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Published On August 23, 2018

BASIC RESEARCH

Is there a Doctor in the Kitchen?

Physician-chef Rani Polak explains why clinicians should learn cooking skills—and teach them to patients.

Midway through medical school in Jerusalem, Rani Polak had doubts about his chosen path. He decided to quit and pursue a different passion, cooking, at Le Cordon Bleu academy in Sydney. It was among the pots and pans that he began to see a way that he could help people lead healthier lives—through food, but in the role of a physician. He completed his medical degree, and today is a leading physician-chef in the burgeoning field of culinary medicine.

In 2014, Polak started a telemedicine program based on an old-fashioned idea now supported by growing evidence: when it comes to health, home cooking matters. While many doctors may agree, most don’t have the training to teach patients how to cook healthy meals for themselves. To help other physicians, Polak founded and directs the Culinary Healthcare Education Fundamentals (CHEF) Coaching program at the Spaulding Rehabilitation Hospital in Boston, which helps clinicians lead patients to build healthier—and often tastier—habits around food.

Q: What is culinary medicine?

A: The American College of Preventive Medicine calls it “the practice of helping patients use nutrition and good cooking habits to restore and maintain health.” How is this new? Well, until recently, most studies and medical advice about food addressed specific nutrients—this is good for your body, that is not.

What’s new is the understanding that food is a behavior that requires skills to maintain. If you want people to adhere to a diet, you need to offer them ways to behave around food—and that includes tools and solutions for mealtimes. If you want a person to cut down on one food, you’ll have more success if you can suggest a flavorful, healthy alternative. And if we teach people to cook those better foods themselves, they’ll start eating in a healthier way, almost by default.

Q: How does that work in practice?

A: One of my first patients in Boston was a physician with type 2 diabetes. The lunches he bought near his office were mostly unhealthy, so we talked about meals he could prepare at home. He felt confident about making sandwiches but didn’t have time to buy fresh rolls every morning. We discussed how to freeze and defrost fresh bread for use, and that led to major improvements in his diet. If people know what to buy at the grocery store, how to make a meal and make more time to cook, they can make very important changes.

Q: Isn’t food the domain of the dietitian or nutritionist?

A: Usually only people with certain health conditions are sent to that kind of specialist. But most patients can benefit from a change in their diets. Clinicians should also know how to talk about food. If they had training in culinary medicine, they could plan interventions to improve their patients’ eating habits—working together with dietitians and nutritionists to achieve better outcomes. It might take only a minute to ask the patient questions and prescribe culinary videos and then to follow up on future visits. Doctors can do this even if someone has simply come in for an annual physical or has the flu.

Q: How did you get started?

A: For my medical school thesis, I developed a culinary medicine program for patients with inflammatory bowel disease in Israel. Then in 2013 I came to Boston to pursue a fellowship at the Institute of Lifestyle Medicine, which was then located at the Joslin Diabetes Center. I wanted to invite patients into the kitchen and cook with them. But like most hospitals and medical schools around the world, we didn’t have a teaching kitchen. They are expensive to build and maintain.

As part of my fellowship, I received training in online coaching, and immediately saw the possibilities of using telemedicine to teach food habits. I worked to develop the CHEF Coaching program—a combination of culinary training and health coaching principles, delivered through the internet.

The program works mainly with clinicians. We have cooking videos that clinicians can review in their own time and prescribe to patients, and doctors can join us live from their own kitchens for cooking classes. The idea is that once providers learn, they can lead those under their care to better health. But we also work with some patients. We are starting a three-year randomized controlled trial at Spaulding soon to study the impact of our telemedicine program on overweight and obese participants.

Q: You place a huge emphasis on home cooking. What does the research tell us?

A: It is a worldwide epidemic: People cook significantly less today than they did 30 or 40 years ago. But study after study shows that home cooking results in better nutritional intake. Even when people say they are not trying to lose weight, and they eat anything they want from their own kitchens, they still do better than they would in a restaurant—but cooking instead of eating pre-prepared foods is better in general. We use fewer fats and sugars in our own kitchens than commercial kitchens do.

Ultimately, home cooking is a behavior, not a skill. It is not simply about picking the right raw ingredients, or knowing to roast vegetables. It is about making the time to cook, gaining some basic skills and having the confidence to enter the kitchen and come out with something you’d like to eat. So those are the skills that our program tries to build.