I'm delighted today to be joined by Dr. Joseph Skelton, professor of Pediatrics, founder and director of Brenner Fit, a program at Wake Forest University School of Medicine. FIT stands for Families in Training, which is a family-based pediatric obesity program. He's the author of a new book on children and their weight, a topic we discussed in a separate podcast. But in this podcast, we're talking about something he teaches at Wake Forest, a course in culinary medicine. This is a fascinating, pioneering area of focus, so let's dig in.

Interview Transcript

There's a lot of language about medicine and nutrition now, so people talk about food as medicine. There's a move afoot to get more training and nutrition and medical education, and here you are doing culinary medicine. Tell me how all these things differ from one another.

Our interest in this here at Wake Forest School Medicine started a little organically with our program. A lot of what we do is focus on family meals. There are decades of research showing the benefits of family meals, not only for the nutrition and obesity risk, but the quality of nutrition, time spent together, parent child communication. Kids are less likely to get pregnant or do drugs and alcohol. All these things from just spending that time together over the meal. And I inherited a small teaching kitchen that was at a local organization that someone before me had gotten funding for. And we, sort of, took it over and used this opportunity to teach families how to cook. And a lot of families know how to cook but trying foods in different ways and to get kids involved and things like that. Then a couple years after that, the local YMCA approached us. They had some space and wanted to do this as a partnership. So I became a fundraising machine for a year or two and took a lot of dinners to raise the funds. And we built this gorgeous teaching kitchen, and we were mainly doing it in the efforts of sort childhood obesity treatment or prevention, getting families, teaching them new recipes, which then kind of extended to that whole key thing of getting families just to be comfortable in the kitchen and spending that time together. And we just started seeing these amazing things. We always say we've converted more kids to Brussels sprouts than I think any other effort of just getting them cooking it a different way. You and I were both probably raised with steamed Brussels sprouts, which I think is an abomination. If you really want to highlight the sulfur smell of a food, then you're going to steam it. And so, we really started to do that. And then students started volunteering. Actually, it was a student, Josh Patman, he's an emergency medicine physician now at East Carolina University, and he was a cook in a professional kitchen college. And he said, hey, could I help volunteer with that? And then more student medical students wanted to do it. And then we all found that you, much like I did, I'm a self-taught cook myself, and the more time you spend in that, the more you learn, the more comfortable you are. And the more you start to know, you know, I can teach med students nutrition all day, but that doesn't teach them how to get nutrition on their patients' plates, into their mouth. And so it really grew from there. And then I, kind of, stumbled upon what other people were doing. It started in New York, but the biggest program started was really Tulane School of Medicine that had it as a very focused way about teaching nutrition through cooking. Not just on a blackboard through PowerPoint slides and stuff like that of like hey, let's teach it in a different way. And the old-fashioned analogy, and actually the medical educators hate this, it used to be see one, do one, teach one. That was sort of the old surgical thing. And so, it's really you got to see how to make a recipe and you got to do it yourself. And what we found that when students start then teaching each other, or teaching patients or teaching community members, it really drives home and gives them a much deeper understanding of what nutrition in the real world is.

Let's talk about the need for this. If we go back in time and we think about your parents or my parents, you know, the likelihood is that meals were being prepared from the real foods rather than from a package, let's say, or in a micro. How are things different now for the modern parent that has kept people distanced from their food and where it comes from, and that's led families to be distant because they're not having meals together as much? What does that look like now?

Yeah, pulling from our own history, you know, Home Ec is not really a thing anymore. We did this study in our own med students. You know, most of their cooking, nutrition, the nutrition education they're getting tends to be the popular media. They're learning it from social media. Very few students have a degree in nutrition or took a nutrition class. And as much as we have to cram into medical student's education, there's not much room for it. They mainly learn to cook from their families. And what we know is families are cooking less and less for multiple reasons. They're much busier. Especially parents, actually parents of kids of all ages with that. And again, the marketing of food, you know, it's much easier to get ready made meals. And I'm not badmouthing those, you know. We're in talks right now of actually writing a cookbook for families, and one of the things that we promise is we're going to have a chapter on assembled meals. You know, having a pre-made salad with a rotisserie chicken, that's still going to be a better thing to do if you bring that home, sit at a table or at a bar or around a coffee table and eat that meal together. It's still going to be better for your family in multiple ways on multiple levels than eating out. And what I see, it really with families right now when it comes to actually raising "healthy eaters" or raising good eaters is when we... and again, I love a good restaurant, I'm not trying to badmouth that... but when you're going out to eat a lot of kids have endless choices and there's two issues. One is a paradox of choice. Whatever they get, they're always going to think that other thing might have been better. And it doesn't allow them to spread their palate and try different foods and get exposed to different things. And we always laugh... whenever in this field we want to play a drinking game where every time you say complex or complexity, you take a drink because, but it is such a complex issue with parents. You know, with kids and getting meals on the table. And hopefully finding some time, whether it's a breakfast or it's a dinner, but finding that time to come together around a meal.

You mentioned the paradox of choice. I was reminded at one point I downloaded this cute app called You Choose or something like that. And it would help you make a decision if you were undecided. It would flip a coin, it would roll a dice. It would do, yes, no, it would do rock, paper, scissors, it would do all these things. And I was at a restaurant once. I couldn't decide between two entrees, so I used it. I did rock, paper, scissors, or something, and I then it said, okay you should choose X. So I ordered X and the second I ordered it, I immediately thought I should have ordered Y. Alright, so tell us about culinary medicine. What does this course look like that you teach?

Yeah, the best way to think about it is applied nutrition. Because again, you can understand a ton about nutrition, but if that doesn't change into you getting the foods that you want in front of you, to me it's almost theoretical or scientific. It's applied nutrition. It's this idea of teaching some very basic cooking skills, and then including within that very core elements of nutrition. And for us, we tend to do it by the balanced plate. We think that works really well for families. But having it be very real world. You know, so again, we have recipes... in two weeks, I'm doing one... we're doing a rotisserie chicken and you're breaking it apart and making a chicken salad out of it. We were always teaching using microwavable rice and a couple of the students cornered me and said, this is very offensive to my culture. You need to teach people how to make real rice. But what it looks like for us is about a quarter, almost a third of med students will rotate through these classes. So, it's voluntary. Next year we're actually hopefully going to surpass half of the first-year med school class.

That's unbelievable. That's very impressive.

Well, especially up until last year I was doing this in my free time and paying for it with fundraising money. But yeah, Wake Forest is really behind this now. But about a quarter to a third of med students. They do five classes. And it's set up and again, that sort of theme of that family meal. They come in and we get stuff cooking. We get stuff in the oven; we get stuff on the stove top. We usually take some time out for a very short lecture. Again, tends to be very practical stuff. We include a lot about social determinants of health and food insecurity. Given what I do, we talk about picky eating. Very little do we go into details about Mediterranean diet and Dash diet and some of the really core things with that. We really just try to keep it about getting that balanced plate of a protein, a starch and a fruit or vegetable on the plate in front of you. They come back and usually finish what they're cooking, and then they sit down to eat together. And unlike when I was in med school and you were in grad school, or when you were teaching, a lot of students don't go to class anymore. A lot of students, they record the lectures so they can listen to th...