Food’s impact on health is the focus of two courses at Emory bridging the university’s resources across the health sciences and liberal arts with the culinary expertise of Emory Dining. The courses have offered a curricular model other units in the university are looking to replicate.
The Emory courses — “Textbook to Table” for undergraduates in Emory College and “From Clinic to Kitchen,” a pilot course for second-year medical students in the School of Medicine — took place last fall and serve as models for ongoing and future courses.
The courses focus on helping students understand the many facets of food, from calories to culture, and how what we eat impacts all aspects of health. They combine intensive study of relevant research with hands-on meal preparation for the students to apply what they’re learning.
While the idea of using food as medicine dates back to Hippocrates, the cross-campus partnerships create modern-day lessons for students.
Emory College senior Maanasa Gade and School of Medicine student Lula Belak see the coursework in the respective classes they took as especially applicable in their ongoing volunteer work with the Grady Health System, a longtime Emory partner.
“The patients I’ve met are always super interested to learn about diets so knowing the scientific benefits of certain foods is immediately relevant,” says Gade, a psychology major and nutrition science minor who took the Center for the Study of Human Health’s “Textbook to Table” course. “I knew the required dietary intakes, what you should eat, but not how that translated to the plate.”
Belak, a second-year medical student, leads a follow-up class for patients discharged from Grady, one of the largest public hospitals in the Southeast, which has a commitment to serving some of Atlanta’s most vulnerable residents. They, too, want to know how to eat healthily.
“I’ve always been interested in the complex relationship between nutrition and medicine,” says Belak, who is considering a career in primary care or sports medicine. “Food is integral to what we talk about with patients, whether it’s for treating diabetes, hypertension or another condition.”
Taking the textbook to the table
Grounded in the latest research and guided by evidence-based practice, the popular “Textbook to Table” course offers students the opportunity to explore nutrition science through dynamic lectures, interactive discussions and experiential cooking sessions. The class, first held in 2016, takes place each fall and often has a waiting list.
“Our unique course structure combines a rigorous analysis of the science of health with innovative methods in implementation science,“ says instructor Jill Welkley, associate professor in the Center for the Study of Human Health.
This past fall, Welkley, alongside Teresa Douglas, an instructor in the School of Medicine, encouraged students to consider the influences of history, culture, economics and public policy on diet. Many undergraduates were drawn by the course's focus on translational health.
“I’m leaning toward a career in medicine or nutrition, so I want to teach people how they can control some aspects of a healthy life,” says Savannah Ramsey, a senior majoring in human health. “Culturally specific foods, like chickpeas and lentils, can be the less expensive, accessible options in global areas experiencing malnutrition.”
Once students examine the scientific and social foundations of certain ancient grains, herbs, proteins and berries, they practice proper culinary skills for preparing the foods with staff from Emory Dining and Bon Appétit, Emory’s food service vendor. Three cooking sessions help students plan for the final showcase — a community health event where they create, execute and present their own menus for guests across the university.
"The showcase empowers students to apply and disseminate their learning," says Welkley. “We hope that, whether our students pursue medicine, public health, policy or another profession, they serve as informed and effective ambassadors for better dietary choices in their communities.”
Sydney Navid, a senior human health major with a nutrition science minor, is a testament to the lasting impact of the course on students. She enrolled in “Textbook to Table” after spending her summer interning with a New York City nonprofit that teaches nutrition and cooking to low-income elementary school students.
“The class helped me think about how to incorporate ingredients in nutrition education for kids, to expose them to foods and the health benefits with a meal,” says Navid, who plans to become a registered dietitian working with children and pregnant women.
Experiential learning through campus partnerships
Welkley launched the undergraduate course more than two years ago to put scientific and cultural evidence into practice. The course grew out of grass-roots student initiatives related to food and nutrition that Welkley had established with the help of Dave Furhman, then director of Emory Dining, starting in 2013.
“That early work catalyzed these cross-campus partnerships and established the infrastructure that has led to the development of such innovative courses,” says Furhman, now senior director of operations for Campus Life.
In addition to Emory College and School of Medicine faculty, both the undergraduate course and the medical school course also brought in registered dietitian Carol Kelly, assistant director of nutrition at Student Health, who discussed specific foods and diets. Fuhrman, who is also a trained chef, taught cooking techniques and helped students in both courses prepare meals.
Furhman and Chad Sunstein, current director of Emory Dining, also have partnered with the Marcus Autism Center for a hands-on cooking class for young clients there.
More cross-campus collaborations are in the works. The Nell Hodgson Woodruff School of Nursing will offer an undergraduate elective course which models Textbook to Table next spring, says Welkley, who worked with Lisa Muirhead, associate clinical professor of nursing.
And after a successful pilot last fall, the “From Clinic to Kitchen” curriculum in the School of Medicine will potentially be piloted with a cohort of physician assistant residents at the Atlanta VA through a collaboration with the Atlanta VA Health Care System's Whole Health team, which is led by Dr. Javier Valle, one of the Clinic to Kitchen instructors.
Food as treatment
Nutritional learning is often overlooked in medical schools, even as “lifestyle changes” such as diet are increasingly recommended for a variety of diseases and ailments.
Dr. Emily Herndon, a family physician and assistant professor in the Emory School of Medicine, invited Valle to lecture about such lifestyle medicine to address some of those issues.
But as Valle was finding in his work at Emory’s Lifestyle Clinic in Dunwoody, and Herndon saw in her practice and the classroom, there is a growing general interest in all facets of a healthy lifestyle, food included. The pilot “From Clinic to Kitchen” course was created to address that need, in part by modeling the handful of culinary medicine courses at other medical schools.
Feedback from the students enrolled in the medical school’s pilot course was very positive, with preliminary data showing it “improved students’ confidence in counseling future patients about appropriate diet changes,” Herndon says.
The medical school plans to continue to offer the course as an elective for second-year students as well as increase the number of students who can enroll.
Before hitting the kitchen, the medical students were presented with a fictional patient with a common ailment who they must support in part with a prescriptive recipe. Fictional cases included an elderly obese patient losing muscle mass and strength, a prediabetic patient and another patient who had been on multiple fad diets.
The results were shared in class, with critiques from the professors, Kelly and Furhman. Final recipes were then shared with patients in Grady’s Healthy Living program to try at home.
“You learn by doing,” Herndon says. “What this class does is allow medical students to experiment in the kitchen and apply what they have learned, so that they can better counsel their future patients.”
One case study involved a woman with irritable bowel syndrome who needed a meal that would meet her dietary restrictions but also be appealing to her new “foodie” boyfriend. Belak considered the social context of the meal in suggesting turkey burgers (red meat would be harder for an IBS patient to digest) and a sweet carrot salad to make up for the limited sugar the patient should eat.
Eric Bethea’s recipe, meanwhile, called for the patient, a graduate student on a limited budget, to make a gluten-free flatbread. That would let the boyfriend use whatever toppings he wants and allow the patient to focus on the more restrictive options in hers.
“I knew nothing about cooking before this class, so I sympathize with wanting to offer something simple that anyone can do,” says Bethea, who is considering going into internal medicine. “If you’re not exposed to culinary medicine, it might not be at the top of your mind as a way to help your patient.”
Hands-on lessons
Making the meals brings “ah-ha” moments for both medical school students and undergraduates. Light bulbs go off in students heads, for instance, as Furman reveals the creamy texture of risotto comes not from a dairy ingredient but from coaxing starch out of rice by stirring slowly.
Fuhrman is always thrilled when students realize the kitchen is another classroom. “At the end of the day, these courses build on Emory’s innovations to create another opportunity for our students,” he says.
Kelly, the dietitian who offers ideas and details as students begin to cook, also sees the coursework as a chance for students to learn and apply that knowledge immediately. That increases the ability for them to talk authentically about what they’ve learned, because they are experiencing the science of food firsthand.
“Emory is committed to understanding health as broadly as possible,” Kelly says. “The question of translating what you know about health and food’s contribution to it is helped by what you’ve tried yourself. Health is a practical matter.”