How UTSW’s Food as Medicine Program Is Revolutionizing Physician Education

Physicians undergo at least seven years of training after college to learn how to keep patients healthy, but many don’t receive any instruction or guidance on what can be the most critical factor in maintaining one’s health: food. UT Southwestern’s groundbreaking culinary medicine program, led by Dr. Jaclyn Albin and Program Director Milette Siler, aims to change the narrative, one cooking class at a time. ¶ Research from the Mayo Clinic found that a poor diet is now the No. 1 cause of early death and early disease in the country. If physicians want to impact their patients’ long-term health, being able to influence their nutritional choices can go a long way. Albin’s journey to be a leading voice in the country in the food as medicine movement began when her husband fell ill during her first year of combined internal medicine pediatric residency. He was losing weight despite eating well, and had chronic respiratory issues. The couple couldn’t figure out what was wrong, but eventually, a lightbulb went off.

The culprit was celiac disease. Although a diagnosis was good news, this was before the gluten-free revolution, and the couple struggled to find solutions. “We were completely lost, and I was embarrassed that I didn’t know how to help us,” Albin says.

The experience highlighted her lack of understanding about how food can impact health outcomes, and she wanted to do something about it. Albin connected with Siler, a dietician who, at the time, was leading a cooking experience for cancer patients. The two concocted the idea to launch a full-blown culinary medicine experience, where students and residents would receive instruction about how food impacts disease.

Table of Contents

The value of a good diet

Cause

Around half of all the deaths in the United States caused by cardiometabolic diseases (heart attack, stroke, diabetes, etc.) are associated with poor diet.

Education

Most medical students receive just 11 hours of nutrition training, less than half of the 25 hours recommended by the National Academy of Sciences.

Impact

Those who receive some form of culinary medicine training are 82 percent more likely to stick to the Mediterranean diet.

Working with physicians, dieticians, and chefs, the program aims to help doctors and patients improve health outcomes and address specific illnesses through food. “Food is a shared experience, and we can use the culinary medicine program to truly empower people to improve their relationship with food,” Siler says. “Not everybody’s on the same playing field, and we are doing everything that we can within the scope of our program to promote access. We believe that delicious, nutritious, accessible food should be for everybody.”

Albin and Siler got approval for their initiative from the medical center’s top brass and launched their class for medical students at UT Southwestern and other nearby institutions in 2017. The system was the first in the country to implement the Health Meets Food curriculum, which is now being used at 60 medical centers and training programs across the country. Using an industrial kitchen at UTSW as a classroom, the curriculum gives students and trainees real-world experience preparing food that will improve outcomes for specific conditions and reduce chronic disease and obesity. The program allows future doctors to develop a comprehensive understanding of nutrition and the cooking techniques to prepare delicious, nutritious, and, importantly, realistic food. It quickly became one of the most popular electives for medical students.

When internal medicine resident Dr. Joseph Campain was in medical school at UTSW, nearly half of the 250-person class applied to take one of only a few dozen spots in the culinary medicine elective. “The class gave me the confidence to explore on my own and share recipes with others,” Campain says. “I definitely feel more able to pass along my learning to patients rather than give vague lifestyle recommendations based on principles that are hard to swallow and have no cultural sensitivity.”

Culinary education helps UTSW students advise future patients on how their dietary choices can help them manage their health.

Today, the curriculum is open to 20 graduate students each semester, including students from UTSW’s School of Medicine and School of Health Professions. It is a required course for family medicine residents, and available to many physicians pursuing sub-specialty fellowships, including gastroenterology and endocrinology. Since its founding, the program has reached 390 students and trainees, who will be able to pass along what they learned to their patients, emphasizing the power of food as medicine. Meantime, a different kind of expansion is underway.

Although educating physicians and students is essential to scale the impact of the culinary medicine movement, Albin and Siler wanted to be able to impact patients directly, too. Siler had been working with cancer patients at UTSW’s Moncrief Cancer Institute in Fort Worth. Over the last couple of years, she and Albin have expanded their program through UTSW’s presence at Red Bird in southern Dallas, where there is now a first-of-its-kind clinic.

Patients can schedule appointments directly, but most are referred to Albin and Siler by their primary care physicians or specialists to receive tailored guidance for patients who struggle with conditions like type II diabetes and obesity.

Just as they had done with medical students, they wanted to give patients hands-on experience with preparing meals that were healthy, accessible, affordable, and culturally sensitive.

The UTSW Medical District campus has an industrial kitchen. Red Bird lacked such a space, so Albin and Siler contacted churches in Southern Dallas to find one that would allow them to use their facilities. They connected with Oak Cliff Bible Fellowship and Concord Church, which agreed to provide kitchens for the classes, all of which would be covered by insurance. The team secured a National Institutes of Health grant that refurbished the kitchen at both churches, which will also benefit each church’s programming.

The first cohort launched earlier this year, while a second group launched in August, and a third will in September. Bringing classes to patients’ neighborhoods has been a game-changer. “We are taking culinary medicine to where people live and work and interact,” Albin says. “It feels different and is a microcosm of grassroots change that might not happen in a more traditional medical encounter.”

The cooking classes hope to address other needs, too. “Social isolation is a risk factor for early death and cardio health,” Siler says. “The nature of the class is a loneliness buster and promotes the community while overlaying expertise and resources.”

Leveraging Tech

Nutrition Network

UT Southwestern’s eConsult program saves physicians and patients time while improving health outcomes.

In addition to in-person appointments and cooking classes, the culinary medicine clinic at Red Bird offers expert nutrition advice delivered to patients electronically. The demand for improving outcomes of specific conditions through food is on the rise, as is the need to eat healthy foods on a budget, but most physicians don’t have the expertise to provide that info. Although an appointment with a dietician is ideal, limited availability and unreliable reimbursement make it unrealistic for many. Albin and Siler launched the program to allow doctors to request an electronic consult for their patients to help point them in the right direction. Partnering with 11 primary care physicians for a pilot program saved patients time and provided culinary advice connected to conditions as diverse as fatty liver disease and eczema. Most of the consults were covered by insurance. “The consultation includes recipes, education about what foods to celebrate, and resources in their ZIP codes to obtain healthy foods to steer them wherever it may be applicable,” Albin says.

Taught and staffed by Albin, Siler, and an army of volunteers, the classes are available to patients who have received a consult at the culinary medicine clinic. A big challenge is overcoming the stereotype that healthy food isn’t delicious and that delicious food is difficult to make. The team pushes patients to try dishes they wouldn’t have made on their own, giving them the experience and confidence that they can repeat it for their families. Each year, UTSW’s culinary medicine program has 400 touch-points with patients via cooking classes and reaches thousands more through virtual and large group demonstrations.

Research shows that helping people change their relationship with food is best done through hands- on learning.

The biggest roadblock to widespread understanding of culinary medicine is scaling the learning and making it more sustainable. Most clinics don’t have an industrial kitchen to host cooking classes, and many hospitals or medical schools can’t afford the needed food or other supplies. By working with community organizations and funding the program through health insurance reimbursement, the program has staying power. Albin and her team also work with food banks to secure program donations and is looking to expand throughout North Texas. “The limitation isn’t if people will come, but will we be able to support the demand,” Albin says. “Plenty of faculty members and dieticians want to be trained, and we think about what it would look like to give people the national certification with a local boot camp. We need to copy ourselves.”

Albin and Siler have recruited a group of volunteers to help bridge cultural and diversity gaps and see themselves as facilitators rather than experts handing cooking advice down from on high. They work with patients to identify cultural dietary patterns and find healthy ways to cook those meals.