The Pleasure of Eating Healthy Foods

The main component of CM highlights the pleasure of consuming healthy foods and their medical benefits rather than persistently stressing about avoiding unhealthy ones, which often shows poor compliance. People today also prefer ready-made foods because they spend significantly less time cooking meals at home. These modern dietary practices could be inclined to the ongoing interest in the culinary arts, as shown by the multimedia popularity of chefs and cooking channels.^10,14 Most restaurants, supermarkets, and social media outlets cleverly and enticingly showcase food items, emphasizing mouth-watering plating and aesthetic presentation. Altogether, people eat with their eyes first. This strategy was confirmed by neuroimaging studies, which revealed the highly reactive response of the salient cortical networks of the brain to food presentation. This process creates an urge to grab the attractive kind of food in images or actual displays.¹⁵

Similarly, some studies reveal that the anticipatory reward is activated in the "pleasure centers'' of the brain when the craved food is finally taken. It was also revealed that the anticipatory reward could be positively shifted from responding to unhealthy cravings toward healthier ones over time. This finding is a favorable indicator that familial, cultural, and environmental predispositions to eating behaviors can be highly flexible.^16,17 Consequently, such results made clear that encouraging the enjoyment of taking pleasure in healthy food could be an effective strategy used in culinary medicine to prevent and treat chronic food-related diseases.^7,18

Culinary Medicine Therapy

Health professionals provide culinary medicine therapy (CMT) recommendations with the assistance of RNDs and culinary medicine coaches (CMC). The focus of such treatments is on the overall patterns of food selection tailored to meet individual nutritional needs with less emphasis on specific nutrients unless indicated or specified in the medical treatment plan.¹⁹ The eventual change in one's eating behavior and improved health outcomes over time is a critical goal. Thus, culinary medicine coaching is integrated to initiate and sustain these recommendations. Depending on the readiness to make the change, individuals are encouraged to take small steps for a meal, day, or week.²⁰

During the initial visit, health care professionals assess the individual's level of readiness to change. Inquiries on the specifics of food preference are asked, such as the ability and physical support in planning and preparing food in the household. Other factors include literacy, food-related religious and cultural preference, and budgetary constraints.^21,22 CM providers should be cautious about expectations when helping individuals create eating plans. The guiding principle in implementing CM therapy is to empower the patient to take a recommended diet tailored to support their medical, social, economic, cultural, and emotional inclinations without compromising the pleasure of eating.^10,23

Medically Tailored Meals

Not everyone who needs CM therapy can plan and prepare healthy meals. This change can sometimes become so overwhelming that individuals see it as a significant barrier to change. The inability to prepare meals may be due to time constraints, physical incapacity to perform the task, absence of a caregiver or family support, or lack of the skill to cook and prepare healthy and nutritious meals. Medically tailored managements (MTMs) are crafted for individuals at risk for specific medical conditions. They are designed according to the updated dietary recommendations for chronic conditions such as diabetes, heart disease, hyperlipidemia, obesity, and renal disease. MTMs are often available as pre-prepared meals from healthy ingredients and are facilitated through home delivery or to-go.²⁴ Pilot programs on MTMs showed improved health outcomes and lower healthcare costs.^25,26

MTMs are also utilized for individualized Medical Nutrition Therapy (MNT). Considering the limited time spent in medical appointments, patients requiring an individualized meal plan for chronic health conditions may have the option to seek a referral to a registered nutritionist and dietitian (RND). The RNDs are members of the health care team and are qualified to evaluate the patient's appropriate dietary needs. Nutrition intervention for chronic diseases could begin with short-term MTMs with future sessions on meal planning and cooking medically-tailored meals at home. Other chronic conditions, such as end-stage renal disease, uncontrolled diabetes, and post-heart bypass patients, may necessitate the long-term use of MTMs.

Physician Delivered Medical Nutrition Counseling

The American Heart Association (AHA) and the American College of Cardiology (ACC) emphasize implementing a heart-healthy diet and physical activity as vital components for cardiovascular disease risk reduction. There was an emphasis on physicians providing regular specific nutrition prescriptions and counseling for at-risk patients. Furthermore, it should be implemented and maintained like any prescribed medication. Other clinical guidelines recommend a healthy diet to manage diabetes, hypertension, metabolic syndrome, hyperlipidemia, and obesity.²¹ Despite these guidelines and strong recommendations, studies show that intentionally structured nutrition counseling is only implemented in one-third of primary care visits with minimal counseling rates. The emphasis on diet and exercise is specifically overlooked.^28,29

The limitation is attributed to several barriers in patients’ counseling about nutrition, including lack of time, disbursement issues, and poor knowledge and skills in counseling. Studies also revealed that Physicians would least likely talk about a specific lifestyle they do not personally pursue. On the other hand, providers who perform regular exercise and consume healthier diets can easily counsel patients because they have experiential motivation.²⁸

The lack of training and declining interest in nutrition among healthcare providers further complicates the limited personal motivation. Medical training has no specific lifestyle medicine-related requirements (nutrition, exercise, behavioral counseling, etc.), resulting in minimal motivation to seek advancement in nutrition training to enhance the provider’s skills.³⁰ This gap is reflected as neglect in nutrition counseling for patients needing lifestyle therapy as the first line and maintenance intervention.