Teaching Kitchen Research Conference October 18–19, 2022

Editor's Note: When I took up my first position as a PhD student in an integrative medicine hospital, there was something revolutionary there: a teaching kitchen. Theoretically, patients everywhere learn what they should be doing in terms of nutrition, but they will never really do it if they are not taught the how as well as the what. In a teaching kitchen, however, they acquire both the knowledge of proper nutrition and the skills to prepare it. It is astonishing that something so apparently fundamental still astonishes even today. Today, teaching kitchens are a major movement, largely through the work of the Teaching Kitchen Collaborative and its founder David M. Eisenberg, MD, director of culinary nutrition and adjunct associate professor of nutrition at the Harvard T.H. Chan School of Public Health. JICM is honored to again partner with David Eisenberg and the Teaching Kitchen Research Conference to publish the abstracts of their 2022 meeting, for the third time in a row. Culinary medicine—and teaching kitchens as its practical implementation—is playing a growing role in the fields of integrative medicine, lifestyle medicine, and whole health as these communities of health professionals, educators, and researchers are all increasingly interested in the need for improved nutrition education as well as the prospect of using teaching kitchens as learning laboratories and centers for translational research. David Eisenberg will provide an overview here of current developments in culinary medicine in general and the keynotes, plenaries, and selected abstracts from the 2022 Teaching Kitchen Research Conference, in particular, and once again demonstrate that nutrition education is first and foremost practice, not just theory. —Holger Cramer, Editor-in-Chief

Teaching kitchens routinely incorporate nutrition education, hands-on cooking instructions, exercise prescription, mindfulness training, and strategies to optimize behavior change.^1,2 Teaching kitchen programs have been used in a variety of settings and populations,³ which has led to the establishment of the Teaching Kitchen Collaborative (TKC; www.teachingkitchens.org), an independent, nonprofit invitational network of 46 institutions with teaching kitchens, dedicated to the development of best practices relating to nutrition, culinary, and lifestyle education and research (Appendix A1).

In May 2022, the U.S. House of Representatives passed the bipartisan McGovern Resolution (H.Res.1118),⁴ calling for medical schools, graduate medical education programs, and other professional training programs to provide meaningful education on nutrition and diet or risk discontinuation of $10.3 billion in federal funding for the training of residents in U.S. hospitals. Similarly, the recently published White House National Strategy on Hunger, Nutrition, and Health calls for expanded nutrition education in medical education curricula, board examinations, and postgraduate training.⁵

Research involving teaching kitchens and their potential to contribute to health professionals' training, clinical and biomedical research, translational nutrition research, and health care policy and financing, as well as future models of patient care, is emerging.

The first Teaching Kitchen Research Conference (TKRC) was held in 2018,⁶ hosted by the Harvard T.H. Chan School of Public Health in association with the TKC.⁷ The second TKRC was held virtually in 2020 due to the COVID-19 pandemic. It attracted over 2500 registrants from 75 countries.² The third TKRC took place on October 18–19, 2022, at the University of California, Los Angeles (UCLA). The motivation behind the selection of this venue was to recognize the newly established built-in teaching kitchen at UCLA. This teaching kitchen is intended as a “shared asset” of the university, accessible to students, health professionals, patients, employees, and community populations.

All three conferences have been supported, in part, by NIH R13 grant awards. The 2022 TKRC was partially supported by the National Center for Complementary and Integrative Health and the National Heart Lung and Blood Institute and received financial support from the Ardmore Institute of Health, The Bernard Osher Foundation, Meshewa Farm Foundation, CancerScan, and Pacific Coast Producers. In-kind support came from the Academic Consortium for Integrative Medicine and Health, the American College of Lifestyle Medicine, the Food Law and Policy Clinic (FLPC) at Harvard Law School, the Blue Zones Well-Being Institute, Food Tank, the Semel Healthy Campus Initiative Center at UCLA, and the Center for Food as Medicine.

The 2022 TKRC was offered in person and virtually. It attracted over 500 registrants, representing 11 countries and 45 states. Over 60% of registrants (n > 300) confirmed the existence of teaching kitchen facilities in their institutions, demonstrating the widespread and rapidly growing interest in teaching kitchens.

The 2022 TKRC included presentations from 5 keynote speakers in addition to 2 panel discussions and over 90 abstract presentations. Highlights of the TKRC 2022 are presented below. Keynote presentation recordings are available to the public for on-demand viewing at https://www.hsph.harvard.edu/nutrition/tkrc/. Abstracts are available at https://doi.org/10.1089/jicm.2022.29113.abstracts.

David Eisenberg, Director of Culinary Nutrition at the Harvard T.H. Chan School of Public Health and founding Executive Director of the TKC, shared a welcome and overview of the field entitled, “Teaching Kitchens, Past, Present and Future.” He underscored the unique capability of teaching kitchens to address a “blind spot” of medicine, namely the fact that all patients eat food and can benefit from medical advice about optimal food choices. He reflected that teaching doctors—or patients—about ‘nutrition’ and optimal food choices in the absence of teaching kitchens is like teaching kids and adults the benefits of swimming in the absence of swimming pools.

Next, he discussed the Food is Medicine (FIM) Map, an interactive map that showcases programs that fall into any of the following domains: teaching kitchens, medically tailored meals, fresh food “farmacies,” produce prescriptions, and nutrition incentive programs. The FIM Map is currently being populated and welcomes additional programs to join (please see https://teachingkitchens.org/map-fim/ to apply). Dr. Eisenberg summarized selected research on the application of teaching kitchens across venues and populations and offered a description of teaching kitchens of the future.³

Finally, he discussed the current paradox of teaching kitchens, namely the observation that self-insured third-party payers are interested in teaching kitchens, but lack the skills to formally evaluate them; while the medical establishment remains skeptical of their impact, lacks a financial incentive to invest in teaching kitchens, but has the capacity to evaluate them authoritatively.

Thus, as Dr. Eisenberg argued, solving this paradox is an essential priority as we look to the future of teaching kitchen-related research.

Dexter Shurney, President of the Blue Zones Well-Being Institute and Chief Health Equity, Diversity, and Inclusion Officer at Adventist Health, presented a plenary entitled “An Economic Conversation on Teaching Kitchens: Who Pays?” He described the declining diet quality observed in the United States through the past few decades and the enormous economic implications of diet-related illnesses. He presented evidence showing the promising role of teaching kitchens in both the prevention and treatment of chronic disease.

Additionally, he discussed the tremendous cost-saving potential of teaching kitchen programs and opportunities for third-party payment for these programs. His primary message was that employers, as opposed to third-party insurance companies, bear the (principal) costs of health care and are the only entity in the mix of payers who have a real interest in controlling costs. The focus about “Who will pay for Teaching Kitchens,” he argued, should be on large self-insured employers.

Finally, he offered thoughts on strategies to assess, demonstrate, and increase the value of teaching kitchen programs across multiple venues and populations.

Joshua Metlay, Chief, Division of General Internal Medicine, and Interim Chief, Department of Medicine, Massachusetts General Hospital, provided a plenary presentation entitled, “Moving Primary Care out of the Clinic and into the Kitchen.” Dr. Metlay reflected on the potential threats to primary care, including a shrinking workforce and accelerating demand for care. He shared strategies to improve the future of primary care practice and training, highlighting the role of teaching kitchens in this imagined future.

He envisioned Lifestyle Medicine as a subspecialty of General Medicine and described the Massachusetts General Hospital's “Healthy Lifestyle Program,” which promotes healthy lifestyles through integration of clinical practice, education, research, and community programs. Dr. Metlay conveyed that teaching kitchens can and should be incorporated into the training and practice of primary care practitioners of the future to strengthen the primary care workforce and improve population health.

Additionally, he shared that teaching kitchens, as a core component of a lifestyle medicine program, have the potential to address the needs of both patients and clinicians.

Christopher Lynch, Acting Director of the NIH Office of Nutrition Research (ONR), presented a plenary entitled, “The New NIH Office of Nutrition Research—Mission, Current Programs, and Planning.” He provided an overview of the ONR, including its role in implementing the Strategic Plan for NIH Nutrition Research. He discussed various nutrition, health, and social problems that the ONR seeks to address and emphasized the power of Food as Medicine Programs to combat many of these issues. He shared the aspirational concept of Food as Medicine Networks or Centers of Excellence, many of which could involve teaching kitchens.

Furthermore, he described potential strategies to improve health within medical systems and community settings, including implementation of culinary medicine and teaching kitchen programs as part of future NIH-funded initiatives.

Emily Broad Leib, a Clinical Professor of Law, Faculty Director of the Harvard Law School's Food Law and Policy Clinic (FLPC), and Deputy Director of the Harvard Law School Center for Health Law and Policy Innovation, presented a plenary entitled, “Making the Case: Requiring Nutrition Education for Doctors and Other Health Professionals.” She explained the importance of focusing on food, noting that the food system sits at the center of many issues relating to health, safety, justice, and the environment.

She described FLPC's commitment to addressing these challenges by educating students on food law and policy and providing legal services to nonprofit food system actors. She discussed opportunities to increase nutrition education for physicians, including at the federal, state, and local levels. She argued that, teaching kitchens should be included in these efforts as they offer education, skills, and confidence around nutrition, all of which are critical for creating a fairer, equitable, and sustainable food system.

She argued for a more coordinated approach across all federal and state agencies with authority over food. Importantly, considering H.Res.1118⁴ and the recent White House Conference,⁵ she proposed specific examples of ways in which federal, state, and professional requirements regarding nutrition education and documented competencies could be implemented.

The first panel discussion was entitled, “What if the Culinary, Lifestyle and Integrative Medicine Communities Worked as a United Front?” and included presentations by Cate Collings, President of the American College of Lifestyle Medicine⁸; Amy Locke, Chair of the Consortium of Academic Health Centers for Integrative Medicine and Health⁹; and David Eisenberg, representing the teaching kitchen and culinary medicine community.

Proposed collaborative strategies included (1) asset mapping to identify and map individuals who participate in two or three of these communities, as well as topics of shared interest to all three stakeholder groups; (2) expanding the FIM Map (https://teachingkitchens.org/map-fim/) to include integrative and lifestyle medicine professionals and programs; (3) creation of a semiannual newsletter to be shared broadly across all three communities, highlighting meetings, publications, news articles, and resources, as well as research and educational initiatives of shared interest; (4) establishment of a shared research platform, with similar or identical outcome tracking tools to be used across all three communities; and (5) planning for the establishment of competencies and credentialing criteria for teaching kitchen facilities and trainers, as these will likely be essential as research in this area progresses.

The second panel discussion was entitled, “The role of teaching kitchens in promoting health equity.” Speakers included Nicole Farmer, Staff Scientist at the NIH Clinical Center; Kofi Essel, Director of the George Washington University School of Medicine and Health Sciences Culinary Medicine Program; John Wesley McWhorter, Director of Lifestyle Medicine at Suvida Healthcare; and Alma Guerrero, Associate Clinical Professor of Pediatrics at UCLA.

Dr. Farmer presented definitions of health equity and food insecurity and ways in which teaching kitchens can impact food skills, social environments, and personal agency.

Dr. Essel described the Family Lifestyle Program at Children's National Hospital, which is evaluating the impact of a teaching kitchen program to enhance the health of children and families.

Dr. McWhorter discussed the concept of cultural humility and ways in which teaching kitchens can be used to celebrate diversity.

Finally, Dr. Guerrero described the teaching kitchen within the Venice Family Clinic, a partnership with UCLA, which has demonstrated positive impacts on food insecurity experienced by children and families in that community.

UCLA's Semel Healthy Campus Initiative

Wendy Slusser, Associate Vice Provost for the UCLA Semel Healthy Campus Initiative (HCI), described the growth of the Semel HCI over the past decade. This initiative was launched by UCLA's Chancellor in 2012; received support from the UC President in 2014; became a research center in 2018; and built multiple partnerships with faculty, students, and campus administrators. It now includes a model teaching kitchen, which serves as an educational interactive space for members across the entire campus community.

In 2021, UCLA received an anonymous $13.5 M gift in support of the Rothman Food Institute, thereby expanding UCLA's commitments to allow students to explore the subject of food in an academic way related to their own interests, such as health, politics, social justice, or history.

Twelve original scientific abstracts were selected for oral presentation at the 2022 TKRC and over 80 were presented in poster format. Some noteworthy abstracts include:

• The abstract by Herman et al entitled, “Examination of an Online Cooking Education Program to Improve Shopping Skills, Attitudes toward Cooking and Cooking Confidence in WIC Participants” (awarded Best Trainee Oral Abstract).¹⁰ The “Family Kitchen” online cooking education program was completed by 257 adults enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Cooking confidence increased significantly, particularly among food-insecure participants. These findings support the benefits of an online cooking education program for WIC recipients.

• The abstract by Siler et al entitled, “From the Kitchen to the Electronic Medical Record: Culinary Medicine E-Consult Empowers Nutrition Integration in Clinical Care” (awarded Best Overall Oral Abstract).¹⁰ The Culinary Medicine e-Consult is a blended model led by a physician–dietitian team, incorporating aspects of teaching kitchen interventions and electronic consultations (e-consults). During a 12-month pilot phase, 25 e-consults were completed, with a 100% reimbursement rate. Positive feedback was received on the themes of patient satisfaction, ease of use, and time-saving innovation. As these findings suggest, the Culinary Medicine e-Consult is a low-resource and scalable innovation, with the potential to bridge the gap between emerging teaching kitchen concepts and traditional clinical care and billing pathways.

• The abstract by Bergquist et al entitled, “The virtual Emory Health Kitchen Collaborative had similar health outcomes as the in-person program.”¹⁰ The Emory Healthy Kitchen Collaborative is a 12-month, worksite wellness program and clinical trial. The program has been completed by 2 employee cohorts, one in person and one virtual. Participants showed significant improvements in diet quality, mindful eating, perceived stress, and quality of life, with results comparable across cohorts.

• The abstract by McClure et al entitled, “A Culinary-Based Intensive Lifestyle Program for Patients with Obesity—a Teaching Kitchen Collaborative Curriculum (TKCC) Pilot Study.”¹⁰ The TKCC is a 16-week pilot program that provides education on nutrition, culinary skills, mindfulness, physical activity, and behavior change strategies. Overall program satisfaction was strong, and participants (n = 12) demonstrated significant improvements in cooking behaviors and mindful eating. Certain culinary skills, dietary choices, and exercise habits also trended toward improvement. Thus, the TKCC is a feasible, well-accepted, and potentially effective tool for engaging participants in lifestyle change.

• The abstract by Shannahan et al describing a “Culinary Medicine Curriculum Pilot for Family Medicine Residents” implemented at the Northwestern Family Medicine Residency at Lake Forest.¹⁰ In this curriculum, residents (n = 23) completed 3 weeks of virtual learning and training sessions centered on culinary topics relevant to patient care. This was followed by a 3-week service component, in which residents taught weekly nutrition classes at a local middle school. Residents' nutrition counseling confidence, cooking confidence, and knowledge about plant-based diets significantly improved. This pilot demonstrates the feasibility and positive impact of incorporating a culinary medicine curriculum into a Family Medicine residency.

• The abstract by Carter et al entitled, “Teaching Kitchens in K-12 Schools: Innovative Education Meets Health and Wellness Training Meets Engaging Entrepreneurship,” describing the implementation of a teaching kitchen in a K-12 environment.¹⁰ This kitchen was built adjacent to a 4,000-square foot greenhouse at Cincinnati Hills Christian Academy. A semester elective course was designed for high school students, along with a series of grade-appropriate classes for K-8 grade students. Students signed up in record numbers (153 of 454 total students), propelling this elective to become the most popular in the school's history. Potentially, this model can serve as a prototype for other K-12 schools nationally.

• The abstract by Ruiz-Canela et al entitled, “Feasibility analysis of the methodology used in the Nutritional and Culinary Habits to Empower Families (n-CHEF) project.”¹⁰ In this study, 15 families attended a series of culinary–nutritional workshops led by a chef and dietitian. This intervention was shown to be well accepted and successful in increasing families' adherence to the Mediterranean diet. It is being used as the basis of a multisite trial proposal across organizations in the European Union (EU) with teaching kitchens.

• The abstract by LaCroix et al describing “Implementation of a Women's Healthy Teaching Kitchen Program Across the Veterans Health Administration.”¹⁰ A woman-specific Healthy Teaching Kitchen Program was successfully implemented at more than 50 sites across the Veterans Health Administration. Feedback from participants (n = 314) was resoundingly positive in both making changes and increasing confidence, suggesting potential for this type of programming to effect sustained behavior change.

• The abstract by Harris et al entitled, “Comparing Effectiveness of Virtual to In-Person Culinary Medicine Courses among Cancer Survivors and their Caregivers: Impact of COVID-19 Pandemic.”¹⁰ A 6-week, in-person, culinary medicine course was conducted among cancer survivors (n = 19) and their caregivers (n = 4). An identical population (n = 6 cancer survivors and 2 caregivers) completed a 3-week virtual course. All participants improved in at least one healthy behavior, such as home-cooked meal preparation, fruit and vegetable intake, and nutrition label use. Dietary knowledge and beliefs also improved among both in-person and virtual participants.

• The abstract by Hellerstein et al entitled, “Teaching Kitchens for Perimenopause.”¹⁰ This program, delivered to perimenopausal women, involved virtual cooking and nutrition classes, combining the expertise of a chef, dietitian, and doctor. Participants (n = 269) showed significant improvements in dietary habits and cooking confidence, as well as a significant decrease in weight upon program completion.

• The abstract by Gierlinger entitled, “From liability to asset: Northwell Health's pragmatic approach to transforming hospital food.”¹⁰ In response to a 2016 “Quality of Food” analysis, Northwell Health undertook a collaborative approach to transform its hospital food. This involved implementation of hospital gardens, teaching kitchens, and food “farmacies,” as well as the creation of quality standards around purchasing, preparation, and delivery of hospital food. In 2022, Northwell's “Quality of Food” patient experience measure ranked at the 9th percentile, an increase of 72 rank points from 2016. Importantly, this was accomplished in the absence of a major increase in food procurement costs.

• The abstract by Ellrott et al entitled, “Multicenter evaluation of a Culinary Medicine elective for medical students in Germany delivered virtually.”¹⁰ The Culinary Medicine elective at the universities of Göttingen, Giessen, and Brandenburg is a teaching kitchen-based elective provided to medical students (n = 70). Conducted virtually, the curriculum included 7 weekly modules. Counseling competencies on nutrition and lifestyle medicine topics significantly increased. Improvements in knowledge and subjective well-being were also observed. This program is an example of teaching kitchens being successfully implemented across the EU.

• The abstract by Janisch et al describing the “Application of the Food is Medicine Map.”¹⁰ The FIM Map was catalyzed by the TKC and operated in partnership with Geisinger, God's Love We Deliver, Gretchen Swanson Center for Nutrition, and Wholesome Wave. It invites organizations with teaching kitchens, medically tailored meals, fresh food “farmacies,” veggie Rx programs, and produce prescription programs to share information about their respective programs on this open-sourced map. The map is intended to be highly visual, with each “pin drop” illustrating the physical location and colors differentiating program domain types. Furthermore, a location search feature helps users identify programs within specified areas. Since its initial launch in 2020, the map now shows 138 organizations in 10 countries. The FIM Map has the potential to serve as a powerful public health resource for both the FIM community and the programs and populations that it seeks to reach. Those interested in adding their programs to the map can visit https://teachingkitchens.org/map-fim/

In addition to the science, the 2022 TKRC showcased personal stories of lives transformed through teaching kitchens. This was accomplished through the introduction of 2 additional award categories, namely (1) a Recipe Demonstration Video and (2) a Life Impact Video. Over 50 submissions were received, including over 30 Recipe Demonstration Videos and 20 Life Impact Videos. Awards were provided to the following:

• A Recipe Demonstration Video submitted by Heidi Davis of Providence Milwaukie Community Teaching Kitchen, sharing a Mediterranean-inspired “Enjoy-A-Bowl” recipe (https://youtu.be/kp1SNn_8rV4). The Enjoy-A-Bowl is a nutritious, cost-effective, and versatile meal that incorporates whole grains, vegetables, protein, and various toppings. This video features an engaging recipe demonstration along with discussion on the benefits of a plant-centric eating pattern.

• A Life Impact Video submitted by Anthony Imamura of MedStar Health entitled, “Paul Schwartz's Story–Healthy Eating Saves a Life” (https://youtu.be/MKhiX5cNZ3w). This video outlines the inspiring story of Paul Schwartz, who experienced depression and weight gain following a family tragedy. Paul was referred to MedStar Health's Fresh and Savory Culinary Medicine Program, which takes patients out of the examination room and into the kitchen, arming them with practical skills to lead healthy lives. Paul saw great success through this program, losing over 100 pounds and normalizing his blood pressure and cholesterol levels. Paul's inspirational story is a testament to not only his personal strength and dedication but also the life-changing potential of teaching kitchen interventions.

Finally, subject matter experts led interactive breakout sessions, involving robust discussions about teaching kitchens, as applied to a diverse range of settings. These breakout sessions included discussions about the following: (1) reimbursement strategies for teaching kitchens; (2) the importance of collaboration between culinary, lifestyle and integrative medicine communities; (3) the role of culinary instructors in teaching kitchens; (4) the use of teaching kitchens to educate health professionals; (5) the potential of teaching kitchens to promote health equity; (6) the role of registered dietitians in teaching kitchens; (7) teaching kitchens relating to sustainable food systems; and (8) how to set up a teaching kitchen. These breakout sessions sought to identify new teaching kitchen research priorities as well as opportunities for additional collaborations or partnerships to advance teaching kitchen research.

Teaching kitchens are being built and utilized with increasing frequency across the United States and globally. They now number in the hundreds. Several scientific abstracts presented at this conference documented that virtual, interactive teaching kitchen classes may be comparable to in-person teaching kitchen activities in terms of impact, thereby confirming their scalability. Teaching kitchens are being used across a wide range of venues and populations, and evidence that multidisciplinary teaching kitchen curricula, when applied in controlled settings, can alter (a) behaviors; (b) biomarkers; (c) clinical outcomes; (d) quality of life; and (e) costs is increasing.

In light of the recent H.Res.1118⁴ and the 2022 White House Conference on Hunger and Nutrition,⁵ both of which called for enhanced nutrition education, and given the NIH's plans to explore funding for research involving food as medicine and teaching kitchen programs, research in this area as well as the relevance of teaching kitchens to the fields of culinary medicine, lifestyle medicine, integrative medicine, conventional medicine, and whole-person health will likely remain of interest to the broader health professionals' community for the foreseeable future.

Appendix A1.

2022 Teaching Kitchen Collaborative Member Organizations

Nonprofit member organizations • 1440 Multiversity • Alberta Health Services, University of Calgary • Bon Secours Richmond • Boston Medical Center • Cabell Huntington Hospital–Huntington's Kitchen, Marshall University • Children's Healthcare of Atlanta Center for Advanced Pediatrics • Cincinnati Hills Christian Academy • Cleveland Clinic • CU Anschutz Health and Wellness Center • Culinary Medicine Germany • Dartmouth–Hitchcock Culinary Medical Program • Emory University Lifestyle Medicine & Wellness • FamilyCook Productions • Free Library of Philadelphia • Griffin Health • Hackensack Meridian Health Network • Kaiser Permanente San Francisco Medical Center • Maine General Health • MedStar Health • Northeastern University • Northwell Health • Northwestern University Osher Center for Integrative Medicine • Palo Alto Medical Foundation • Phipps Conservatory and Botanical Gardens • Presbyterian Healthcare Services • Providence Milwaukie Hospital • Spartanburg Regional Healthcare System • Stanford University • Turner Farm, Inc., in collaboration with University of Cincinnati • University of British Columbia • University of California, Berkeley • University of California, Irvine Susan Samueli Integrative Health Institute • University of California, Los Angeles • University of Minnesota Bakken Center for Spirituality & Healing • University of South Alabama • University of Southern California Keck School of Medicine • University of Texas Southwestern • University of Vermont Medical Center • UTHealth School of Public Health, Nourish Program • Veterans' Health Administration • YMCA of Greater Pittsburgh–Sampson Family Branch

Corporate members • Banyan • Barilla, Inc. • CancerScan • Compass Group, North America • Google, Inc. Contact info@teachingkitchens.org

Author Disclosure Statement

The author declares the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: David Eisenberg, MD, is the Executive Director of the TKC; Co-Director of the Harvard CIA Healthy Kitchens, Healthy Lives educational conference; Scientific Adviser to Campus for Health, LTD., Japan; Scientific Adviser to Cookpad, Inc., United Kingdom; former Scientific Adviser to Better Therapeutics, Inc.; and a member of the Health and Wellness Advisory Board of Barilla, Inc., Italy.

Funding Information

The conference was partially supported by R13AT0011986 from the National Center for Complementary and Integrative Health (NCCIH) and the National Heart Lung and Blood Institute (NHLBI). Financial support was received from the Ardmore Institute of Health, Bernard Osher Foundation, Meshewa Farm Foundation, CancerScan (Japan) and Pacific Coast Producers. In-kind support came from the Academic Consortium for Integrative Medicine and Health, the American College of Lifestyle Medicine, the Food Law and Policy Clinic at Harvard Law School, the Blue Zones Well-Being Institute, Food Tank, the Semel Healthy Campus Initiative Center at UCLA, and the Center for Food as Medicine.