Using Food as a Resource in Patient Care
Scott Morris is proud of his new kitchen. Really proud.
"We are building the greatest kitchen in America," proclaims Morris, an MD and CEO of Church Health, a local faith-based nonprofit organization that provides primary and specialty healthcare to low-income and uninsured Shelby County residents. The new kitchen is part of Church Health's effort to underscore the importance of good nutrition.
Of course, healthy eating is nothing new. For years, most medical professionals have agreed that diet plays a significant role in preventing or treating certain chronic illnesses and have encouraged their patients to practice good nutrition. But, according to nutrition experts in the Mid-South, the effort recently has gained momentum and grown in scope. Food now is viewed as a tool to assist in a patient's care.
Church Heath's kitchen, part of its beautiful new home in the Crosstown Concourse, actually serves as a classroom . . . and at times physicians are both students and teachers.
"The way to get doctors talking about food with their patients is to get them in the kitchen," Dr. Morris said. "We are now giving physicians and medical students the skills to show their patients how to make nutrition changes by using simple terms."
Church Health, in partnership with the Goldring Center for Culinary Medicine at Tulane University, is one of the first in the United States to adopt a licensed, evidenced-based culinary curriculum. Known as "culinary medicine," the curriculum provides hands-on nutrition training.
Church Health began implementing pilot cooking programs last June. Based on the Mediterranean diet, it focuses on eating plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts and replaces butter with healthy fats, such as olive oil. Sharon Moore, manager of nutrition and wellness education for Church Health, says it's an evidence-based diet that works for people with most medical conditions.
"We want to change the way the community thinks about food and use it as a form of medicine," said Moore, who says the classes are especially important for people who have medical conditions such as diabetes and hypertension.
According to the Center for Disease Control, Tennessee ranks seventh as one of the states with the highest diabetes rate in the United States.
There are four components to the culinary medicine program at Church Health:
- Training medical students in culinary medicine as part of their medical school curriculum.
- Offering continuing medical education credits (CMEs) to physicians on nutrition and lifestyle changes.
- Teaching the community how to cook and eat well.
- Tracking the progress of community participants as they take classes and make lifestyle changes over time.
Tim Harlan, MD, founder and executive director of the Goldring Center, discovered that physicians counsel patients about their diets and other lifestyle habits, but medical students fail to receive much nutrition education in their curriculum.
The National Academy of Sciences recommends that medical schools offer 25 hours of nutrition training, but according to a 2015 report published by the Journal of Biomedical Education, only 29 percent of U.S. medical schools offer it. Moore hopes to improve that.
Starting this spring semester, Church Health will collaborate with the University of Tennessee Health Science Center to offer an elective curriculum credit for fourth-year residency students. Students will take a six-week course as part of a culinary medicine rotation to teach students the importance of nutrition.
"The goal for these students is to create and understand the medical application and how to apply nutrition in a patient's everyday life," Moore said. "We had success last year with pilot classes, but students did not receive academic credit for them. Now students can receive credit. This is a first step in making culinary medicine a part of a university curriculum in the Memphis area."
Moore said students learn the principles of the Mediterranean diet, collaborate on case studies focused on certain medical topics and discuss medical conditions associated with them. Then they cook recipes that relate to each curriculum topic. Each student learns the correct serving size and nutritional value of each dish. At the end of each class, the students eat the food they prepare and discuss the case study with a nutrition expert on how they can use the nutrition information with patients.
Local food suppliers and farmers provide the ingredients used in the teaching kitchen. Plans to have a fruit and vegetable garden on top of the roof at Crosstown have been discussed. Produce grown there would help supply the kitchen with in-season foods.
Nichole Reed, a registered dietitian at Le Bonheur Children's Hospital, participated in a case study discussion in the Church Health teaching kitchen as a nutrition expert for a pilot class last year. She sees value in the culinary medicine curriculum for medical students.
"I notice that medical residents ask dietitians a lot of questions on nutrition therapy," Reed said. "They recognize the importance of food in a patient's care. The teaching kitchen offers beneficial information that medical students can use."
Additionally, Church Health offers practicing physicians four hours of CME credits through Tulane University. The curriculum is similar to the medical students' curriculum, but according to Moore, the CME credit component hasn't been successful due to the cost. Currently, the cost for each physician to take the classes is $200 and is open to medical professionals of all disciplines.
"This curriculum isn't just for doctors or medical students," Moore said. "It's for anyone who has contact with patients in any capacity. There are opportunities for all healthcare professionals who can apply nutrition to other medical disciplines. For instance, we have worked with students from the Southern College of Optometry and discussed what foods affect a person's eyesight."
Also, Church Health recruits its own patients to attend community culinary classes. Anyone can sign up online at churchhealth.org/nutrition. The classes are free. Funding for these community classes is raised through a monthly event called The Art of Food. For $50 per person, couples can have a fine dining experience and prepare their own food. The event began last June and, Moore said, has been highly successful. Church Health tracks the progress of its patients in the culinary medicine program by drawing blood samples over time.
"The Goldring Center does a pre- and post-program survey, but we take it a step further," Moore said. "Church Health is the only institution doing this in-depth research analysis."
Church Health is by no means the only Mid-South institution using food as a tool to prevent and manage illness. Mid-South hospitals have changed the way they prepare and serve food to patients and hospital staff.
Christy Davis, a registered dietitian at Baptist Memorial Hospital, Memphis, said the hospital offers fresh, not frozen, food to patients and has redesigned its cafeteria to make healthier foods more accessible.
"It's long been a challenge in the healthcare industry to provide quality food," Davis said. "Patients demand fresher, sustainable food, and we provide that through our entire hospital system. Green beans are delivered fresh and we cook them in olive oil. We serve appropriate serving sizes to our patients and use that as a tool for both nurses and patients. For example, a patient with diabetes can have spaghetti for a meal. It just depends on the serving size you give them."
Davis said offering a variety of food also is important in a hospital setting.
"At one time the hospital initiated a program called Wellness Wednesday, where the café didn't serve any fried foods one day a week," she said. "This didn't go over well. People still wanted fried chicken or other fried foods as an option. We still offer fried foods as an option, but with a grilled option as well.
"Now we offer a Wellness Station in the café to expose guests and staff to new, healthier options such as whole grains, salmon and even quinoa. These are foods that people may not have been exposed to before, and it has been successful."
Reed said therapeutic needs are different in a children's hospital. Le Bonheur provides a different menu for each patient's nutritional needs and monitors the menus closely.
"We are prescribing and providing nutrition therapy for kids," Reed said. "We provide food with specific nutrients to help children grow and get better, yet we provide them with foods with which they are familiar. Our healthy lifestyles clinic redefines what eating healthy means. For example, pizza can be healthy when you put vegetables on it."
Davis participated in the culinary medicine curriculum at Tulane. She recognizes the importance of teaching kitchens for both physicians and patients.
"Ultimately, I would like to see teaching kitchens in hospitals across America during the next 10 years," she said. "It's an important tool for patients to assist them with their nutritional needs for certain chronic conditions."