A growing body of new research is supporting the adage that we are what we eat—not only physically but psychologically. For example, studies have linked diets high in processed meat, fast food and sugar to depression (Psychiatry Research, Vol. 253, 2017) and attention-deficit hyperactivity disorder (Pediatrics, Vol. 139, No. 2, 2017). And the physical health problems associated with poor diet, such as diabetes, can come with accompanying mental health concerns.
“All food is not created equal, and the dietary choices we make affect our bodies and minds over the weeks, months and years,” says Lauren Broch, PhD, a clinical health psychologist based in New York City who specializes in dietary and sleep issues.
And it’s not just what we eat. How we eat can also influence our physical and mental health. Psychologist Barbara Fiese, PhD, a professor of human development and family studies and director of the Family Resiliency Center at the University of Illinois at Urbana-Champaign (UIUC), for example, has shown that nutrition, biology and family factors—such as mealtime rituals and child involvement in food preparation—interact to predict dietary habits later in life (Appetite, Vol. 126, 2018).
Now, practitioners and health-systems administrators are using these insights to improve patient care in a variety of ways: through culinary medicine programs for clinicians, which combine cooking skills with nutritional science; hands-on learning initiatives for children; and integrated-care programs for patients.
“Psychologists are a crucial part of the interdisciplinary effort to improve diet quality, which in turn improves overall physical and mental health,” says Leanne Mauriello, PhD, director of behavioral science and lifestyle management at Spectrum Health, an integrated health system based in Grand Rapids, Michigan. “Their expertise in human behavior allows them to help patients make successful and sustained changes to their dietary behaviors.”
The training psychologists pursue to work on nutrition issues is varied. While some earn doctorates in clinical health psychology then earn a master’s in nutrition, others get less formal training. Here are some of the efforts psychologists are spearheading to apply culinary health insights to boost population health.
One of the leaders in supporting nutritional health is Spectrum Health, which serves nearly 1 million members with 12 hospitals and 3,600 providers in western Michigan. The health system’s culinary medicine program, launched in 2017, offers a curriculum for medical residents as well as continuing education for licensed clinicians, including nurses, psychologists and dietitians. Classes combine nutritional education with hands-on cooking instruction to give participants the knowledge, skills and confidence to cook healthy and affordable meals at home. Spectrum Health also began offering classes to its patients in October.
Psychologists are central to the effort, both in educating medical residents and clinicians about the behavioral principles associated with nutrition and dietary change and in working directly with patients who need support maintaining healthier diets and implementing the skills learned during culinary medicine classes.
“Psychologists know that when patients leave, there’s still a whole set of barriers and routines that can either help or hinder them translating what they’ve learned into their home kitchen,” says Mauriello, whose expertise in behavior change stems from her training in experimental health psychology. “The power of the clinical health psychologist is in coaching the patient to overcome those barriers and in providing continued support throughout the behavior-change journey.”
Spectrum Health’s team-based approach involves a collaborative effort among psychologists, dietitians, chefs and physicians. To follow patients’ progress, the health-care team relies on ongoing electronic communication with patients, reviewing photos of meals, sending healthy recipes and prescribing mobile applications such as MyFitnessPal to help patients monitor their own progress.
A practical tool
Clinical health psychologists are also incorporating new culinary health findings into their work with patients. After 20 years in clinical psychology practice, Broch earned a master’s in nutrition after observing a pattern in her patients and personal life: Digestive issues appeared closely linked to feelings of poor mood and low energy.
“I often suggest an elimination diet that challenges patients to cut out foods they may be sensitive to,” such as dairy, gluten and red meat, she says. Broch monitors how patients respond and instructs them to reincorporate foods slowly over a period of several weeks.
Nicole Bereolos, PhD, MPH, a clinical health psychologist and certified diabetes educator based in Dallas, helps patients make dietary changes to address both chronic illness and the associated psychological issues. Diabetes, for instance, can present with obsessive-compulsive disorder or disordered eating because of the numerous metrics patients must monitor, such as blood sugar levels and insulin-to-carbohydrate ratios.
She helps patients reduce unhealthy eating habits by making small, manageable changes. Even losing a few pounds can greatly increase a patient’s self-efficacy and lead to more significant progress, she says.
For example, one patient’s dietitian instructed her to monitor water intake, exercise, steps, calories consumed and more than 12 different macro- and micronutrients in her charge to lose weight. “She was going to get tired of that in about three days,” Bereolos says. “My job was to take those instructions and psychologically set her up for success.” They picked two items to track: protein and exercise. Bereolos says the patient achieved a minor success early on, increased her confidence and ultimately met her weight-loss goal.
Teaching kids healthy behaviors
Psychologists are also key to the Illinois Junior Chefs program, which is run by the University of Illinois Office of Extension and Outreach and teaches low-resource children ages 8 to 13 the importance of a healthy diet as well as how to cook. Typically administered in five two-hour lessons during summer break, the experiential program, which began in 2016, will go nationwide next year.
“We know that culinary skills have gone by the wayside in the last decade—adults cook much less than they used to,” says Fiese, whose doctoral student is evaluating the program’s effectiveness. “This is beginning to have an impact on kids because they don’t have opportunities to model these skills early on.”
“Regardless of their background, it’s important for kids of all ages to develop independent cooking skills so that they can make healthy choices when they’re on their own,” says Jessica Metcalfe, MPH, a doctoral candidate in human development and family studies at UIUC and research coordinator for the program.
According to research by Fiese and Metcalfe, children who participate in the one-week class show significant improvements in cooking skill, attitudes toward cooking, healthy cooking behaviors and preferences for fruits and vegetables (Journal of Nutrition Education and Behavior, Vol. 49, No. 7, 2017).
Moving forward, Bereolos suggests that dietitians, physicians and psychologists collaborate more in their work on dietary behavior change. “Integrating our continuing education and practice is the best way to identify gaps in our training. This will allow us to continue opening our eyes about the relationship between food and mental and physical health,” she says.
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