Okay, good morning, ladies and gentlemen. Welcome back to those who had joined us for the first session of the Culinary Medicine Lifestyle Medicine session, and welcome to those who are joining us for the first time now after the break. Again, my name is Dr. Nathan Jones. I'm an active duty Air Force physician, board certified in occupational medicine, also lifestyle medicine, and engage in a number of lifestyle medicine initiatives, specifically within the military and also with some civilian corporations and companies as well, and have given multiple presentations and published on integrating lifestyle medicine into the occupational medicine setting, as well as publications, presentations, and that sort of thing. I have been given the impossible task to fill in for Dr. Pam Heimel, who many of you know and love, who was the initial moderator for this session but was unable to join, so she requested that I step in and help lead our expert panel here through some interesting discussions and hopefully educational, informational content for all of you to implement. Mandatory disclosure, any opinions that I share do not represent the official position of the United States Air Force Department of Defense or the U.S. federal government, but I did want to, before we kick off some of the questions and get to our panelists, talk about a little bit my own journey into lifestyle medicine and specifically lifestyle medicine in the workplace. You know, it's really kind of been a sequential process for me. Many of you may know Dr. Kales, the residency program director at Harvard and my residency program director, and he's been preaching the Mediterranean diet for years and specifically looking at and researching how that can impact health, specifically of firefighters and other public safety personnel, which is a passion and an expert niche of his. And then Dr. Ron Stout, who I know was here earlier, obviously, with his work throughout his career and now most recently with the Ardmore Institute of Health, has also been influential leader in this space. And Dr. Pam Heimel, who we wish could be here with us, certainly has been inspirational in terms of her kind of embedded approach to wellness and health promotion in the workplace. And Dr. Kenji Saito, our outgoing ACOM president, has also had a firm hand on integrating lifestyle medicine and collaborating with lifestyle medicine into occupational medicine through his presidential task force, which Dr. Pam Heimel led and I was privileged to serve on in terms of providing a guidance statement, which you should all keep your eyes out for, on how to integrate lifestyle medicine into occupational medicine. So for those who joined us for the first session, we heard a lot of great informational content from our panelists, and now we'll follow up with some questions and hope to preserve time at the end for questions so that you can all have your specific issues or concerns addressed. So the first question, which we'll go down the line and start with Dr. Wasserstrom and then just move on down from there, I think one of the most important pieces to me of medicine in general, but lifestyle medicine specifically, is the actual impact that this can have on the individual patients and their lives, the individual worker. And so the question for each panelist is, is there a specific patient or worker, or it could be an initiative that you've helped to push through that really comes to mind to demonstrate the importance and the power of culinary medicine, lifestyle medicine on the individual level. There's so many, but because that's really been my passion, is speaking to a patient and finding out where they start, and then leading them to eating more fruits or vegetables or whole grains to be able to reverse some of their illnesses. So I have one patient that when I first started speaking to her, it was during COVID and it was via televisits. She was living in an RV because her husband did a lot of traveling for work, and she was diabetic on several medications, hypertensive on several medications, high cholesterol on several medications. And we spoke about her diet, and her A1C at the time was nine, and I think she was on three different oral medications for diabetes. And she wasn't doing much exercise and not eating much fruits or vegetables, and we just spoke about incorporating some fruits, some vegetables, some legumes and starting to walk. And a few months later, she moved into an apartment and was able to do a lot more. And as she moved into an apartment, she started to use an Instapot and was making beans and was really loving them. She said beans couldn't taste better. She started to walk and she would start calling the office saying, I feel really dizzy when I come home. My blood pressure is 90 over 60. My glucose is running low. And so we were able to take off her blood pressure medications after a while, her diabetes medications when we got rid of the Amaryll, because she was really getting hypoglycemic after her walks. And she lost a lot of weight just by kind of each time having sessions, little by little incorporating small goals each time. But this, you know, was an example of someone that almost reversed their diabetes. And I've had others that didn't want to start medications when they were diagnosed with diabetes or hypertension and were able to reverse their condition without even starting a medication. So it's really, you know, giving the patient the all the options and all the treatments that are available, including the lifestyle treatments. Dr. Watkins. Yeah. Thank you. And, you know, that's a great tactical approach and thank you for sharing. One of the things that we did, especially with an incredibly large company with many employees, you know, in different time zones all over the place, right? We were really, really pleased when our CEO gave us a challenge of having the healthiest workforce in America. So being very blessed that, you know, from our chairman and CEO to really say, hey, there's commitment from the executive level. Second, we thought about rather than, and this is something that I think is germane to the group, because many times it feels like you're pushing a heavy rock uphill when you're talking to CFOs and other folks, like what is this going to cost us, right? And what's the ROI? So what we did is we really took a different approach and said, how could we get down to the grassroots level and maybe use a page out of the community health workers playbook, right? So kind of the peer leader, right? And what we did is we wanted to collect inspiring stories from the field, and we called them wellness 360 champions. And we wanted them to present their story around wellness to us. And so leadership comprised of Kroger Health, Kroger, and other executives, and a team of their peers would then select a champion, and they select about 18 champions a year. And one of the things that happens is they get to tell their story at our wellness festival. It's one of the largest wellness festivals in the country. It's not a shameless plug, but it happens the third week in September. But the point here is that these are true stories from folks that now are spreading, I'm going to call it the message, to their own about what they're doing, rather it being, you're sitting in front of a physician or a nurse practitioner or a physician associate telling you what to eat, and they're telling their story. And they're incorporating a lot of the same tools that I just talked about, right? Maybe understanding how to read a food label, how to use a food score, how to find things like hidden fat in foods, right? And so it became very practical that, oh, I didn't know that my favorite yogurt that I was buying had 18 grams of sugar. I found a product that is much lower in sugar, and I also added some nuts and some berries to it, right? That really made it nutritious. I was able to make a smoothie, right? And Chef will show us a little bit about that later. But that's probably one of the biggest things that we did is we used our own to tell the story. And it's incredibly cost-effective, guys, right? It doesn't cost you anything to begin to create that longitudinal approach where you're asking your own associates. Because what you'll find likely within your cohort, the cohort of employees that you have, there are some that are advocating for this already. They're already advocating for it. So you don't necessarily need to reinvent the wheel. Find a way to echo or actually raise their voices. And what will happen is you'll be amazed at the steam that it takes on and how it grows. Yeah, great. So my story kind of goes along with those of you here. One of our orthopedic surgeons, I had a conversation because, you know, we don't, can't always do knee replacement on our obese patients. And I had a conversation with him and I said, you know, some of these veterans are not going to see a BMI of 35 or below. And you know, are they ever going to be able to get that knee replaced? And it started a conversation about, well, he said, it would be okay to do the surgery at a higher BMI, but we want to see some positive lifestyle changes and some changes in the BMI. And then he did a little introspective look as a physician who was overweight himself and what he might need to do to change his lifestyle and, you know, kind of picking on himself a little bit. And he happened to be the physician who did my husband's knee replacement too. So we established a relationship. So hadn't seen him in a little while, got a little team's message from him and he said, you know, I just kind of thought about what we talked about and eating more healthy and that, you know, there's not a perfection, you know, people aren't going to be perfect. We're not going to get, you know, this miraculous change from people. And I decided to make a few changes myself. So I just went with, you said about just eating whole foods, you know, looking at, you know, I always kind of preach to people. How about when you look at the ingredients, you're looking at a sweet potato and you say, sweet potato, right? This is chicken. This is broccoli. If you're flipping a label with a lot of ingredients, that may not be your healthiest choice. So he said, you know, I just kind of went through, I'm going to eat whole foods like that. And he said, I've lost 45 pounds. I feel better. I, you know, I feel better and I feel like I can talk to my patients in a different manner because I have my own journey that I went through to make myself healthier. So I thought it was a great story of someone that I did, I didn't know I had any impact on, but again, with those simple tools and you're going to make that one little statement and maybe it's from their coworker, but that one little statement may be the journey for them to be healthier. Wow. So many things that with this program that has been impactful to me, but I think one of the most impactful has been my own personal impact. When I started into the program, my own personal health was not particularly good. My blood pressure was high. My blood sugar was high. I was not eating well. Chefs do not have the healthiest diets. I don't think anybody necessarily thinks that chefs are the most healthful eaters. You know, they say, never trust a skinny chef. I'd like to flip that on its head and say, you should trust a healthy chef. For me, getting involved in culinary medicine was a catalyst of my own personal health journey. My diet improved. It also made me want to exercise. I always liked cycling, but I dove into the gym, something that I'd never really done before and all of my numbers have improved to the point where now I take one med and I'd like to get rid of that one, but that's cholesterol, by the way. So I'm still fighting that battle. But other than that, I have to say that just being involved with the program, working with physicians, working with dietitians has allowed my own health to be dramatically improved. And it's also been impactful with the college because the partnership we developed with the College of Medicine has really led us on a trajectory to want to embrace the healthcare and wellness side of hospitality because, you know, we always think of the hedonistic, the pleasurable side of hospitality and having fun. But healthcare needs hospitality too. Lifestyle and wellness needs hospitality too and our own students can benefit from this. And so as a part of this process, I have developed a culinary health course that's actually piloting at the Rosen College this fall, which we are not medical practitioners and that's not our wheelhouse, but we do know a thing or two about nutrition and we know a thing or two about food. And so this course will be geared towards professionals in our industry, making them help with better choices on menu design, menu creation, planning for things like hotels, planning for things like restaurants and all of the food and beverage side of things. And so we're really interested in improving diet, making people healthier through better culinary choices. And we're also really concerned with life health, well, life balance and things like mental health because in our industry that's been ignored for way too long. And so things like mindfulness, improving the work-life balance are going to be part of the course as well. Great. Thank you to our panelists. And I think just for the sake of those who may have joined us for this second hour, I just want to take a quick minute and make sure you know who our panelists are and introduce them briefly. So Dr. Wasserstrom here is an associate professor of medicine at the University of Central Florida School of Medicine, board certified in internal medicine and lifestyle medicine, and has helped to lead the lifestyle medicine elective course as well as a culinary medicine elective course for the medical students. Dr. Watkins is an accomplished physician executive and currently works as the chief medical officer at Kroger Health. And Ms. Williams-Link is a registered dietician, nutritionist, who has served as the chief of nutrition and food services at the Orlando Veterans Affairs Medical Center here for the last 20 plus years. And then Chef Jay, who you just heard from, is a trained chef and culinary educational professional. He is also a senior instructor and program and assessment coordinator at the University of Central Florida Rosen's College of Hospitality Management. And you heard him speak a little bit about a course that he's developing there and delivering to the hospitality students and trying to bridge into that space in terms of lifestyle medicine, culinary medicine. So next question to Chef Jay specifically, we talked in the first session a bit more about teaching kitchens and how that can be an effective tool to educate not only the end consumer being patients and or workers, but also health care providers and health care workers. Do you have any ideas that you can share with us who may not have a world class chef at our disposal of how we may be able to scale or at least start a teaching kitchen maybe in our workplace or within our workforce? Well, first of all, not everybody has the benefit of world class facilities, obviously. And certainly people that you're going to be counseling your patients may or may not have large, expansive kitchens. They may not have a big kitchen at all. In fact, they may not have a kitchen. We hope that they do. But setting up a teaching kitchen doesn't require a giant footprint. What it requires is a safe space that can be kept clean and sanitary. That's critical and absolutely key, obvious potable water source, things like that. And then very minimal equipment is really required. It doesn't take a lot of equipment. Most people are going to be cooking on a typical range, a typical stove. So start with that. You don't have to have a commercial stove. You don't have to have high dollar gas powered appliances. Even a small portable burner could work. You don't have to have a ton of space. And again, I would emphasize to you that most of the patients you're going to be counseling aren't going to have that. So if you're working within their capabilities and their resource levels, I think that you will be able to connect with them just fine. Great. Thank you. And Dr. Wasserstrom, a question for you. Again, we've spoken about teaching kitchens and how that can be an effective venue and tool to use to educate patients and or workers on the benefits of culinary medicine, lifestyle medicine. Do you have any other alternative methods that you've specifically found to be effective in terms of educating, teaching that message of lifestyle medicine to the patients and any comparison of pros and cons of some of those different approaches? I mean, an approach that's very effective and that can also include a lot of people at once are group visit programs. So like the DPP program that I was speaking about, and there's many such other programs, many shared medical appointments around the country that are being done, which can be with groups like 20 patients who have a similar comorbidity. I say they're all diabetic and they want to learn together how to eat healthier, but they also have the benefit of their peers going through the journey with them. And in my office, I've been running group visits and they, as a primary care physician, being in a group, you can bill for 20 patients in one hour or two hours that you're spending with them like they're individual patients. So you actually save a lot of time seeing 20 patients, but instead of speaking about a specific nutrition concept again and again and again separately for 20 patients, you can do that all together with the 20 patients and then have the benefit of more time for the patients to then interact with each other and ask questions to me as well. And there's a lot of benefit in that. So I see that as a great way to have, let's say, as an example, the DPP program for your employees maybe as a lunch thing. You know, come together six times, you know, 16 times during lunch and then maybe once a month check in with the same group of people and then they can have buddies together and make goals together and see each other, you know, in the workplace and see how and hold each other accountable. And that's really what a lot of the groups patients are drawn to find their accountable buddies. Yeah, absolutely. Thank you for that. And I know I can speak to my own experience of how effective that can be when you're leveraging that peer support and anyone who was able to attend Dr. Rich Saphir's talk, I believe on Sunday, he spoke to the power of that peer support within the workplace. How are you creating that environment in the workplace that is actually promoting this healthy lifestyle that now we're trying to preach to the individual worker or the patient? So Dr. Watkins, we'll direct the next question to you. You know, I think, and you may have spoken to it a little bit, but I think the pitch to the individual worker or patient is pretty clear that you will feel better, you'll be healthier. Can you speak from an organizational perspective of how we as occupational health professionals may be able to approach leadership and actually demonstrate maybe some of the value of initiatives like this at the organizational level? Yeah, there's a lot of evidence that suggests that, uh, you know, Dr. Wasserstrom just pointed out the, the run rate on costs with chronic disease is, um, any of the CFOs and the executives can see that, uh, if they're self-insured what they're paying for chronic disease, that's, that's no, a no brainer. And that's probably a cost escalation that's happening year over year. One of, one of the conversations that, that have been incredibly helpful is, is that, um, either you, you're going to pay for it now or pay for it later. And how do you really want to pay for this, right? Um, if you're paying for it forward as a, as a culture change, think about that as a sustainability opportunity and retaining, uh, your employees for a longer period of time, uh, that, that, so you're not out recruiting, right? Replacement costs are way too high. If, if any of you are having conversations with leadership, um, if you're looking to bring a new employee or associate on board, that training cost is, is much higher than it would be to keep the current associate or employee in place. So that's been some of our conversations. And let me maybe echo, uh, just another opportunity. Um, whether you're, you're having conversations with the benefits team or in the C suite, um, remember you can have conversations at, I'm going to call it at the bedside, making those conversations really important. And, and as leaders in the room, I often, um, uh, encourage you to, to, to do what's in your power, right? Many times we think we need to kind of beat this drum and get way upstream to make meaningful change. Uh, but changing the life of one person is huge. If you're fortunate enough to do that again and again over a course of a career, think about the impact that's made for that family, for those children. Those are huge. And let me give you an example. So, um, I used to always say, uh, as a teaching point to not only residents, but, but also to our teams, uh, especially through things like a chart review or, um, a hot wash or, or just understanding what's happening in the clinical realm. Did you address someone's weight? Did you address someone's smoking? Did you, did you address kind of safety issues? Did you ask about seatbelt? Did you ask about all of those things that we know to ask about? Right. And they would like doc, what, you know, they were here for a sore throat, right. Or they were here just for, uh, you know, a medication refill. But if you're not asking, they think it's not important. Let me reiterate. They're likely walking around. I mean, chef Judy, we've all can give examples of opportunities where we're not the best versions of ourselves, right? We may need a little help, but if we, as a professionals, especially those wearing a white coat, if you don't bring it up, if you don't address sort of the 800 pound gorilla and the BMI is at 35 and you say nothing, or you see smoking on the chart and you say nothing, you further validate a bad behavior. If you just begin to have those conversations, you've heard about tools around lifestyle medicine. You heard about the things we're doing at Kroger. You already have the power to make the change, right? And you can do that one by one at the bench, right? So, so it doesn't matter if it's a work comp case. It doesn't matter if it's an injury case. It doesn't matter if it's a hearing conservation, right? It doesn't matter if it's a DOT physical. Address some of those things, right? Have conversations about those. That's really impactful. And then create that culture. So we've been trying to create a culture of change where we're really approaching a world of care in store, right? How we're really caring and wrapping arms around patients, whether you're at our pharmacy or in our clinics, but then taking a step back and looking at it from just a holistic point that we really are caring about our customers at any point along their journey. Yeah, that's great. Thank you. And I think there's power in combining kind of those organizational level metrics and showing value, but also not forgetting those individual stories. I remember in my occupational medicine residency training, one of the most impactful visits that I had gone out on, we were visiting with the safety manager in the office, and he had pictures of all of the workers at that site in his office with their families. And it was just a visual reminder to him of like, hey, I'm not just focusing on the numbers of OSHA recordables. Here are the actual people and the families that I'm impacting. We have the same opportunity with some of these health promotion lifestyle medicine initiatives, and that can be powerful and impactful both for your benefit as occupational health professional, but then also as you're trying to communicate this to your leadership to get buy-in to an initiative like this. So Ms. Williams-Link, a question for you. We're going to bring it back to teaching kitchens. Wanted to hear a little bit more about your experience having teaching kitchens and classes for your staff specifically and kind of how those were received. So the VA does offer healthy teaching kitchens over video as well as face-to-face to our veterans. And as I alluded to in the earlier, we took the sessions that were working with our medical students, and I spoke to our employee wellness coordinator, occupational health. Can we offer these to our staff members? And we decided that we were going to target our providers, our physicians, our nurse practitioners, and PAs as our first cohort. So we invited them to come to a teaching kitchen where our medical students taught our physicians and our providers some cooking classes of what they learned on Monday. They came to the VA on Tuesday and taught. So what became, let's see how this works, really had a huge positive impact. And this was the first year we did it. So we asked them to sign up, and we asked to sign up for one session, and many people wanted all four sessions. It happened at the end of the day. So they did spend about an hour after work, 4.30 to 5.30. But hey, they got a free meal, so that was okay, right? So what we found is as our providers filtered in, they had the opportunity to relax. They had the opportunity to learn. They had the opportunity to see and do and tell their own stories. We had a couple of providers who had had their own weight loss journey and were sharing that with their patients and with each other. They were learning from our younger medical students on cooking techniques and things like that. So the benefits came, you know, the opportunity to interact with fellow staff members who they didn't get to see all day. So it became social. It became an emphasis on them and their health, an opportunity to learn something for themselves, and that great opportunity to learn something to teach other people. So as we just continue to discuss what could we do with this, could we take small, healthy teaching kitchens? Doesn't have to be in a huge kitchen. Doesn't have to be taught by a chef. One of the recipes that a tried and true recipe from our class is a nice black bean burger. Comes out really good and quite a simple recipe, and you can make a good quantity. Those stick them in the freezer, so there you have your nice vegetarian black bean burger ready to go. So, you know, could we offer this as a session that we could offer groups that work together? So work together, kind of play together, kind of learn together and be healthy together, and that's something we're looking at. So again, healthy teaching kitchens can help teach people new ways of doing things, but the other benefits can be the camaraderie that comes with that, the opportunities that they see, you know, as an outside of the work activity that they can do together, and then form those relationships with each other that they can bounce off of to continue to stay healthy. Yeah, that's great, and you know, for those of you who are familiar with lifestyle medicine, you'll know that one of the other pillars is social connectedness, and so the workplace being a venue where you can promote that social connection with co-workers and peers, and how can you use a teaching kitchen or other similar educational opportunity to promote not only the nutritional health of your workforce, but also building some of those connections among co-workers and peers. Dr. Wasserstrom wanted to ask you this next question. One of the things that struck me as I was going through the lifestyle medicine certification curriculum is the strong focus on behavioral change, you know, and kind of the science behind promoting that. I was hoping that you could share maybe some of your best practices or techniques that have been most effective for you in your practice of actually promoting that behavior change among individual workers or patients. What really helps some of those educational concepts that you're teaching make the transition into implementation? So, one thing that I use with many patients as a quick snapshot to get a sense of where they are in each of their pillars is I have 15 questions, you know, about where do you rate your health from 1 to 10, so I get a gauge of where they're coming from, and if they, how much they sleep, do they feel they have an issue with sleep, you know, do they feel that they need to lose weight or gain weight, where are they coming from, if they smoke, what do they feel about their smoking on a scale of 1 to 10, you know, and the same thing with alcohol, and in terms, and the last question I ask on there is a free test question, which says what motivates you to be healthier and make these changes? So, like, just in a very short time, they can fill that out, and I quickly look at it, so I already have some idea of some of where they're coming from, because you really need to know where they're coming from to know where to go next, you know, do they have, if they're a smoker and they smoke two packs a day and they have zero concern about the smoking, then you can go one way, you know, if they say that they're very concerned about their smoking, you probably know that they know all about the dangers of smoking, and they've even thought about maybe ways of stopping, and they're ready to make that change, so you need to know where someone is in their stage of change to be able to effectively use your time, because you might know all you can know about how important it is to eat a certain way, but if someone says that they're not really interested in talking about that, you're wasting your time going through that sometimes, but then you might want to go into where they are right now, you know, and what little change they might want to make, or if they don't want to make a change, where they're coming from, you know, maybe you need to give some education about the dangers at that point, so I think that it's really important to have that conversation and have some useful tools to get you there to be able to make effective use of your time to make those changes. Yeah, absolutely, and I think the key there, in my opinion, is really finding that motivation, you know, what is it, what's the vision that they're trying to get to, and then demonstrate to them how some of these actionable steps will get them closer to that vision, you know, if it's being healthier for their grandchildren, you know, in the military, especially with some of the high, fast burners, we call them, you know, you can have pilots or other special forces that they live for what they do, and if there's anything that they can do to gain a slight edge in what they do or to get back on fly status or whatever it is, they're open to that, and so if you use some of those pressure points or, you know, positive goals that someone is striving towards, that can be a strong motivator to actually help them take the steps of the educational materials that you're sharing with them in the clinic or workplace or other setting. So, Miss Williams-Link, next question for you. Kind of the opposite side of that same coin, I guess, you know, we're talking about these techniques and principles that might help people to engage with some of these healthy practices. There will obviously be a lot of barriers. Some of those may be cost, some of those may be, you know, other environmental factors, the food environment that someone is in. Are cost and some of those other barriers that might prevent someone from engaging with a healthy nutritional lifestyle, is that something that you take into consideration with the teaching kitchen, or do you have ways to address those concerns? Yes, definitely, and I feel like we could probably have a whole session on this, and some of you feel the same way. As you employ people of all different socioeconomic statuses, we must, we have to know this information. So, as you can imagine, working with veterans, we do have different socioeconomic statuses to consider, and, you know, so when we're looking at a healthy lifestyle, we do have to look at income and income variables and what the cost of food is. Fortunately, you know, well, you will hear from people, I can't afford to eat healthy, and I challenge that day in and day out. We can't afford to eat healthy, and there is those opportunities. When we looked at things that were contained in the various diets we had, like Mediterranean diets, you know, we have legumes, we have beans, but then you're going to have the person says, I don't know what to do with that. So, we do have to look at cooking techniques, and as Chef Jay brought out, we don't have to have a full-fledged, giant, perfect kitchen. So, when you're looking at what you're going to teach, and you're meeting the people where they're at, you have to know that information. You have to know what's available to them as tools in a kitchen. Do they have a kitchen? And you have to know what's available to them from an income perspective. In the class that we teach, we do have taught the community using the boxes that they give from food banks and the various foods from there. We have had recipe books utilizing food that we know come from food banks. You may have staff members who have a lot of food insecurity, and as I said, that could be a whole other topic here, and occupational health is food insecurity. But we also have to know the culture of the people that we're talking to, and I had a little conversation with someone, and you know, where do you live, and what is the population, and what do they eat culturally? Because you may not understand what that person cooks, what they like to cook, and then how to help modify that. So, the individual I was talking to was from New England, and she said, I can't tell somebody they can't have clam chowder, right? You lost them, right? Right from the start. So, you have to look like, how do you modify that recipe? So, both looking culturally, looking economically, and looking at skills and ability, I think, is paramount in helping make people healthy, and if we ignore that, I think we've ignored that for too long. We say, here's a handout, here's low cholesterol food, eat salmon, use olive oil, you lost them. You have to know where they're coming from, and what steps you can make from the start, and what they feel they're capable and can afford to do, and if affordability is an issue as occupational, in occupational health, what resources are in your area for them? They may need to know whether it's local food banks, they may need to know where there's opportunities to fill in that food insecurity. That's great, and so important, and I think I can only speak for myself that, you know, as a clinician, you see a patient in the clinic, let's say you're even being very diligent, and you identify some of these health concerns, and then you even take the next step, and you, you know, turn on your lifestyle medicine brand, and you say, oh yeah, well, here are some of the lifestyle medicine pillars that may be applicable here, let me give you some education, and then you walk away, just thinking that you did a great thing, and the patient walks out the other door, scratching their head of, how am I supposed to eat healthy? How am I supposed to access some of these resources that you're trying to point me to, if we don't take into consideration kind of that complete picture? So that's super, super helpful, and I can speak from personal experience on military installations, for example, if you drive through, you know, you'll drive past multiple Burger King, after Burger King, after Burger King, no offense intended, no federal indictment of Burger King, but it becomes a question of, hey, as a large employer, as the government, as the military, what could we be doing maybe a little bit better to promote an environment that really makes the healthy choice the easy choice for our service members, and as well as civilian employees who are working on base? So that could be a question to take back to your own organizations, of performing maybe a nutritional environment assessment in your workplace, where do the cues that point people towards unhealthy choices, what are the barriers that prevent your workforce from engaging with the healthy choices, and be able to maybe come up with some actionable next steps that might actually, again, make that healthy choice the easier choice for your workers. So Dr. Watkins, next question to you. I know that Kroger has an important initiative surrounding food as medicine, just curious to hear any of your experiences or best practices surrounding the best way to evangelize that, or kind of spread that message. So, you know, one of the things that make it pragmatic, right, so maybe sharing a little quick story. I was at a conference listening to this cardiologist, and he had a patient, you know, let's say Mr. Smith, and he was going back and forth with him about, you know, farm-raised salmon versus wild-caught salmon. Back and forth, right, about, you know, mercury levels, which is better for me to eat, and he went back and forth, back and forth, which one has a higher degree of omega, you know, fatty acids, which one's better for my heart health, and he kept going back and forth to this patient, and he finally looked at him and said, Mr. Smith, how about you stop smoking? The story there is that sometimes we'll overcomplicate things, and the pragmatic approach is the best approach. It was stop smoking and eat either salmon. That's the healthier choice, right? It's regardless of its farm cart or farm-raised versus wild-caught, right? So folks can get caught up and hear all this information, and it becomes very confusing. So we wanna make the healthy choice the easy choice, right? I went through this opt-up scoring system as one of the examples to do that. Another thing I mentioned about our teledietitian services, but as we think about really pragmatic things that leaders in this room can do, by show of hands, in your organization that you support, is there a cafeteria? One of the things that I learned from one of my good friends, mentor, Dr. Dexter Sherney, we had a conversation about how do you sort of look at the cafeteria, maybe it's subsidized, maybe it's not, and help people eat healthier. One of the things that he said, he said, let's just think about not taking choice away. Why don't we figure out how to make the healthy meal, the fast meal, and make the burgers and fries made to order? We're not taking them away, but the combo meal of the healthy choice of the day was subsidized maybe, it included a vegetable, a fruit, you got a water or something, and it was ready to go. So you didn't waste any time standing in line, but if you want that double cheeseburger or the fried chicken sandwich, you had to wait. Monumental in the adoption of, because now you're pressing with time. Another example, and I'll share one about how things we overcomplicated, and so when I was, it's my last year active duty, and we were figuring out why so many of these PFCs are smoking. And we didn't understand it, and I said, Colonel, you know, they come in and they check on their entry physical that they don't smoke, and all of a sudden I'm seeing that they're smoking, and it's a lot of peer pressure. They also were figuring out, the culture said, I got an extra 15 minutes twice a day if I wouldn't smoke with the staff sergeant. Those that didn't smoke, I know we're talking about food as medicine, right, but those who didn't smoke stayed at work. These are probably 30 minute extra breaks when they're in garrison, and I said, well, sir, here's my recommendation, sir, that the colonel could do what he wanted. We agreed that if you move the smoking hut a little further away, and it took them longer to get there, would you then sort of change behavior, because time is something you can't get back. Now, that PFC can't be late to come back to work, right? Major, you know that, right? Maybe the staff sergeant, the gunny, could be a little bit late, but that PFC or Lance Corporal can't be late, and so we were incrementally changing the structure, changing some of those things. The example about making the healthy choice, really the elevated choice, highlighting it on the whiteboard in the cafeteria, saying this is, and then giving points for that, right? Maybe reward that behavior, and some of the things that we're doing at Kroger is just that. We've launched an opportunity where we have a food benefit card, where we're actually loading in benefits so that an insurer can then incentivize members to eat healthier, so that they're activated that, hey, my card is now enabling me to shop the produce aisle. I'm gonna get leaner cuts of meat, and then be incentivized to do that, and then we can measure that longitudinally, and those are just some real practical examples that could happen even starting next week when you're back in the office. Yeah, absolutely, thanks for that, and anyone who's been to any of the previous talks that I've given here at AOHC on lifestyle medicine in the workplace, you know that I actually like to use the hierarchy of controls as kind of a framework. You know, we're all very familiar with that in terms of controlling hazardous exposures in the workplace, and maybe we can use that same framework to systematically evaluate our workplace for how conducive or maybe unconducive it is to implementing lifestyle medicine practices among our workforce. Major, maybe one more point, right? This may be interesting. Is anybody familiar with the Gus-SNP program of how dynamics scoring for food might work, and one of the things that you can think about even in a cafeteria is to maybe price dynamics, right, and if you have a workplace cafeteria that maybe that the healthier for you items are reduced and the higher, less healthier items are priced higher to offset the cost, so it's cost neutral to the vendor. Your CFO would say, hey, there's no skin off my back, but then it's dynamically scored, right? That's how we do a little bit of that on the Gus-SNP programs where we're dynamically scoring food benefits for those that have financial headwinds that they can actually use it to find benefit without increasing the total cost. Yeah, no, great idea, and exactly that kind of systematic approach, which levers can we turn or knobs can we turn and levers we can push to try to move that needle. So in the interest of time, we'll ask one, our last question to Chef Jay, and then we'll be able to open up to any questions from the audience. So Chef Jay, just curious on your thoughts of any exciting developments maybe in the future of culinary medicine, where do you see things going from here, including maybe speaking more to the course that you've opened up at the School of Hospitality, but just any things we should be on the lookout for in the future of culinary medicine? Well, something I'd like to see is it mandated as part of the curriculum. I keep hearing elective, elective, elective, but this is important stuff. It should be part of the curriculum. Maybe I'm preaching to the choir here, but all of this is critical. I heard someone say a minute ago they can't afford to eat healthy. I would say you can't afford not to eat healthy. And again, when I see students get excited about food, whether they're culinary students, future doctors, whatever, when they get excited about food and they start taking the process in their own hands, making it personal, that's the connection. Food and nourishment is one of the most, if not the most personal thing there is. And attaching something of importance like that to health and wellness, engaging with practitioners, and making it research-based so that it works is how we get to the next step. That's awesome, thank you. So ladies and gentlemen, we'll wrap up the formal portion of our session right now. And I hope you'll join me in thanking our speakers for sharing their expertise and their experience with us at this time. Thank you. So, any questions from the first session or questions that have come up during the second session, please make your way to the microphone so that you can address the panelists for the benefit of everyone. Dr. Joe Mignone, great stuff. Just a comment. For those of us that have been in the corporate setting, to Dr. Watson's comments, getting corporate change to the penny pinchers is sometimes very intimidating. About 25 years ago, Dr. Greg Stave and I put together a smoking cessation program at Glaxo. It was part of a health and wellness contract that we sold to the employees and was based on the stages of change model. We learned very quickly that just asking the question, do you smoke, had a quit rate associated with it. And it didn't cost any money whatsoever. And then also getting the corporate leadership involved and having them sign onto these programs, the photo ops and publicizing it to the rest of the employees, really, really made a huge difference. It's so intimidating to try and do it all at once, but you're doing it one employee at a time, one patient at a time, it just replicates. It's exponential. So I just want to reiterate that it was a great comment that you both made. Thank you. Appreciate the comment. And I would just add, as our next question is coming up, that translates also to culinary medicine. There are a lot of good studies that show it doesn't have to be a super complex intervention. If you're helping people to even just track what they're eating, that intervention in and of itself helps people to eat healthier, and it makes it easier for them to actually decrease their caloric content. The Air Force is exploring a few opportunities within AI and computer vision technology to actually help some of our young airmen just take a picture of their food, and then that logs what they're eating. Or even before they make that choice, at the cafeteria, at the chow hall, in the supermarket, take a picture, where does this food rank in terms of healthfulness, and help people make that preemptive healthy choice. But again, it doesn't have to be something super complex and complicated. This can be as easy as asking people the question. So thanks for that comment. I'm Dr. Abuaba from the Naval Hospital in Beaufort. And when you talk about smoking, instead of asking do you smoke, do you use tobacco products? Because someone who uses smokeless tobacco, and I work with the Marines, sailors, et cetera, they don't think about if they use tobacco products. If you ask them if they smoke and they use tobacco products, they're going to tell you no on the questionnaire. So make sure that you include that. In addition, you have to think also about the food deserts. There's so many places where there are food deserts. And if you make it so that food, eating unhealthily is more expensive, where you grab a burger as opposed to making a salad, for example, and incorporating healthy meals, where you can afford it, because the cost of living has gotten pretty high. And so when someone can pay a dollar for, and I'm not knocking Burger King or wherever the fast food places are, I could go home and make a healthy meal in 30 minutes. But if you can go to the store and pick up a Big Mac or a DQ, all of these things, then it's more likely that you'll do that. The other thing is on the military base. When I see the Mountain Dew truck pulling up, honestly, and so they come here, they're buzzed because they've had two or three Mountain Dews, and they come in and their blood pressure is elevated. You're going to do a DOT physical, and so you have to let them sit around for a little bit so that the blood pressure goes down. So we have to think in terms of, in totality, the questions that we ask, because brevity is the soul of wit, but you have to think about, when you ask the question, what does it mean to that PFC or that lance corporal or that sergeant, et cetera, what does it mean to them? And you always need to take extra time, no matter what they come for. If it's a DOT physical, and all you do is you certify them. I always tell them, I certify you for life. The firefighter who comes in, you have to discuss that with them. Again, conservation, not just for work-related activities, but also non-work-related activities. Because the hairstyles don't care where the noise is coming from. So it's the same thing you have to think in terms of how you ask the question and address not just occupational, but non-occupational. Because a healthy lifestyle, a healthy worker is a more productive worker, so you have to always be thinking about that. We can all learn something from the good doctors. So thank you for reminding us that it's just as important how you say things and how you ask the questions. And she's absolutely right about the words of tobacco use versus do you smoke. The same thing can be applied to what do you drink, the quantities, all of those things. And really, so thank you for reminding us. We can all learn something. Many thanks. All right. Here in front. Hi. Hi. That was a great two hours we spent here. As a person who's been vegetarian for almost, I have a comment and then a question. As a person who has been vegetarian for almost 28 years myself, I'm obviously a big advocate for plant-based diets. And one of the things I personally do is when I work with nonprofits or other people who are doing galas or fundraisers, I always put myself on the food committee and keep advocating because at those things, there is very little plant-based options and people are always gravitating towards the rubber chicken for some unclear reason. So it's just a little thing that I try and incorporate. But my real question is, we didn't talk about BMI and how that plays into lifestyle choices. And I'm curious how everybody feels about that. I was thinking about that through our two hours. We did not emphasize any of this morning of what we did on weight. And those of you who work in healthcare and work with weight loss as a registered dietician, you know, that's kind of the pillar of what we do. But I think we all know in our military, it's a crisis, right? We're meeting the BMI and I have been on conferences with many of my co-workers that work with the military on this topic. We have a weight issue in the United States. We all know that. But just, and we should bring up the topic of weight, right? If we don't address it, the doctor doesn't think I have a weight problem. She didn't tell me I had to lose weight, right? So we do have to address it. But, you know, we've discussed all these layers that are related to weight and related to culinary medicine. And that weight could be related to Burger King is cheaper. It can be related to food insecurity. It can be related to the lifestyle which they came from and the recipes they're cooking through the, you know, that they're accustomed to and how we can adjust that. And I have to say in my practice and the practice that we have, we don't always emphasize that weight. We have to emphasize all these lifestyle changes because we can go on these new medicines that are out there right now and we can lose 45 pounds, but when we didn't change the lifetime that 45 pounds will be coming back on, you know, that person will regain the weight. So I think I'm kind of happy we didn't emphasize weight because although it's a huge factor, we've got to emphasize all the other changes that we have to make. So believe it or not, I'm a dietician. I don't emphasize weight. How about you guys? I would just add, if you really dig into the lifestyle medicine literature, there's actually some good evidence that regardless of your BMI, I mean, within a reason, obviously, you still get a lot of health benefits just from engaging with the pillars of lifestyle medicine. Even if your BMI remains in an unhealthy range, you know, getting the regular exercise, participating in the whole food plant-based diet, you still get significant health benefits in other ways even if your BMI remains outside of, again, the normal range that we as a medical profession have chosen to define as such. Anything else? Major Kesteller. Yes. Thank you. I appreciated the discussion here today. Question for you is, I don't have a lot of time in my own practice within the military to be able to take a lot of time, although I love the idea of doing 20 patients at once and talking about these lifestyle changes in a larger group, I've not been able to get that type of model done in my clinic. And I'm wondering if any of you have any recommendations for things that you could give to a patient within a few minutes at the end of a visit and say, hey, let's address your BMI, let's address the dietary change that you need to be a healthier firefighter, a healthy police officer. Is there something that you would recommend as a resource or a reference for patients to go to that we could say, hey, I know we don't have a lot of time to talk about it. Yes, you should be exercising, getting 150 minutes or more of exercise per week. Here's another resource that you can go to to learn more, to learn those culinary skills that I can't teach you in this non-teaching kitchen. Right. I mean, there are many and some that we showed today that the ACLM just came out with the videos that maybe either before or after you have a place that someone could go if you think they could benefit on listening to the two or three minute video that was shown right at the beginning of this panel discussion on nutrition. So it gives some information in that way. And then another handout that I showed is the nutrition handout through the ACLM. They have it on all the six pillars. It's a one page summary of some of the most beneficial, you know, habits to do more of or to do less of and making SMART goals about it. So giving that kind of handout or identifying one thing that they would want to be able to change by them filling out that kind of questionnaire before going in to see you and seeing that their top thing that they'd like to change is nutrition. And then having something like the fullplateliving.org cards or having even just on different placards for each of the different pillars, you said you're interested in focusing on nutrition. Here is a course you can do like culinary Rx that's available to anyone. Here is some, a website you can go to to do on your own learning, you know, how to eat more fiber and things like that. So having those kind of resources available and quick ways to figure out what they might need on the way out. Yeah, and I would just add, you know, all of the resources that Dr. Wasserstrom just mentioned will be uploaded to the swap card app. So those who have access will be able to look at some of those. And yeah, just reiterating, American College of Lifestyle Medicine, the Ardmore Health Institute, Fullplate Living have a lot of great resources, both, you know, directed towards the healthcare provider to educate us as we educate patients, but then also patient facing too that can be directed in that direction. So we're out of time, I'm sure maybe some of the panelists would be willing to stick around if there are additional questions. But once again, want to thank all those in attendance for coming and participating. And also one more thank you to our expert speakers and panelists.

culinary medicine

lifestyle medicine

occupational health practices

peer support

group visits

healthy choices

cultural factors

economic factors

food deserts

smoking cessation