916699

research-article2020
AJLXXX10.1177/1559827620916699American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine

vol. 14 • no. 4 American Journal of Lifestyle Medicine

Michelle E. Hauser, MD, MS, MPA, FACLM, Chef,

Julia R. Nordgren, MD, FNLA, Chef, Maya Adam,
MD, Christopher D. Gardner, PhD, FAHA,
Tracy Rydel, MD, Alaina M. Bever, BS, BA,
and Emma Steinberg, MD, FAAP, Chef

The First, Comprehensive,

Open-Source Culinary Medicine
Curriculum for Health Professional
Training Programs: A Global
Reach
Abstract: Providing a strong a CM course. The CMC highlights a of CM courses and expanding the
foundation in culinary medicine predominantly whole food, plant- reach of CM and counseling on dietary
(CM)—including what constitutes a based diet as seen through the lenses behavior changes into patient care.
healthy diet and how to find, obtain, of different world flavors and culinary
and prepare healthy and delicious traditions. It was developed, published, Keywords: culinary medicine; medical
food—is a cornerstone of educating and distributed with the aim of education; health professional education;
health professionals to support patients expanding CM by reducing barriers nutrition; diet; teaching kitchen
in achieving better health outcomes.
The Culinary Medicine Curriculum
(CMC), published in collaboration Diet has been identified as the most
with the American College of Lifestyle
Medicine, is the first, comprehensive,
important risk factor for morbidity
open-source guide created to support and mortality in the United States.
the implementation of CM at health
professional training programs (HPTPs)

C
worldwide. The CMC is modeled after to creating CM courses within most ulinary medicine (CM) is an
the successful CM elective course types of HPTPs and practice settings. emerging, evidence-based field
for Stanford University School of During the first 2 months the CMC was that integrates nutrition
Medicine students. Key goals of the available, it was downloaded 2379 education with culinary knowledge and
CMC include presenting healthy food times in 83 countries by a wide variety skills to assist patients in maintaining
as unapologetically delicious, quick, of health care professionals interested in health and preventing and treating food-
and inexpensive; translating lessons teaching CM. The global interest in this related diseases by choosing high-quality,
learned to healthy eating on-the-go; first, freely available, evidence-based healthy food in conjunction with
practicing motivational interviewing CMC underscores the demand for CM appropriate medical care.1,2 Diet has
on healthy dietary behavior changes; resources. Such resources could prove been identified as the most important
and demonstrating how to launch foundational in expediting development risk factor for morbidity and mortality in

DOI: 10.1177/1559827620916699. From the Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
https://doi.org/

(MEH, TR); Internal Medicine-Obesity Medicine, Palo Alto Veterans Affairs Health Care System, Palo Alto, California (MEH); Internal Medicine-Primary Care, San Mateo County
Health System, San Mateo, California (MEH); Pediatric Lipid and Weight Management, Palo Alto Medical Foundation, Palo Alto, California (JRN); Department of Pediatrics,
Stanford University School of Medicine, Stanford, California (MA); Stanford Prevention Research Center, Department of Medicine, Stanford University Medical School, Stanford,
California (CDG); Harvard Medical School, Boston, Massachusetts (AMB); and Department of Pediatrics, Kaiser Permanente, Northern California, San Francisco, California
(ES). Address correspondence to: Michelle E. Hauser, MD, MS, MPA, FACLM, Chef, Internal Medicine-Obesity Medicine, Veterans Affairs Palo Alto Health Care System, 3801
Miranda Ave, MC 111A, Palo Alto, CA 94304; e-mail: mehauser@stanford.edu.
For reprints and permissions queries, please visit SAGE’s Web site at www.sagepub.com/journals-permissions.
Copyright © 2020 The Author(s)

369
 American Journal of Lifestyle Medicine
the United States3 and is associated with
11 million deaths across the globe
annually,4 yet most health care providers
fail to meet the recommended number of
hours studying nutrition during their
training.5,6 The majority of nutrition
education offered is didactic and focused
on the biochemistry of nutrients and
health consequences of deficiency
states—content that is of limited use in
clinical settings where the risk of
overnutrition looms far greater due to
high intake of ultra-processed, calorie-
dense foods. CM fills this educational
gap by focusing on practical dietary
behavior changes, nutrition knowledge,
and cooking skills needed to make food
that is delicious, healthy, and accessible.
Consideration of time availability,
financial resources, and cultural food
traditions are also important parts of any
successful CM program.
In recent years, understanding of the
importance of the CM approach to
nutrition education in health professional
training programs (HPTPs) has increased.
However, the lack of an easily accessible,
evidence-based guide to implementing
CM has constituted a major barrier at
most institutions. The Culinary Medicine
Curriculum (CMC),7 published in
collaboration with the American College
of Lifestyle Medicine in December 2019,
is the first, comprehensive, open-source
guide created to support the
implementation of CM at academic
institutions worldwide.
The CMC is modeled after the
successful CM elective course for medical
and physician assistant students at
Stanford University School of Medicine.2
Both the Stanford CM course and the
CMC were developed by a group of
experts whose training includes internal
medicine, family medicine, pediatrics,
obesity medicine, lipidology, integrative
medicine, lifestyle medicine, nutrition
science, epidemiology, public policy,
medical school curriculum design, and
culinary arts. The success of the course
and many requests for dissemination of
the curriculum, prompted author,
physician-chef Michelle Hauser, to
partner with the American College of
Lifestyle Medicine (ACLM) to expand the
370
reach of this curriculum beyond
Stanford’s campus.
The Stanford CM course was taught by
dually trained physician-chefs with
nutrition expertise. Understanding that
this combination of training is rare
among health professionals, the CMC
was adapted to enable a wide variety of
health professionals to teach CM in their
training programs. Examples of
combinations of instructors likely to be
successful in teaching a CM course using
the CMC include (a) a professional with
training in culinary arts, nutrition, and
the same health profession as students
taking the course (eg, a nutrition-savvy
physician-chef); (b) a clinician-educator
who is knowledgeable about nutrition
and cooking; or (c) 2 or more instructors
trained in complementary fields that
cover formal or informal culinary
training, nutrition expertise, and direct
patient care experience (eg, a chef,
dietitian, and physician). For the example
class size of 12 students, it is
recommended to include at least 2
instructors per session to divide the
workload and ensure adequate student
oversight; however, this number can be
increased or decreased proportionally
according to actual class size and kitchen
or classroom space. To increase the
generalizability of the content, lead
instructors can invite other faculty
members from a variety of specialties or
focus areas to join on a rotating basis.
This helps students understand how CM
content is applicable broadly in medicine
and other health professions. Class
sessions can also be taught individually,
rather than as a full course, and can be
customized, if desired.
The CMC incorporates lessons learned
in medical practice caring for diverse
patients of all ages and with varying
levels of education and resources. Key
goals of the curriculum include
presenting healthy food as
unapologetically delicious, simple, filling,
and inexpensive; translating lessons
learned to healthy eating on-the-go;
practicing motivational interviewing on
healthy dietary behavior changes; and
discovering how to set up and run a CM
course from the ground up. The CMC
Jul • Aug 2020
includes detailed instructions and
content needed to accomplish these
goals and suggestions for modifications
to adapt content to alternative CM
session or course formats such as
one-time or limited-session classes (Table
1).
This open-source curriculum was
developed to be used as a foundation for
the creation of elective CM courses
within most types of health professional
training programs. As written, student
time commitment includes 9 class
sessions, each of 2 hours duration, with
an average of approximately 30 minutes
of preparatory work for each session.
This can be done weekly for those on
the quarter system. Class sessions
encompassing more than 1 topic—Soups
and Salads, for example—can be divided
into 2 sessions to give more time to
cover the material in detail while sticking
with a weekly class schedule for those
on the semester system. Instructor
preparation for each session varies and is
indicated in the Instructor’s Outline—a
detailed guide to leading each course
session (Table 2). Topics and techniques
covered include common and high-yield
healthy cooking techniques that can be
easily incorporated into the repertoires
of families from a variety of cultural food
traditions that are common in the United
States.
While CM does not endorse a single
dietary philosophy, the CMC has been
designed to focus on whole food,
plant-based (WFPB) nutrition. It
highlights the dietary principles
supported by the ACLM as outlined in
the official position statement: “For the
treatment, reversal, and prevention of
lifestyle-related chronic disease, the
ACLM recommends an eating plan based
predominantly on a variety of minimally
processed vegetables, fruits, whole
grains, legumes, nuts, and seeds.”8,9
Because patients come from a variety of
backgrounds and food traditions, the
curriculum introduces a predominantly
WFPB diet through the lenses of different
world flavors and culinary traditions
while keeping in mind resource
constraints.
 vol. 14 • no. 4 American Journal of Lifestyle Medicine

Table 1.
Contents of the Culinary Medicine Curriculum.

• Descriptions of personnel and equipment needed for nine, 2-hour, in-person class sessions
• Suggestions for modifying curriculum content for use in one-time or limited-session CM classes
• Example course syllabus
• Explanations of faculty expertise required to teach a course
• Draft email invitations to invite faculty to join CM sessions
• A detailed Instructor’s Outline with all content needed for each session
• Goals and objectives for students for each class session
• Suggestion for class pre-work (in lieu of homework)
• Selected nutrition content to highlight during sessions
• Suggestions for supplemental materials, videos, references, and other resources
• Flow and content of each hands-on teaching kitchen session
• Menus, recipes, and handouts for each class session
• Discussion starters and patient-provider role play examples for interactive dinner discussions
• Health and safety considerations for CM courses
• Financial considerations in starting a CM course
• Equipment list for stocking a pop-up teaching kitchen

Abbreviations: CM, culinary medicine.

Table 2.
Instructor’s Outline.

Sessions Each Session Includes

1. Introduction to Kitchen Basics • Goals (for students)
2. Sauté, Stir-fry, Simmer, Braise • Objectives (for students)
3. Roasting • Materials to Review Before Class Session (Required and Optional
4. Soups & Salads Materials)
5. Beans & Whole Grains • Meal Description
6. Healthy Breakfasts • Recipes
7. Pastas and Sauces • Class Session Outline (ie, timing, instructor preparation, content, session
8. The Dessert Flip & Healthy Desserts flow)
9. Final Potluck • Key Points for Instructors/Faculty Volunteers to Discuss with Students
• Dinner Discussion (with patient motivational interviewing role play
activity)
• Related Nutrition/Clinical Correlates in the Curriculum
• Optional References

Western diets fall short of the major and most people find it difficult to patterns. Commonly cited challenges
goals of a predominantly WFPB diet10 abruptly change engrained eating include lack of nutrition knowledge and

371
 American Journal of Lifestyle Medicine
food preparation skills, existing taste
preferences for less healthy foods,
limited availability of healthier options,
family demands, financial resources, and
time constraints. Given that any level of
behavior change can potentially yield
improved health and well-being,11,12 the
CMC focuses on meeting individuals
where they are and using motivational
interviewing to tailor dietary assessment,
recommendations, and interventions
according to a patient’s personal goals
and readiness for change.13-15 Concrete
strategies are given for health care
providers who wish to partner with their
patients on improving dietary choices,
thereby assisting them in transitioning
along a spectrum toward more plant-
centric diets emphasizing the
consumption of whole foods.
Though the CMC was created for health
professional training programs (eg,
medical schools, nursing, psychology,
and dietetic programs), it is easily
adaptable to a variety of other
educational environments, including
residency programs, health and wellness
coaching, and master’s-level courses. To
adapt for patient care, patient education,
public-facing education, or
undergraduate studies, one can simply
omit the portions of the curriculum
focused on teaching providers to coach
patients on making dietary lifestyle
changes. The majority of the curriculum
is broadly applicable.
The CMC was written, published, and
distributed with the aim of expanding
CM by reducing barriers to creating CM
courses (e.g., financial, knowledge, etc)
within most types of HPTPs and practice
settings. Permission to use the materials
can be obtained simply by emailing a
request to the address indicated in the
copyright statement, following
downloading of the CMC from https://
lifestylemedicine.org/culinary-medicine.
Use permission is granted on the
condition that appropriate attribution
accompanies all materials whether used
as-is or in edited form. There is no
charge.
To evaluate the reach of the CMC and
demand for evidence-based, open-source,
CM content, descriptive statistics were used
372
to analyze self-reported data for those who
downloaded the curriculum during the first
month it was available (December 2019 to
January 2020). For this initial analysis, total
downloads, total number of countries in
which downloads occurred, proportion of
those downloading who had targeted
credentials, and proportion who planned
to teach CM within 2 years were
calculated. Those listing credentials were
allowed to list more than one applicable
credential. A follow-up analysis was
conducted for data collected during the
first 2 months the CMC was available
(December 2019 to February 2020) and
included total downloads and total number
of countries in which downloads occurred.
During the first month the CMC was
available, it was downloaded 1481 times
in 63 countries. Of those listing targeted
credentials (N = 1226; 82.8%), the most
frequently reported included physicians
(N = 711; 58.0%), registered dietitians (N
= 130; 10.6%), public health professionals
(N = 102; 8.3%), nurses (N = 78; 6.4%),
nurse practitioners (N = 60; 4.9%), and
health coaches (N = 60; 4.9%), with
smaller numbers in the categories of
doctors of philosophy or psychology,
physician assistants, and physical or
occupational therapists. More than two
thirds planned to teach CM within 2
years either in a HPTP or patient care
context. At 2 months, the CMC had been
downloaded 2379 times in 83 countries.
Providing health care professionals
with a strong foundation in CM—
including what constitutes a healthy diet
and how to find, obtain, and prepare
healthy and delicious food—is a
cornerstone of educating health
professionals to support patients in
achieving better health outcomes. Based
on the analysis of data from the first 2
months during which the Culinary
Medicine Curriculum was available,
evidence of substantial global interest
emerged. This interest included the
development of CM courses across the
spectrum of HPTPs and for patient care.
The global interest in this first, freely
available, evidence-based CMC
underscores the demand for CM
resources. Such resources could prove
foundational in expediting development
Jul • Aug 2020
of CM courses and, by extension,
expanding the urgently needed reach of
CM and counseling on dietary behavior
changes into patient care. Future
research is needed to determine
frequency of use of curricular materials,
impact on clinical practice for those who
have taken related CM courses, and
effects on patient health outcomes.
Acknowledgments
This article includes numerous directly quoted excerpts and
summarized sections of the Culinary Medicine Curriculum
(CMC), an open-source guide to running culinary medicine
(CM) courses in health professional training programs, that
was published and distributed online by the American College
of Lifestyle Medicine in 2019. Because this content
comprises the majority of the manuscript, quotation marks
are not used to designate directly quoted material. The
authors thank Chef David Iott for his assistance in preparing
for and teaching the CM sessions at the Teaching Kitchen @
Stanford University Dining Services, all of the Stanford
University School of Medicine students who took the Teaching
Kitchen Elective for Medical Students, and all of the faculty
who volunteered as session facilitators. Funding for the
course was provided by the Stanford Teaching and Mentoring
Academy Innovations Grant Program and Dr Jeanne Rosner
via SOUL Food Salon. Dr Hauser received support from the
National Heart, Lung, and Blood Institute via Training Grant
5T32HL007034-39 while teaching the course. Thanks also
to our diverse patients and research subjects who have
taught us so much about the complexities of making dietary
changes; ACLM Executive Director, Susan Benigas, for her
support of the CMC and expanding the reach of food as
medicine; Paulina Shetty for her assistance in producing and
reviewing the CMC; Brenda Rea and Kayli Dice for reviewing
the contents of the CMC and providing feedback; Jason
Wimmert for his support in expanding the reach of CM; and
Beth Frates for her mentorship in lifestyle medicine.
Author Contributions
Dr Hauser was the primary author of the Culinary Medicine
Curriculum from which this article was created; Drs Nordgren,
Adam, Gardner, Rydel, and Steinberg, along with Ms Bever,
were key contributors. Dr Hauser conducted data analysis. All
authors made critical revisions to the content and assisted in
drafting manuscript content.
Declaration of
Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
 vol. 14 • no. 4
Ethical Approval
Not applicable, because this article does not contain any
studies with human or animal subjects.
Informed Consent
Not applicable, because this article does not contain any
studies with human or animal subjects.
Trial Registration
Not applicable, because this article does not contain any
clinical trials. AJLM
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