I pause, unsure how my question will be received. “Have you had kale chips?”
That was the first time I posed the question to a patient in a medical exam room. With more than a decade of practicing internal medicine under my belt, I had never felt particularly inspired or successful in counseling my patients about their weight. Then I attended Healthy Kitchens, Healthy Lives (HKHL), an annual medical conference at the Culinary Institute of America in St. Helena, Calif., a gathering aimed at training doctors in nutrition and cooking. Within weeks upon my return, I was “prescribing” my first recipe.
Like many of my patients in the San Francisco Bay Area, John, who is in his late 40s, is overweight. He has never been successfully motivated to slim down because no “diet” has ever worked for him. When I bring up his chart and show him his body mass index (BMI), he says, ”I’m fat, but nothing I try ever works.”
Chipping away at the weight issue
“What do you eat on an average day?” I ask. “Do you eat fruits and vegetables?” John says he loves vegetables and loves to cook. He even volunteers at a local farmers market. But he has a weakness: “Chips,” he says. “I can’t stop eating chips.” John’s idea of chips is the potato variety, soaked in fat, fried and overly salted. I suggest he try kale chips and give him a simple recipe (see below). I tell him he can eat as many as he likes.
A month later, John has lost 5 pounds and is perceptibly happier and more confident. “Doc,” he says, “No doctor has ever given me a recipe before. Those kale chips are so good! Thank you.”
Granted, obese patients need more than a recipe for kale chips to find their way to a healthy weight, but a simple nutritious and non-fattening recipe is a first step and a great incentivizer. By giving John a fantastic-tasting substitute for his beloved chips rather than forbidding him to eat one of his favorite treats, I was able to convey that a different way of eating would allow him to enjoy snacks while feeling healthier and losing weight along the way.
Healthy recipe Rx
When doctors discuss food, it’s usually in the context of nutrition rather than flavor, as in: “You’ve really got to cut back on the junk food.” Well, patients know that, they just may not know what to replace their junk food with. What if doctors began giving out simple recipes for healthful, whole-food alternatives before they handed out prescriptions for cholesterol-lowering medication? Or gave a prescription for exercise and a decadent tasting fruit-based dessert to help control blood pressure?
Traditionally, medical schools do not include coursework in nutrition or, certainly, in cooking, and insurance companies are unlikely to reimburse for nutritional counseling. It’s much faster and easier to write a prescription for a drug, and because it may require no change in lifestyle or self-discipline on the part of patients, they may prefer a pill as well. And if the doctors themselves aren’t the best role models, due to long work hours and the same poor dietary and exercise habits she is asking her patients to rectify, they may not have credibility behind their message.
How do we change this? First, doctors must learn about nutrition and healthy cooking. Showing patients how to shop and cook, and giving them actual recipes should be the next step doctors take. This would instigate a cultural shift and require advocating for insurance coverage, but the change would improve the nation’s health and save health-care dollars in the long run.
Cooking for the cure
Dr. David Eisenberg, a professor at Harvard Medical School, is devoted to this idea. He founded Healthy Kitchens, Healthy Lives with the goal of turning physicians into foot soldiers in the war against obesity and other nutrition-related diseases. Over a four-day course each March, doctors swap scalpels for chef’s knives, and white coats for aprons, as they attend cooking demonstrations and get hands-on in the kitchen. They leave the conference with a changed perspective and a renewed zeal to talk prevention.
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An HKHL alumnus, Dr. John Principe, completely restructured his Chicago-area practice and now has a teaching kitchen. Principe, who says that he had been “burnt to a crisp by the methods of conventional medicine,” credits Eisenberg and HKHL for saving his career. “The ability to empower people to take control of their health through the simple tools of a knife, fire and water is amazing,” he says. “It’s primitive but essential!”
A sprinkling of other programs around the country are also taking the initiative in teaching doctors how to cook. Dr. Robert Graham, associate program director for the Internal Medicine Residency at New York City’s Lenox Hill Hospital, runs a six-week program to instruct medical residents in nutrition, weight management and exercise. Students take cooking classes at the Institute of Culinary Education. The University of Massachusetts Medical School offers cooking classes tailored to physicians’ medical specialties, and Tulane University’s Medical School and Johnson and Wales University recently established the first Culinary Medicine collaboration, with the goal of pairing physicians and chefs.
So picture this: At your next checkup, you’ll be weighed in, get your blood pressure checked, and your latest cholesterol and blood sugar numbers. Then your doctor will hand you her favorite kale chip recipe or one that turns frozen bananas into ice cream. It seems far-fetched now, but it would make medical and fiscal sense to make such a scenario a reality in the immediate future.
Dr. Shiue’s Kale Chips
1 head kale, washed and completely dried
a few pinches of salt, to taste
1 to 2 tablespoons olive oil
1. Wash whole kale leaves, shake out or dry in a salad spinner, then place on a rack to dry thoroughly. Depending on your temperature and humidity conditions, this can take an hour or several hours. Alternatively, dry thoroughly with towels.
2. Preheat oven to 275 F.
3. Once kale leaves are completely dried, tear leaves off the fibrous central stem into bite-size (potato chip sized) pieces and place onto two baking sheets in a single layer with some space around each leaf.
4. Sprinkle on salt and drizzle with a small amount of olive oil, about 1 tablespoon per baking sheet. Toss with tongs to evenly distribute salt and oil.
5. Place prepared kale leaves into the preheated oven, and bake for 20 minutes, turning over leaves halfway through baking.
Variations: Experiment with tasty seasonings, including cayenne pepper with a squeeze of lime juice, Bragg Nutritional Yeast and nori furikake.
Top photo: Baked kale chips. Credit: iStockphoto