The prescriptive whiteness of culinary medicine: Reinforcing medical authority through epistemic erasure

Introduction

Registered Dietitian Nutritionists (RDNs) provide nutrition care in clinical settings in the U.S., with medical nutrition therapy representing a core reimbursable service for chronic disease management. And because many patients experience myriad barriers to healthy food consumption, including limited access to whole foods and limited culinary skills, medical nutrition therapy frequently includes food-based counseling and education (No author, 2024). In recognition of the important role that nutrition plays in the management of diet-related disease, interest in nutrition has grown across health professions. A nutrition nurse credential, for example, aims to formally integrate nutrition interventions into nursing practice (Dogan et al., 2022). Similar training efforts are emerging in pharmacy and other allied health fields (Board of Pharmacy Specialties, n.d.; Harvard Medical School Professional, Corporate, and Continuing Education, n.d.)

Within this context, culinary medicine (CM) has emerged as a disruptive innovation that integrates food and nutrition into clinical medical education and care (Eisenberg and Burgess, 2015; La Puma, 2016; Mozaffarian et al., 2024). CM is framed as both a clinical and curricular breakthrough to help patients make food-related decisions (Croxford et al., 2024; Deuman et al., 2023; La Puma, 2016; Mozaffarian et al., 2024; Thomas et al., 2023). The interest in nutrition and CM is also observed in an influx of new federal and organizational investments in CM research and implementation. More than a dozen large scale grants totaling hundreds of millions of dollars are funded by agencies like the National Institutes of Health and United States Department of Agriculture. These efforts underscore that CM is not a fringe innovation but a field rapidly institutionalizing through the support of substantial policy and research infrastructure (The Rockefeller Foundation, n.d.; United States Department of Agriculture and National Institute of Food and Agriculture, n.d.; United States Department of Health and Human Services, n.d.).

Early critiques of CM have begun to emerge, particularly those that highlight how CM reinforces existing medical hierarchies and perpetuates gatekeeping around access to food. For example, scholars Landry and Hollis-Hanson argue that CM largely excludes individuals who are uninsured, low-income, or food insecure, the most at-risk groups who are frequently excluded from traditional systems (Landry and Hollis-Hansen, 2025). They highlight how early approaches to CM programs and policies reproduce structural exclusion in existing systems and fail to address the root causes of diet-related chronic disease. Deepening that critique, this article asserts that CM’s institutional ascent depends on epistemic erasure that serves to recenter white, male, medical dominance over historically feminized, marginalized knowledge and expertise. I explore how CM reproduces epistemic inequity and reinforces dominant hierarchies in CM’s two domains: medical education and clinical integration. In both cases, CM reframes previously devalued food-based care as a novel medical innovation, ignoring existing dietetic and community-based knowledge systems and only recognizing more prestigious, white, male-dominated models. This recoding and appropriation of culinary health expertise reflects racial capitalism, epistemic injustice, and gender bias. While CM may offer short term solutions to gaps in access to healthy food, this article highlights the need for a more inclusive ideological foundation to strengthen efforts and address root causes of diet-related disease to improve population health.

Methods and conceptual framework

This article uses critical theoretical analysis to examine how Culinary Medicine (CM) is framed, legitimized, and institutionalized within the U.S. health system by interrogating the power structures and epistemic logic that underlie its emergence. The analysis is interpretive in nature, drawing on interpretive policy analysis and critical approaches to discourse to examine how legitimacy, authority, and knowledge are constructed within CM (Dvora, 2000; Fairclough, 2010.). This approach identifies patterns in how CM is described, justified, and positioned within dominant institutional narratives.

I became interested in CM through its presentation in recent literature, particularly work exploring interdisciplinary collaboration and the role of nutrition in medical education and clinical care. These texts prompted a deeper investigation into CM’s institutional development and the narratives constructed around its novelty. To trace these developments, I conducted an iterative review of academic literature, professional publications, and public-facing documents that shape and reflect CM’s institutional narrative. Through citation tracing and repeated engagement with publicly available texts, I identified the organizations and institutions most central to the development and promotion of CM, including Tufts University’s Culinary Medicine program, Health Meets Food, and the Teaching Kitchen Collaborative.

What is culinary medicine?

Over the past two decades, CM has gained broad acceptance as both a curricular innovation in medical education and a model for food interventions in clinical care settings. CM comprises two primary domains: (1) nutrition education within medical education and training and (2) patient-facing programs and services known as Food is Medicine interventions, encapsulating medically tailored meals and produce or grocery prescription programs.

In medical education, CM is framed as a novel addition to the medical curriculum that compensates for historical gaps in nutrition training among physicians. Although CM is presented as filling a void, physicians emphasized the importance of nutrition in medical education as early as the 1930s but efforts to integrate it into the medical curriculum were not sustained or systematically embedded in training (Nutrition Education in U.S. Medical Schools, 1985). Subsequent periods of renewed interest, particularly in the 1960s and again in later decades, similarly failed to produce lasting structural integration, reflecting a recurring pattern in which nutrition is periodically elevated but not institutionalized within medical education.

Until recently, most U.S. medical schools offered only minimal instruction on nutrition, and board certifications did not require competency in food-based care (Eisenberg and Burgess, 2015). In response, organizations like the American College of Culinary Medicine have developed curricula that combine basic nutrition science with culinary skill-building, clinical case application, and lifestyle counseling. These initiatives have been widely adopted, with the Health Meets Food curriculum reaching over 50 medical schools (Health Meets Food, n.d.; Magallanes et al., 2021) Flagship events like the annual “Healthy Kitchens, Healthy Lives” conference further cement CM’s role in reshaping medical education (Healthy Kitchens, Healthy Lives, n.d.).

Patient-facing components of CM focus on integrating food directly into treatment and care plans. Food-is-Medicine (FIM) programs include medically tailored meals, produce prescription programs, and medically tailored groceries, all of which are designed to improve clinical outcomes by addressing food insecurity and poor diet quality (Deuman et al., 2023; Mozaffarian et al., 2024). These programs are often linked to healthcare systems via electronic health records and are promoted as solutions to improve health.

CM is frequently described as a novel, evidence-based, and interdisciplinary approach to addressing diet-related disease through clinical and educational interventions (Eisenberg and Burgess, 2015; La Puma, 2016; Mozaffarian et al., 2024). Early leaders emphasized its innovation and framed CM as a practical response to patients’ immediate dietary needs, distinct from other approaches. This positioning implies that CM occupies a new domain of clinical relevance, separate from and potentially superior to the long-standing field of dietetics. While these claims are used to justify the need for CM and its full-scale integration, they are not explained or substantiated. Instead, CM’s implementation centers physicians and medical organizations, epistemically erasing and repackaging nutrition expertise under medical authority. The sections below examine how CM, across its domains of medical education and healthcare integration, reflect and reproduce entrenched patterns of racial capitalism, epistemic exclusion, and the devaluation of feminized labor. The first traces how CM’s institutional narrative marginalizes dietetic expertise and the second section shows how similar erasures shape CM’s relationship to community-based programs.

Medical authority and the erasure of dietetics

CM’s institutional rise within medicine depends on reorganizing professional authority in ways that erase the feminized expertise of dietitians. Despite its frequent description as an innovative, evidence-based response to the absence of nutrition education in medical training, CM routinely fails to acknowledge the long-established contributions of dietetics, a profession composed predominantly of women and shaped by over a century of food- and nutrition-based care (Eisenberg and Burgess, 2015; La Puma, 2016; Mozaffarian et al., 2024). While CM leaders gesture toward interprofessional collaboration, its organizational structures and rhetorical strategies consistently reinforce medicine’s centrality, with physicians as the drivers of nutrition innovation and rendering dietetic expertise invisible (Croxford et al., 2024; Deuman et al., 2023). This pattern reflects epistemic erasure, a systematic dismissal of the knowledge held by marginalized groups and a reconfiguration of authority that legitimizes food-based care under male-dominated medical institutions (Dotson, 2011).

This pattern is evident in some of the earliest and most widely cited peer-reviewed publications describing CM. John LaPuma, who helped popularize the term Culinary Medicine, describes it as “not nutrition, not dietetics,” but rather “a practical discipline concerned with the patient in immediate need, who asks, ‘What do I eat for my condition?’” (La Puma, 2016: 1) This assertion relies on a rhetorical distinction: CM is presented as clinical, urgent, and medically relevant – and implicitly in contrast to dietetics, which is cast as unresponsive, indirect, or insufficient. But dietetics is, by definition, focused on what one eats for their condition (Merriam-Webster, n.d.). While LaPuma draws a boundary between CM and dietetics, he does not elaborate on what differentiates the two fields, a notable omission given that dietetics encompasses clinical nutrition therapy, therapeutic meal planning, nutrition counseling, and evidence-based dietary interventions for chronic disease management (No author, 2024).

Instead, the distinction functions rhetorically: CM is framed as clinical, relevant, and urgent in contrast to dietetics, which is left unnamed and uncredited. David Eisenberg, describing CM’s origins in an interview, credits collaboration between medicine and the Culinary Institute of America (another white male-dominated institution), while entirely omitting decades of dietetic expertise and attention to the same issues they identified as novel and urgent (Multiversity, n.d.). Eisenberg positions nutrition knowledge as absent from healthcare rather than marginalized within it. Even credentials offered within CM, such as the Certified Culinary Medicine Specialist program, positions RDNs as learners alongside physicians and nurses, recasting dietitians’ expertise as a deficit to be remediated through medical instruction (Why Become a Certified Culinary Medicine Specialist?, n.d.). Using discourse that renders dietetics invisible or tangential to CM is a contemporary iteration of a much older pattern of dismissal: nutrition and home cooking, historically coded as “home economics,” were long dismissed by medicine as domestic, unscientific, and feminized labor (Dreilinger, 2022; Scott, 2009). CM’s failure to recognize dietitians as co-creators of the practices they’ve built reflects a deeper logic of preserving medical hierarchy and asserting epistemic dominance in healthcare. Innovation, in this case, is just recoding.

The historical record challenges CM’s claims to novelty. As early as 1884, Sarah Tyson Rorer, considered a founder of modern dietetics, led a cooking school in Philadelphia where she regularly lectured to physicians and medical students about food preparation, dietary modification, and therapeutic nutrition (Cassell, 1990). Culinary approaches to health have long been core features of dietetics practice, which includes nutrition counseling, clinical care, and culinary instruction (Croxford et al., 2024; Thomas et al., 2023). Yet this foundational expertise and the resources to provide it are rarely acknowledged in CM literature. For example, while teaching kitchens and culinary education programs often rely on RDNs for implementation, these professionals are described in supporting roles, with leadership and authorship concentrated in medicine (Croxford et al., 2024; Thomas et al., 2023). Known barriers to incorporating nutrition into medical education include resources like funding, kitchen space, time, and faculty (Hildebrand et al., 2025; Thomas et al., 2023), which are already embedded in (and often core features of) dietetics education and training programs. What CM promotes as novel (culinary skill-building, patient-centered nutrition education, and food-based disease prevention) has long been central to dietetic training and practice (Thomas et al., 2023).

Nutrition has long been dismissed by medicine as outside the boundaries of legitimate clinical care, largely because of its association with women’s domestic labor. Early 20th-century physicians viewed nutrition education as imprecise, intuitive, and unscientific and best left to “women’s cooking schools” rather than integrated into medical curricula (No author, 1910). Even as early dietitians and home economists embraced scientific methods to legitimize their work, their proximity to the kitchen and caregiving rendered their expertise subordinate to that of male physicians (Dreilinger, 2022; Scott, 2009). Women working as dietitians professionalized under male oversight, but remained structurally marginalized, shaped by white, gendered values about eating and feeding.

The treatment of dietetic expertise within CM reflects a broader pattern in which medicine has systematically appropriated women’s health expertise. The displacement of midwifery offers an instructive parallel. As obstetrics professionalized in the early 20th century, medical authorities positioned midwifery as antithetical to scientific progress, with prominent obstetrician Joseph DeLee declaring in 1915 that midwives had “perverted obstetrics from obtaining any standing at all among the science of medicine.” White, male obstetricians recast Black midwives as untrained and obsolete, so they could dominate maternal care under claims of professionalism and safety (Goode, 2014). This type of exclusion was foundational to establishing medical authority, extracting practices from female-led care systems, then re-legitimizing them through male-dominated professions. Culinary Medicine, in its appropriation and reframing of dietetics, follows this same structural logic.

These omissions reflect more than simple oversight. They illustrate how medical authority erases women’s dietary health labor, reframing it as inferior or outdated, making it easier to rebrand (Bueter and Jukola, 2025; Dotson, 2014). Dietetics became a feminized profession in large part because male-dominated medicine dismissed nutrition work as imprecise, domestic, and unscientific, resulting in an undervalued and undercompensated female-dominated profession (Dreilinger, 2022; Scott, 2009). By positioning CM as distinct from and superior to dietetics, CM leaders reinforce medicine’s dominance and elevate physician expertise, even in a domain historically shaped by women and community-based practitioners who have been excluded or devalued in the medical professional hierarchy.

In the practice of CM, registered dietitian nutritionists are selectively included in implementation but rarely acknowledged as experts or leaders. Often responsible for therapy, counseling, and group education, and menu design, RDNs are framed as supportive team members rather than architects of the practices now being institutionalized within medicine. This marginalization persists despite that accredited dietetics programs require rigorous training in nutrition science, behavior change, culinary science, and chronic disease management, which is more comprehensive than the nutrition education in medical education and culinary medicine training programs (Academy of Nutrition and Dietetics, 2021; Why Become a Certified Culinary Medicine Specialist?, n.d.). Yet CM leaders, including those affiliated with the Health Meets Food curriculum, have positioned dietitians as part of the target audience for culinary medicine certification, grouped alongside physicians, nurses, and pharmacists as learners (No author, n.d.). This reframing is not neutral. It recodes dietitians’ expertise as a deficit to be remediated by attending (less rigorous) training programs offered within medicine.

Medicine has historically dismissed cooking and food-based care as unscientific, feminized domestic labor. In the contemporary CM movement, this dynamic appears dietitians are cast as recipients (not experts) of nutrition and culinary instruction, sidelining a deep body of knowledge developed largely by women. In doing so, CM leaders recast dietetic practices through a medical lens to bolster physician authority, while erasing the women-led expertise that built them. In essence, appropriating feminized labor while denying its legitimacy. This dynamic is consequential in interprofessional practice settings where it implicitly shapes whose knowledge is centered and which professionals are treated as experts.

Erasing expertise outside the clinic

The way medicine has absorbed culinary interventions has not only erased dietetic expertise but also overlooks long-standing community-based models that already operationalize nutritionally tailored meals programs at scale. While often framed (and thus understood) as a critical community resource serving low-income older adults, programs like Meals on Wheels operate within broader socially hierarchical systems shaped by racial capitalism. These systems produce the conditions that drive food insecurity, shape the need for access programs, and influence how programmatic efforts are valued relative to clinical interventions.

For more than seven decades, Meals on Wheels (MOW) has supported the health of older adults by providing meals adapted for low-sodium needs, vegetarian preferences, or culturally specific diets (Meals on Wheels America, 2023). A 2023 review by Meals on Wheels America analyzed 38 studies from 1996 to 2023 and found consistent positive outcomes among MOW participants, including increased food security, increased diet quality, reduced nutritional risk, reduced social isolation, and reduced falls and increased home safety (The Case for Meals on Wheels: An evidence-based solution to senior hunger and isolation, 2023). Healthcare related outcomes were also measured, finding reduced hospital admissions and readmissions and reduced emergency department visits, the kinds of outcomes CM programs use to justify intervention. What MOW lacks in sophistication, it makes up for in perseverance. MOW is commonly known as an underfunded public program, sustaining itself through federal, private, and philanthropic mechanisms. The meals themselves are not considered gourmet nor individualized, some recipients even compare the quality to the school meal stereotype (Papadaki et al., 2024).

Despite developing a successful model for how to scale a nutritionally tailored, home delivered meals program, MOW and similar community-based programs are absent from the CM literature. In their place is medicine’s claimed innovation of medically tailored meal (MTM): nutritionally tailored meals rebranded as clinical interventions. This shift reflects the logics of racial capitalism, in which practices developed in low-prestige, under-resourced contexts are devalued until they can be repackaged within dominant institutions as profitable (i.e. billable) innovations (Robinson, 1983). The epistemic erasure of existing community-based programs may be related to their lack of prestige, particularly through medicine’s elitist lens. CM was championed by white male physicians and chefs from the Culinary Institute of America, including those who conceptualized CM on a vineyard in Napa Valley (Healthy Kitchens, Healthy Lives, n.d.). This rebranding created a market opportunity for MTM providers, a billing mechanism for insurance companies – ultimately, additional ways to generate profit, particularly for dominant groups, illustrating the entrenchment of racial capitalism within healthcare systems.

Community-based programs like MOW, remain unrecognized as predecessors of CM because they fall outside of the medical hierarchy that epistemically privileges dominant clinical, elite institutions and renders everything outside of that space invisible (Carel and Kidd, 2014). CM’s roots in prestige and professional dominance have shaped its construction whereas MOW, with little prestige and operating within spaces lower on the medical hierarchy, is ignored because of this perceived irrelevance. This erasure is not benign. It devalues community expertise, reduces the possibility of co-created interventions, and replicates patterns of institutional harm through structurally sustained epistemic oppression (Dotson, 2014). Specifically, the pattern of ignoring or failing to recognize programs outside of the medical sphere reflects a pattern of contributory injustice, whereby the knowledge created by a marginalized group or one with less structural privilege (e.g. one at the bottom of the medical hierarchy) is ignored or misunderstood by the dominant group. In this case, despite decades of proven impact, community-based programs like MOW are not viewed as equivalent to CM because they exist outside the medical hierarchy, thus lack prestige and, to some degree, legitimacy as recognized models of early FIM. Instead, physicians leading CM redefine what counts as a credible nutritionally tailored meal intervention by casting FIM as their innovation, reinforcing the hierarchy in which community-based expertise is overlooked.

These same patterns of epistemic exclusion appear in how CM engages with cultural foodways and non-Western health knowledge, further reinforcing biomedical norms. Data indicate that community-derived food knowledge is frequently subordinated to white, biomedical dietary health frameworks, despite its importance for cultural humility and effective, personalized care (Burt, 2021; Croxford et al., 2024; Hassel, 2014; Maddox and Morton Ninomiya, 2025). When patients or community members bring up traditional, cultural, or community-based food or dietary health practices (e.g. herbal treatments for ailments or culturally specific dietary norms) in CM settings, physicians and other health care providers often reinterpret these practices through a white normative, biomedical lens. In doing so, health professionals frame cultural practices as unscientific, outdated, or even unhealthy, and privilege white practices. By framing non-Western and community-rooted knowledge as unscientific or in need of correction, CM reproduces the epistemic injustice and silencing knowers whose experiences and perspectives could expand and deepen FIM programs.

This reflects how knowledge and legitimacy in CM are measured by alignment with elite institutions and professional hierarchies rather than patient outcomes. FIM programs mirror the same epistemic exclusion and institutional biases, likely impacting the possibility of more equitable and informed models of food-based care. Programs like MOW, which are shaped by community-rooted, feminized, and racialized expertise, are marginalized by professional norms that prioritize white, medical authority. This exclusion is structural and it limits the possibilities for more equitable, community-informed models of food-based care within CM.

Toward immediate food access and structural transformation

Culinary Medicine (CM) offers a case study in how structural and ideological biases shape food and diet related care. Across domains of medical education and nutritionally tailored food programs, CM reflects broader patterns of epistemic exclusion, institutional appropriation, and medicalized gatekeeping that redefine dietary care along racialized and gendered lines. Importantly, they also reinforce racial capitalism, where marginalized forms of expertise are rendered invisible until they can be commodified for profit under dominant groups.

These implicit biases also manifest explicitly in CM’s implementation. For example, the continued use of high BMI as an eligibility criterion for MTMs perpetuates structural gender and racial bias and medical gatekeeping. As scholars have argued, BMI is not a neutral clinical tool; it has well documented racialized and gendered origins and applications, embedding white, thin-bodied norms into definitions of health and risk (Flegal, 2023; Strings, 2019). When used to determine eligibility for services, BMI transforms from a measure of risk into a mechanism of gatekeeping, making access to nutritionally adequate food conditional on meeting standardized clinical thresholds. As a result, individuals whose food access and health risks are shaped by structural inequities may be excluded simply because it is not captured by the metric itself.

These interventions provide short-term support but do little to dismantle the structures that produce food insecurity in the first place. In general, charity-based models of food procurement fail to address root causes of food insecurity and instead perpetuate a corporatized system that benefits dominant groups and masks inequities (Caraher and Furey, 2022; Poppendieck, 1999). CM mirrors this logic by medicalizing food insecurity and positioning clinical intervention (rather than systemic change) as the solution.

While perpetuating dietary biases, CM programs also demonstrate measurable health benefits. Participation in CM programs may improve vegetable intake, blood pressure, cholesterol, or food security scores (Hudak et al., 2025; Seligman et al., 2025). These findings are valuable and deserve continued attention. And, access to these foods needs to be sustained outside of the intervention period if long term benefits are to be realized. Otherwise, patients discharged from FIM programs will be reintroduced to their regular home food environment and lack the support to maintain their new eating pattern. Despite promise for CM interventions, systemic benefit cannot be realized through short-term clinical gains. To truly improve population health, CM must confront the structural and institutional biases it reproduces by embracing feminized, racialized, and community-rooted knowledge and expertise and integrating it into more equitable, interprofessional models of care to improve long term health outcomes through clinical gains and more equitable systems.