

Conclusions: A healthy lifestyle consisting of a proper diet and exercise helps to significantly reduce the risk of many diseases, and as such, it is crucial to teach children these healthy eating and exercising habits. The Refresh Kids Summer Camp was effective in providing the kids that participated with a foundation of knowledge about nutrition that can subsequently be developed, as well as the confidence that they need to implement a life style that promotes good health. The program is a crucial step toward engaging the community through providing a fun and enjoyable way for children to develop many of the skills necessary to limit the risks of a number of diseases.

Support: This program was funded through a grant from the Emeril Lagasse Foundation

University of Houston, Department of Health and Human Performance

Title: The Development of GirlFit: Fitness and Wellness Workshops to Promote Self-Efficacy among At-Risk Female Adolescents

Authors: Maggie Yip, Ashley Dao, Rashika Sunku, Katherine R. Arlinghaus, MS, RD, Craig A. Johnston, PhD

Contact info: krarling@central.uh.edu

Introduction: As part of an obesity and nutrition experiential learning program, undergraduate students volunteered as health mentors in the PE class of low income, ethnic minority middle school students. During their time volunteering, the undergraduates noticed that female students were more concerned about how they looked and more hesitant to be physically active in class than their male classmates. However, there were no programs at the middle school to address female health.

Description: The undergraduates conducted a literature review on gender differences in adolescent health. Based on their literature review and through mentored discussion, the students developed a program to address these issues for girls. Specifically, the program took place in the adolescents’ physical activity class. It focused on basic nutrition education, mentorship from undergraduate students, separate physical activity workouts for girls and boys, group fitness activities, and self-monitoring of diet. Undergraduates worked with school administrators and teachers to obtain approval for the project to be implemented. They also applied for and were awarded fellowship funding to implement their project.

Summary: Consistent with the undergraduate’s observations, there is considerable evidence that, compared to males, adolescent females are less likely to be physically active, more likely to have concerns with body image, and are more likely to engage in unhealthy dieting behaviors. However, little progress has been made in addressing these health issues. Through an interview process, we found that girls had multiple concerns that were not being addressed when in a co-ed class. This educational endeavor illustrates the role experimental learning opportunities can play in motivating undergraduate students to address health issues in a meaningful way.

Ochsner Hospital, University of Queensland-Ochsner Clinical School

Title: Kuzamura Ubuzima: Growing Health in Rwanda Farm to Bedside

Authors: Dr Craig Conard, MD MPH, Alexandra Babinchak, MS3 UQ-Ochsner

Contact info: v-ababinchak@ochsner.org

Introduction: In Rwanda, government hospitals are unable to provide food to their patients. This means poor and vulnerable patients go hungry, leading to poorer health outcomes.

KU is working to break this cycle of malnutrition and eliminatte poverty amongst this vulnerable population through growing crops on hospital land and providing patients with the nutrition they need.

Description: KU was established to address food and nutrition security of vulnerable patients, providing 2 meals a day to inpatients with expansion planned to other district hospitals in Rwanda. Education is a cornerstone of the KU goal: improving immediate wellness is successful only if there is community involvement. KU provides education on health, sanitiation, hygiene and nutrition to patients and their communities. Currently, KU provides meals and education to over 100 patients daily, with a goal of doubling this number by the end of 2019.

KU also looks to the future by improving immediate health outcomes for inpatients of all ages. Provision of adequate nutrition, farmed locally and with cultural sensitivity, is key for continued success of the program. KU has worked with the Peace Corp. nutritionists, and physicians and partners with local organisations to ensure that all education programming is appropriate and sustainable.

Summary: KU’s Farm to Bedside project provides inpatients in Rwanda with two nutritious meals per day from community managed gardens surrounding the local hospital. In addition to providing education seminars to these patients, the impact of proper nutrition while hospitalised has long term effects on health outcomes in this vulnerable population.

Perelman School of Medicine at the University of Pennsylvania

Title: A pilot nutrition and culinary elective for fourth year medical students increases confidence in counseling patients for the prevention and treatment of diet-associated diseases

Authors: Joshua Rothman, MS; Morgan Berman; Jose Saucedo; Maria Mascarenhas, MBBS; William Duffy, MD; Horace DeLisser, MD

Contact info: Delisser@pennmedicine.upenn.edu

Introduction: Diet-associated chronic diseases are leading causes of morbidity and mortality [1-4], with data demonstrating that counseling on high-quality, whole foods can improve patient outcomes [5]. Graduating medical students, however, feel underprepared to intervene in their patients’ care in regard to nutrition. This is not surprising as most medical schools fail to provide recommended hours of nutrition instruction and what is presented is typically offered in preclinical years, without the benefit of clerkship experiences that would enable correlations between nutrition and clinical outcomes. Medical schools are therefore increasingly utilizing hybrid culinary and nutrition courses

Data, however, are lacking on the impact of culinary medicine courses directed at clinically experienced students.

A pilot nutrition and culinary elective course was thus developed to determine the impact of the course on the confidence of clinical level students in counseling patients with diet-associated diseases.

Description: Eighteen fourth-year Perelman medical students participated in an elective comprised of eight, 2-hour, disease- focused sessions. Students did primary literature readings prior to each session. Individual sessions consisted of culinary skills development, cooking and a case discussion led by physicians and registered dietitians. Students completed pre-and post-surveys to evaluate nutrition knowledge and counseling skills.

Students reported significant increases (p < 0.01 – 0.001) in the confidence they possessed in (i) their knowledge of pertinent nutrition information; (ii) discussing nutrition with patients; and (iii) their ability to impact patient behavior through their counseling.

Summary: The result of participating students’ self-report surveys shows that a culinary medicine course for clinical-level medical students increases confidence in nutrition knowledge and in counseling patients on management of diet- associated diseases. This is extremely valuable clinically as diet-associated chronic diseases are leading causes of American morbidity and mortality. Limitations of these findings include the small sample size, lack of a control group and no assessments of students’ competence in counseling patients. Implementation of this course requires access to a kitchen, cooking supplies and food ingredients, as well as a chef, physician, and registered dietitian, and thus could be readily replicated by medical educators at separate institutions.

Spectrum Health

Title: Bringing Families to the Kitchen: A Culinary Medicine Approach for Metabolic Wellness

Authors: Krista Gast and Lora Boroff

Contact info: krista.gast@spectrumhealth.orglora.boroff@spectrumhealth.org

Introduction: The Kent County, Michigan community faces alarming rates of childhood obesity (23.7%), poor health behaviors around energy balance (68% at-risk for inadequate fruit and vegetable consumption and 37% for physical activity), and food insecurity (18.2% at-risk).

Description: The Spectrum Health FamilyKitchenRx program has an overall goal of reducing the incidence of childhood obesity and subsequent chronic disease and the coinciding economic burden of escalating healthcare costs. The program seeks to transform care delivery to underserved at-risk youth and their families via a two-pronged approach:

  1. Expand delivery of and evaluate the impact of an evidence-based and innovative professional culinary medicine program to resident physicians and healthcare workers employed at Spectrum Health (SH) pediatric and family medicine clinics; and
  2. Implement and evaluate a family culinary medicine program inclusive of hands-on cooking skill development in a teaching kitchen, coaching from a registered dietitian, technology enabled self-management, and access to fresh healthy ingredients to children and families who are dually challenged by food insecurity and overweight/obesity.

Through this program, we are evaluating the impact of a high-tech teaching kitchen environment at the Grand Rapids Downtown Market, combined with health app enabled coaching with an RD in improving diet quality of overweight children and their families. In class, we focus on nutrient dense yet approachable and affordable recipes. We have partnered with local healthy food access points in our community including the YMCA veggie van and the Grand Rapids Community Food Club. Collaboration with our local culinary school, Grand Rapids Community College Secchia Institute for Culinary Education allows for culinary instructors to teach participants helpful basic kitchen skills in order to translate healthy cooking knowledge in their home kitchens.

This work is currently funded through the Michigan Health Endowment Fund for this pilot phase and seeks to reach 200 children in our community. Collection of metrics including diet quality and BMI trends will be important for scaling and sustaining this program.

Summary: We expect to demonstrate meaningful improvements in dietary behaviors and diet quality by utilizing the Family Nutrition and Physical Activity screening tool, Cooking for Health Optimization with Patients (CHOP) survey for children and adults, as well as biometrics, including Body Mass Index (BMI).

UT Southwestern Medical Center, Children’s Health System of Texas & The Moncrief Cancer Institute

Title: Culinary Medicine Enrichment Elective: Two Years Into Launching a Nutrition Curriculum for Medical Students

Authors: Jaclyn Albin, MF, FAAP, FACP; Lucy Cheng; Yun Liang; Milette Siler, RD, LD

Contact info: Jaclyn.albin@UTSouthwestern.eduLucy.Cheng@UTSouthwestern.edu, Milette.Siler@moncrief.com

Introduction: Disease burden has increasingly shifted toward chronic conditions impacted by lifestyle factors, particularly nutrition and physical activity (1). Despite this increased public health burden, physician education continues to provide inadequate exposure to nutrition education. Only 25-30% of U.S. medical schools meet the minimum requirement of 25 hours of nutritional education set by the National Academy of Sciences (2). Surveys have demonstrated that physicians are considered to be credible sources of nutritional information; however, over half of graduating medical students consider their nutrition knowledge as “inadequate” (2). In fact, an internal survey of third year medical students at our own institution, UT Southwestern Medical School (UTSW), showed that only 41% of students felt that they had adequate knowledge to counsel patients with particular diagnoses (hypertension, diabetes, celiac disease) about their nutrition and 66% of students either disagreed or strongly disagreed with the statement “my pre-clinical years adequately prepared me to counsel patients about their nutrition.”

Culinary medicine is an evidence-based field that seeks to highlight the intimate connection between food and medicine, further aiming to empower patients to make informed decisions about the food they eat in order to prevent or manage their diet-related chronic disease. The cost burden of chronic disease is steadily increasing, now greater than 75% of our total  health spending, and low income individuals being disproportionately affected (3-4). With the goal of addressing the inadequacy of nutrition education and barriers to providing evidence-based nutrition recommendations to patients, we launched the first Culinary Medicine Enrichment Elective at UTSW in August 2017.

Internal survey from student participants during the first year (N= 34) showed that 82% reported changing personal diet and more than 95% reported believing that a physician’s personal health habits influenced patient outcomes after completing the enrichment elective. Furthermore, 100% of students endorsed understanding basic Mediterranean diet research (vs 68% pre-elective), 83% reported feeling comfortable having a discussion with a patient regarding eating habits and health (vs 26% pre-elective) after finishing the course (5).

Given the positive influence and high student interest, we renewed our Culinary Medicine elective, created a flexible 4th year nutrition elective, partnered with several local food pantries to provide patient culinary medicine education, and launched a community outreach program called “Food as Medicine (FAME)” project. This poster provides an updated survey data analysis from the two years Culinary Medicine Elective has been in place at UTSW, as well as insights to successfully continuing and expanding culinary medicine at a medical institution. We aim to highlight the ongoing impact of the elective among UTSW medical students and the benefits of optimizing culinary medicine as a health promotion modality.

Description:  The Goldring Center for Culinary Medicine at Tulane University has developed a comprehensive, case-based curriculum for medical students through their team trained as physicians, dieticians, and chefs. UT Southwestern Medical Center (UTSW) possesses licensed use of the curriculum in partnership with the Moncrief Cancer Institute. Developing a first year medical student elective was the goal of our initial launch of Culinary Medicine curriculum at UTSW in 2017. To enable the implementation of medical student training in Culinary Medicine, we first developed an interdisciplinary partnership with UTSW’s School of Health Professions, Department of Nutrition.  The Department of Nutrition has a campus teaching kitchen with five stations for their dietetic program, and they allow use of their kitchen for the Culinary Medicine elective.  In turn, second-year dietician students deliver interdisciplinary education to medical students during elective modules, satisfying a curricular requirement.

Due to the time and resource-intensive needs of a high quality Culinary Medicine elective, the physician director recruited student facilitators to serve as leaders for the elective. The three student leaders then recruited over a dozen third and fourth year medical students to serve as “peer mentors” for the elective.  These students serve in an essential volunteer role. While initially using personal continuing education and discretionary funds, the physician director applied for and received a small education grant for $4,000 to support the updating of kitchen equipment, food costs, and scholarly work. Additional funding sources are in progress, including plans to offer continuing education in Culinary Medicine at UTSW through additional partnership with the Goldring Center.

The Culinary Medicine curriculum at UTSW was launched as an Enrichment Elective in August of 2017 with a pilot group of first year medical students and returned for another year in August of 2018. The recruitment process was similar to the inaugural elective class where the physician and student leaders briefly described and advocated for the Culinary Medicine Elective during the first year students’ orientation. Two cohorts of 17 medical students enrolled in each group as a first-come, first-serve approach (with dozens of students on a wait list due to high interest and lack of space), and groups are expected to complete a minimum of six out of eight scheduled modules, with each module taught twice to accommodate two groups of students.  Each module includes preparation of several complete recipes, case-based discussion with peer mentor assistance, and didactic teaching by the physician director and dietician. At the start of each session, groups of four students prepare dishes in the kitchen based on a designated menu from the curriculum as it relates to the module being discussed that evening. After cooking, groups present their cooked dishes by sharing the ingredients and nutrional facts with the class. This is followed by clinical case studies with support from volunteer peer mentors to guide the discussion. The last portion of the session involves a didactic presentation delivered by course directors, a physician and registered dietician team, where students learn about current literature and recommendations for different nutrition principles. At this point, the students enjoy the dishes that the groups prepared, allowing them to try things that they may not have encountered before and to evaluate their own cooking abilities. Throughout the module, peer mentors work to support the cooking process, keep the kitchen clean, and encourage pre-clerkship students regarding the clinical implications of what they are learning.

The fourth year medical student culinary medicine elective called Building a Food Foundation is a self-guided exploratory month with weekly assignments and reports due back to the physician director. It was created due to overwhelming upperclassmen student interest and lack of other opportunities for fourth year medical students to be exposed to the culinary medicine curriculum or any nutrition education. This four week elective provides students an opportunity to explore current nutritional sciences literature as it relates to their desired specialties while providing a flexible month for interview season. All assignments and reports are electronic and minimal face-time is required aside from attending a Culinary Medicine Elective module night as a peer mentor.

Additionally, given the success of the enrichment elective at UTSW medical school, the Culinary Medicine curriculum at UTSW was expanded to the local community through the “Food as Medicine (FAME)” project in partnership with Crossroads Community Services. The FAME project is a multi-component education program for low-income families in Dallas where students lead food demonstrations at three local food pantries during client distribution days. Clients are also invited to the Culinary Medicine courses that are held on Saturdays at the pantries. At the demonstrations and Culinary Medicine courses, clients and student volunteers have the chance to share recipes, samples, and material lists that underlines the critical link between food and health.

Summary: Previous studies have demonstrated superior effectiveness for a hands-on cooking and nutrition education approach compared to traditional clinical methods of teaching when it comes to medical students’ competency in providing nutrition counseling for patients and improvements in their personal wellness (5). Internal survey results from the last two years of the Culinary Medicine Elective show that 100% of students agreed or strongly agreed that the information learned through the elective was helpful (N=60), and 92% of students believed that a physician’s personal health habits correlates directly with patient outcomes after completing the elective compared to 66% at the beginning of the elective. The number of students who felt confident in the kitchen and comfortable speaking to patients about their nutritional status and eating habits increased significantly following a year in the enrichment elective (p<0.05). Compared to 54% of students (N=64) prior to the elective, 97% (N=60) answered that they were familiar with the basic tenets and research associated with the Mediterranean diet after completing the elective. Furthermore, a significant number of students (from 44% to 77%, N=64 and 60, respectively) answered “strongly agree” when asked if speaking with patients about their food choices is an essential part of any discussion about health (p<0.05).

Medical school-based nutrition education in a teaching kitchen can not only be applied to medical professionals, but also to patients. Improvements in HbA1c, blood pressure, and cholesterol were seen in patients with type 2 diabetes who participated in a Mediterranean diet evidence-based nutrition curriculum for over approximately six weeks (6). As chronic disease continues to necessitate lifestyle change for effective management, the demand for physicians equipped with this skillset increases. After initiation of a single culinary medicine module for UTSW third-year medical students during their Ambulatory Clerkship, the student feedback overwhelmingly requested earlier and increased educational content of a similar nature. Additionally, student interests continued to far exceed elective spots in this recent year of Culinary Medicine elective as it did during the course’s initial launch in 2017. In part due to this increased student interest, a community pilot program was launched in partnership with Crossroads Community Services at three local food pantries. We are currently in the process of gathering results from the community participants.

Future contributions to the field of Culinary Medicine and expansion of educational opportunities at UTSW include several strategic efforts. We plan to continue our collaboration with research colleagues in the UTSW School of Clinical Sciences and Crossroads Community Services to grow our community programs. From an educational standpoint, several campus residency programs have requested Culinary Medicine classes for resident learners, and we are actively planning to launch this for a small fee to campus residency programs which will cover costs of the classes.  We continue to partner with UTSW’s Moncrief Cancer Institute, and they sponsor the dietician co-course director’s role. Finally, we are partnering with the Goldring Center to eventually serve as a site for continuing education in Culinary Medicine, an approach that will lead to modest protected time for faculty leadership and will ensure sustainability of our program. Through these avenues, we hope to infuse culinary medicine into the undergraduate, graduate, and community education to optimize the prevention and treatment of lifestyle-related diseases.

University of New Mexico

Title: Culinary Medicine at University of New Mexico

Authors: Deborah Cohen, Amy Robinson

Contact info:  Dcohen02@unm.edu, Arobinson@salud.unm.edu

Introduction: This is the first Culinary Medicine course and initiative at UNM and in the state of New Mexico. This course is also the first interdisciplinary collaboration between the UNM Main Campus (which is where the Nutrition Program is housed) and the UNM School of Medicine.

Description: We were able to incorporate the Culinary Medicine course into the School of Medicine as a 4th year elective. Our main objective was to utilize this opportunity to teach Nutrition to medical students. In addition to utilizing the GCCM Modules (we only use 5-6 since it is only a 4-week course), we added weekly seminars so that we have an opportunity to discuss Nutrition concepts behind the modules, students present on one timely nutrition topic and participate in journal club, spend 8 hours in Registered Dietitian Nutritionist (RDN) observations, tour of a local food bank, tour a local farm and participate in a body composition lab.

Summary: Based on three semesters of student feedback, the activities we have incorporated into our course have been well received. In addition to reviewing pertinent published literature of the concepts associated with the GCCM Modules in the 6-hour weekly seminars, the students spend a total of 8 hours with both in and outpatients RDN’s for the primary purpose of explaining/demonstrating how to refer to a RDN once they are practicing in the community as physicians. We also have them spend time at the food bank so that they are familiar with local resources for those who require food assistance. During the body composition lab they learn how to utilize some basic tools in their practice (scales, stadiometers, waist circumference, bio electric impedance analysis) as well as learn about other modalities (underwater weighing, Bod Pod) to assess body composition. The tour of a local farm introduces the students to sustainability concepts.

University of California Berkeley

Title: What’s in your box? A local food system and culturally conscious approach to the food prescription model

Authors: Carina De La Cueva

Contact info: cdelacueva10@berkeley.edu

Introduction: Food prescriptions that are grounded in theory and are aimed at addressing sustainable and culturally appropriate forms of reducing food insecurity among under-resourced communities is a potentially impactful way to integrate education, nutrition, and food justice empowerment to the individuals of these communities. This is important because creating an environment that provides the resources supportive of alleviating food insecurity through a systemic approach will help create health equity among different neighborhoods and therefore quality of life.

Description:
First: This is a theoretical model for a potential food prescription intervention that can be carried out among different clinic location sites, particularly pediatric sites. To create such a model requires understanding the local food systems that exist in a given neighborhood. Oakland Ca was chosen for this endeavor. In addition, engagement of general public in the region to understand concerns revolving access to healthy foods and preparation will be assessed for incorporation into the study.
Second: Identification of a study sample of interests was based on the literature, Latino, particularly Mexican origin, women have health outcomes that result from food insecurity-associated poor diet quality and households with children are disproportionately impacted by higher and food insecurity rates. Because of the focus to change health behaviors, dyads of parent-child participation is an ideal form for obtaining participant involvement.
Third: Recruitment will occur through clinic visits for pediatric patients and collection of baseline and outcomes from a control and intervention group will consist of both groups beginning with receipt of culturally appropriate weekly delivery of fruits and vegetable deliveries from the local CSA service and gradual introduction of novel items that can be consumed raw and with demonstrated cooking guidance on how to prepare them.
Fourth: Payment of intervention will be a combination of grants and additional efforts to enlist MediCal/and interested insurance entities to support this intervention as a preventative medical treatment in effort to integrate more smoothly across health care service and business entities.
Fifth: Education component will consist of nutritionist and local chef/restaurant partnerships to further integrate local community members who already prepare culturally familiar foods and existing dishes familiar to Latino households.
Sixth: Engagement in the study through cooking class group engagement, and home photovoice and feedback on experience, paired with anthropometric and diet recall measure again will emphasize community formation among participants and local businesses to empower participants themselves to engage in improving existing systems of food availability and practices in their community.
Last, create a report for local city council on needs of the community for further supporting local food systems and engagement in healthier eating practices.
Summary: It is found that fruits and vegetables have a protective role in cancer prevention, coronary heart disease, and strokes as well as emerging data in suggesting F&V have a protective role in cataract formation, chronic obstructive pulmonary disease, diverticulosis, and hypertension (Van Duyn & Pivonka, 2000). Children of specific Latino subgroup households are especially susceptible to poor health outcomes (Kersey et al., 2007). There are still few early prevention programs focused on Latino population despite the significant associations and increased prevalence of diet related diseases and proven low resources for changing diet quality and eating patterns (Watt et al., 2013).

Community Supported agriculture is promising in improving access and increasing consumption of fruits and vegetables. It’s difficult to have families from low-income communities to participate due to an upfront payment structure for weekly deliveries, barriers to the logistics of the delivery and unfamiliar produce can all decrease participation in the project(Seguin et al., 2017). Based on my personal observation of methods from 2 pilot food prescription-CSA partnered intervention studies, subsidizing participation with tailored nutrition is a way to engage low-income families with children especially among the Latino population. My observations showed that recruitment through clinic sites that are partnered with local urban farm businesses provides a promising structure for building rapport among medical interprofessional teams and local owners of businesses that promote consumption of fresh, locally grown, and sustainable nutrient rich produce. Partnerships among two different clinics and several food resources entities including the county food bank forms a mutual benefit to the health of the healthcare center’s patients and to the economic stability of the businesses that exist in the neighborhoods. This format of a food prescription intervention carried out through a clinic has potential because of its ability to identify families who have increased risk for poor health outcomes based on current medical presentation and social needs screening that is being measured more universally in clinics, particularly in pediatric settings.

University of Houston and Texas Southern University

Title: Utilization of Food Scholarships among Community College Students

Authors: Barbara Morris, Geselle Zuniga, Jessica Della Costa, & Daphne C. Hernandez, PhD, MSEd

Contact info: dhernandez26@uh.edu

Purpose/Hypothesis: Food Scholarships is an innovative program designed by the Houston Food Bank to assist low-income students’ availability to food while they are trying to further their education. To examine the monthly utilization rate (i.e. participation rate) of the Food Scholarship program.

Methods/Design: Between March 2018 – April 2019, students based on the criteria described below, were provided access to a Food Scholarship. Once a week, food was set up similar to a farmer’s market experience at a designated community college campus. Students were allowed to visit the market up to twice a month and access the food.

a) Outcome Measures: Average monthly utilization rate and the range of the utilization rate.
b) Study Setting: Large community college, with multiple campuses, located in an urban area.
c) Participants; Community college students who are 18 years of age with an expected family contribution of $0 and total income reported on federal student aid forms of $25,000 or less. Students were required to meet satisfactory academic progress and could be attending school either part-time or full-time. Students who were 17 years of age or less and/or concurrently in high school were excluded. Enrollment into the Food Scholarship program is on-going. Over the 14-month period, 273 out of 500 students enrolled into the Food Scholarship, with 220 students enrolling within the first month.

Results: On average the utilization rate was 23%. During the spring 2018 semester utilization ranged from 23% – 63%. During summer 2018 utilization ranged from 17% – 31%. During fall 2018 semester utilization ranged from 14% – 21%. During spring 2019 semester utilization rate ranged from 12-13%. The poster presentation will include a cluster column bar chart displaying the number of cards redeemed to the number of eligible participants. Another bar chart will display the monthly utilization rate for the 14-months.

Conclusions: While the community and the community college that the students attended made great strides to make food available to them, utilization of the program was low. Thus, accessibility of the program appears to be a problem. Understanding why this discrepancy occurred is an area of future research.

Support: Funding for project is supported by the Kresge Foundation, the William T .Grant Foundation, Grant # 187656, and the Research and Extension Experiential Learning for Undergraduate (REEU) Program of the National Institute of Food and Agriculture, USDA, Grant # 2017-67032-26021

University of Houston and Texas Southern University

Title: Basic Needs Assessment of Community College Students

Authors: Jessica Della Costa, Barbara Morris, Geselle Zuniga, & Daphne C. Hernandez, PhD, MSEd

Contact info: dhernandez26@uh.edu

Purpose/Hypothesis: A basic needs survey was conducted to identify which childhood and adulthood adverse experiences place community college students at risk for food insecurity.

Methods/Design: During January – February 2018, community college students based on the criteria described below, were provided an opportunity to fill out an online survey. The survey focused on basic needs, in addition to childhood experiences (i.e. food hardship and adverse childhood experiences) and current experiences (i.e. adverse experiences of major life events in the past 12 months, stress, depression, and anxiety), and food security status.

a) Outcome Measures: Food insecurity status based on the USDA 18-item Food Security Scale.
b) Study Setting: Large community college, with multiple campuses, located in an urban area.
c) Participants; Community college students who are 18 years of age with an expected family contribution of $0 and total income reported on federal student aid forms of $25,000 or less. Students were required to meet satisfactory academic progress and could be attending school either part-time or full-time. Students who were 17 years of age or less and/or concurrently in high school were excluded. Enrollment into the Food Scholarship program is on-going. Out of 1000 students eligible to take the survey, 504 completed the survey (51% response rate).

Results: Bivariate analyses indicate that negative childhood experiences and current adverse experiences are correlates of community college students experiencing food insecurity (p = .000). Specifically, students who experienced food insecurity (n = 249) also experienced greater food hardships (mean = 2.78, SD = 1.95) and adverse childhood experiences (mean = 2.91, SD = 2.66) compared to students who experienced food security (n = 265) [food hardships (mean = 1.05, SD = 1.50) and adverse childhood experiences (mean = 1.63, SD = 2.14)].

Students who experienced food insecurity (n = 249) also experienced greater major life events (57% vs. 35%), stress (mean = 7.52, SD = 2.83 vs. mean = 5.52, SD = 3.01), depression (33% vs. 13%), and anxiety (28% vs. 10%) compared to students who experienced food security.

Conclusions: Results suggest that food insecurity is correlated with adverse experiences that occurred during both childhood and adulthood. While food insecurity is considered to be episodic, perceiving that food insecurity only occurs during childhood or goes away once students graduate from high school is not accurate. Reframing food insecurity as episodic and a consequence of cumulative adverse experiences may provide insight as to why food insecurity is currently being observed among community college students.

Support: Funding for project is supported by the Kresge Foundation, the William T .Grant Foundation, Grant # 187656, and the Research and Extension Experiential Learning for Undergraduate (REEU) Program of the National Institute of Food and Agriculture, USDA, Grant # 2017-67032-26021

University of Houston and Texas Southern University

Title: Food Scholarships: Increasing Community College Students Availability of Food

Authors: Geselle Zuniga, Jessica Della Costa, Barbara Morris, & Daphne C. Hernandez, PhD, MSEd

Contact info: dhernandez26@uh.edu

Purpose/Hypothesis: Food Scholarships is an innovative program designed by the Houston Food Bank to assist low-income students’ availability to food while they are trying to further their education. To examine the number of pounds of food community college students obtained on a monthly basis through the Food Scholarship program.

Methods/Design: Between March 2018 – April 2019, students based on the criteria described below, were provided access to a Food Scholarship. Once a week, food was set up similar to a farmer’s market experience at a designated community college campus. Students were allowed to visit the market up to twice a month and access the food.

a) Outcome Measures: Average total pounds of food, including average pounds of meat, fresh fruit, fresh vegetables, and dry goods.
b) Study Setting: Large community college, with multiple campuses, located in an urban area.
c) Participants; Community college students who are 18 years of age with an expected family contribution of $0 and total income reported on federal student aid forms of $25,000 or less. Students were required to meet satisfactory academic progress and could be attending school either part-time or full-time. Students who were 17 years of age or less and/or concurrently in high school were excluded. Enrollment into the Food Scholarship program is on-going. Over the 14 month period, 273 out of 500 students enrolled into the Food Scholarship program, with 220 students enrolling within the first month.

Results: On average students accessed 71 total pounds of food on a monthly basis. This equated to on average students accessing 20 pounds of meat, 11 pounds of fresh fruit, 13 pounds of fresh vegetables, and 26 pounds of dry goods on a monthly basis. When students were asked what they wish they could access more of, students replied meat, followed by fruit. The poster presentation will include five bar charts that will display the monthly averages of total pounds of food, in addition to the monthly averages of total pounds of meat, fresh fruit, fresh vegetables, and dry goods.

Conclusions: Students accessed dry good and meats more frequently compared to the fresh fruit and vegetables. While fresh fruit and vegetables were available, students did not access them as frequently. Understanding why this discrepancy occurred is an area of future research.

Support: Funding for project is supported by the Kresge Foundation, the William T .Grant Foundation, Grant # 187656, and the Research and Extension Experiential Learning for Undergraduate (REEU) Program of the National Institute of Food and Agriculture, USDA, Grant # 2017-67032-26021

West Virginia University School of Medicine Eastern Division

Title: Using the Mediterranean Diet Score as a Counseling Tool in the Primary Care Setting

Authors: Jane Tuttle, MS2; Denisse Arteaga, MS2; Kara Bird, MS2; Ella Bushman, MS2; Morgan Bush, MS2;, Amy Schattel, MS2; Shelby Shajimon, MS2; Jasmin Tharakan, MS2; Rosemarie Lorenzetti, MD, MPH, CCMS; and Madison Humerick, MD, CCMS.

Contact info: humerickm@wvumedicine.org

Purpose/Hypothesis:  The purpose of this study is to determine the Mediterranean Diet Score of patients in primary care clinics in the Eastern Panhandle of West Virginia and to use the Mediterranean Diet Score as a healthy nutrition counseling tool for patients.

Methods/Design

  1. Outcome Measures: 2nd year medical students from West Virginia University School of Medicine (who received additional education in nutrition from culinary medicine faculty members at WVU School of Medicine) interviewed patients in primary care clinics in the Eastern panhandle of West Virginia, asked about their intake of food groups in each of the 9 categories in the Mediterranean Diet Score, and calculated a Mediterranean Diet Score on each patient.  Diet scores range 0-9 points with patients earning 1 point based on the following criteria:
    1. Vegetables: At least two cups per day
    2. Legumes: At least four or more times per week (2 oz per day)
    3. Fruit/nuts: At least 8-9 oz per day
    4. Fish: At least two servings per week (1 oz per day)
    5. Dairy: Less than ¾ to 1 cup per day
    6. Meat: Less than 4 oz per day
    7. Unsaturated fats (eg olive oil) as the main source of fat
    8. Whole grains: At least 2-3.5 cups per day
    9. Red wine: 5 ounces per day or less

Medical students then counseled on 1-2 things that the patient could do to increase their score, for example: eating more non-starchy vegetables daily or eating more fish per week.

  1. Study Setting: Primary care clinics in the Eastern panhandle of West Virginia.
  2. Participants: Patients in primary care clinics who were >18yo.

Results: 96 patients over the age of 18 were interviewed by second year medical students.  49% of study participants were female.  The average Mediterranean Diet Score was 3.75 (SD 1.84), median score of 4.  There were no differences in Mediterranean Diet Scores with respect to different age groups.  Those with the highest Mediterranean Diet Scores (6-9) had a higher proportion of female patients (70%), while the lower scores (0-3) had a higher proportion of male patients (66%).

Those with the lowest med diet scores (0-3) reported a statistically significant, lower consumptions of vegetables, legumes, fruit and nuts, fish, and whole grains at a higher frequency than those with the higher scores (p=? for each category).

The 2 most common counseling points with patient commitment were increasing vegetable intake (47% or patients) and increasing fish intake (32% of patient).  Fewer patients were committed to reducing consumption of unhealthy foods.  For example, 5 patients committed to reducing portion sizes, 3 patients agreed to reduce snacking, 3 were willing to reduce soda intake, and 2 promised to eat fast food less often.  Overall, patients were more willing to add items to their diets rather than take something away.

Conclusions: The average Med Diet Score obtained in this study is higher than the proposed average that would be achieved through the standard American diet, which should be around 2 (as proposed by Jacobs et al. 2018).  This may indicate that patients tend to self-report higher consumption of healthy foods.  A study that administers a food frequency questionnaire in conjunction with the Mediterranean Diet Score tool would be needed to determine whether patients are over or underreporting the intake of certain food groups.  Anecdotally, student feedback indicates that the Mediterranean Diet Score as a tool to assess the quality of patient’s diets is a helpful tool in finding areas of intervention and counseling with the patients.  A follow up study examining whether medical student counseling on Mediterranean style diet impacts patients’ eating habits at home is needed to assess the effectiveness of the Mediterranean Diet Score as a counseling tool.

University of Alaska Anchorage

Title: Community Culinary Nutrition Intervention Results & Future Plans

Authors: Allison Hillen, BS; Carrie King, PhD, RD, LD, CDE

Contact info: cdking@alaska.edu

Introduction: Students enrolled in new health-related culinary education courses at the University of Alaska, Anchorage (UAA) in the fall of 2018 and spring of 2019. These courses were taught online and included students who were located all over Alaska and one was located overseas.

Students completed their major course project, the Community Culinary Nutrition Intervention (CCNI) where they determined the culinary nutrition needs of a food insecure population in their community and how best to meet them.

The purpose of this poster is to describe the CCNI assignment.

Description: The Community Culinary Nutrition Intervention (CCNI) gave students the opportunity to complete a hands-on project in their local communities in which they gained real-world experiencing applying what they learned in the online classroom. First students formed a group of two and identified a community partner site of interest. Next they arranged a site visit where they inquired about the site’s interests and needs. A needs assessment was completed along with an interview of the site program manager and an intervention plan was drafted. The intervention was executed at the site; options included: Walking the Line, Cooking Demonstration, Taste-Testing. Finally, students reflected on the process and determine the strengths and weaknesses of their intervention. Students participated in focus groups to determine course outcomes as well as outcomes from their major course project, the CCNI. Qualitative results from focus groups will be outlined and described using rich quotes from students. Future plans for health-related culinary education community outreach at UAA will be discussed.

Summary: Determining qualitative outcomes of health-related culinary education in the community setting and comparing these with expected outcomes will help to further develop the culinary medicine curriculum. Further, the unique online format of UAA’s curriculum will add a new dimension to the scope of health-related culinary education.

University of Alaska Anchorage

Title: Undergraduate Culinary Education – Preparing Future Health Care Professionals via Online Delivery

Authors: Carrie King, PhD, RD, LD, CDE; Chef Naomi Everett, MS

Contact info: cdking@alaska.edu, neverett@alaska.edu

Introduction: The University of Alaska Anchorage (UAA) Dietetics and Nutrition program previously offered two required foods courses online for undergraduate dietetics students. In 2018-19 these courses were updated to reflect the nationwide trend to provide health-related culinary education for students across health care disciplines.1  Two new courses were developed:  DN A270 Culinary Nutrition and DN A275 Introduction to Culinary Medicine. Nutrition science must be translated into practical advice that health care professionals can apply personally, and also disseminate to their patients.1 

The purpose of this poster is to describe the curriculum for the two new courses.

Description: UAA’s Dietetics and Nutrition program is delivered online to students throughout Alaska. Two faculty, one from Culinary Arts and Hospitality Administration, and one from Dietetics and Nutrition, collaborated to develop the curriculum for the new courses. Distance education technologies were utilized to provide interactive, asynchronous courses that facilitated culinary skill demonstrations from faculty and students. Assignments included video recordings of culinary techniques, quizzes, case studies, nutrition care plans developed by student teams, self and peer evaluation of recipe preparation, recipe modification and culminated with a culinary nutrition intervention in a community setting with a food insecure population.

The short-term goal of the new health-related culinary education courses is to positively impact student cooking attitudes, behaviors, knowledge and self-efficacy of healthy eating behaviors at the end of the two-course sequence. The long-term goal of the partnership between the Culinary Arts and Hospitality Administration and Dietetics and Nutrition programs is to establish a culinary medicine program with courses for students (undergraduate, graduate, medical) health care professionals and community members.

Summary: There is evidence that healthcare professionals are not confident about addressing the nutrition issues they encounter in practice. This is largely due to perceived inadequacies in the nutrition education included in their entry-level training.2 The achievement of the student learning outcomes in these courses is a necessary step towards improving public health and reducing health disparities such as food insecurity and elevated rates of lifestyle-related chronic disease.3 Training, through the completion of these courses, will lay the foundation for translating culinary nutrition knowledge and skills to improve their patients’ outcomes in their future careers.

The outcomes of the new courses at UAA demonstrate that the online delivery of health-related culinary education is enthusiastically received and applied.

West Virginia University School of Medicine

Title: First Year of the Culinary and Lifestyle Medicine Track at WVU- Organization and Lessons Learned

Authors: Rosie Lorenzetti MD, Madison Humerick, MD Melody Phillips MD and Gwen Emery MD

Contact info: cannarellar@wvumedicine.org

Introduction: The first year of the Culinary and Lifestyle medicine Track (CLMT) with enrolled students began summer 2018. The track is just completing its first full year.

This poster is to define and show what was accomplished during this first year’s activities.

Description:

  1. Recruitment activities for first cohort of students (admitted as freshmen in spring 2018) and second cohort (students entering medical school August 2018)
  2. Organization of the GCCM modules for each cohort school year 2018-2019
  3. Organization of the school year learning sessions for each cohort
    1. Orientation
    2. Teaching kitchens
    3. Face to face contact with each cohort
    4. Clinical Learning Groups sessions
  4. Externship activities 2018
    1. Learning sessions
    2. Community activities
    3. Teaching kitchens
    4. Community research project
    5. Clinic work with patients
  5. Externship activities projected 2019
    1. Learning sessions
    2. Community activities
    3. Teaching kitchens
    4. Community research project
    5. Clinic work with patients
  6. Formal evaluation plans for the CLMT

Summary:

Lessons learned this first year of the track

Initial observations and in-time adjustments made as CLMT evolved over the past year

changes needed to be made

Questions we asked ourselves

  • Would students want to sign up for the CLMT?
  • Was there going to be interest in this culinary medicine and lifestyle education?
  • What kind of student would want to take on this extra work
  • When and how do we work in the teaching kitchens
  • Besides the culinary info- we also teach about practical lessons on
  •             Sleep
    Stress management
    Movement/physical activity
    Self-care

What sources should be used to teach these concepts as well

Lessons learned

  • Students are super-interested in culinary medicine and lifestyle lessons. We had 8 applicants to the first CLMT cohort (students that were freshmen in spring 2018) and we accepted all eight. We knew what money was available through a philanthropic donation to cover summer externships for the students that summer. We also wanted the CLMT students to be able to be together in the required Clinical Learning Groups sessions during the first and second year of the medical school curriculum. These groups work best with at least 6 students and no more than 10 students, so we were trying to keep into that range
  • Be mindful of expected/required curricular activities/ test schedules during school year- and work the GCCM modules to what topics they are studying in mandatory school classes
  • Mandatory attendance at the teaching kitchens were necessary as those could not be made up- but be sure to schedule way ahead of time at a time most convenient to the students
  • Letting students choose their own leader/communicator between the cohort and the faculty
  • Students enjoyed getting together prior to actually starting school- enabled them to bond
  • Financing the program was more demanding than originally anticipated

Externship costs/student
Food for each teaching kitchen
Reimburse/assign faculty for time lost from clinic to precept students in CLGs
Travel costs for faculty

Based on the success of the CLMT’s first school year= we are eagerly looking forward to the third cohort to be admitted this summer, and the beginning of an IRB approved formal evaluation for the admitted students. Also, longer term student input to curricular changes for the whole school  are being sought– e.g. practical slide input to Pharmacology Lectures. Lastly- a community project to improve patient wellness at the University Hospital when the students can participate in will also occur this year

University of Nevada Reno School of Medicine

Title: UNR Med Medical Nutrition Initiative – Nutrition Science As An Element of Case-based Learning

Authors: Alyssa Eckert MS2, Laura Moles MS2, Tasha Vazquez MS1, Samantha Romanick PhD Candidate, Samantha Carson MS2, Erika Mauban MS3, Deryan Smith MS1

Contact info: lauramoles@med.unr.edu

Introduction: Interactive and case-based learning has become a standard element in preclinical medical education. Similarly, integration of nutritional topics into preclinical education provides an opportunity to build science-based understanding of nutritional recommendations and pathology. With both goals in mind, the Medical Nutrition Initiative Committee at UNR Med has worked to integrate case-based learning with hands-on nutritional workshops. Taken together, these two elements better prepare students for USMLE Step 1 performance, clinical rotations, and a lifetime of wellness-focused patient care.

Description: The Medical Nutrition Initiative Committee at UNR Med was founded in 2017 with the mission to empower medical students with a nutritional skillset as they approach their future in clinical medicine. The committee is primarily student-driven with representation from first, second, and third year medical students as well as PhD candidates from the biochemistry department. Experts in the field also make up a portion of the committee with medical school faculty, dieticians, and local clinician involvement.

During the 2018-2019 academic year, focus was placed on collaboration with case-based learning within the existing preclinical curriculum. Cased-based learning at UNR Med is comprised of three primary elements: a case introduction session at the beginning of the week, team-based out-of-class assignment(s) throughout the week, and a case wrap up session typically led by a local clinician at the conclusion of the week. The cases highlight a different diagnosis each week, as applicable to the block information at the time. Each case introduction and wrap up session is designated as mandatory for student attendance. As the first step in collaboration, nutritional topics were integrated into out-of-class assignments in the form of additional questions to prepare for the week’s case wrap up. This ensured self-guided learning in the nutritional applications of the case.

Next, a workshop was either combined with the case wrap up or added immediately afterwards to take advantage of the mandatory attendance policy of existing sessions. Additional experts in the field of nutrition such as RDs and CDEs were included at case wrap up. Most workshops began with a short game or discussion to gauge students’ understanding of the nutritional implications to the case. Workshops then transitioned to hands-on cooking sessions, meant to be integrated into management of the clinical case. Cooking plant-based meals to increase higher fibrous prebiotic intake, a hypertension-friendly cooking competition, and iron deficiency dietary interventions were amongst these sessions. Topics presented during these workshops educated students on both the foundational science behind dietary modifications, as well as the behavioral and economic implications to these changes. Presentations discussing gut microbiome biology, physiological effects of sodium intake, and the purine pathway for gout served as foundational science discussions, while behavioral implications including eating disorder management, portion sizing, and budgeting skills during shopping encompassed behavioral sciences. Student learning was then assessed by the addition of exam questions to the block final examinations. In 2018-2019 we were able to integrate nutritional topics into 15 of 21 cases presented during the first-year curriculum and provide 6 workshops. Future directions for the medical nutrition curriculum at UNR Med include the incorporation of the Culinary Medicine Curriculum into the first two years of the program, expansion of case-based nutritional cases into the second year, incorporation of nutrition-based didactic sessions in each third-year clerkship, and a Culinary Medicine elective which has been approved for incorporation into curriculum for the Class of 2021.

Summary: In retrospect, we gained valuable insight during our first year of implementation. Key points included:

  • Students responded especially well to team competitive opportunities. Each was an opportunity to build interpersonal relationships as well as practice teamwork dynamics, something challenging to foster in the first two years of medical education and important for future career advancement.
  • Mandatory attendance policies were crucial to ensuring participation and normalization of nutrition as part of medical education.
  • Avoidance of timeframes immediately preceding exams improved participation and enthusiasm.
  • A key challenge was coordination of multiple parties – block directors, guest speakers, student instructor schedules.

Based on the success of the initiative’s pilot year, UNR Med purchased the Culinary Medicine Curriculum in April of 2019. Looking forward, additional long-term goals of the committee include formalized assessment of the program model, local community involvement, and creation of sustainable resources for local clinicians, students, and community members

Goldring Center for Culinary  Medicine, Tulane University School of Medicine

Title: Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: A randomized controlled trial

Authors: Alexander C. Razavi, Dominique J. Monlezun, Alexander R. Sapin, Isabella G. McCormack, Kathrine Pedroza, Ofure Akhiwu, Brennan Gagen, Colleen McCullough, Leah Sarris, Emily Schlag, Amber Dyer, Timothy S. Harlan

Contact info: arazavi@tulane.edu

Purpose/Hypothesis: This pilot study examines the effects of family-oriented hands-on cooking and nutrition education classes based on the Mediterranean diet on family dynamics around food, as wel as children’s food preferences and eating behaviors in an urban New Orleans community.

Methods/Design: The Cooking for Health Optimization-Family (CHOP-Family) study was a phase I, Bayesian-adapted randomized trial designed to test whether hands-on cooking-based nutrition education compared to standard of care whether family-oriented hands-on culinary education would improve Mediterranean diet adherence in families, compared to standard nutrition education. The CHOP-Family study utilized a parallel design. The unit of recruitment for this study was families with young children, and recruitment and participation occurred between January 1st, 2017 to September 20th, 2017. Written informed consent was obtained from each adult family member participant aged 18 years old or older. The study protocol was approved by the institutional review board at Tulane University Health Sciences Center.

Outcome Measures: Mediterranean Diet Score: The primary endpoint of the CHOP-Family study is the validated Mediterranean diet adherence score developed by Trichopolou et al. in 2003. This Mediterranean diet score was calculated through collected grocery store receipts from families participating in the study and assesses concordance with the Mediterranean dietary pattern based on the diet’s nine integral components, fruits, vegetables, legumes, whole grains, monounsaturated fats, fish, meat, and wine. Survey respondents are assigned a score of +1 when intake of the food group was higher than the median in the study population, or in the case of meat, when meat intake was lower than the median in the study sample. A score of 0 was assigned to study participants in the opposite of the latter two situations listed above. A higher score corresponds to higher adherence to the Mediterranean diet. In addition to the composite Mediterranean diet score, individual components of the diet score were also assessed as secondary study outcomes.

Cost Efficacy: Among secondary endpoints of the CHOP-Family study were cost efficacy or family food cost savings, determined through grocery store receipt data of participating families. Grocery store receipt data was obtained at baseline and after the 6-week intervention phase from families in both the control and intervention arms of the study. Participating families were instructed to save receipts throughout the duration of the study and turn in receipt data and the end of the 6-week period. Projected annual grocery store costs were calculated for each participant family by extrapolating study results and comparing extrapolations to published USDA family food costs and morbidity and mortality data.

Study Setting: Goldring Center for Culinary Medicine (GCCM) at Tulane School of Medicine

Participants : Families with at least one child between the age of 4 and 18 participated in this study. Any family with children between the ages of 4 and 18 were included. Families with younger or older children were excluded. The study participants were recruited through community outreach via brochures in New Orleans, Louisiana. The recruitment phase yielded 39 families, including 55 parents and 90 children, who met all eligibility criteria. Among those who met inclusion criteria, 18 families (46%) were randomized to the intervention.

Results: The CHOP-Family study was designed to provide greater than 80% statistical power to detect a 15% increase in high or medium versus low Mediterranean Diet adherence at a significance level of 0.05 using a two-tailed test. A fixed-effects regression panel analysis was used to assess the effects of hands-on cooking education on the change in composite Mediterranean diet score, individual Mediterranean diet score components, as well as family- level food cost savings. Fixed effects panel analysis was conducted in STATA 14.2 (STATACorp, College Station, Texas, United States of America) and used to obtain point estimates and confidence intervals, accounting for time invariant unobserved and unbalanced baseline covariates.

Hands-on cooking and nutritional education improved Mediterranean diet score by approximately 0.5 points on a 9-point scale (B=0.43; p-value < 0.001; 95% CI = 0.22, 0.65). Compared to families receiving in-office nutrition education, families participating in kitchen-based nutrition classes experienced nearly a three-fold  increase in high  or medium versus low Mediterranean adherence (OR = 2.93; p-value < 0.001; 95% CI = 1.73, 4.95). Similarly, HmF curricula significantly increased fruit (OR = 4.54; p-value < 0.001; 95% CI = 2.52, 8.20) and vegetable (OR = 2.33; p-value = 0.001; 95% CI = 1.42, 3.80) consumption by over four-fold and two-fold, respectively.

GCCM and control subjects go to the grocery store a comparable number of times per week (1.71 vs. 1.83). GCCM only increases the treatment group’s grocery store trip costs by $7.77, though every 1 class of GCCM significantly increases the odds of cooking 5,6 or 7 days a week instead of eating out (OR 1.56). Based on the current American family of 4 eating out 4.2 times/week with $12.75/meal and at current average grocery store costs for home cooked supplies at $4/person/home cooked meal, switching one family meal from commercially prepared to home cooked would save the family $35/week. GCCM on average produces $74.55 ROI for each class a family takes in terms of saved commercially prepared food expenses.

Conclusions: GCCM vs. control significantly improves MedDiet score over average of 3 months by nearly 0.5 out of 9 points (p<0.001). These are our strongest results to date as they are from an RCT with advanced causal inference statistics, using objectively reported grocery store receipts per evidence-based protocol. Indicating that culinary medical education in a family setting can lead to increased Mediterranean diet adherence

Support: This study phase was funded through a grant from the Humana Foundation.

University of California, San Francisco School of Medicine

Title: An Experiential Approach to Nutrition Education in Medical School – A Culinary Medicine Curricular Intervention

Authors: Diana Thiara MD, Tracy Fulton PhD, Emma Steinberg MD, Chef, Andrea K. Garber, PhD, RD

Contact info: diana.thiara@ucsf.edu, tracy.fulton@ucsf.edu, emma.steinberg@ucsf.edu, andrea.garber@ucsf.edu

Purpose/Hypothesis: Poor nutrition and physical inactivity are the second leading causes of death in the U.S.1 However, in Undergraduate Medical Education (UGME), traditional nutrition education emphasizes biochemistry and includes minimal training in food-related decision making or nutrition-based skills for health promotion. Even though physicians manage comorbidities of poor nutrition and patients believe physicians should provide nutritional counseling, many physicians do not. Less than half of primary care providers report advising patients about nutrition and less than 14% of residents believe they were adequately trained in nutritional counseling.2,3 Locally, a needs assessment demonstrated this imbalance for UCSF students who reported deficits in nutrition skills despite rigorous nutrition didactics. Culinary medicine is an interdisciplinary and experiential approach that has been shown to improve health outcomes and confidence of participants.4,5 It also addresses core competencies in multiple domains, including patient care, professionalism, nutritional knowledge, practice-based learning, and healthcare systems.

Methods/Design: We implemented a single day culinary medicine intervention in the UCSF School of Medicine. Participants were medical students in the early months of their clinical clerkship rotations. The course was delivered over four hours: a one and a half hour hands-on cooking session, one hour lunch, and one and a half hour small group case discussion that related cooking methods and materials to diseases and their underlying metabolic and biochemical processes. For example, encouraging high fiber and low glycemic load foods while avoiding high fructose corn syrup for patients with pediatric obesity and nonalcoholic steatohepatitis. To examine the effects of the curriculum, we administered a validated questionnaire developed by the Tulane Goldring Center for Culinary Medicine before and after the intervention to assess beliefs, attitudes, and self-efficacy regarding providing nutritional education to patients, as well as examining personal dietary changes.

Results: 96 (N=180) students completed both pre- and post-surveys. We found statistically significant changes in attitudes and beliefs that physicians should include nutrition counseling during appointments (p=0.000) and physicians can affect patients’ dietary behaviors (p=0.001). Perceived efficacy to independently educate patients about nutrition increased in 23 of 25 topics, including but not limited to: serving size (p=0.001), Mediterranean Diet (p=0.000), DASH diet (p=0.000), vegetarian diet (p=0.000), very low fat diets (p=0.000), high protein/high fat diets (p=0.000), diabetic diets (p=0.001), and fiber in disease prevention (p=0.000). Intention to improve students’ own dietary habits significantly increased in 9 of 13 areas, including increasing intake of: vegetables (p=0.000), lentils/beans (p=0.000), fruits (p=0.001), nuts/nut butters (p=0.002), non-fried fish or seafood (p=0.012), and decreasing intake of: red and processed meat (p=0.002), baked products (p=0.001), calorie-containing beverages (p=0.002), and saturated fats (p=0.006). Students also reported a 67% increase in likelihood to provide nutrition assessment and counseling to their patients (p=0.000).

Conclusions: The results of this intervention demonstrate that a single day session in culinary medicine is effective in addressing important gaps in medical education, including self-efficacy, which physicians cite as a primary obstacle to counseling patients about nutrition.3

Support: Haile T. Debas Academy of Educators Educations Innovations Funding Grant

Family Health Centers of San Diego

Title: Empowering Healthy Living: A Weight Management Program at a Federally Qualified Health Center in San Diego

Authors: Jie Liu, Stephanie Constantino, Aichel Nateras, Amber Ortega, Brandon Brown, Harris Niazi, Cynthia Jauregui, Thao Tran

Contact info:

Purpose/Hypothesis: To conduct a behavioral weight management program of nutrition and weight loss education in a group of low-income obese adult patients with metabolic disorders and cardiovascular risk factors.

Methods/Design: Within the family medicine residency program at Family Health Centers of San Diego, the Class of 2018 developed a curriculum for group visits which included the following: 6 classes that occurred monthly lasting 2.5 hours long led by resident physicians, an attending physician, a behavioral health provider, physical therapists, and a health educator; topics such as healthy eating, cooking demonstrations, mental health, the relationship between weight and medical conditions, overcoming barriers; food preparation demonstrations and education based on Leah’s Pantry curriculum; one-on-one medical and behavioral health visits; giveaways like water bottles, kitchen scales, cutting boards, pedometers, measuring cups, and grocery store gift cards; baseline and endpoint labs of HgbA1c and lipid panel.

Outcomes Measures: Baseline and endpoint labs of HgbA1c and lipid panel. Patients’ weights, blood pressure, and waist circumference were checked at every class. Residents kept a journal of their impressions of how the class was going and how patients were doing.

Study Setting: Family Health Centers of San Diego is a Federally Qualified Health Center. It is a designated Teaching Health Center sponsoring an ACGME-accredited family medicine residency program. The residency is based in the neighborhood City Heights in San Diego, CA. The residents of this community face enormous health disparities such as a lack of health literacy, poor access to healthy nutritious foods as well as safe and affordable spaces for physical activities. The obesity rate in the City Heights clinic population is 29% and the children who live in the City Heights area have a higher rate of obesity than other parts of the county.

Participants: Inclusion criteria: Target population 18-65 years old, BMI>30 kg/m2, motivated to lose weight, screened through visits with their primary care provider who is concurrently a member of the research team, notparticipated previously in a commercial weight management program, not currently on weight loss medication, not had bariatric surgery.

Exclusion criteria: pregnant patients, age<18 years old, age>65 years old, comorbid conditions including eating disorders or severe physical disability.

Results: The six class series ran from October 2017 to March 2018. A total of 20 participants enrolled and participated in at least one class session. Three participants attended 5 of 6 classes, 5 participants attended 4 of 6 classes, and the remainder attended one class. Primary biometric end points where a change in BMI and weight. Patient demographics were: average age 53.9 yo, 17 women, 2 men, one transgender man, 8 patients with type 2 DM, 1 patient with prediabetes. Sixty-five percent of the participants had a co-diagnosis of chronic pain, knee pain, or back pain. Eighty percent had a mental health diagnosis; these diagnoses included depression, post-traumatic stress disorder, panic disorder, anxiety, social phobia, hoarding, borderline and bipolar disorders. Depression and PTSD were the most common mental health diagnoses.

Table 1. Mean Initial Patient Values

Characteristic Mean Value
BMI 42.0kg/m2 (SD 8.72)
Weight 251lbs (SD 50)
HgbA1c 6.09% (SD 1.03)
Total cholesterol 190mg/dL (SD 52.3)
HDL 43mg/dL (SD 10.8)
LDL 126 mg/dL(SD 48.3)
Systolic blood pressure 127mmHg (SD 10.5)
Diastolic blood pressure 78mmHg (SD 8.3)

The mean BMI at the last visit was 41.2 kg/m2 (SD 8.06), a reduction of 0.8 kg/m2. The mean weight at the last visit was 242 lbs (SD 55), a reduction of 9 lbs.

Participants reported feeling more competent in reading food labels and had decreased intake of fried foods, salty foods, and deli meats. They reported overall increased levels of physical activity. There was no reported change in consumption of sugary drinks and foods. Participants had the following comments on what were their barriers to weight loss: “hiding behind weight since being abused”, having “sabotaging/unsupportive family members”, “poor health throwing me off my goals”, “pain, “lacking motivation due to other major events in life”. Participants reported the following positive behaviors after taking the classes: “eating more vegetables”, “learning to say no to unhealthy foods”, “trying new healthier foods”, and “making nutritious choices”. Almost all patients said that being able to share ideas and discuss weight loss strategies with others in the group was the best part of being in the group. All participants who responded would recommend the class to a friend or family member.

Limitations included: The pre-test questionnaire was given to all participants and 14 completed it, only 5 completed the post-test; only one participated completed both post-class HgbA1c and lipid panel, retention of participants, equipment failures, data collection difficulties.

Conclusions: The family medicine residents at FHCSD set out to pilot a weight management group focused on behavioral weight loss interventions in an urban underserved community in San Diego. This group class setting was able to provide a sense of community for the participants who were able to share in each other’s experiences. The questionnaires, group discussions, and one-on-one interviews demonstrated that adverse childhood and life experiences can contribute to obesity. The individualized behavioral health component which addressed coping mechanisms, mental health co-morbidities, and individualized motivational interviewing can help patients’ weight loss efforts. Despite data collection challenges, the project showed that a billable weight management clinic in an FQHC setting is a viable model for helping obese patients start to lose weight and achieve a healthier lifestyle.

Support: This project was supported by an AAFP Foundation Resident Research Grant in the amount of $2000.

Texas Christian University

Title: A Culinary Medicine Course Improves Nutrition And Dietary Competencies Of Health Professions Students

Authors: Adams,1; H. Tullos,1; M. Siler, RD, LD,2; R. Dority, MS, RD, LD, CDE,1; A. VanBeber, PhD, RD, LD, FAND, CCMS1; L. Dart, PhD, RD, LD1

Contact info: a.vanbeber@tcu.edu

Purpose/Hypothesis: Nutrition plays a vital role in disease prevention and health promotion; however, few health professions’ curriculums provide adequate nutrition education. The Culinary Medicine program (CM) was developed at Tulane University Goldring Center for Culinary Medicine in 2012 to train health professions students about nutrition and healthy eating practices. Students also participate in a 10-year longitudinal study (Cooking for Health Optimization with Patients, CHOP) to assess learning outcomes. The purpose of this study was to evaluate both retrospective pre- and post-Culinary Medicine course CHOP data for 2016 – 2018, plus pre- and post-Culinary Medicine course Mediterranean Diet Score data for the Spring 2019 cohort of health professions students.

Methods/Design: The CM curriculum was first offered in Fort Worth, TX in 2014 and taught by faculty from University of North Texas Health Science Center (UNTHSC), Texas College of Osteopathic Medicine (TCOM), Texas Christian University (TCU), and Moncrief Cancer Institute (Fort Worth, TX). During 2016-2018, students participating in the CM course were assessed pre- and post-course using the 4-part CHOP survey including demographics, attitudes, dietary habits, and degree of proficiency in competencies related to nutrition/dietary knowledge and application. Additionally, medical and physician assistant students completed the Mediterranean Diet Score sheet both pre- and post-CM course for the spring 2019 session to determine personal dietary changes during the 6-week period. Study procedures were approved by TCU IRB, and informed consent was obtained. Data were analyzed to meet study objectives (SPSS, p<0.05).

Outcome Measures: Assess outcomes of a Culinary Medicine course for improving nutrition and dietary competencies plus personal eating practices of health professions students.

Study Setting: Nutrition Laboratory Kitchens, TCU Department of Nutritional Sciences

Participants: 2016 – 2018 included a cohort of 77 first and second year medical and 13 physician  assistant  students  (57/female;  33/male)  from  the  UNTHSC  and  TCOM. 2019 participants included 26 first and second year medical and four physician assistant students (18/female; 12/male) from the UNTHSC and TCOM.

Results: 2026 – 2018 results showed that students who participated in the Culinary Medicine course reported greater proficiency in their ability to inform patients about nutrition/dietary competencies: (1) health effects of the Mediterranean, Dash, and low-fat diets; (2) weight loss strategies, portion control, food label facts and serving sizes; (3) dietary practices for Type 2 diabetes, celiac disease, and food allergies; (4) role of dietary cholesterol/saturated fats in blood lipids; (5) recognizing warning signs/symptoms for eating disorders; and (6) role of fiber and omega-3 fatty acids in disease prevention and heart health (p<0.05). Post course Mediterranean Diet Scores showed that students who participated in the Spring 2019 course reported significant increases in overall diet score. There were significant increases in individual questions answered “yes” in all but one question. Vegetables, fruits, whole grains, and legumes all showed significant increases in the percent of students who chose “yes”. Nuts, fats, and fish categories also showed significant increases. The category that showed no change was meat, and the category that showed the most change was red wine. Total scores also shifted from a 0- 8 range to a 4-9 range. In the pre-course scoring, 5% of students scored in the 0-3 category, and in the post-course scoring, no students scored within this category. In the post-course scoring, the percentage of students who scored in the 6-7 range increased from 5% to 12%. There was also a significant increase in students who scored within the 8-9 range (p<0.05).

Conclusions: Study results underline the value of dietetics educators providing innovative learning opportunities that integrate nutrition into training for health professions students.

Support: TCU Department of Nutritional Sciences

Clemson University

Title: Culinary Medicine: An Evaluation to Assess the Knowledge, Attitudes, Behaviors and Confidence of 1st Year Medical Students in a Culinary Medicine Teaching Kitchen

Authors: Lauren Vanderpool, M.S.

Contact info: levande@clemson.edu

Introduction: The topic of this research project is the assessment and evaluation of a culinary medicine pilot study course for 1st year medical students at the University of South Carolina School of Medicine Greenville (USCSOMG). The findings of this study benefit the USCSOMG as it grows and improves the culinary medicine program as well as other schools interested in implementing a culinary medicine program in the future.

Description: This study aims to assess the culinary medicine knowledge, attitudes, skills, behaviors, cooking confidence and self-efficacy of the five medical students participating in the USCSOMG culinary medicine pilot course. In addition to this assessment, student engagement and overall efficiency and effectiveness of the course was observed. Lastly, after the culinary medicine pilot course was completed, student feedback and satisfaction were evaluated. Assessment tools for this study include the Cooking With a Chef survey, an observation checklist, an exit focus group, and a participant feedback questionnaire.

Summary: The findings of this study show that the culinary medicine pilot course at the USCSOMG was effective in increasing and improving 1st year medical students’ culinary medicine knowledge, attitudes, behaviors, confidence and self-efficacy. The results of this study also show that student engagement was consistently high throughout the study, and the course was efficient and effective. The exit focus group and the feedback questionnaire revealed that the students did suggest changes to the course in the future, but the students were overwhelmingly satisfied with the course. The findings from this study are beneficial to other institutions as they implement similar culinary medicine programs and/or improve their existing culinary medicine programs.

Lake Erie College of Osteopathic Medicine – Arnot Ogden Medical Center; Tulane University School of Medicine

Title: Nutrition Education of Medical Students: Evaluating the Health meets Food Culinary Education Program versus Online Education Modules

Authors: C Wyman, OMS-III1; E Shermadou, DO, PGY-2; C Newell, OMS-III1; S Maniar, OMS-III1; Jordan Ramage, OMS-III1; D Monlezun, MD, PhD, MPH2; T Harlan, MD2; A Dyer2; L Sarris, RD2; B Dollinger, MD1

Contact info:

Purpose/Hypothesis: This short-term, prospective cohort study evaluated the changes in the level of nutrition knowledge in medical students completing the GCCM curriculum, consisting of hands-on cooking and online learning, versus exclusively the GCCM online learning modules.

Methods/Design: The GCCM curriculum was implemented at Arnot Ogden Medical Center (Elmira, NY) for third-year LECOM medical students during the 2018-2019 school year, operating within the GCCM’s Cooking for Health Optimization with Patients (CHOP) study. The CHOP study is a multi-center prospective cohort study on nutrition education of medical trainees, with 32 sites nationally.

A cohort of 20 LECOM students voluntarily enrolled and completed the GCCM class, which included hands-on cooking classes, problem-based learning sessions, and online education for a total of 28 hours of instruction over 8 weeks. At the start of the training, these students completed the CHOP research-validated survey and a baseline nutrition knowledge assessment. Throughout training, students’ nutrition knowledge was assessed by quizzes focused on each module topic. After completion of training, the students again completed the CHOP survey.

A second cohort of 15 LECOM students were recruited to complete a Nutrition Teaching Day, which consisted of the GCCM online education curriculum and lecture videos, for a total of 8 hours of instruction over 2 days. These students completed the CHOP survey before and after completion of training. They also completed a baseline nutrition knowledge assessment and, throughout the training, quizzes focused on each module topic.

The end-points collected and analyzed include the baseline nutrition knowledge assessment, individual quiz grades from modules 1 through 8, and a course total (average of all module quiz grades). A two-sample t-test assuming equal variances was used to analyze the data.

Results: 20 LECOM students completed the GCCM class, including the hands-on cooking and online learning, and 15 students completed the GCCM online learning modules as part of a Nutrition Teaching Day.  The end-point averages are displayed in Graph 1.

The average baseline assessment score was 46.0% correct in the GCCM class group and 45.6% correct in the online module group. The difference between these two averages was not statistically significant, with a p-value of 0.879.

The average course total, calculated by averaging the scores from modules 1 through 8, was 94.9% correct in the GCCM class group and 76.9% correct in the online module group. This difference between the course averages of the two groups was found to be statistically significant, with a p-value < 0.001.

Conclusions: This small, short-term, prospective cohort study suggests that completion of the GCCM online learning modules increases the level of nutrition knowledge of medical students. However, this increase in knowledge is less than that gained by students who complete the comprehensive GCCM curriculum, including hands-on cooking and online learning.

Limitations include small sample size and short-term follow-up.  Future studies should improve the study design, including moving the timing of the module quizzes in the GCCM class group to after the hands-on cooking class, and assess any differences between program completion during the preclinical versus clinical years.

Support: Grants that supported this project were obtained from Wegmans and Lake Erie College of Osteopathic Medicine.  Equipment and space at the Economic Opportunity Program of Chemung and Schuyler County was utilized for the modules.

Lake Erie College of Osteopathic Medicine – Arnot Ogden Medical Center, Tulane University School of Medicine

Title: [none provided]

Authors: C Wyman, OMS-III1; D Monlezun, MD, PhD, MPH2; T Harlan, MD2; A Dyer2; L Sarris, RD2; D Molina, OMS-III1; C Newell, OMS-III1; B Dollinger, MD1

Contact info:

Purpose/Hypothesis: This study evaluated the impact of hands-on cooking and nutrition education, versus traditional clinical education, on LECOM medical student’s dietary habits and competencies and attitudes toward nutrition counseling of patients.

Methods/Design: The GCCM curriculum was implemented at Arnot Ogden Medical Center (Elmira, NY) for third-year Lake Erie College of Osteopathic Medicine (LECOM) medical students, operating within the GCCM’s Cooking for Health Optimization with Patients (CHOP) study.  The CHOP study is a multi-center prospective cohort study on nutrition education of medical trainees, with 32 sites nationally. The GCCM curriculum consists of 28 hours of instruction over 8 classes, which includes 0.5-hour preclass online lecture videos, 1.5 hours of hands-on cooking, and 0.75-hour postclass problem-based learning (PBL) sessions as trainees eat their prepared meals.  These PBL sessions provide an opportunity for students to practice clinical application of the lecture material.

From 2012 to 2018, 86 LECOM students voluntarily enrolled and completed the 8-week GCCM class, titled Health meets Food.  These students completed the CHOP research-validated survey before and after completion of training.  An additional 190 LECOM students who received traditional clinical education also completed the survey and served as a comparison group.  The survey was designed to identify baseline competencies, dietary habits, and attitudes toward nutrition education.

Propensity score-adjusted multivariable regression was conducted controlling for the likelihood of taking an elective GCCM class.

Results: 276 LECOM students, 86 of whom completed the GCCM class, were included in the analysis.  Compared to traditional clinical education, students who completed the GCCM training had higher odds of: earning MedDiet point with legumes (OR 1.60, 95%CI 1.08-2.39, p=0.020); strongly believing physicians can improve patients’ diets with nutrition education (OR 1.29, 95%CI 1.01-1.65, p=0.045); and perceived level of competence educating patients on food allergies (OR 1.50, 95%CI 1.05-2.13, p=0.024), glycemic index (OR 1.73, 95%CI 1.19-2.54, p=0.005), and fiber (OR 1.49, 95%CI 1.09-2.03, p=0.012).  Trainees had lower odds of staying within the appropriate meat limit to earn a MedDiet point (OR 0.51, 95%CI 0.39-0.67, p<0.001).

Conclusions: Findings suggest that GCCM hands-on cooking and nutrition education improves LECOM trainees’ own diet and perceived competencies for educating patients on multiple core nutrition topics already demonstrated to improve patients’ morbidity and mortality.  At an osteopathic medical school with a large proportion of graduates entering primary care fields, this curriculum has the potential to greatly improve nutrition counseling of future patients to address the obesity epidemic and nutrition-related chronic diseases.  Limitations include self-report and short-term follow-up.  Future directions include assessing GCCM impact on pediatric nutrition competencies and patient outcomes.

Support: Grants that supported this project were obtained from Wegmans and Lake Erie College of Osteopathic Medicine.  Equipment and space at the Economic Opportunity Program of Chemung and Schuyler County was utilized for the modules.