Creating Teams of Family Medicine Residents and High School Culinary Students Reduces Some Barriers to Implementing a Culinary Medicine Hands-On Workshop.

Background: Barriers to implementation of culinary medicine in resident training include lack of facilities, administrative support, and community engagement. Activity: Twenty-five family medicine residents were teamed with 17 high school culinary arts students to prepare recipes aligned with the Mediterranean diet (MED) and the USDA low, moderate, and liberal cost food plans. Results: The workshop took place in the high school teaching kitchens. A pre-survey informed the planning committee's design of a 4-h hands-on workshop that was considered a success. Discussion: Post-surveys documented improved resident confidence and skills in recommending MED to their patients and interaction with their own peers and high school students, as well as enjoyment by all participants of this hands-on approach.

Sharing the 'weight' of obesity management in primary care: integration of registered dietitian nutritionists to provide intensive behavioural therapy for obesity for Medicare patients.

BACKGROUND: Clinical provision of intensive behavioral therapy for obesity (IBTO) has been a reimbursable treatment for obesity since 2012. However, gaps remain in the literature regarding its impact on patient outcomes. OBJECTIVES: The primary objective of this study was to examine the integration of registered dietitian nutritionist provided IBTO into a primary care setting and evaluate clinic outcomes for Medicare Part B beneficiaries. A secondary objective was to examine intensity of IBTO (quantity of IBTO visits) versus clinical outcomes and influence of socioeconomic factors. METHODS: A case-control retrospective chart review was conducted at a rural, Academic Family Medicine Clinic in Eastern North Carolina for patients seen between 1 January 2016 and 1 January 2019. In order to be included in the treatment group, patients had to be female, white or black race, have Medicare insurance and a body mass index ≥ 30 kg/m2. RESULTS: Mixed model analysis showed statistically significant improvements in clinical outcomes from IBTO treatment. Weight decreased by nearly 3 pounds, while body mass index was half a point lower. A1C was 0.1 units lower for IBTO patients, and they took prescription medication and average of 6 days less than the control group. Minorities and older respondents experienced smaller, all else constant, and annual fixed effects suggest that differentials widen over time. CONCLUSIONS: Registered dietitian nutritionist (RDN) provision of IBTO has demonstrated benefit in improving clinical outcomes including weight, A1C, and reduced medication duration (use) as demonstrated by the IBTO treatment group versus control. IBTO intensity was not predictive of success, and its impact was reduced with older and African American patients. IBTO is beneficial and can be delivered within the primary care setting by a RDN.

A "Hands-On" Thread, Part of a Medical Nutrition Education Curriculum.

Required "hands-on" medical nutrition education sessions are woven through years 1-3 at the Brody School of Medicine. An elective opportunity also is available for third and fourth year students. These active learning sessions focus on diet and chronic disease, including obesity, prevention, and treatment.

Validation of a combined health literacy and numeracy instrument for patients with type 2 diabetes.

OBJECTIVES: This study aimed to validate a new consolidated measure of health literacy and numeracy (health literacy scale [HLS] plus the subjective numeracy scale [SNS]) in patients with type 2 diabetes (T2DM). METHODS: A convenience sample (N = 102) of patients with T2DM was recruited from an academic family medicine center in the southeastern US between September-December 2017. Participants completed a questionnaire that included the composite HLS/SNS (22 questions) and a commonly used objective measure of health literacy-S-TOFHLA (40 questions). Internal reliability of the HLS/SNS was assessed using Cronbach's alpha. Criterion and construct validity was assessed against the S-TOFHLA. RESULTS: The composite HLS/SNS had good internal reliability (Cronbach's alpha = 0.83). A confirmatory factor analysis revealed there were four factors in the new instrument. Model fit indices showed good model-data fit (RMSEA = 0.08). The Spearman's rank order correlation coefficient between the HLS/SNS and the S-TOFHLA was 0.45 (p < 0.01). CONCLUSIONS: Our study suggests that the composite HLS/SNS is a reliable, valid instrument.