Abstract
Objective
While obesity is a public health threat, many providers feel ill-prepared to advise patients on diet and nutrition for disease prevention. Miami, Florida, has a unique mix of ethnicities and cultures, and more than half of its residents are born outside the US, which creates additional barriers to providing adequate dietary advice. This study aimed to develop and refine a “food-as-medicine” and community service program in this culturally diverse region to improve future health care providers' knowledge, skills, and self-care practices.
Methods
Feasibility was assessed using Bowen et al.'s framework, examining demand, acceptability, practicality, and implementation. Preliminary efficacy was determined by assessing student learning. A panel of four medical students provided consultation for developing this course. Twenty-four medical and six physical therapy (PT) students attended, and 21 completed both the pre- and post-surveys. The course consisted of four 2.5-hour classes, including lectures on diet/nutrition, social drivers of health, case studies, and chef-led cooking activities. Attendees subsequently provided diet/nutrition workshops to children in the community.
Results
Most students (87%) attended at least three class sessions and the community service activity. Nutrition subscales, knowledge (P = 0.018), health equity awareness (P < 0.05), and dietary advice confidence (P < 0.05) improved. PT and medical students did not differ in attitudes toward the importance of nutrition for disease prevention or the survey subscales.
Conclusions
Strong participation, improved understanding, and confidence in dietary advice confirmed the feasibility and preliminary effectiveness of integrating a “food-as-medicine” program into medical and PT curricula, enhancing nutrition awareness and developing referral competencies for obesity-related chronic disease prevention.
Obesity is a complex condition influenced by genetic, social, environmental, and behavioral factors. 1 While genetic factors generally remain stable, obesity rates have risen from around 30% to 42% over the past two decades.2,3 Evidence suggests modifiable lifestyle behaviors can alter the impact of genetic predisposition on obesity. 4 In turn, obesity is a risk factor for non-communicable chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease, and cancer. 5 Over the past 50 years, diets deficient in essential nutrients from fruits and vegetables and high consumption of saturated fat, sugar, and salt have worsened healthcare burdens. 6 Conversely, dietary improvements are central to chronic disease management and prevention.7,8
The Greater Miami region is the largest metropolitan area in Florida and the sixth largest in the United States, with a population of over 6 million people. 9 In Miami, 67% of adults 10 and 30% of children 11 are overweight or obese. The population of Miami is highly diverse, with 69% Hispanic, 14% Black or African American, and 13% white non-Hispanic; 66% speak a language other than English at home, and almost 54% were born outside of the US.12,13 More than half of the Hispanic/Latinos in Miami are Cuban; other sizable populations come from Venezuela, Colombia, Dominican Republic, Puerto Rico, Honduras, Guatemala, Mexico, Nicaragua, Haiti and Jamaica. 14 While integrating food-based nutrition strategies, such as a food-as-medicine approach into healthcare can promote long-term health,15,16 social drivers of health that influence dietary intake, including cultural norms, affordability, and food literacy make dietary guidance challenging. 14 As such, healthcare providers must consider multiple factors including cultural food preferences and cooking practices when they consider patients’ diets and nutritional intake to identify and address nutritional problems.17,18
Diet and nutrition education in U.S. medical schools are often insufficient, with many healthcare providers, including physicians, receiving minimal training and lack proficiency in obesity screening and recommendations; few medical schools teach the recommended 25 hours of nutrition, and few healthcare practitioners feel adequately trained. 19 Many schools have no required diet and nutrition classes 20 and an estimated one third of approximately 192 accredited medical schools in the United States have some form of hands-on cooking or culinary medicine programming. 21 A global meta-analysis spanning 11 US-based studies found that insufficient education hindered medical students' ability to deliver effective dietary counseling. 6 Even when offered, nutrition courses seldom include global cultural perspectives. 22 A pervasive lack of adequate training necessitates significant reform at all levels of medical education, 23 and is spurring a growing national call for sufficient medical nutrition education. A coordinated, multidisciplinary approach among physicians, physical therapists (PTs), and other healthcare providers can provide consistent guidance to support improved nutrition behaviors 23 Moreover, a range of providers with nutrition assessment skills can facilitate effective referrals to registered dietitian nutritionists (RDNs) when in-depth nutrition counseling is needed. 24
While physicians can play an essential role in advising patients on diet, PTs are well-positioned to reinforce nutritional messaging during recurring visits. 17 Although nutrition education is required for U.S. PT programs, its specific content is frequently undefined. 25 Less than 20% of PT students feel confident advising clients in diet and nutrition, and there is a vital need for more nutrition content and counseling skills to be taught in the PT curriculum. 26 This gap highlights the need for more comprehensive nutrition education throughout the healthcare spectrum. Recent food-as-medicine interventions have shown promise in addressing these educational gaps, with studies demonstrating improved nutrition knowledge, food literacy, and counseling self-efficacy among participants. However, most studies have evaluated programs geared toward medical students, and there is limited evaluation of interdisciplinary approaches that include physical therapy students. 27
Academic health systems can play a vital role in enhancing health and well-being, not only through patient care and the education of future healthcare providers, but also through community partnerships. Collaborative relationships with the community can enhance the academic health system’s role as a community health leader and increase health equity by building community trust. 28 By involving students, faculty, and staff and providing resources to enhance the health and well-being of the community, the neighborhoods surrounding medical schools can benefit. 29 This also provides student exposure to social and cultural influences effecting diet and nutrition. Student community involvement can include participation in free medical clinics, food pantries, and community health education. As more students participate in service activities that positively impact community health, they can continue to foster academic health partnerships within the community and learn directly about the communities they serve.
Teaching and learning kitchens used to create culinary medicine courses for food-as-medicine education offer both didactic medical nutrition education and hands-on cooking experiences and can be more effective than traditional medical school curricula because they enable students to actively engage with the curriculum, integrating knowledge into a practical understanding.20,30,31 The Culinary Medicine Project (CMP) is a feasibility study of an extra-curricular pilot program adapted from Northwestern University’s Cooking Up Health medical education program, 32 and incorporating suggestions from a panel of medical student advisors, and our community partner, Common Threads.
The current study addresses a gap in literature by describing the feasibility of an interdisciplinary culinary medicine program within a community-engaged learning framework that addresses a unique mixture of ethnicities and cultures in Miami, Florida, and taking into consideration the multifactorial influences on diet and nutrition. There is growing demand to increase educational focus on social drivers of health (SDOH) within the domains of nutrition, food, and health. 33 Our program responded to this call in gearing our program through the lens of cultural diversity and social economics. There have been few studies examining implementation with this focus. The innovation lies in: (1) interdisciplinary education targeting both medical and PT students, (2) a focus on developing nutrition awareness, cultural competency, food literacy, and referral proficiency, (3) developing community partnerships and integration of community service as a core curricular component for a sustainable academic-local community connection. The overarching goal is to use this project as a model for building a required course, as well as threading diet and nutrition throughout courses for students across multiple health professions.
Methodology
Study Design and Theoretical Framework
This pre-post intervention study design draws from Social Cognitive Theory, emphasizing the role of self-efficacy in behavior change and the importance of observational learning through hands-on experiences. 34
Program Development and Implementation
We partnered with Common Threads, a nonprofit organization specializing in nutrition education for children and families, tailored to promote sustainable and healthy eating habits that align with the diverse dietary needs of the Miami community. The curriculum was built around an experiential learning model. Studies have shown that interactive, hands-on learning fosters better retention and application of nutrition knowledge in clinical settings. 11 The program encourages students to translate theoretical nutrition principles into actionable patient care strategies by emphasizing active participation. Furthermore, including a community service component at the Overtown Youth Center allowed students to apply their skills in real-world settings while contributing to ongoing public health efforts in Miami’s inner-city communities. The project was funded by the Sylvester Comprehensive Cancer Center, entitled Project 33136—Partnerships for Health Equity grant program.
Curriculum Design and Content
Culinary Medicine Project Curriculum Outline
In the hands-on cooking classes, CMP students prepare meals aligned with therapeutic dietary patterns while highlighting patient related cultural preferences, affordability, and taste. Food literacy is emphasized, the ability to plan, manage, select, prepare, and eat food to meet needs and circumstances, representing a critical competency for healthcare providers. Growing evidence suggests interventions targeting food literacy are more effective than traditional nutrition education alone in promoting sustainable changes in dietary behavior. 41
Each session was incorporated with discussions, role playing, and case-based studies focused on patient communication and behavior change. CMP students engaged in discussions on integrating nutrition guidance into routine healthcare visits, emphasizing motivational interviewing methods, and readiness to change to encourage sustainable dietary behavior change. 8 The sessions provided foundational knowledge on dietary patterns, including Mediterranean and plant-based diets, and their role in disease prevention and management.
The chef-led, hands-on culinary medicine training involved cooking demonstrations, during which CMP students prepared meals using fresh, nutrient-dense ingredients under the guidance of professional supervision. Participants developed key food preparation techniques, including knife skills, meal planning, and cooking methods that maximize nutritional value. By incorporating culturally relevant meals, the program emphasized the importance of adapting dietary recommendations to patients’ cultural food preferences, a crucial factor in achieving sustainable dietary changes. 7 CMP students cooked meals based on multi-ethnic plant-based recipes including tagine vegetables and couscous, sweet potato and bean tacos, portabella mushroom burgers, and grain bowls with spices from around the world.
The program’s community service engagement component involved CMP students, guided by our community partner, Common Threads. For training purposes, each cohort of CMP students was required to watch the Small-Bites training video created by Common Threads. The CMP students then taught in English at least one, hour-long lesson to second through fifth grade elementary school children at the Overtown Youth Center (OYC) in Miami, Florida, delivering nutrition education on healthy eating, food literacy, and basic cooking skills using the Common Threads' Small Bites curriculum. 42 CMP students guided children in preparing recipes including mango salsa with tortilla chips and yogurt fruit parfaits and facilitated activities including games for reading nutrition labels.
The program emphasized interprofessional collaboration, focused on health promotion, lifestyle medicine, community engagement and communication. Overarching learning objectives included: 1. Practice teamwork, communication and shared leadership in both the kitchen and community outreach settings. 2. Deliver (developmentally) appropriate nutrition education activities in a community environment 3. Appreciate the role of clinicians as role models and advocates for healthy lifestyle behaviors that can reduce health disparities. 4. Adapt nutrition teaching to address social determinants of health, food access, cultural preferences, and family environments. 5. Cultivate personal and professional commitment to lifelong learning in nutrition and health promotion.
Study Participants
Thirty students participated in the CMP program, including 24 medical students and 6 doctoral PT students. In line with the IRB guidelines, completion of the surveys was voluntary, with 21 students completing both the pre- and post-surveys (70%). Participants were recruited through institutional email announcements, interest meetings, and outreach efforts within academic departments. Interested students responding to the announcements, accessed a Qualtrics survey using a QR code, and provided their contact information and assurance of availability to attend most class sessions and at least one community activity of two that were offered per cohort. Enrollment was open to students across different years of training, fostering an interdisciplinary approach to nutritional education.
Data Collection and Assessments
A pre-post study design was used to assess feasibility, acceptability, and preliminary efficacy. Feasibility was assessed using Bowen et al.'s framework, which examines multiple domains of intervention viability. 43 Demand and engagement were evaluated through attendance records, with a priori benchmarks predicting at least 90% of participants would attend three out of four didactic and culinary sessions, and 90% would engage in one community service day, based on prior research on effective participation thresholds for nutrition education interventions. 9 Acceptability was measured through student satisfaction ratings of curriculum components and retention rates (percentage completing the course). Practicality was assessed through successful recruitment (achieving target enrollment within the planned timeframe). Implementation feasibility was evaluated by examining whether all planned curriculum components were successfully delivered and student knowledge improvement.
Surveys were adapted from previously published studies
32
and included 33 questions divided into four subscales (see Figure 1). Three subscales, Confidence in Health Equity Knowledge, Brief Nutrition Knowledge Competence, and Confidence in Patient Advising Skills were assessed pre- and post-program. The subscale, Attitudes and Beliefs about Nutrition, Diet, and Health was administered only at baseline to determine if there were baseline differences in attitudes between medical and PT students. Moreover, we expected little change in attitudes over time due to the self-selection of the students into an extracurricular course on “food-as-medicine,” as well as concern about participant burden with lengthy assessments. Survey. The survey subscale, Attitudes and Beliefs about Nutrition, Diet, and Health was administered pre-program. Survey subscales, Confidence in Health Equity Knowledge, Brief Nutrition Knowledge Competence, and Confidence in Patient Advising Skills were assessed pre- and post-program
Data Analysis
Quantitative data analysis was conducted using IBM SPSS Statistics (Version 29). Descriptive statistics summarized participant demographics, attendance rates, and survey responses. The Wilcoxon signed-rank test was used to evaluate changes in nutrition knowledge, counseling confidence, and attitudes toward health equity from baseline to post-course. Post-hoc exploratory analyses used Mann-Whitney U tests to compare baseline and post-elective changes between medical and PT students. These nonparametric statistical methods were chosen due to the small sample size, ensuring a robust analysis despite the limited number of participants. 44 These analyses provide insight into the program’s effectiveness in enhancing medical and PT students’ nutrition education and counseling abilities.
Ethical Considerations
All participants gave informed consent, and data was anonymized to maintain confidentiality. The study adhered to institutional review board (IRB) guidelines, and all program components prioritized participant safety and well-being.
Results
Participant Demographics
Two cohorts of CMP students enrolled in the program, comprising 16 students in cohort one and 14 in cohort two, for a total of 30 attendees. Among the combined cohorts, 24 were medical students, and 6 were PT students. A total of 24 women and six men attended. Notably, this is a higher percentage of women than at the UM medical school, in general, where depending on the year, 55 – 60% of the medical school class are women.45,46 Twenty-one students completed both pre- and post-surveys (70%). Most students completing the survey (66.7%) were aged 18-25, while 28.6% were aged 26-30. The age range preponderance was likely due to most (75%) students being in their first year, while two were in their second, two in their third, and four in their fourth year. Heavy rotation schedules beginning in the second year for both medical and PT students, likely lead to fewer students in upper class years. The CMP program included 19.0% of students who self-identified as Asian or Asian American, 4.8% as Black or African American, and 23.8% as Hispanic or Latino. This is compared to a recent UM medical school enrollment report of 35% Asian, 4% Black/African American and 13% Hispanic/Latino. 47 According to the UM office of Admissions, PT demographics are like the medical school program, with 56% female; although, there is a higher percentage of Hispanic/Latino PT students (30%) (unpublished data). Most students (81%) reported having no prior formal nutrition education.
Feasibility of the Program
The program demonstrated feasibility across multiple domains of Bowen et al.'s framework. 43 Practicality was evidenced by the successful enrollment of 30 students within the planned timeframe. Demand exceeded benchmarks: 90.7% of students (n = 27) attended at least three of the four class sessions, meeting the 90% threshold (10 attended all four classes, 17 attended three classes, and three attended two classes). Community service participation was strong, with 100% of students attending at least one session at the Overtown Youth Center and 80% attending both sessions, where CMP students taught an hour class in nutrition and diet to over twenty 2nd–5th grade children. Implementation was successful, with all planned curriculum components, four didactic sessions, hands-on cooking demonstrations, and community service activities, delivered as designed.
Acceptability
Quantitative Survey Feedback
Students rated the resources provided in the curriculum on a scale from 1 to 5, with 1 representing the highest rating. Discussions with the MD and DPT instructors had the highest mean rating (M = 1.71, SD = 0.27), followed by hands-on cooking classes (M = 2.07, SD = 1.00), Q&A with the chef (M = 3.00, SD = 1.18), articles (M = 4.00, SD = 0.92) and lastly videos (M = 4.29, SD = 1.07). Additionally, students rated their agreement with the statement, “The class format provided enough time to cover the health topics, discussions, and cooking skills and training” on a scale of 1 to 7, with seven being the highest, resulting in an average response of 6.55 (SD = 0.61).
CMP Student Outcomes and Exploratory Comparisons
Combined Student Pre- and Post-course Changes in Knowledge and Skills
Comparing PT and Medical Students Pre- and Post-Course in Knowledge and Skills
Discussion
Despite growing evidence that nutrition and dietary education for healthcare providers improve patient health, many institutions lack programs, and among those that do, the content and depth of training vary. 48 Inclusion of nutrition materials in medical school class lectures is optional by the professors at UM, and as of Spring of 2026 there is not currently a formal required medical school course. The PT students receive six hours of nutrition lectures. To address this critical need, CMP was an extracurricular program adapted from Cooking Up Health, 32 modified to fit an interdisciplinary structure, training medical and PT students, and emphasizing the influences of social and cultural factors within a food-as-medicine framework. CMP recognizes that brief educational programs are most effective when they focus on enhancing nutrition awareness and developing competencies for appropriate referral to registered dietitian nutritionists. Moreover, forging a connection between an academic medical institution and the community can improve community relations and health in Miami’s inner city. Common Threads served as our community partner, connecting our academic university with inner-city community members. Such academic-community connections are sustainable when community service is incorporated into medical education coursework. Course development methods were explored for their acceptability and effectiveness in knowledge acquisition. This pilot project showed preliminary feasibility, acceptability, and impact. Our findings correspond with other programs with medical students teaching children.49,50 The course significantly improved nutrition knowledge, confidence in patient communication, and competence in health equity knowledge for both medical and PT students. Enhanced competence will likely translate into improved identification of patients who would benefit from nutritional intervention and referral to specialized nutrition professionals, thereby addressing a critical gap in healthcare delivery.
Student feedback was overwhelmingly positive, with course evaluations favoring hands-on cooking and discussions over readings and videos, suggesting a shift toward valuing interactive learning. This is an important point for other programs contemplating incorporating such activities. The sparse differences between medical and PT students in baseline and post-course knowledge suggest the curriculum’s broad applicability across healthcare disciplines, while also highlighting opportunities for targeted curricular enhancement. Given the positive findings, next steps will include implementing and assessing a required food-as-medicine course for medical and PT training and expanding to include other health care professional students, such as nursing and public health graduate students to incorporate diet and nutrition knowledge across the healthcare spectrum. Moreover, we plan to increase the number of sessions, as well as urge the medical education system to thread diet and nutritional education throughout all years of study. Finally, to more firmly establish a connection of our academic institution with the surrounding community we plan to implement community service to include education to families and older adults. This will require programs in various languages including English and Spanish.
Despite its strengths, this investigation has limitations. A small sample, particularly the smaller number of PT student attendees, may affect generalizability and short-term assessment fails to capture long-term knowledge retention or clinical application. Evaluating community attitudes toward dietary change and their views of program graduates’ dietary counseling may have further validated the program’s effectiveness. Additionally, self-reported survey data may introduce response bias, as students may overestimate competency improvements. Finally, as a feasibility study, participant outcomes should be interpreted with caution. Larger-scale studies and extended follow-ups remain crucial for refining and sustaining the program.
Conclusions
The program deepened students’ understanding of nutrition, health equity, the importance of patient’s cultural identity, and patient counseling. Attendees reported greater confidence and competence in guiding patients through lifestyle and dietary changes, which are key to addressing obesity and strengthening preventive care.
Supplemental Material
Supplemental Material - Feasibility of Creating a Teaching and Learning Kitchen for an Interdisciplinary Group of Medical Professional Students While Creating a Bridge With an Inner-City Miami Community
Supplemental Material for Feasibility of Creating a Teaching and Learning Kitchen for an Interdisciplinary Group of Medical Professional Students While Creating a Bridge With an Inner-City Miami Community by Ritika D. Modi, Paola Rossi, Haley B. Brennan, Linh T. Ton, Akash Patel, Morgan Kidd, Stephanie White, Melinda Ring, E. Robert Schwartz, Teresa Glynn, Laura S. Redwine in Global Advances in Integrative Medicine and Health.
Footnotes
Acknowledgements
We thank Emily Del Rio, Osher Center for Integrative Health project manager; Victoria Nieto, chef/culinary educator; and Common Threads, Inc., our community partner who organized the Chef-led culinary lessons and the community service activity.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Sylvester Comprehensive Cancer Center
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
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