Okay, good morning, everyone. My name is Dr. Nathan Jones. Just want to welcome you to this session on culinary medicine and applications in the occupational or workplace setting. And this will actually be a two-part session, so this will be the first part. We're excited to hear from some excellent, very well-qualified speakers. And then after the break, if you come back, there should be a very engaging and educational panelist discussion with different questions being run by the speakers as well. So again, thank you for being here. And with that, we'll turn the time over to our speakers. Well, welcome, everyone. I know you were just, as you were walking in, I'm Dr. Sharon Walsh. Just when we were watching a video from ACLM, the American College of Lifestyle Medicine, who's before walking in here had heard about the American College of Lifestyle Medicine with a show of hands? That's great. And who among everyone knows that there's a board certification in lifestyle medicine? And who in the audience is board certified in lifestyle medicine? Wow, that's, you know, so it's really a growing group of people. And this Lifestyle Medicine and Food as Medicine Essentials course is a great intro for any that want to learn more. And it's available for anyone to take for free. And so we're going to dive right in. I'm Dr. Wasserstrom. I don't have any disclosures. I'm going to tell you a little bit about my journey of how I got here. When in medical school, I felt after I finished that my main goal as an internist was to teach about prevention and how to prevent disease. But when I got out into the workforce, I didn't necessarily feel that I learned enough in medical school. So I went on a journey. And I first went to Columbia University. And they don't have this course anymore, but it was medical nutrition for the health care professionals. And there were GYNs, pediatricians, nurse practitioners, all different people that flew in from other parts in the country once a month on the weekend to learn about nutrition. And then once I learned about nutrition, and really I learned mainly that no matter what disease there is, eat more fruits, vegetables, legumes, and whole grains. And that's the main message. And then motivational interviewing and how to help others make that change was more the challenging part. And so then I needed to learn for myself how to eat a healthy diet. So I enrolled in something called Culinary Rx, where you could learn in your house how to cook. I learned knife skills. I never knew how to use a knife before that correctly. And then I myself did a 21-day kickstart through PCRM.org. They have an excellent free app to learn 21 days to dive into eating a whole food plant-based diet because that's not how I grew up. And I needed to learn more about that if I was going to tell my patients about how to eat that way. And then in addition, I then, after eating that way, wanted to learn more about the evidence behind that. So I earned a plant-based nutrition certificate through eCornell, which is available. And then I found the American College of Lifestyle Medicine, and I became board certified. So as a physician or any healthcare professional, you become board certified in lifestyle medicine, doing 30 hours of CME, going to a conference, writing up a case report, and taking an exam. And I was among the first that got that board certification. And if you're now in residency or you're a medical student looking to go into lifestyle medicine or have that as an additional board certification, you can do that in many residency programs around the country. There's over 300 that now have a lifestyle medicine residency curriculum program, and you can find out more about that. So the objectives in my talk today is what is lifestyle medicine? What is the role of diet in chronic disease? What are the benefits of lifestyle medicine in the workplace? And some successful examples of food as medicine programs. Because food is medicine in the workplace, what are some ways you can empower the workforce to eat more nutritiously? What is lifestyle medicine, for those who haven't heard of this before? It's an evidence-based approach to treating, reversing, and preventing chronic disease through non-drug means. There are six pillars. There's the pillar of nutrition, sleep, exercise, substance abuse, stress management, and healthy relationships. And all six are important to optimize your wellness. But today, we're going to speak about the nutrition pillar. So why is it so important to even speak about this with our patients? We have a chronic disease epidemic, according to the World Health Organization, 80 percent of heart disease, stroke, and type 2 diabetes, and 40 percent of cancer could be prevented primarily with improvements in diet and lifestyle. So poor diet is linked as the leading cause of death and disability globally. So chronic disease in America, 6 in 10 people in the U.S., adults have a chronic disease, and 4 in 10 have two or more. So the key lifestyle risk for chronic disease, as you see below, is tobacco use, poor nutrition, physical inactivity, and excessive alcohol use. Less than 3 percent of people live a healthy lifestyle, according to this Mayo Clinic study, where they looked at a healthy lifestyle defined by moderate or rigorous exercise for at least 150 minutes a week, adult diet score in the top 40 percent of a healthy eating index, and a body fat percentage of under 20 percent for men or 30 percent for women and not smoking. And when filling and looking into that, less than 3 percent fulfilled that. And they also did another study, an NPR poll, looking at people and asking if they thought they ate healthy. And 75 percent of Americans say they eat healthy, despite evidence to the contrary. A fact is that more than 80 percent of Americans fail to eat the recommended amounts of fruits and vegetables. And I find that also with my patients when I would ask, are you eating vegetables? If they were eating vegetables twice a week, they said that that was healthy. So there's a misconception based on how much you are eating and what is recommended. And so food is medicine. And what you eat and what you put in your body, and if you can have in your workplace ways that can make the healthy choice the easy choice, it's important. Because if poor diet is causing these problems, a healthy diet can correct the problem. And as you see in this table here, diet is the leading cause of chronic disease and disability. So we really have it in our power to speak to anyone that you represent and find a way to make a healthier diet available or give the skills or tools for someone to learn how to eat healthier. There is no medication that's as powerful as making these lifestyle changes. So nutrition shows that eating a predominantly whole food plant-based diet, you know, you get in more nutrition and less harmful foods, and it's the best way to prevent, treat, and reverse many chronic diseases. And there's many health-promoting diets. These are just a few, vegan, vegetarian, Mediterranean, and the common thing between them is all of those are whole food plant-predominant ways of eating. Any way that you eat more fruits, more vegetables, more legumes, and more whole grains is a way that you're adding healthier things to your diet. And what does it look like in the workforce? This is lifestyle medicine in action. When you look at these six domains, eating better, moving more, sleeping more soundly, managing stress better, cultivating relationships, and avoiding risky substances, overall, that's going to account for better health, less people absent from work, greater focus at work, you know, more energy at work, heightened creativity, fewer accidents, and higher productivity. So it's more effective, and it's actually less costly in the long run. U.S. employers spend nearly $900 billion annually on health care benefits, with illness-related lost productivity accounting for another $500 billion each year. So if you focus on lifestyle medicine, you could dramatically reduce these costs. So it's not only for the betterment of our wellness and to have healthier people and less chronic disease. It's better for the pocketbook, and that's sometimes what others need to hear when you're trying to convince them to make these changes in the workplace. There's a decreased need for expensive drugs and medical procedures and lower rates of absenteeism. In a world in which U.S. employers spend more than $20,000 per year on health care per family, lifestyle medicine represents a meaningful money-saving potential. And this is just a busy slide, but it can be found on the American College of Lifestyle Medicine website, and this shows this is your workplace on lifestyle medicine, and it's different components of where you could put it in. You can make the environment more conducive by making more lactation rooms or making healthy foods more the easy choice in the place where you work. You can engage the peers and have walking buddies and have group visits where people together make changes. You can, you know, expand benefits that help you make changes, like having a health coach or nutrition counseling at your fingertips. So there's a lot of different ways that you can have this in your workplace. And there were a couple of examples that I'll give you. At Vanderbilt University, they ran a CHIP lifestyle program, and they showed that after six months of a diabetes-focused lifestyle medicine pilot, which cost $32,000, reduced health care spending by $92,582. So just in six months, there was a 210% return on investment. In Maryland, the largest private employer, it was lifestyle medicine was a way at work. They made the workplace a place where lifestyle medicine was first. You know, it was what was easy, maybe, you know, they prioritized that. Imagine your workplace when you have a Zoom meeting. It's an hour, then another hour, then another hour. Instead, have it for 50 minutes, and then it ends no matter what, and there's 10 minutes to stretch, stand up, and you have time to regroup. Just putting in those kind of things really could work for a healthier workforce. And preventing diabetes is really important. It begins with identifying employees at risk, and there is a great program. You don't have to reinvent the wheel with a lot of programs. There's a lot of programs out there that you can implement and already have slide decks. So the Diabetes Prevention Program is one of them, and you can see the links below where you can get tools and this kind of resource to use to convince employers or bosses about why you should bring such a program. So preventing type 2 diabetes, 84 million adults have prediabetes, and 1 in 3 have it, and 9 out of the 10 don't even know they have it. And it increases medical costs for someone to then become diabetic, as you see, about $237 billion in direct medical costs, and people with diabetes have medical expenses that are approximately 2.3 times higher than those without diabetes. So in the U.S. population, the average total expense for someone with diabetes is $16,750 per year, of which $9,600 is attributed to the disease. And healthcare spending is roughly $2,700 more per year for employees who have recently transitioned from prediabetes to type 2 diabetes. And there's lost productivity, more time off, higher turnover rates, reduced morale. So helping employees at risk with the National DPP Program by having 16 weekly sessions for the first six months and once a month thereafter for the rest of the year can be very empowering and maybe could even be offered during lunch hour. And the business case for this, they had an average follow-up of three years of people in this structured program, and the incidence of type 2 diabetes going from prediabetes to diabetes was 58 percent compared to those who didn't go through a program. And this is basically a lifestyle medicine program. And those that were older, even less went on to diabetes, whereas when they looked at those that just took metformin to prevent prediabetes to diabetes instead of changing the lifestyle, that went down by 31 percent. So it's an important thing to do. And I want to just give you some resources. This is a resource that just came out from the American College of Lifestyle Medicine. It's a video series that could be played, and you're going to see this video at the beginning of the next session. There's one on nutrition. So we're going to play that for you, and so you could see what this is, and this is something available for anybody to use. And there's also these flyers that are available for anyone to use on the lifestylemedicine.org. There's also implementation models that are available to use. So don't, you don't have to spend all your time reinventing the wheel. There are lots of great programs out there that you can copy, you know, and use. This is what they're there for. And so UC San Diego has a supervised lifestyle program for weight loss and obesity treatment, and there's the slide deck of all of the content, and you can get the content and even the PowerPoint and, you know, basically use it where you are. There's a diabetes reversal program that they did at Midland Health, which was structured, and it kind of goes over how each is structured, and also maybe how it would be paid for by insurance. And there was also a Kellen Foundation brief. So there's many of these implementation models. And on the last slide that I'll show, I have all the websites for all of these to find. This is a great resource free from Ardmore Institute of Health, fullplateliving.org, that I give to many of my patients to learn about how to eat more fiber. And they have one, four, or eight-week programs that are free to utilize to facilitate how to eat more fiber. So this is, I'm just going to quickly show some of the slides from it, but these are slides. So when you go on to the fullplateliving.org, you can find all of these slides to use. You know, are all fiber foods the same? Some meal makeovers, which I love the, you know, 1260 calories versus 590, how to do that makeover, how to make over your negative thoughts. I don't want to lose too much weight because my family and friends may think I'm sick versus I'm doing this to prevent sickness. And powering up your day, you want to rev up your healthy life. Each of these slides are the title of each of the eight sessions. And this is one slide that I took from each of the eight session packs to just show you an example of what they have. Making the most of your mornings, powering up your oatmeal, how to make it healthier, smart grocery shopping. So I'm just going through this quickly, but you can find all of this on fullplateliving.org, tips for eating out, and the teaching kitchen collaborative. You could look at that up because that's a collaborative where there are teaching kitchens around the country in schools, in healthcare centers, in employee centers, and there are examples of each and every one of them. And the Emory Healthy Teaching Kitchen Collaborative is one example that I saw, which is for employees. And what they did is they taught their employees the skills of cooking. It's a hands-on cooking sessions, and education, and learning meditation together. So you should take a look at that one. That's been highly successful. And for more information and additional resources, you can use this. And this is a good slide to look at. And it has all of the resources because it took me a while to find all these resources. And these are very helpful. I can go on probably for days about each and every one of them. But if you could bring it to your workplace and convince employers, you're just making such a big difference in the lives and decreasing the tide of chronic disease. And now, we're going to hear from Dr. Kroger. Well, good morning. Maybe I'll get this mic working. So everyone can hear me. Good morning. My name is not Dr. Kroger. Thank you, Dr. Washington. My name is Mark Watkins. I have the pleasure of serving as the chief medical officer and vice president at Kroger and support both our total rewards, our benefit design at the company, as well as our health care arm. And you may be wondering why in the world is a retailer sitting up here talking about food as medicine, and why is that so important? This way? Well, I'm going to keep on going. I'm not sure where my slides are, but we'll work on the power of technology to fill the slides in in just a minute. So again, I'm Mark Watkins. It's very nice to be with you. And I started by saying, why in the world would a retailer be sitting here? So the Kroger Company is the largest traditional grocer here in the United States, about 141 years old. Started with roots in Cincinnati, Ohio. A little bit more than 3,800 traditional grocery stores in 35 states, including the District of Columbia. So one of the things that we really aspire to do is to understand how we could play in the space around food as medicine, and how can we make a difference in the lives of the communities that we serve. So as soon as my slides are up, I'll begin to walk through some of this, which I think is germane to what the good professor just talked about. She gave you all of the tools from where the science lives and breathes. Thinking about how do you empower your patients, your organizations, to really make an opportunity to sort of engage once they're engaged, right? So as you get the information from whether it's all of the resources that she's shared, how do you now help your folks when they're in their natural environment? So I use the term when they're out in the wild. How do they make good choices, right? So we'll step through this today. So I kind of unpackaged a little bit about what goes on at Kroger Health. And just to reiterate what the good doctor said is that, you know, we just sometimes don't get it when it comes to nutrition, despite the fact that many Americans really, really want to eat better, just don't know how to do so, right? If anybody ever looks at the back of her food label, it's awfully confusing. You're seeing percentages of daily allowances. You see all kinds of numbers and things on the back of this food label. And you go, well, how many calories? What's my unit serving? How much sodium? How much fiber, right? How much saturated fat? All of that can be incredibly confusing. And we just saw that, you know, the impacts of poor nutrition. She laid out how poor nutrition really is one of those key drivers in really preventing chronic disease. Suboptimal nutrition is a leading risk factor for deaths worldwide. We know that. And then finally, we think there's about $50 billion attributed cost associated with poor nutrition around cardiovascular disease and things that can be preventable and controlled like blood pressure and obesity. So at Kroger, we believe food as medicine is a dedicated, educated, and personalized approach to eating and enjoying food so we can live healthier lives and prevent illness before it starts. And let me just pause a second and just go back to my opening comments. Why is that important to the Kroger company? Healthy communities is good for everyone. As part of the community and the fabric of the community, as I mentioned, for over 141 years, healthy communities are active communities, productive communities. They are likely to be engaged in meaningful activity around work. Also play and social activities. That's a good thing for investments, opportunities for businesses to come to those communities. And unfortunately, when we look at the disparities that exist between zip codes around the country, we see a lack of investments. That's pretty clear. And then we also see something that's incredibly startling. And as an occupational medicine physician, as a public health professional, when you see between zip codes sometimes 10, 12, 15 years of lost life, right, or years of productive life, that's startling. And we believe there's an opportunity to maybe course correct with nutrition. It's not alone, right? That's not all that we need to do. But it's a start. And our core DNA at Kroger is food. And so as we move on, let me just kind of unpackage our food philosophy. And if you look at the screen, our tactics are things that we can do. And on the other side is food is medicine feel, right? So how do we inspire by nourishing food and inspiration, joy in eating? Think about some of your most incredible moments. I'm having my 20th anniversary in a couple of weeks. And the first thing my golfing buddy says to me is like, where are you taking your wife to go eat? You know, so we celebrate around food. We cry around food. Every opportunity we have, whether it's a holiday that you cherish or one of your fondest memories of your childhood, potentially revolves around food. And we like to frame Kroger as a food playground and not demonize any food and really think about it as not being a moral or guilt issue, but really using it as opportunities to motivate behavior change. And on the tactic side, and I'll unpackage this as we go through this, really leveraging things like understanding, compassion, and empathy, making it personalized. I'll share a quick story about personalization. I'm getting ready for a talk, and if anybody's from Memphis and knows Memphis, I'm heading up to talk to a predominantly African-American Baptist church group. And I asked the dieticians as we're getting ready, and I said, make sure you give me something to really, I want to connect with this group. And then I said, I leaned in and said, don't send me up there talking about no daggum quinoa and kale salad. I'm going to get up there. I'm going to lose the audience. So understanding how to make that practical so it's relatable, pragmatic, really simple. And then finally, really make it solution-oriented and product-specific so that if folks are looking for a certain product on our shelves, or anywhere for that matter, they can find it and understand how it's better for them. So as the evidence is mounting, and I think many of us in this room are singing from the same part in the hymnal, that food is medicine. We've all been taught you really can't outrun a poor diet, understanding that this is a continuum of what we've been working on. And I'll begin to unpackage this very quickly. We have a proprietary opt-up scoring system. This isn't a plug, but it's one of our attributes that we're using to help people understand what is a healthier choice for me. And so back in 2018, we really showed in a correlation study that higher opt-up scores really correlated to a higher health activation index. And we partnered with our friends at UnitedHealth Group to really validate that against some of their methodology, that as your opt-up score increases, so does your health activation score. So this is a first-of-its-kind study that really looked at correlating a food score from a retailer with an insurance company health activation score. And if many of you are working with large insurers, there are many types of health activation index they may use. There's things that measure your likelihood to be admitted to the hospital. And so you can use these types of scores, not only from us, but things that the good professor talked about as a way to measure longitudinally how folks are doing. Another thing that we worked on, and I'll just be very brief here, is that we worked with the University of Cincinnati in a pivotal study that was published in Nature that really talked about leveraging a registered dietitian and the DASH diet. And so many of you know that the DASH diet is the Dietary Approaches to Stop Hypertension. So we saw a significant reduction in systolic blood pressure when combined with a nutrition intervention, a retail-based intervention, and a shopping list that was provided by the dietitians through a one-on-one opportunity. So this is what it looked like in our randomized control trial. And just very briefly here, as we walk through this, the big point to take home, it's a busy slide, but DASH scores improved even more when we added the personalized teachings from the dietitian and in-aisle grocery shopping. As we really simplified that process to help them understand which foods made sense to them, we saw a better adherence to the DASH diet. And if anyone's ever used the DASH diet, we know it's difficult for patients to sustain for a long period of time. And in fact, many of the nutrition labels become confusing. You're unsure if it's a 1,000 milligrams, 1,200, 1,800 milligrams of sodium a day. Is that per serving? It can be very confusing. But the bottom line here is that with a dietitian, we were able to really begin to leverage the personalization of the experience to prove that with personalization coupled with in-aisle experience that a retail-based intervention actually can reduce blood pressure in that group. So just moving on to telenutrition as just a means of talking about what I think is our bread and butter, and the professor talked about this a little bit, and I'll just lean in a little bit more, is that when the dietitian is involved through a telenutrition platform, it's an opportunity to engage at scale and really deliver the bread and butter solution that dietitians can provide. So many of us may have access or may not have access to dietitians. How many of the group here utilize dietitians monthly, yearly, refer to a dietitian? I saw a few hands. That's likely pretty true for many of us. There are some considerations that we're working through to try to elevate the profession, make it easier for clinicians to get their patients to dietitians, but the bread and butter of our telenutrition service and what dietitians offer, and this is just not what happens at Kroger and Kroger Health, but it's the medical nutrition therapy. It's an evidence-based therapy that incorporates nutrition assessments and interventions and typically results in prevention delay or management of diseases or conditions. As I opened, I talked about how do we prevent illness before it starts. Here's a tactic that's in your armamentarium as providers and as clinicians, thinking about how you can kind of prevent disease before it starts, getting a dietitian involved, especially if someone is a pre-diabetic and they don't know it. How do you have those conversations? And thinking about, I had a conversation over dinner last night, thinking about injury and injury prevention and what could occupational medicine physicians and clinicians do in the space, especially when you're seeing an increase in the number of injuries or recordables in the workplace and you have an initiative maybe to reduce those. What about addressing someone's glucose? Maybe their vision hasn't been checked in a while. Maybe their A1C is not in line, and that metabolic dysregulation creates a lot of cognitive potential issues, short-term memory. There's also sometimes some balance associated with that. Many of you know that. And so addressing some of those things can, especially for safety-sensitive work or even non-safety-sensitive work, can be a huge factor. This is a little bit more about our opt-up rating system. It's something that I'm very, very proud of. We've been doing a lot of research to understand how we begin to score foods, and let me just take you through this a little bit. This is, if many of you may be familiar with things that score food, like food frequency questionnaires, that's very, very difficult for patients to log their foods, catalog their foods, bring that in. This is all passively done at the point of purchase. So as you're checking out, the foods are being scored today and tracked over time longitudinally. And that's one of the nice things about this, taking the guesswork out of it. But I'll take you through how we score our foods, and it's very simple. It's on a scale of 1 to 100. Everyone can get it. If you're scoring in the single digits, it's not as good as if you're scoring in the higher upper 80s and 90s, so it makes a lot of sense. And so how do we get a product scored, right? And I think our dietician that's here will approve that our nutrition ratings tend to increase as food contains more fiber, fruit content, nut content, protein, vegetable content, and whole grains. You heard the whole kind of backbone of the American College of Lifestyle and Medicine. You heard a lot about the whole food, plant-based diets, and whole foods. We also know that these ratings also decrease when we have a lot of added sugar. High in calories, high in saturated fats, and sodium. So our dieticians have helped me with a little trick in that looking at food labels. Hey, Doc, make it simple. If it's high in sat fat, high in added sugar, and high in sodium, maybe it's no bueno. Look for something else, right? And that's a good way of beginning to think about it. And then the food rating system that you see there in the little box down to the right really says that we want 50% of your basket to be in the green. We want only 40% to be yellow and 10% to be red. And hence the name Opt Up. If we can help you move from red to yellow to green, that's the Opt Up philosophy. So that if you have things that are in the red, for example, can you find a healthier item that maybe scores a little bit higher, has a little bit less sugar, a little bit less saturated fat, maybe doesn't get you all the way to green, but maybe gets to yellow, right? Incremental steps. That's important because we know that we're not going to move someone from potato chips to kale chips overnight. That's impossible. But what's possible is maybe a baked chip instead of fried, maybe a chip that has a lower saturated fat content or sodium content. Those are incremental steps that folks can get behind. And this Better For You carousel is just another example of some of the nutrition insights that we put online to help folks understand which are better for me as they're scrolling with items either online or using their phone to actually scan items in the store. Understanding how this relates over time. This is your purchase breakdown and really shows you longitudinally how this may work. So why is this important? We have this really aspirational goal that at one point with our ecosystem of opt-up, could we actually use our opt-up scoring system as a vital sign in the clinician's office as a way to say, one, are you – is there an opportunity to have a conversation about your food and your health activation score, much like a conversation happens with things like your blood pressure, things like your weight, right? Could this be one of those dynamic types of tools? Could we use this to really push suppliers to give us healthier types of foods in our stores, right? I talked about all those food attributes. And then finally, we see this as not something that just lives at Kroger but lives brand agnostic not only to Kroger and other retailers but to use that to inform customers and shoppers Once they're empowered by the great clinicians to take charge and be activated, how do they then make healthy the easy choice? And then finally, this is a little bit more about our medically tailored meals. I won't spend a lot of time on that, but learning from our dieticians is a great segue to our next panelist as she can begin to talk about this. So as I finally wrap up, many times clinicians may feel overwhelmed and feel really that, hey, I'm doing all I can for our patients. But sometimes it's leveraging your ecosystem to use the power of the health care ecosystem like dieticians to help them with your patients make great food recommendations. And so with that, over to my colleague. All right. Thank you. All right. I'm ready. All right. Thank you. I'm the chief of nutrition and food services at the local VA here in Orlando. So I know many of you are guests with the second largest VA system in the country with the largest being right north of us at Gainesville because you know everybody retires and moves to Florida. And that's where many of our veterans are. We have a great system here with a fairly new inpatient facility that's right across the street from the UCF School of Medicine. So you might notice everything is always new in Orlando, right? You look around, everything's new, right? So and I've been a resident here for about 35 years and worked at the VA for 23 years. Thank you for the pluses for a registered dietician. The VA does employ many dieticians. So we do work that into seeing our patients. So it's a blessing that we get to do that. So okay. How do you do this slide? Green button. Green button. This one here. Okay. So that's pretty easy. I was going to talk a little bit about culinary medicine. And we are going to talk about the program that we do at UCF School of Medicine. It is the utilization of unique combination in nutrition and culinary skill. We have Chef Jay with us as well. And that is a way that we can assist patients in learning the best way to maintain optimal health. Look at the grocery. They have purchased the food. Look at how they purchase and how the food they eat can optimize health. 34 U.S. medical schools teach culinary medicine. So that's not all our schools. We know that. Many of the physicians that are here have not had that education. And then this is a 2000 and our 2021 statistics. Culinary medicine attempts to improve patients' conditions whether she or she regularly eats and drinks. And special attention is given to how food works in the body as well as the sociocultural and pleasure aspects of eating and cooking. And the objective is to attempt to empower the patient, as we're discussing, to care for himself or herself effectively and happily with food and beverages as a primary care technique. So that very, you know, definition of what culinary medicine is. How can we take what we eat and take charge of our health with what we eat? So at UCF Medical College, under Dr. Westerstrom, we do have an elective. We do offer it to our third-year medical students and the physicians, dieticians, as well as chefs do help teach the medical students. A little bit about how we do that. On Monday, that's kind of our didactic day. So all day Monday, we do work on culinary skills and some didactics from our physicians and dieticians. So the day may look as, you know, we have a nephrologist who speaks specifically on nutrition and nephrology. Our students then go in to the kitchen and do culinary skills. The first day of class, we've got to learn basic knife skills, a lot of basic techniques, and we move on to working our way through recipes, discussing the recipes, discussing what nutrients are provided by that recipe. Working with the physician and looking at, well, how can, in some case studies, how can some people benefit from improving their nutrition and improving what they eat? So what do we do with that with our medical students? On the subsequent days, we go ahead and teach and do. So one of the days they come over to the VA, we work with some of the veterans in some of our various mental health programs, and the student, the medical student is now side by side with the patient working through a recipe, so able to teach them both the skills of cooking and the ability to talk and discuss health and the benefit of eating better. We do have had a variety of groups that we work with in various communities throughout Orlando so that our medical students can go teach in these. We've taught children. We've worked at food subsidiary programs. We've worked at the food pantries, so just different locations. So one of the things we did this year that was fun is a session with some of the physicians and medical providers at the VA. So our third year medical students got to teach those who teach them how to cook. So kind of a fun thing for them to do and work together to help teach our physicians. We'll talk about this a little more later, but a little bit wellness for the physicians that work at the VA. So this provides an employee benefit for those members of our staff that were able to participate in that. So what is interesting about culinary medicine? Why is there an interest? So we see a lot about culinary in the media, right? We have cooking shows. We have famous chefs. There's a lot of celebrity related to eating and cooking. So that piques people's interest in learning what to do. So there is dissatisfaction with conventional medicine. So people do look towards the route of doing things more naturally. How can I take care of myself more naturally? And want to know what else they could do for themselves to be preventive. So the cost of health care, of course, everybody in this room knows is a burden. It can be a burden to the individual as well, to the companies where we're employed. So we know that eating is the base. What we eat and how we take care of our health can decrease those costs to everybody. And then we have become more cognizant about additives, more cognizant about organic foods and healthier ways of living, eating local foods, even home gardening and ways of taking care of things ourselves. So all of that has piqued our interest in eating healthier and the availability of food and then, of course, knowing what to do with it. So as it's been pointed out by our physicians here, we have plenty of studies and a lot of correlation to show that how we eat, what we choose to eat, things such as following the DASH diet can be just as effective as medication changes. So you know, as providers, everybody in this room knows probably the first step you should take is looking at lifestyle for the patient. Sometimes it's difficult to take that step for you if you're looking at treatment and prevention from further problems, but lifestyle is something that can effectively change somebody's medical condition. We know that medications, we know that foods such as more fruits and vegetables can have that anti-inflammatory effect and we know information is a culprit for many things. So when we're looking at, you know, there's tried and true treatments in medical nutrition therapy, anti-inflammation, the ketogenic diet specifically for epilepsy, I'm talking not for weight loss and diabetes, and then we know that a Mediterranean diet, as we linked it through time, we now have the basis and these studies to show the decrease in an advancement of disease such as cardiovascular, colon cancer, and diabetes. So some foods we've linked specifically, and so when you're looking specifically at discussing with people some changes you take, recipe ideas, things that can make a big difference to people is, you know, more legume intake, more soy intake, looking at nuts, ensuring we have some intake of fish for the heart health and, you know, different things that we could look at. Like when I, when people come to me, you know, from a personal basis or ask for a little bit of advice, you know, you're talking to somebody, they ask you what you do and they, oh, I really need to eat better, I really need a piece of advice, I need to change, and we know these changes can be very large. You know, I give a few simple quick answers and I'll give the example of my niece who was diagnosed with Crohn's and she is 36 years old, and I talked to her a little bit about what she was going through and a little bit of how she ate and, you know, where's the fruits, where's the vegetables, she's not eating until dinner time, right, not eating all day. She's a social worker, she works in the medical field, she should know better, right? So I said, okay, Lindsay, let's just start simple. So I said, buy a bag of apples, she lives in upstate New York, okay, buy a bag of apples, I want you to eat an apple a day, right, the apple a day keeps the doctors away, right? I feel firm on that one because to me an apple, you know, or for a piece of advice for someone, they can grab a bag of apples, they last in the refrigerator for a little while, they're portable, right? They don't have to do any work on that. Can you just eat an apple a day, right? Some point in the day, mid-morning, if you didn't eat it on your way home, you know, I asked her to do that, I said, now, what are you going to have for breakfast? How about you have some regular oatmeal, not instant oatmeal, regular oatmeal, you can handle that, right? So just got her to convince her to do a couple of things like that, she's pretty good about making salads and stuff, eating lean protein sources, so the text I got from her about a week or so later, she calls me Aunt Lou, Aunt Lou, you know, I just want to tell you, I pooped at the same time, three days in a row, like that was an achievement, right? So, and I thought, oh, this, you know, 36-year-old who has been fighting, not really knowing what her diagnosis was, and just so pleased that she started eating regular and pooping at the regular time, you know, three days in a row, and it just made me stop and realize in my own personal life, people I know who just are not following some good, basic, healthy eating. And I gave you a simple change in some, maybe many people in this room are in this room because you're interested, or already a healthy eater, or maybe you're like, hmm, maybe I should buy some apples, right? But we can give people simple ideas and simple changes that they can make, and that's where, you know, you can come in as occupational health providers. You may not have all the resources Kroger has with dieticians, obviously, I'm going to promote dieticians as the experts, but you guys are medical providers and experts, too. So, having the resources that Dr. Wasserstrom presented to you, and utilizing some of those resources where you can, you know, get some changes amongst your, the members of your staff, and get some buy-in, and helping them, making them healthier. Next slide I have up here, but just some of the things in a Mediterranean diet, just as a reminder of some of the things people can change. Eating fruit, having some fruit available, having a contest to commit to eating some more fruits and vegetables, and some of the healthier things that we do that we know are tried and true that help with our health status. So, anti-inflammatory goes along the same theory. When we have more fruits and vegetables, less refined food, we're going to have less inflammation. So, there are some of the things a person can do for a healthier lifestyle, like I said, and maybe you want to emphasize eating more servings of fruits and vegetables, the elimination of sugary foods and sodas, a planned shopping list. So, we had this, we talked about the assistance Kroger can give us in that planned shopping list, because I hear that a lot from people. They understand and hear what we're supposed to eat, and then they look at us and say, but then I have to go shopping, right? And they're not sure about that, but now we can shop online, right? We can get that list all ready to go. We can get the food delivered to us. So, you know, COVID did bring us some great things, and that certainly is one of those. So, if we don't have the burden, we don't have the time, we can do all that kind of shopping online too. You know, bringing healthy snacks along with them, drinking more water, you know, doing that regular exercise, and of course, the sleep. So, the other pillars of lifestyle medicine can certainly be helpful. So, these are, as I said, some ideas that you as occupational health providers can do to help. We're trying to help you with your resources, ideas, and ways to pitch healthier eating and culinary medicine for the groups, because I know that's, you know, what you're looking for. And as we continue in the morning, we'll continue with that. Thank you. Thank you. Wow, hard to follow this wonderful panel that we have here. So, I will do my best. My name is Chef Jay Judy. I am a senior instructor at the Rosen College of Hospitality Management at the University of Central Florida. So, if you're not from Orlando, you may have not heard of us, but we are the number one college of hospitality management in the United States and consistently ranked in the top five in the world. I've had the pleasure and privilege of co-teaching, along with Dr. Wasserstrom and Ms. Mary Lou, the culinary medicine elective at UCF Rosen College and UCF College of Medicine. We've been doing this now since 2018, I think, 2017, and this is my fifth year being involved. I wasn't involved in the first year. But I have to say, this has been an enlightening journey for me. Just to give you just a very brief bit of information about my background. So, I came to the college from the industry. I've been a chef in industry for over a decade. And then I had been a culinary teacher at a high school teaching a culinary program that the National Restaurant Association actually administers. And so, I did that for nine years until I came to the college. And I've been now at Rosen College for 14 years. So, you do the math, I've been teaching culinary for over 20 years. And I've been teaching the culinary medicine class for about five. So, it's new to me relative to my career, but the importance of it, I have to say, within my career has been immeasurable. It's just been amazing. And it has allowed me not only to connect certain things in my own life, but it has allowed me to expand my teaching repertoire to a whole new body of students. The class is geared towards medical students that are just about to go into their residency. And so, one of the things we feel strongly about is they need to know how to counsel their patients about good dietary choices. We feel strongly about this because we know that this is a serious deficit in the medical profession. And so, we want to address it right away before they're out into the field. One of the things I will tell you is that the medical students that I work with are extremely motivated, but they don't know anything about cooking. And that's not surprising, since they've been working on medical studies since they were in their teens, probably, in some cases. And so, we want to address the life skill piece, because cooking is a life skill. And it is an underappreciated life skill for many. People don't think they have time, they think it's hard or it's unapproachable. And so, one of the things that we dispel right away is that it is difficult or something that they can't do. And they can't. And by the end of the course, working with us over the course of the four weeks that they're in the kitchen, they absolutely become great cooks. First learning safety and sanitation principles, then knife skills, and then finally how to execute recipes on their own. One of the things that we emphasize being, well, the Mediterranean diet is really important to the program. And so, we emphasize healthy protein swaps using lower fat, lower calorie options instead of higher fat or saturated fat options. One of the very first things we do is we teach them how to make spaghetti, but we first show them the traditional spaghetti, full fat, 80-20 ground beef, very, very high fat, very low nutritional value. And we work through a few different iterations until finally they're doing a plant-based version that is just about the same protein content, if not even a little bit higher, but much more nutritionally dense. And as you might imagine, the calories are still lower because it's plant-based. And so, this is just one of the things that we can teach the students that they can go on to counsel their future patients. And I think that's really the power of this triad that we have with the medical doctor, the dietician, and the chef, where we each have specific skills, but they overlap. And the important thing is making them overlap more so that the medical doctors actually understand how to make food taste good, but make it more healthful. And there's really three things that we have to deal with. We love fat, we love sweets, and we love salt, right? Those are things that we crave, and we make sure that we always have these tastes because we love them. And what do you do? You want to make things taste good. Well, three of those things can all be addressed. We can make things taste better with lower salt by using aromatic ingredients, things like garlic and ginger and spices, lowering sodium, increasing flavor. We can address fat by using healthful fats or less fat, or things like avocado or extra virgin olive oil in place of things like cream and butter. And then finally, we can address the sweets by using targeted sweets, things like honey that gram for gram are actually sweeter than sugar, or overall flavor balance to make sure that everything works and tastes good. Now, I only have a minute, so I just want to touch on the slide on the screen. This is just an example of a technique that we use. This is something that can be done really easily, that your patients very easily can take on this technique, and these are healthy bowls. These are just examples of ingredients you use with using a leafy green as a base, something besides iceberg lettuce, which is, you know, not nutritionally valuable usually, but does have a nice crunch. I like iceberg. But something like romaine or arugula, and then building flavors, building nutrition by adding ingredients, and these are things that can be made in advance. They keep for days in the refrigerator if they're prepared and cooled safely, wrapped and stored and chilled, and you can combine flavors to make some really delicious ingredients. And can we have that last slide, please? And this, finally, is just a really good example of something that really gives a good way of sneaking in nutrition to something that can taste really delicious. Everybody loves smoothies, so we teach one of the things that we teach is smoothie techniques, where once you learn the technique, the ingredients can be varied almost ad infinitum. You can make just about any smoothie you want once you learn the basic techniques. One really interesting strategy is to use frozen fruit in place of ice. That gives you the chill, gives you the body, and yet it doesn't dilute. And so you can use many different ingredients. Of course, the green smoothie, putting in kale or putting in those really nutritionally dense ingredients can make for a really healthful smoothie, but you can also add flavorful fruit. Of course, when fruit is in season here in Florida, we love to use fresh strawberries, coming right into end of that season right now, just plugging Florida produce. But again, these are just techniques. The trick is to learn the technique. Once you learn the technique, it can be applied to anything. And if your patients know these techniques, they will be more healthful. It doesn't take a lot of money, basic resources. I know Kroger provides some great examples, or the Kroger supermarket provided some great examples of how you could use those healthful ingredients a little bit more strategically. And so again, there's many different things we can do to make our future doctors better ambassadors for nutrition. And thank you all very much for attending. I know our time is up. So it is break time right now. So please go enjoy, refresh. But if you come back for the second session, we'll be sure to have plenty of time for questions for the speakers. But again, thank you to our speakers and thanks for attending.

culinary medicine

workplace setting

lifestyle interventions

healthy eating

nutrition

chronic diseases prevention

Mediterranean diet

protein swaps

flavor enhancements

mindful eating