Will LaShomb and Grace Trompeter hopped aboard Metro Rail during the bluster of a Buffalo snowstorm last week to find cheap food ingredients that could be combined into a nutritious, affordable meal.
The two fourth-year medical school students wanted to feel what it’s like for those of modest means to overcome barriers to good health.
“I usually only have to cook for myself,” Trompeter said. “I don't have three jobs and I have access to a car. I'm also not worried about how much I'm spending on food.”
LaShomb and Trompeter are among 11 students taking the first elective nutrition course offered by the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. Two UB graduate-level dietetics students also are taking the four-week “Introduction to Culinary Medicine.”
The course is designed to give those about to enter the health field a greater appreciation for the tie between healthy eating and wellness, along with the challenges many face navigating that connection. It’s part of a growing understanding in medicine that doctors and other providers need a better grip on needs in a weight-challenged country where poor eating habits heighten risks – and hamper treatments – for patients with heart disease, diabetes and other chronic illnesses.
“Despite widespread recognition that diet is a primary driver of illness in the United States – two-thirds of Americans are overweight and obesity-related illnesses consume nearly 10% of U.S. gross domestic product – our health-care system hasn’t traditionally done enough to intervene,” Dr. Dhruv Khullar, a physician at NewYork-Presbyterian Hospital, recently wrote in a Washington Post opinion piece. “Too often nutrition counseling at the doctor’s office has consisted of little more than advice to eat less and move more – followed by a physician offering a stern look and higher dose of insulin at the next visit. But that’s starting to change amid mounting evidence that crafting the right diet for patients can improve outcomes and reduce costs.”
The new class is based on a simple, scientific, evidence-based Health Meets Food curriculum adopted by more then 50 medical schools across the nation.
“It is not as intimidating as people think to compose a healthy meal of quality ingredients and get it on the table in a fairly short amount of time,” said registered dietetic nutritionist Nicole Klem, program director of the dietetic internship program in the UB School of Public Health and Health Professions.
Klem and Dr. Helen Cappuccino, assistant professor of oncology in the breast surgery division at Roswell Park Comprehensive Cancer Center, combined forces with the Erie Community College Culinary Arts Department to design the new elective. It bubbled out of ideas Cappuccino and others shared in the local chapter of Chaîne des Rôtisseurs, a cooking club.
Cappuccino, a clinical assistant professor at UB medical school, said she learned nutrition “in dribs and drabs, but nothing formalized” while a student there in the 1980s. Her quarter-century of work in breast cancer care convinced her that patients need more from doctors when it comes to recommending food as medicine.
Kristin Goss – associate professor and chair of the ECC Culinary Arts Department, and a 10-year breast cancer survivor – agrees.
“We discussed this collaboration and I really felt that the registered dietitians could bring a special piece to it, the physicians could bring their knowledge to it, and the chefs could bring our expertise,” Goss said.
The trio teach the elective. They are among a small group of determined women at UB, Roswell Park and ECC who have tried for more than five years to move healthy eating classes into all three teaching institutions.
Klem, who once lived in California, said some medical schools and college health programs on the West Coast offer lifestyle medicine concentrations with courses on yoga, acupuncture, chiropractic, mindfulness and nutrition, so a physician’s therapeutic toolbox includes interventions that go beyond pharmaceutical drugs or surgery.
Students in the new UB elective took classes related to diabetes and cardiovascular health before last week’s six-hour lab and classroom session. The latest lesson focused on patients with health disparities based in part on where they live, how little they are paid, and what access they have to transportation, adequate housing and grocery stores that offer affordable, wholesome foods – all considered social determinants of health. The class ends this week, when students learn how to take a nutrition history and help improve a patient’s diet with help from a health care team that includes a nutritionist or dietitian.
LaShomb and Trompeter were tasked with feeding a family of three with $15 or less. They bought ingredients from an Aldi grocery store in North Buffalo and gathered more from a food pantry on the ECC City Campus to make tuna lump cakes, a fresh bean salad, and “french fries” made from roasted, spiced carrot sticks.
Fellow students were assigned similar scenarios, including one group required to shop for a vegetarian meal and another for a gluten-free family member. Then all gathered at the ECC City Culinary Arts kitchen to turn their ingredients into healthy meals, as they also have in previous classes.
“This really underlined what some patients go through – especially today with the weather. It was not a pleasant shopping trip,” said LaShomb, 25, a Williamsville native who will start an anesthesiology residency after he graduates in May.
“Most of the course hasn’t been focused on any one specific diet but being able to utilize whole foods to create wholesome meals,” added Trompeter, 29, a Rochester native who plans to become an obstetrician-gynecologist. “I think we've been given the tools to be able to counsel anybody with questions about diet in the beginning stages, to talk about small changes they can make in an effort to overhaul their diet over time.”
Participating medical students plan to specialize in anesthesiology, immunology, internal medicine, obstetrics and gynecology, and pediatrics, Cappuccino said.
Class teachers praised Lisa Jane Jacobsen, associate dean for curriculum at the Jacobs School, for adding the course to the medical school course offerings this semester. Slots filled quickly and outstripped demand.
The UB School of Public Health has offered occasional nutrition workshops to medical school students in recent years, Klem said. She hopes the elective will lead to more regular classes that recognize that nutrition experts need to be part of the health care team of the future, and that similar courses can be offered to nursing, occupational and physical therapy, dental and social work students.
“This lends itself well to all of us,” she said, “because weight is the elephant in the room in all of our health care studies.”
People who eat better and exercise make better patients, Klem said. Their disease risk is lessened, recovery from illness and surgery faster, and dependence on pain medications lower. A growing number of surgeons, she said, also are reporting better results when patients eat light, nutritious foods before procedures instead of fasting, and continue that habit afterward.
Michelle Whittum, a fourth-year medical student from Rochester, said she and fellow classmates are grateful to ECC for hosting the class and allowing participants to experience scenarios common to patients they will soon serve. She plans to take up a collection from participating students to help restock the school pantry they used for part of the latest class assignment.
Whittum, who plans to become an OB-GYN, worked with fellow med school student Marcia Chen to prepare lentil soup, honey soy drumsticks, an Asian stir-fry and kale chips with foods from Price Rite and the pantry.
“I think it's really easy for us as physicians to look at our patients and say, ‘Eat healthy,’ ” she said, “but it's really hard for us to say that honestly when we don't even know what that means ourselves.”