Hippocrates, the ‘father of medicine’ said, “let food be thy medicine and medicine be thy food.” The role of nutrition in health has been recognized since the beginning of medicine, yet somehow nutrition education has fallen by the wayside in most medical curricula. Given that 34.9 percent of Americans are obese and obesity has been linked to diabetes, heart disease, stroke and certain types of cancer, nutrition should be a focal point of medical education.
In 2010, a study published in Academic Medicine revealed that instructors from 79 percent of the 109 American medical schools surveyed thought the nutrition education at their institution was inadequate. The average amount of nutrition education provided at medical schools in the United States was 19.6 hours, though the recommended amount is at least 25 hours.
While 26 of the schools had a course dedicated to nutrition, more than 80 percent of the instruction around nutrition was not part of a dedicated course. The authors suggested that this might dilute the nutrition education and indicate that nutrition education was a side note rather than the focus of learning.
The survey was administered at three time points between 2001 and 2009, and the trend was towards fewer schools requiring a nutrition course, fewer schools providing at least 25 hours of nutrition instruction, and fewer hours of mandatory nutrition education.
Given the increased burden of diseases related to modifiable factors, especially related to diet, certain schools are developing programs to supplement nutrition education among medical students.
Isadore Budnick, a first-year medical student at Tulane University School of Medicine, feels strongly that nutrition should be an integral component of medical education. He is the president of the Teaching Kitchen Student Government Organization at Tulane.
“It should be absolutely required that every medical student have some form of nutrition education not only for themselves, but because they’ll be playing a role in the primary care community,” said Budnick. “It’s an important part of long term health and long term well-being. It can’t be ignored.”
At Teaching Kitchen, classes can accommodate 16 to 20 people at a time and last two to three hours depending on whether students are medical students or members of the community. Classes include a lecture on topics ranging from macronutrient groups, micronutrients and vitamins, managing hyperlipidemia and eating disorders. There is then a hands-on cooking class. Instruction for medical students also includes analysis of a case study.
Budnick states that the case studies help students understand how nutrition can be applied to the individual patient.
“You take into account the individual’s lifestyle prior to the intervention and what you think the individual is able to do based on the case study. They do a pretty good job of ways to identify certain meals that are easier and making changes that aren’t too time consuming,” said Budnick.
Budnick feels that an understanding of healthy nutrition habits will benefit medical students as well.
“For some of my classmates, it’s been a phenomenal experience; to some people, it doesn’t come naturally to them, or it didn’t interest them initially. It dispels any incorrect notions they had about certain food trends or certain food items that are marketed as being healthy,” said Budnick.
The program also considers financial restrictions of students and patients.
“All of the recipes are pretty cost-effective,” said Budnick. Many of the recipes cost $2.50 per serving.
In addition to finding recipes that suit patients’ lifestyles and budgets, an emphasis is put on evidence-based nutrition education.
“The curriculum we use is one of the few nutrition curricula that is based on evidence-based medicine. Our nutrition classes are based on the Mediterranean diet, which is one of the few diets that has been demonstrated to be efficacious at reducing risk for cardiovascular disease and diabetes,” said Budnick.
The program at Tulane continues to expand and they hope to include more students and incorporate opportunities for students to practice counselling patients about nutrition.
“The goal is to expand the number of students in class. This is the first year that every single first year took one of the classes,” said Budnick.
In the future, Budnick hopes that students will have the opportunity to interact with patients during the course to apply their counselling skills.
“Med students can volunteer at the community classes. At the moment, we’re helping with the activities that are going on in the kitchen. In the future, I think it will progress more and more so that students who have completed the class will take on a more serious role when it comes to counseling,” said Budnick.
Another student advocate for nutrition education in medicine is Natalie Uy, a third-year student at Baylor College of Medicine. She is the head officer of Choosing Healthy, Eating Fresh (CHEF).
CHEF began as an elective course about five years ago. Currently, 20 students are accepted to take the course during the fall of their second year of medical school. They meet once a month for five months. During the first hour, a lecture is given covering topics including healthy eating, tracking carbohydrate intake and meal-prep for busy students.
“We try to tailor more to the busy med student or the busy patient or the underserved patient,” said Uy.
The next two hours of the class are dedicated to cooking. Chefs come in and students typically prepare three course meals. Uy says they experiment with a variety of different foods that students may be unfamiliar with to expand their palates and introduce them to locally-sourced produce.
“The chefs may give different tips like how to blanch vegetables or how to dice onions. We have a pretty good variety of foods. Most of the foods are vegetarian-friendly because it’s obviously cheaper,” said Uy.
Students are required to complete projects at the end of the course. For her project, Uy ate on a food stamp wage for three weeks. She said it was very challenging to make healthy meal choices with limited income. Her roommate did a diabetic diet and found it difficult to eat healthy with limited fruits and breads. Other students grew and harvested their own vegetables.
A primary focus of Uy’s involvement in the CHEF program is the Texas Children’s Hospital’s Adolescent Bariatrics Cooking Class. Students involved in the CHEF program have the opportunity to work with teens attending a bariatric surgery support group. Sessions for teens are similar to those for medical students in that they include nutrition lessons as well as hands-on cooking. The teen class also incorporates fun activities such as competitions with prizes.
Uy feels the Adolescent Bariatrics Cooking Class is important as many of the patients may not have had much exposure to information about making healthy nutritional choices. Often, their parents have also struggled to maintain healthy weights and have also undergone bariatric surgery. The focus of the class goes beyond nutrition education to encourage healthy lifestyle habits.
“They want it to be a lifestyle change, not a quick fix,” said Uy.
The Adolescent Bariatrics Cooking Class is run in collaboration with dietitians and topics covered include healthy back-to-school lunches and holiday cooking. Uy says that the program attempts to use food items that the adolescents will enjoy rather than introducing too many new foods. The recipes are also culturally tailored, a factor which is important to Uy as she sees cooking a way of preserving her own cultural heritage as well.
“We address the recipes to our population because not everyone uses coconut oil or has access to certain ingredients,” said Uy.
They also try to make the program fun by incorporating games and competitions. Uy is planning a scavenger hunt for the adolescents at a local grocery store. For example, points will be awarded for comparing the sugar and fiber content of different cereals, finding different types of lean meats, or comparing the fat content of different types of milk.
Uy also makes up quizzes using educational or government sources. Prizes include gift cards to grocery stores.
Another part of the CHEF program is a collaboration with local farmers’ markets in Huston to expand services to the Texas Medical Center. There is an annual fee and customers can then pre-order online. The officers of the CHEF program pick up the produce and deliver it to the medical center.
“It gets you to try new ingredients from our community,” said Uy who advocates for eating local, seasonal vegetables as a means of cutting costs.
“We’re probably one of the most active organizations on campus, if not the most active,” said Uy. “People really like it because everyone loves food. CHEF is something that Baylor is really proud of.”
Uy is passionate about food and uses this to help her patients. She has a food blog which she uses to catalogue her own recipes and her experiences in medicine. She also uses the blog to help decide which recipes to introduce to patients.
“This is where I test out a lot of recipes so that when I give them to my patients, it doesn’t taste terrible,” she said.
She said that the title of the blog, Obsessive Cooking Disorder, alludes to the obsessive characteristics that medical students tend to express.
“Cooking is my way of de-stressing. And writing is my way of expressing how I feel at that time. It’s kind of a way of showing people we’re all vulnerable and we all have our fears and anxieties and it’s okay. Med students kind of put on this strong facade,” said Uy.
The literature suggests that conventional nutrition education for medical students falls short, but programs like Teaching Kitchen and CHEF are rectifying these shortcomings. For example, conventional nutrition education may neglect to account for the complex political or biopsychosocial issues that contribute to poor nutrition but these programs examine nutrition with an emphasis on the patients’ specific contexts.
Further, it has been suggested that nutrition education would be more effective during the clinical years when students would be able to see the effect on patients. While Teaching Kitchen and CHEF primarily enroll students in pre-clerkship, these programs enable students to see real-life applications of nutritional principles by giving students the opportunity to cook with patients or community members.