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In the San Antonio, Texas area (69% Latino) families, health care leaders like Dr. Mark Gilger, and philanthropy groups like the Goldsbury Foundation are exploring what healthy and culturally fun Latino meals look like with the Children’s Hospital of San Antonio’s new Culinary Health Education for Families (CHEF) program. Aiming to be a new culinary health model for families needing help in preventing diet-related disease such as childhood diabetes, hypertension, and obesity, the goal of the program is to provide San Antonio residents with tools, resources, and education to lead healthier lives and encourage healthy weights for children.
EMERGENCE
Awareness/Learn: Dr. Mark Gilger, pediatrician-in-chief at the Children’s Hospital in San Antonio, has seen first-hand a local and fast-growing “silent killer”—diabetes.
San Antonio has double the incidence rate of the national average, and rates recently rose from 11.4% in 2012 to 14.2% in 2014, according to the city’s Metropolitan Health District.
People who are overweight and obese are at greater risk for diabetes.
According to 2014 data, just fewer than 1 million adults (71%) in Bexar County are classified as overweight or obese, based on their Body Mass Indices (BMIs), with Latinos at higher rates.
Efforts to reduce local obesity rates are emerging, but many lack a focus on children and don’t offer long-term preventative solutions, Gilger said.
Meanwhile, the San Antonio-based Goldsbury Foundation was keenly aware of the health risks and were working closely with the hospital to explore new ways their foundation could help impact the childhood obesity rates in their community.
The Goldsbury Foundation had a long history of funding prevention initiatives in San Antonio, as well as deep roots in the food world, said Suzanne Mead Feldmann, CEO of the Goldsbury Foundation.
“We know that the rate of diagnosis of young children with type 2 diabetes is skyrocketing and that’s unacceptable,” Feldmann said. “Like many, we recognize that’s a major problem down the road for our country. We’re a local foundation, we’ve always focused our funding in San Antonio.”
Frame Issue: Foundation officials wondered if there was a way to partner with other groups to help combat the escalating rates of childhood obesity and diabetes in the city.
The foundation met with Gilger in 2013 and discussed local health risks and how to use “all the resources in the community and specifically the Children’s Hospital, the Goldsbury Foundation, and the CIA (Culinary institute of America), which Goldsbury was instrumental in helping bring to the city many years ago,” said Gilger.
That meeting would be the first step in developing a new culinary health model to prevent diet-related illnesses among San Antonio families.
“Here was the chance to marry the passion of our Goldsbury trustees with a critical community need,” Feldmann said. “So it made a lot of sense to us.”
DEVELOPMENT
Education/Mobilization: After their initial meeting, the group engaged with many other local organizations, including Dr. Amelie Ramirez from Salud America!, a national Latino childhood obesity prevention network based at the UT Health Science Center at San Antonio, on addressing the city’s risks of continued childhood obesity through prevention efforts.
Eventually, a theme started to emerge: Culinary medicine.
Culinary medicine is a new facet to medical education, offering medical students, doctors, health professionals and community lessons on cooking and nutrition basics, according to a National Geographic article on Tulane University’s Goldring Center for Culinary Medicine,
“Ultimately we evolved into this concept of culinary medicine,” said Feldmann.
Debate: How could culinary medicine make an impact?
They knew it needed to focus on prevention and intervene from the beginning of a child’s life, Gilger and Feldmann said.
“We started talking about how could we start at the beginning, with the infant and child, and then even to the pregnant mother,” said Gilger.
ENACTMENT
Activation: Progress escalated on the culinary medicine idea when the Goldsbury Foundation offered the Children’s Hospital of San Antonio a $20 million grant in 2013 to support the hospital’s transformation to a free-standing children’s hospital. A portion of the grant was set aside to support community health initiatives.
“We have deep relationships and a long history with the doctors there at the hospital,” Feldmann said.
They met and discussed creating a Culinary Health Education conference for healthcare providers on nutrition to sift through very confusing messages, Feldmann said.
“We thought that there was great value in developing a practical, easy to understand curriculum that would help people navigate through the confusing nutrition messages we are bombarded with every day. We saw an opportunity to promote an evidence-based curriculum to organizations that reach a lot of kids and have their folks trained in a deliberate manner, so we have a consistent message,” she said.
They also wanted to add families to the mix.
So they conceptualized the “CHEF” (Culinary Health Education for Families) program to educate families on nutrition to reduce obesity, alongside a Produce for Prescriptions program that would help mothers access free, fresh produce and help reduce risks of gestational diabetes during pregnancy.
“Our whole focus is to actually do something meaningful and culturally relevant in San Antonio and South Texas,” Gilger said.
Foundation officials, including director Anne Messbarger-Eguia, worked to develop partners for CHEF and Produce for Prescriptions.
Dr. Marisol Garcia-Hodge, for example, offered to volunteer her clinic, CentroMed, and partner up with CHEF for the pilot Produce for Prescriptions program because many of her patients were overweight and either had or were prone to gestational diabetes.
Additional connections were made including Salud America!, the CIA, the San Antonio Food Bank, and the local supermarket chain H-E-B.
“No one entity by themselves is going to be able to move the needle on [the] individual behavior change that’s really necessary for population change in terms of health,” said Kate Rogers, Vice President of Communication and Engagement for H-E-B in a video.
In fall of 2014, Dr. Gilger and Feldmann hired Dr. Julie La Barba as medical director for the CHEF program. One of the first projects for CHEF was to pilot a Prescriptions for Produce program in partnership with Centro Med and H-E-B. The initial pilot was enhanced through a partnership with the San Antonio Food Bank to secure a Food Insecurity Nutrition Incentive (FINI) Pilot Projects grant from the U.S. Department of Agriculture to expand their program to Supplemental Nutrition Assistance Program (SNAP) beneficiaries.
Frame policy: To build the CHEF culinary medicine curriculum, La Barba recruited Maria Palma, chef and program director, and Celina Paras, a registered dietitian and education specialist.
The curriculum is rooted in the belief that food is medicine, and aims to teach children and families common sense nutrition and practical cooking skills through engaging, hands-on experiences.
The hospital partnered with the CIA on the design of the teaching kitchen, which is located in the heart of the hospital’s cafeteria. There, the CHEF team, made up of bilingual chefs and registered dietitians will offer cooking demonstrations and hands-on classes created to teach kids and their caregivers about creating healthier meals that incorporate the key ingredients of fresh fruits and vegetables
For the Prescriptions for Produce program, doctors trained in basic nutrition would write produce prescriptions to pregnant mothers at CentroMed OB/GYN Clinic, giving them access to $40 per month of prescriptions (for up to 11 months) to use on fresh fruits and veggies.
To be qualified for the program and receive the credits for fresh produce, Prescriptions for Produce program participants would take part in a shopping tour and cooking classes from a registered H-E-B dietitian, and go through a nutrition module during clinical visits and a pre/post intervention survey.
“We don’t have some super-secret recipe here,” Feldmann said. “It’s about common sense nutrition and practical cooking skills to make sure that every family, regardless of income level, or education level, can put a healthy, nutritious, familiar meal on the table that’s better for them perhaps than what was there before. It’s often baby steps that help get us there.”
Change: CHEF expects to unveil the on-site teaching kitchens within the Children’s Hospital on May 25, 2016, to help provide San Antonio families and health care providers with education and to give families and children access to healthy foods, and cooking classes.
Beginning in late August 2016, CHEF classes at the Children’s Hospital of San Antonio will be open to the public and those interested in attending can register through the CHEF website.
La Barba explained to the San Antonio Business Journal that families will learn how to prepare nutritious meals together and share in the eating of these while learning how delicious meals can also be good for you.
IMPLEMENTATION
Implementation: Palmas and Paras have already directly reached more than 1,200 people with the CHEF curriculum between last summer and fall of 2015 by teaching about the science of nutrition and building cooking skills at free events at San Antonio’s Witte Museum and other community-based sites.
Working with the local YMCA, Boys and Girls Club, and KIPP afterschool sessions, Palma, and Paras have directed bilingual cooking demos and classes, teaching kids ranging from 8 to 17 years old about herbs and spices, and empowering them to create healthy and delicious snacks all while learning more about the history of ingredients and the nutritious benefits of combining certain foods.
“They had lots of questions and really wanted to learn how to chop the vegetables correctly and how to perform the techniques in the right manner,” Palma said.
Also, various media outlets and cooking demos at The Pearl Brewery’s farmers markets have helped bring the culinary medicine message to other parts of the city.
Feldmann explained that they have brought the culinary medicine education to many groups already, even without the kitchen being open.
Equity: The pilot test of the Prescriptions for Produce program also has helped double the impact with WIC and SNAP to encourage healthy nutrition and cooking habits among pregnant moms, while increasing their future baby’s chance for a healthy weight.
“Those are our youngest patients because they are in utero,” La Barba said, “We’ve learned that all expectant moms want to do what’s right for their unborn child, but when it comes to nutrition, they sometimes may just not know where to start.”
Sustainability: The plans for sustainability rely on the community and future partnerships as well as private donations.
“We’re carefully learning from this and figuring out what works,” Feldmann said. “It’s not just about better education or just about increased access. In our program, it’s about both.”
The CHEF team continues to network with state officials hoping to find more support. La Barba also is working to find a way to code food access and prevention efforts with insurance companies to find future support for the produce prescriptions.
Additional grants from the Goldsbury Foundation will also help to develop three future community teaching kitchens, including one in the San Antonio Botanical Garden to open in 2017.
Feldmann explained that many people are watching and waiting to see the progress of CHEF in San Antonio, calling Goldsbury Foundation offices and telling her if they are successful with the program in San Antonio, this type of program could work in other places as well.
Additional Links:
CHEF website
CHEF Facebook Site
This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.
The stories are intended for educational and informative purposes. References to specific policymakers, individuals, schools, policies, or companies have been included solely to advance these purposes and do not constitute an endorsement, sponsorship, or recommendation. Stories are based on and told by real community members and are the opinions and views of the individuals whose stories are told. Organization and activities described were not supported by Salud America! or the Robert Wood Johnson Foundation and do not necessarily represent the views of Salud America! or the Robert Wood Johnson Foundation.
ABOUT THE PROGRAM
Salud America! The RWJF Research Network to Prevent Obesity Among Latino Children is a national program of the Robert Wood Johnson Foundation. The program aims to educate researchers, decision-makers, community leaders, and the public in contributing toward healthier Latino communities and seeking environmental and policy solutions to the epidemic of Latino childhood obesity. The network is directed by the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio.
For more information, visit http://www.salud-america.org.
By The Numbers
1
Supermarket
for every Latino neighborhood, compared to 3 for every non-Latino neighborhood
This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.
The stories are intended for educational and informative purposes. References to specific policymakers, individuals, schools, policies, or companies have been included solely to advance these purposes and do not constitute an endorsement, sponsorship, or recommendation. Stories are based on and told by real community members and are the opinions and views of the individuals whose stories are told. Organization and activities described were not supported by Salud America! or the Robert Wood Johnson Foundation and do not necessarily represent the views of Salud America! or the Robert Wood Johnson Foundation.
