A child creates a healthy alternative snack. Courtesy Photo.
A child creates a healthy alternative snack.

Dr. Mark Gilger, pediatrician-in-chief of the Children’s Hospital of San Antonio (CHofSA) walked into one of the country’s leading children’s hospitals and straight into a McDonald’s fast food restaurant.

Most of us are happy to indulge in a Big Mac from time to time, but “super size me” is the opposite message we want to give to hospital attendees in a county where 13% of the population has been diagnosed with Type 2 diabetes and 30% of high school students are classified as obese.

“Not in my hospital,” Dr. Gilger said.

Kit Goldsbury, the vision behind the Pearl Brewery revitalization as a culinary mecca, has a passion for food and agreed with Gilger. After the local collaboration with the Children’s Hospital of Philadelphia (CHOP) fell through, Goldsbury committed $20 million to the new CHofSA, earmarking $5 million for a childhood nutrition program, according to Suzanne Feldmann, executive director of the Goldsbury Foundation. With a vision of a culinary medical initiative, the Culinary Health Education for Families (CHEF) was born.

Doctor Mark Gilger stands in a pediatric trauma room.  Photo by Scott Ball.
Doctor Mark Gilger stands in a pediatric trauma room. Photo by Scott Ball. Credit: Scott Ball / San Antonio Report

Fighting disease requires a broad arsenal, and sometimes that arsenal is simpler than we expect: healthy eating. Good nutrition and balanced eating can not only stave off diabetes and obesity, but can help a person fight many other diseases. The challenge is learning how to eat “better for me.”

Set to open in early 2016, the Culinary Institute of America-designed teaching kitchen in the hospital’s cafeteria will be among the first of its kind in a children’s hospital, but there is some precedent; Tulane Medical School has a culinary medicine initiative for its students, also a first, and CHOP has partnered with Aramak to develop a similar program.

CHEF Medical Director Dr. Julie La Barba and Chef Maria Palma lead a powerful and enthusiastic team. Dr. La Barba was the lead consultant at the Witte Museum’s H-E-B Body Adventure and she advised numerous organizations on public health messaging. Palma’s experience with the San Antonio Food Bank as a nutritional specialist and her devotion to grass roots education on preparing healthy meals makes her the ideal person to lead this project.

Celina Paras, MSc, RDN, provides nutrition expertise and organization of curricula as CHEF addresses specific needs. Together, their commitment to the CHEF program is palpable and will no doubt revolutionize health care.

Children raise their hands as dietitian Celina Paras (left) and chef Maria Palma ask questions. Courtesy photo.
Children raise their hands as dietitian Celina Paras (left) and chef Maria Palma ask questions. Courtesy photo.

Typically, when a patient is diagnosed with diabetes, they receive counseling on the need for a diet change but little else other than some pamphlets and vague recommendations. At CHofSA, they’ll receive a prescription for a food class, where the parent and child will learn to adapt their regular meals to a diabetic diet. The goal isn’t to get everyone eating kale salad, it’s to modify a typical family dinner, such as not using lard, or using brown rice instead of white (though kale salad is a personal favorite and grows well in our South Texas climate). Ultimately, the parents and the children will learn about nutrition and how to prepare those healthy meals with foods they already like to eat.

Patients are not the only ones learning about nutrition, as medical professionals also are learning to become culinary role models. Despite the new program at Tulane, most medical schools teach very little about nutrition. The team at CHofSA have their work cut out for them. The menu in the hospital cafeteria has already began to focus on healthy options and the doctors serve as the current test kitchen as the team develops new recipes. Hospital surveys have shown that if the healthy options are there, the staff is more likely to choose them. The CHEF program has just been accredited and three new medical residents are set to begin training in a culinary medicine specialty.

While the program is aimed at out-patients, 92% of the cafeteria customers are repeaters: hospital staff and downtown workers. The program will be open to all, including in-patient families, hospital staff, and visitors. The CHEF team is working to change the internal culture of the hospital, including activities for in-patients, revising menus, and making snacks healthier.

As the team prepares the hospital cafeteria and its teaching kitchen, they are conducting a pilot program with H-E-B and Centro Med Clinics  as part of HEB’s Prescriptions for Produce program. Gestational diabetes affects 11% of pregnant women in San Antonio and can have dire consequences for both mother and baby if uncontrolled.

In this study, 60 women in early pregnancy have been identified by CentroMed and enrolled in the program, according to Stacy Bates, H-E-B registered dietitian and nutrition services program manager. The women agreed to participate in a store tour with a registered dietitian and attend a cooking class. Although most of us believe we know how to shop, labels can be confusing. The dietitian’s role is to explain the labeling and to focus on produce and “better for you” choices. Each woman has $40 per month in vouchers to spend on vegetables and fruits. The H-E-B team then demonstrates how to cook with these “better for you” foods. The dietitians and chefs develop appropriate menus and guide the families to cook those foods most suitable to their health condition.

Chef Maria Palma ties an apron on a boy. Courtesy photo.
Chef Maria Palma ties an apron on a boy. Courtesy photo.

Public health focuses on evidence-based interventions. But because so little has been done in the area of behavioral changes in nutrition, there is a great deal of work to be done. The CHEF team is constantly conducting research. All these projects will provide the basis for evidence-based recommendations in the future. It’s less about “teaching them how to cook” and more about “teaching how to cook differently.”

They have taken this program directly to the kids through a collaboration with the San Antonio Botanical Gardens. The Junior Gardener Camp for six to eight and nine to 12-year-olds teaches children how to grow vegetables. The CHEF team then teaches them how to cook those vegetables. Ideally, as this program grows and evolves, CHEF hopes to work more extensively with school districts. For now, they are collaborating with KIPP schools to develop test programing for students in Fall 2015.

With the ideas of the CHofSA team, the support of the Goldsbury Foundation and partnership with H-E-B and CentroMed, the hospital is poised to become a leader in culinary medicine.

“Imagine in 20 years we’ll say we turned around a town known for obesity and now we’re a model for healthy eating,” Dr. Gilger said.

A child poses for a photo while making a refried black bean tostado with quest fresco, lettuce, tomato, and avocado. Courtesy photo.
A child poses for a photo while making a refried black bean tostado with quest fresco, lettuce, tomato, and avocado. Courtesy photo.

*Featured/top image: A child creates a healthy alternative snack. Courtesy Photo. 

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Cherise Rohr-Allegrini is an infectious disease epidemiologist and consultant. She is currently the San Antonio Program Director for The Immunization Partnership. Dr. Rohr-Allegrini was the Pandemic Flu...