Abstract
In a fast-paced, fast-food world, the practice of home cooking seems to have all but fallen to the wayside. In fact, research suggests that in the United States, the frequency and amount of time spent on home cooking has decreased significantly with a continuing decline. A recent report 1 showed that between 1997 and 2014, expenditures in the United States for food at home significantly decreased, while expenditures for food away from home increased. Unfortunately, these changes in the American eating pattern directly contribute to the burgeoning epidemics of obesity, diabetes, cardiovascular disease, and other chronic disease. That's how important healthy home cooking turns out to be.
John La Puma, MD, FACP, founder of Chef Clinic and co-founder of ChefMD, in an interview commented, “Today, cooking is often something other people do for us. Many people eat more prepared foods than home cooked foods. We watch other people cook on TV while eating something packaged, picked up, ordered in or dropped off. We spend more time eating out than we spend on eating at home.” La Puma added, “Yet the longest-lived and most well-being-centered peoples around the world—those in National Geographic's five Blue Zones (Okinawa, Nicoyan Peninsula of Costa Rica, Sardinia, Icaria (Greece) and Loma Linda, California)—have something in common, which is home cooking for nearly all meals, with only a rare meal out at a friend's house who has cooked for you.”
In fact, one might not have thought that home cooking would ever need to be prescribed, since in decades past, it was a staple of American life. Today, however, healthy home cooking is an essential prescription for preventive health measures and for people with specific medical problems. In a recent study analyzing data from the 2007–2010 National Health and Nutrition Examination Survey, Wolfson and Bleich found that among >9000 participants, 8% lived in households where someone cooked dinner at home once a week or less, 44% had a cooked dinner at home two to five times a week, and 48% had a cooked dinner at home six to seven times a week. 2 This is a significant reduction compared to the percentage of people cooking dinner at home in the past. The good news is that compared to people who rarely had dinner cooked at home (never to once a week), those who frequently had a cooked dinner at home consumed fewer calories and a healthier diet. Cooking more frequently at home was also found to be protective regardless of weight-loss intention, according to the authors, who stated, “If a person or someone in their household cooks dinner frequently, regardless of whether or not they are trying to lose weight, diet quality improves. This is likely due to the relatively lower energy, fat and sugar contents in foods cooked at home compared with convenience foods or foods consumed away from home.”2 This is important information in a world where many of the top chronic diseases of our time now have management and treatment protocols that recommend lifestyle behavior change and particularly eating a healthy diet as a first-line therapy.
Why the Change in Cooking Patterns?
Reasons for the change in cooking habits in recent decades are many and include the abundance of available convenient and prepared foods today, dual-working families with fewer people available or with the energy to cook meals at home, increased takeout options, unlimited dining out options—and the list goes on. Cindy Attias, a personal chef, certified health coach, and owner of Attias Food Consulting, Cleveland, Ohio, commented in an interview, “Daily home cooking has become a thing of the past for many, which led me to reflect on what has changed, what is different? Some of the reasons include the fact that there is an increase of single person homes, homes with two working parents and/or single parent families who are challenged with exhaustion and time constraints, and there are fewer multi-generational homes.” Importantly, Attias added that in addition, fewer people are learning to cook during childhood. She said, “In the past, it was the norm in many families to divide up the chores and prepare a family meal as a team with everyone assigned an appropriate job, and that's how we learned.” Attias pointed out that home economics classes are no longer mandatory in many schools, and she said, “Those classes are where many of us learned how to balance a checkbook, hammer a nail, grill a cheese sandwich, and bake a cake. Today, such classes have been cut from school curriculums. This is unreasonable, and I ask you, as adults, which skill is more important in day-to-day living at home, algebra or scrambling an egg?”
In fact, a recent analysis found that for people entering adulthood, those people reporting “very adequate” cooking skills at age 18–23 years “predicted better nutrition-related outcomes 10 years later, such as more frequent preparation of meals including vegetables and less frequent fast food consumption.” 3 The authors of the study concluded, “Developing adequate cooking skills by emerging adulthood may have long-term benefits for nutrition over a decade later.” 3
Food as Medicine
The thinking that we should eat to live rather than live to eat has perhaps never been more apt in a society that suffers from overconsumption on many levels. Educating people about the importance of healthy home cooking for optimizing well-being is an essential role of a clinician's job, and they should know that home cooking's benefits start early, according to La Puma. He said, “Children who eat more home cooked meals have less obesity and eat more fruits and vegetables than children who spend more time in restaurants. Eating home cooked meals more frequently is also associated with greater adherence to the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets, lower body mass index (BMI) and less body fat.”
In terms of just how important home cooking can be for preventing and managing specific medical conditions, La Puma, in an article on culinary medicine stated, “Some eating patterns have been found to be as or more effective than prescription medication for some conditions: an anti-inflammatory eating pattern for rheumatoid arthritis; a ketogenic diet for epilepsy; a Mediterranean eating pattern for cardiovascular disease, advanced colon cancer, and type 2 diabetes. Several foods have been found to be as or more effective as well: legumes for cholesterol lowering; soy nuts for systolic and diastolic hypertension; tree nuts for metabolic syndrome; baked and broiled fish for heart failure; honey and milk for acute cough. For many patients, nutritious food is medicine.” 4
Compared to consumption of highly processed foods, which abound in our culture today, a home-cooked meal is often prepared with five ingredients or fewer. Attias commented on the benefits of this and said, “When you are aware of the ingredients or the lack of ingredients in a meal, it is less complicated to pinpoint what may be healing a person or what may be making them ill. Food can make us feel sluggish, or it can strengthen us so that we are prepared for the challenges of the day.” She reported that with fewer ingredients in a meal, it is easier for the body to digest the food (less gastrointestinal issues), and the body does not have to work as hard to process vital nutrients. She added, “When speaking to my clients, I often compare their organs to filters. A dirty filter may do its job, but a clean filter will do its job with superior results. I remind them to read labels and tell them, ‘If you don't know what it is, you probably shouldn't put it in your mouth.’”
La Puma agreed that when a person cooks at home, there are benefits to having more control over the ingredients. He said, “Cooking allows a person to be in charge of the flavor and texture of their food. It also allows them to be in charge of their own health. A person cooking at home controls the ingredients and is able to avoid the cheap fillers, flavor enhancers, and added salt, sugar, dyes and tallow that end up in a lot of prepared and processed food.”
Prescribing Home Cooking
In a Johns Hopkins press release on home cooking as a main ingredient for a healthier diet, Wolfson commented, “It's important to educate the public about the benefits of cooking at home, identify strategies that encourage and enable more cooking at home, and help everyone, regardless of how much they cook, make healthier choices when eating out.” 5 She added that “people who cook infrequently may benefit from cooking classes, menu preparation coaching or even lessons in how to navigate the grocery store or read calorie counts on menus in restaurants.”
La Puma affirmed that every patient should have access to evidence-based, practical, culturally sensitive advice about issues of food, cooking, and eating specific to her or his particular case. He said, “These issues, though seldom explicitly discussed, arise daily during patient visits. Identification, analysis, and resolution of these issues should become an explicit part of clinical visits, and a patient's medical history and treatment plan.” La Puma offered a practical way to think about prescribing home cooking in an article and reported: “Culinary medicine, like prescribed exercise, should become another tool in a clinician's toolkit. One such format for writing culinary medicine prescriptions is FOOD: Frequency (of the food, beverage, or meal to be eaten); Objective (its goal); Options (how much, and different methods to prepare, serve, shop for it, or grow it); Duration (how many times per day, week, or month the prescription should be consumed). This format is simple to follow and patterned after how clinicians prescribe medication.” 4 La Puma also recommended having recipes on prescription slips, which he said patients love and that they will make the recipes and talk to their clinicians about them.
Of course, the benefits of home cooking expand beyond the physical results. In her work as a personal chef and health coach, Attias said, “People hire me for a specific reason such as help with a recent diagnosis, chronic illness, or maybe improved stamina, and there are the obvious beneficial results obtained from increased home cooking and eating whole foods such as the decreased need for insulin for diabetics, less joint pain for athletes, or improved sleep and increased energy, etc. But what I enjoy the most are the unexpected results. It has been surprising to me, that 100% of the time, it is the collateral rewards, which have the most meaningful impact on the people involved. For example, I might receive a message from a family with teenage girls that ‘Lisa ate fish tonight and liked it, and Julie commented that dinner was fun, and there was no crying at the table. Thank you.’ In this case there was an improvement not only in the physical aspects, but also in the emotional and social well-being of the family.”
A caveat from many experts, however, is that home cooking is not a one size fits all philosophy. Attias commented, “People ask me all the time to write a cookbook or a blog with the recipes I routinely prepare. As a personal chef, there are no recipes that I routinely prepare. The privilege of being in a home, allows me the opportunity to constantly adjust according to my clients' needs or preferences. I have never had nor will I ever have two clients who eat alike.”
Clinicians should guide their patients toward a system that has the least amount of obstacles and the highest degree of personal preference, according to Attias. She stated, “One person may be receptive to meal plans with shopping lists, another may look at such a document as if it is a physics course in a foreign language. Another person may need to learn how to make meal preparation easier, and maybe it is as simple as guiding them toward a video that teaches basic cooking skills, but it should be everyone according to their ways and their financial resources.” Attias also advised that clinicians have a variety of support services available to distribute to patients such as lists of delivery meal systems, lists of books, available cooking classes, and names of health coaches and personal chefs. She added that a team approach is always helpful and that several service providers could cooperate and provide group cooking classes, resources, menu preparation, coaching, or even lessons in how to navigate the grocery store.
Conclusion
In fact, few perhaps consider the toll that the lack of healthy home cooking is taking on our health and the important benefits of doing so regularly. Clinicians who engage in a conversation about healthy home cooking and better yet develop a habit of prescribing home cooking for their patients will go a long way toward helping their clients.
Finally, La Puma recommended that clinicians “walk the talk” and learn something about cooking and eating that is personal. He advised clinicians: “Take an online or real-life cooking course, or hire an expert to tutor you. Try to find a historical, personal, emotional or social connection to cooking and food that makes you feel good: you'll enjoy all food and cooking more, and believe it or not, your food will taste better. Remember that your own behavior is a strong predictor of how you will counsel your patients. By improving your own habits, your patients can benefit.” ■