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Virtual Culinary Medicine in Diabetes Care

By Heather Davis, MS, RDN, LDN 

Culinary medicine (CM) interventions are setting the bar for the comprehensive delivery of nutrition care to diverse populations. With their integrated and adaptable toolset, CM approaches may be uniquely equipped to address the complex web of behavioral, psychosocial, and nutritional knowledge challenges faced by those struggling with chronic conditions like type 2 diabetes (T2DM).

Appreciating the importance of disease prevention and management through nutrition and culinary education, a multidisciplinary team from the University of Texas in Houston set out to build a virtual CM toolkit (VCMT) targeted at improving the implementation of virtual cooking classes for low-income adults with T2DM.1 Their paper, published earlier this year, brought together a collaborative team of experts, including RDs, chef-RDs, behavioral scientists, and public health professionals. They pulled from their combined experience conducting previous CM interventions, including working within the Nourish program, which is an adjunct training program for dietetic interns at the University of Texas Health Science Center at the Houston School of Public Health consisting of a holistic garden, a culinary research and demonstration kitchen, and a patient simulation lab.1 

The authors of the study say that their VCMT pioneers a shift from lecture-based learning to a multimodal learning model that facilitates culturally sensitive, patient-centered discussions by leveraging animated videos, handouts, recipes, and other tools in an open-access framework. The toolkit promotes condition-appropriate, sustainable, family-oriented eating behaviors that help prepare program participants for long-term success while considering the literacy levels and language preferences of participants.1 

The Study: What Makes It Stand Out 
The rising prevalence of T2DM demonstrates an urgent need for effective, accessible nutrition education.2 In addition, many of those with T2DM may also have low levels of health literacy,3 which is associated with poorer glycemic control in patients with diabetes.4

CM interventions in general provide a structured and integrative approach to develop patients’ consideration of food and cooking as a primary aspect of their health care.5 They typically encourage development of practical hands-on skills while providing education on how nutrition and dietary patterns impact health.6 In studies to date, CM interventions have demonstrated the ability to significantly reduce pre- and posttest hemoglobin A1c levels, diastolic blood pressure, and cholesterol levels in individuals with T2DM.7 However, some experts feel that within the current body of work, there remains an unmet need for inclusion of more culturally relevant topics in the design and implementation of CM interventions for minority populations.8 The current authors developed the VCMT to address this gap.1 

The authors also state that in the current model of CM interventions, there’s a “missed opportunity” to further engage with participants and facilitate discussion during cooking downtime in CM sessions.1 Their VCMT materials are designed to reinforce skills taught during the CM sessions. For example, demonstrations of knife skills at the live CM sessions are reinforced with knife skills videos provided in the VCMT, a resource that participants can reuse as needed as a reference. 

The Toolkit in Action 
The main CM curriculum used by the authors follows the USDA MyPlate nutrition guidelines and is informed by social cognitive theory, including guiding principles of outcome expectations, self-efficacy, behavioral capability, self-regulation, and observational learning.1 The VCMT has adapted and evolved the print materials from A Prescription for Healthy Living, a prior clinic-led food prescription program and CM intervention geared toward patients with T2DM. Using video animation software and storyboard formatting with an eye for diversity and inclusion, all members of the research team, including several native Spanish-speaking consultants, reviewed the content through multiple iterations and contributed to its final presentation.

The primary goals of the provider portion of the VCMT include fostering patient-led communication strategies, empathy, cultural sensitivity, and establishing a more standardized and inclusive approach to delivering CM education.1 The education emphasizes mindful eating topics as well. Noting research showing patients may retain or understand as little as half of the information provided by physicians, the creators of the VCMT hope this resource will inspire other health care providers to broaden their knowledge of strategies for closing the gap in effective patient education.1 

The participant portion of the VCMT, presented in both English and Spanish, offers instructional videos on understanding carbohydrates, tips for grocery shopping, knife skills, and eating balanced meals.1 The toolkit incorporates handouts, worksheets, and culinary skill walkthroughs that partner directly with the live CM sessions. Handouts for participants include a QR code and a link to animated videos providing further opportunities for participants to develop nutrition literacy through guided exercises on topics such as interpreting nutrition labels. The animated videos may be used during a virtual CM session, replacing a more traditional slide-based lecture and providing more opportunities for patient-centered discussions.1

The online version of the VCMT is open access and can be found on the Nourish program website at https://sph.uth.edu/research/centers/dell/nourish/. Videos from the VCMT can be found on The Michael and Susan Dell Center for Healthy Living at the University of Texas School of Public Health YouTube Channel (https://youtube.com/@msdcenter). 

Room for Growth 
There’s no doubt that CM interventions have the potential to effectively address critical behavioral and psychosocial aspects of chronic conditions like T2DM, including dietary habits, attitudes toward healthful eating, culinary skills, and self-efficacy in cooking and maintaining a healthful diet.9 

However, study authors point out that there may be some limitations in the use of the VCMT. For example, not everyone has easy access to the internet or streaming technology required for viewing some of the materials. Furthermore, integrating this VCMT with preexisting CM curricula that targets a different population or disease state may pose a challenge.

The VCMT is currently being tested as part of a CM trial looking to expand the assessment of its impact, including exploring participants’ perceptions of accessibility, cultural relevance, knowledge retention, and recipe satisfaction, among other markers. The trial will also quantitatively assess biometric, psychosocial, and behavioral outcomes on a larger scale.

In many ways, the broad work in CM is just beginning and offers endless opportunities for adaptation. Dietitians are primed for leadership roles across many facets of CM program development and implementation in the community, including helping to guide multidisciplinary teams. RDs bring to the table tailored experience in delivering patient-centered care, MNT, behavioral counseling, and culinary education. The future of sustainable behavior change in health care, including the development of more effective intervention strategies to support some of the highest-risk and most vulnerable populations, may look to dietitians more than ever to chart the way.

 — Heather Davis, MS, RDN, LDN, is editor of Today’s Dietitian.

References 

  1. Ai D, Heredia NI, Cruz V, et al. Development of a culinary medicine toolkit to improve implementation of virtual cooking classes for low-income adults with type 2 diabetes. Healthcare. 2024;12(3):343. 
  2. Downer S, Berkowitz SA, Harlan TS, Olstad DL, Mozaffarian D. Food is medicine: actions to integrate food and nutrition into healthcare. BMJ. 2020;369:m2482. 
  3. Sarkar U, Karter AJ, Liu JY, Moffet HH, Adler NE, Schillinger D. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE) [published correction appears in J Gen Intern Med. 2010;25(11):1258]. J Gen Intern Med. 2010;25(9):962-968. 
  4. Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med. 2013;28:444-452. 
  5. La Puma J. What is culinary medicine and what does it do? Popul Health Manag. 2016;19(1):1-3. 
  6. Hirsch IB, Evert A, Fleming A, et al. Culinary medicine: advancing a framework for healthier eating to improve chronic disease management and prevention. Clin Ther. 2019;41(10):2184-2198. 
  7. Sharma SV, McWhorter JW, Chow J, et al. Impact of a virtual culinary medicine curriculum on biometric outcomes, dietary habits, and related psychosocial factors among patients with diabetes participating in a food prescription program. Nutrients. 2021;13(12):4492 
  8. Villalona S, Ortiz V, Castillo WJ, Garcia Laumbach S. Cultural relevancy of culinary and nutritional medicine interventions: a scoping review. Am J Lifestyle Med. 2021;16(6):663-671. 
  9. Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: a review. Int J Health Sci (Qassim). 2017;11(2):65-71.