Food - You are what you eat
Culinary medicine and nutrition education are beginning to transform health care in Atlanta and beyond
"How many of you have a chef's knife in your house?"
Dr. Preston Maring posed this question during his talk at Georgia Organics' recent Farm Rx conference while holding a gleaming kitchen knife over his head. Less than half in attendance raised their hands. "Now how many of you have actually sharpened it in the last year?" Almost all of the hands went down.
Maring is an OB-GYN at Kaiser Permanente Medical Center in Oakland, Calif., where he's worked for 41 years. Over the last decade, he's become an increasingly visible advocate for food as preventive medicine. Maring has spearheaded the establishment of farmers markets at more than 50 Kaiser Permanente health facilities nationwide.
"Ideally, everybody would have a sharp chef's knife and a salad spinner. They would get their kids involved in the kitchen, and we'd eat more of a whole food, plant-based diet. If we did that, we would save the future of American health," he says.
According to the CDC's most recent data, one in three U.S. adults are obese, including 28 percent of adults in Georgia. Diabetes now affects 25.8 million people nationwide, while Type 2, the form most often caused by poor diet, accounts for 90 to 95 percent of all diagnosed cases. And for the first time in the modern era, researchers say, children in America may have shorter life expectancies than their parents.
The New York Times' food columnist Mark Bittman has spent most of the last two decades urging Americans to change their diets. "Nothing affects public health in the United States more than food," he wrote in a recent column. "Heart disease, cancer, stroke and diabetes kill more than a million people a year — nearly half of all deaths — and diet is a root cause of many of those diseases."
Improving the health of our city and our nation won't come easy. It will require institutional change in our health care system: how doctors are educated and how hospitals provide food; comprehensive cultural change — viewing food as medicine and nourishment for our bodies; and valuing sustainable agriculture as the primary source for that healthy food. Right now, public health professionals in Atlanta and beyond are inventing new community and academic partnerships to focus on preventing disease rather than simply treating it.
Maring's knife demonstration illustrates what he sees as one of the largest challenges to improving our nation's health: getting people back in the kitchen and cooking.
Alice Rolls, executive director of Georgia Organics, calls this "the inconvenient truth" of the good food movement. "We're basically asking you to get in the kitchen, and it's not as convenient as buying fast food or prepared foods," she says.
Rolls was hired as executive director in 2004 after nearly 25 years working for environmental nonprofits. Over the last 12 years, Rolls says she's seen the conversation in the food community broaden from organic food to local agriculture, and now, to health. In many ways, it's a response to the fact that American health and agriculture have devolved into systems of convenience that lack emphasis on preventive measures.
"How do we grow food? Well, we use synthetic fertilizers and we use pesticides because it's easy. Same thing with health care ... 'I'm gonna fix that problem by giving you a pharmaceutical.' We need to get back to the foundation, rediscovering the joys of eating what is truly good for us, while trying to wean ourselves from our chemical-style agriculture, which is just so traumatic to our soils and to our health," Rolls says. "We have a lot of work ahead of us to make these connections."
Georgia Organics held its 16th annual conference in Atlanta Feb. 22-23. Aptly named Farm Rx, the event included an unprecedented focus on food as medicine. The conference brought together farmers, dieticians, doctors such as Dr. Charles E. Moore, assistant professor at Emory University School of Medicine and practicing physician at Grady Hospital, and local food advocates such as Michel Nischan of Wholesome Wave. Wholesome Wave works to double the value of each benefit dollar for families enrolled in the government's Supplemental Nutrition Assistance Program (SNAP) at participating farmers markets.
"We know that food can be medicine," CNN Chief Medical Correspondent Dr. Sanjay Gupta said during Farm Rx's final keynote address. "But we also know that good food is not readily accessible to everyone. It's a problem I know that many people are struggling with ... and we're also trying to change it, make that good food that can be medicine available to more people," Gupta said.
Georgia Organics is currently working on a partnership between DeKalb Medical Center and Decatur's Wednesday evening farmers market. To Rolls, providing a benefit for health care employees while putting retail dollars in the pockets of farmers is a win-win.
"It behooves us to build those connections and partnerships with health care because they're messengers and they're a trusted resource," she says.
But according to a 2009 survey conducted by the University of North Carolina's Department of Nutrition, only 28 medical schools of the 109 respondents met the recommended minimum of 25 hours of nutrition training for their students.
Maring says he probably had about a half an hour of nutrition instruction when he attended the University of Michigan School of Medicine in the late '60s. Moore, who graduated from Harvard Medical School in 1991, says he received "very little," maybe a week in conjunction with another course.
Today, David Attaway, a third-year medical student at the Medical College of Georgia, says the only nutrition training he's getting is tied in with other courses like biochemistry. "I was a little disappointed when I found that there wasn't going to be a class specifically for nutrition because it seems like that would be useful, everyday knowledge," he says.
"The food and prevention piece is in many ways a blip in the history of medicine. But it's a big blip for us now. The disease state has shifted to more lifestyle-related disease than any other time in medical history," says Dr. Timothy Harlan, Farm Rx presenter and executive director of the Tulane University Center for Culinary Medicine. Tulane's Center for Culinary Medicine is the first program in the country to partner with a culinary institute (Johnson and Wales University) to focus on connecting the science medical students receive — physiology, biochemistry, cell biology, etc. — with the importance of nutrition and basic cooking skills.
"I think students are really embracing it. They tell us that they're going home, they're changing their pantries, they've changed their lives," he says.
And that's precisely why Harlan believes Tulane's program will be a game-changer.
"We know from research that when physicians walk the walk and they talk the talk, their patients follow their recommendations at a much higher rate," Harlan says. "I hope to see an effective way for us to hold meaningful conversations with our patients, to help change what they do to make them healthier."
Maring agrees. Health professionals are far more likely to advise their patients based on their own experiences. It's all about eating foods without barcodes he says — and cooking, too. "A lot of my colleagues these days are avid cooks and are talking about it with their patients" he says. "Some are giving out recipes. The more physicians prepare that good food for themselves at home, the better."
Stacia Clinton is a registered dietician and healthy food program coordinator at Health Care Without Harm (HCWH), a global nonprofit that works closely with health care facilities nationwide. According to Clinton, if the health care sector sourced more whole, local foods, it would not only impact the food-supply market in positive ways, but, as a recognized model of healthy behavior, also impact overall cultural change.
Hospitals are places where people go to get well, "and when they go into these facilities, or see people that are associated engage in behaviors that aren't healthy, there's an inconsistency in messaging," Clinton says.
Emory University Hospital is one of HCWH's "model hospitals" in the Southeast. Like Clinton, Kip Hardy, assistant director of food nutrition at Emory University Hospital, believes health care should be the leader in modeling healthier lifestyles.
"I think for a really long time, the health care industry used nutrition from a perspective of all the bits and pieces of it and we didn't think in terms of food," Hardy says. "But things are beginning to shift."
Switching to a room-service model for patients at both Emory University Hospital and Emory University Hospital Midtown has been a big part of reducing overall food waste. Those hospitals have also transitioned to one produce vendor committed to sourcing more local produce, and are experimenting with composting and on-site gardening.
Hardy works closely with the hospitals' executive chef, Michael Bacha, who came to Emory in 2010 after 15 years in fine dining. In Atlanta, Bacha worked at the Ritz-Carlton Buckhead, served as sous chef at Chateau Elan, and worked under chef Joe Truex at the now-shuttered RePast.
While Bacha still likes to eat "all those good fatty foods" he cooked while working in restaurants, nutrition is his focal point at the hospital.
"I don't think anything's more important. I mean, you are what you eat," Bacha says.
"We go fryer-less on Tuesdays and Thursdays now. I think every Wednesday was fried chicken, and now we're down to about once every six weeks. And now it's oven fried instead of deep fried." He also wants to incorporate more local seasonal ingredients into all of the hospital's menus.
At Piedmont Hospital, Jennifer Teems is a registered clinical dietician who works closely with the hospital's food service department. The cafeteria is now offering healthier options, such as fresh instead of canned vegetables, and Piedmont's vending machines are getting leaner, too. Twenty-ounce bottles of soda have been replaced with 12-ounce cans, and healthier snacks like granola bars and trail mix are being stocked at eye level and labeled with a green tag.
"We are disseminating health information and providing health care to a community of sick, hospitalized people." Teems says. "If we don't set an example, then I think that would be a really bad thing."
Moore is another local health professional pioneering new community and academic partnerships to shift the focus of health care back toward prevention. While performing head and neck cancer screenings out of his car in underserved Atlanta neighborhoods seven years ago, Moore realized that among the many unaddressed medical issues, nutrition education was virtually nonexistent.
"There are so many conditions that could potentially be avoided, or at least delayed, if there was more focus on nutrition ... if people had access and the knowledge about healthy foods," he says.
Over the last six years, Moore developed the HEALing Community Center (2600 Martin Luther King Jr. Drive), a comprehensive health care facility that provides care for uninsured and underinsured individuals in Atlanta. One of the center's biggest initiatives is a nutrition prescription program that emphasizes food as medicine. Families are enrolled in cooking classes, taught how to prepare foods, and taken on tours of grocery stores to identify what foods are healthiest. Moore believes that over time, the program will show that real-world nutrition education can and will improve the health of his patients.
Changing Americans' eating habits is doable, but it will take time and effort. In the words of Bittman: "In 2013, let's call for energy, action — and patience."
Our lives depend on it.