In my STEP internship, I assisted Local Matters’ Culinary Medicine Program Manager and Executive Chef to research the best practices for developing Local Matters’ own Culinary Medicine Education (CME) curriculum. I shadowed the program manager and medical students in the culinary medicine program to provide feedback on program structure. I also engaged health systems like Boston University Medical Center and Geisinger, and nonprofits similar to Local Matters, like Wholesome Wave, to discuss food prescription program implementation and program health outcomes. I collected fact sheets and information from these organizations and synthesized them into annotated bibliographies to accelerate CME program development.
Prior to doing this project, I had a preconceived notion of valuing the role of lifestyle, particularly healthy diets and exercise, as being integral to setting the foundation to a healthy, enjoyable life. However, I did not know the degree to which this concept could be implemented and the extent of its effect. Learning that food can actually be versatile enough to be used as medicine was an eye opening concept in itself. Then, learning that institutions, such as Boston University Medical Center, are actually implementing programs around food prescription provided insight into the current state of progressivism in medicine. It is promising to see a shift away from the more strictly traditional means of medicine, particularly away from pharmaceutical emphasis, and more towards holistic, preventative care. This is what I hoped to see while doing this project, and I definitely saw this change occurring.
However, on the flip side, this project made me question the potential of this as a practice. I started to question whether food had a place in medicine, or whether it should simply remain in its own somewhat separate but still similar sect- perhaps medical dietetics as it is now. Limitations may exist with food as medicine, as food right now is restricted to limited therapeutic ability, and focused more on preventative care. Perhaps this could be a direction for genetic modification to travel to engineer food to have more potent “curative” powers, such as to aid in genetic diseases. There is also the barrier of ideology and self gain with these health systems that are implementing the programs. Unfortunately I got an impression, particularly from the private health system Geisinger, that this type of prescription program was as much of a PR move as it was a genuine effort to assist patients in a novel, sustainable health oriented way.
I was definitely moved by the amount of physicians that were on board with the movement of investigating food as a means of medicine. During my research, I encountered a good amount of health systems that had experimented with food prescription programs given the novel nature of this concept. I particularly remember interacting with a group of physicians from Nationwide Children’s Hospital who seriously were interested in the research behind these programs. They are a part of the future foundation of preventative care as not just a pharmaceutical driven field, but more of a patient focused field. This is particularly relevant to me as I look to go into medicine, and want to see, especially coming from a personal training background and as a person who has valued the pursuit of health, a shift towards valuing preventative care more.
The experience that got me thinking about the limits of the therapeutic part of food prescription was shadowing the culinary medicine program each weekly class during the fall and spring semester. It seemed that with each diet they tried, everything was lifestyle disease focused, such as the DASH diet focused on controlling sodium intake for hypertension. There was the occasional deficiency fixing oriented diet, such as higher iron diets combating anemia due to low iron, or even working around a condition like phenylketonuria. Yet, most focus was on lifestyle. This is not to say that lifestyle oriented health does not need a focus, but rather that this is a limited approach. I hope to see research work in tandem, such as the research being done at Nationwide Children’s Hospital that I sat in on, with culinary medicine related programs to make food even more versatile, and add a new element to the realm of preventative care.
Another aspect of my skepticism was in the attitude of the culinary medicine program participants (Ohio State and Ohio University Medical Students) I saw while shadowing the classes. Whether it was due to the nature of the class, or their own demeanor, they seemed uninterested and detached from the significance of the class. Sure, they could recognize the potential of food, particularly the science behind why certain foods have certain beneficial physiological effects, in health. However, they tended to neglect overarching themes of why these programs are implemented, that is for the patients, such as for patients to take more control over their lives and develop a greater understanding of how to incorporate healthy practices, while not having to take a financial hit.
This experience as a whole has grown my perspective on the medical field. I went in with an open mind, and came out with a bank of knowledge and reflection. I not only saw what exists in the way of culinary medicine and prescribing food, and its current state in the medical and pharmaceutical industries, but also was able to ponder whether it should play a larger role in medicine. If it should, how? Experiences and reflections oriented around these themes are pertinent to my life as I look to become a physician. This experience helped me see the expansion of the medical field, potential resistance to expansion, and subsequently how much more the field may have to go to enact institutional changes.