THE PATIENT: He’s a middle aged man who says he feels pretty healthy. However, he carries excess weight around his abdomen, putting him at risk for heart disease and diabetes. His blood pressure is elevated and he has a family history of diabetes, heart disease, and stroke.
THE DIET: His daily routine consists of a trip to Starbucks for a scone and medium mocha breakfast; a Popeyes’ three chicken strip, biscuit and 20-ounce Pepsi combo meal for lunch; a midday snack whereby he washes down a couple of cinnamon buns with an energy drink; and a dinner that combines a pork chop with pepper and butter and mashed potatoes laden with store-bought gravy.
THE TASK: The mission is to advise the patient on dietary and lifestyle changes that will allow him to safely manage his weight and decrease his risk of disease. The goal is to improve his diet by helping him better manage his portion sizes and lower his diet’s caloric density without leaving him hungry.
Chef Emily Schlag, a registered dietitian and director of the SBH Center for Culinary Medicine and Teaching Kitchen, poses this fictional case study to three Department of Medicine residents in a three-hour virtual class on Weight Management and Portion Control.
This is one of several hands-on sessions that have been hosted virtually by Chef Emily for residents in preparation for the opening of the teaching kitchen at the new Health and Wellness Center. Its goal is to teach both members of the community and medical professionals how to cook and eat healthy.
While some of the residents in these classes have considerable cooking experience, the culinary skills of others may be limited to boiling water. Dr. Bismarck Bisono, for example, a second-year medicine resident who took the class, rates himself a “5” on a 1 to 5 basis on how much he enjoys cooking. “I love cooking. I do it as a relaxing technique.”
The class begins with Chef Emily giving a knife demonstration that teaches the students how to cut safely and efficiently. She offers them a primer on the correct way to hold a chef ’s knife –thumb and index finger pinch the blade of the knife, with the rest of the fingers wrapped around the handle, choking up on the metal part of the blade – and techniques for dicing and julienning different vegetables (“You don’t want to shave off your fingers.”).
She reserves an hour of the class for each student to prepare from home one of three healthy breakfast meals on the day’s menu: a spinach and feta frittata (a frittata, she explains, is a fancy name for baked eggs with fillings) and a peanut butter banana smoothie; a stack of oat pancakes with fruit sauce; and granola with yogurt and fruit.
“Healthy eating means different things for different people,” Chef Emily tells them. “So if you tell a patient to eat a healthy diet they may interpret that differently than you intended. Some may not even know where to start.” She guides them through a teaching module that features nutritious, affordable recipes that both taste good and can be Teaching Kitchen Offers Medical Education prepared quickly. The goal, of course, is for them to cook healthier for themselves and share this knowledge with their patients. She answers questions regarding recipes, nutrition facts and ingredients (“What is the purpose of buttermilk in the pancakes?” “Can I add salt to the frittata?” “How many days can cut vegetables safely last in the fridge?” – the answers, by the way, are to activate the baking soda, yes, and up to seven days). She responds gently to her students’ cooking mishaps:
How are the pancakes coming out?
They got a little burned.
What does the other side look like?
They look the same.
That’s ok. Everyone burns the first batch
She has them find nutritional information on Starbucks and Popeyes from their respective websites and discusses the healthful benefits of the foods they have prepared (“A lot of people don’t eat vegetables at breakfast, they don’t think about adding it, so the frittata is a great way of doing it and not adding a lot of calories, while making you feel fuller”). The smoothie or the granola they are preparing, she reminds them, is to have less added sugar and use healthier fats than store-bought varieties. They’re also cheaper to make, which the residents are all pleased about.
She reserves the end of the class for challenging them on ways to offer healthy eating tips for their “patient.” The recommendation for healthy weight loss, she tells them, is generally one pound per week as represented by a deficit of 3500 calories. “But is that realistic for this patient based on the number of calories he needs? If he’s eating 3500 calories a day and his needs are 2300, we would be cutting full meals from his diet to meet that goal. That’s not realistic for him right now.
“If you’re going to tell him to cut out all of his favorite foods, he’ll find another doctor. Instead, let’s focus on small changes or swaps that he can make so that he can still have the flavors he enjoys while making some positive changes to his health.”
This may mean, the residents suggest, getting the patient to ditch the mocha for black coffee at breakfast or the soda at lunch – “Beverages are the first things I try to tackle first,” says Chef Emily – and maybe eat a better breakfast, say the frittata or pancakes, or an afternoon snack of granola and skip the cinnamon buns.
“Start with small changes that he is willing to make. You should come to an agreement together on what he’ll try first, this way he is more likely to stick with it,” she says. “Small changes will have big effects on his health overall.”
For residents who have packed schedules between treating patients and hearing lectures, cooking class seems to be a well-earned respite.
“I think the class was amazing!” says Dr. Bisono. “Now I can teach my patients easy steps to make granola. Also, I can go to the modules and print out healthy choices + recipes for my patients.
“Taking cooking classes that we can explain to patients not only is a great tool to get our patients’ involvement in a dieting plan, but it also decreases physician burden and a sense of feeling overwhelmed. As we know, patients who see a doctor in shape, who is not obese, are more likely to take seriously any diet/exercises recommendations they give.”