Registered Dietitian Nutritionists as Leaders in Lifestyle and Culinary Medicine

Abstract

Registered Dietitian Nutritionists (RDNs) are uniquely positioned to lead in Lifestyle Medicine, Culinary Medicine and Food is Medicine, overlapping initiatives currently gaining momentum in health care. To become a credentialed practitioner, RDNs must demonstrate competency as outlined in The Scope and Standards of Practice defined by the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics. Many CDR competencies align with the interventional and operational components necessary to deliver and direct effective Lifestyle Medicine (LM) and Culinary Medicine (CM) initiatives. Capitalizing on the skills and expertise of RDNs trained in LM and CM is an effective strategy to address the Quintuple Aim of better health care outcomes, lower cost, improved patient satisfaction, improved provider wellbeing and the advancement of health equity. Successful examples like Cooking with Plants, Trinity Health Ann Arbor’s virtual CM series, showcase the positive impact of RDN-led CM initiatives on culinary literacy and health behavior change. This article provides an overview of the Cooking with Plants program and practical guidance for initiating similar programs at other institutions. Guidance includes strategies for assessing community needs, identifying funding sources, engaging stakeholders, and developing and evaluating curriculum.

“The education and skills of RDNs, combined with LM training, position them to effectively extend their scope of practice and serve as leaders in the LM and CM fields.”

Trinity Health Ann Arbor (THAA) is a national leader in groundbreaking programs that provide patients, colleagues, and community members with education and skill-building opportunities that inspire health improvement. One powerful example is the creation of the Lifestyle Medicine (LM) Department in the spring of 2021. The vision of this department is to empower all people to achieve optimal health and wellbeing through transformative lifestyle practices. Not only is the department’s vision innovative, but the structure is unique. The hospital-based team is led by five Registered Dietitian Nutritionists (RDN) who are all board-certified in LM and includes two physician dyad partners who are also LM certified.

The RDN-led team delivers effective, evidence-based programs in the areas of LM, Food is Medicine (FIM) and Culinary Medicine (CM) (Figure 1).

Figure 1.

Venn Diagram of Lifestyle Medicine, Culinary Medicine and Food is Medicine.

The American College of Lifestyle Medicine (ACLM) defines LM as a medical subspecialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions. ¹ A whole-food, plant-forward dietary pattern is one of the pillars of LM and is a strong predictor of health. As nutrition science experts, RDNs are equipped to discuss the science behind why choosing a whole-food, plant-forward dietary pattern supports disease prevention, treatment and reversal.

CM combines nutrition science with the art of planning and preparing healthy meals. RDNs who pursue additional culinary competencies are equipped to connect nutrition science—the “why”—with practical techniques—the “how”—to empower patients with reproducible skills to prepare enjoyable meals that can prevent, treat, and reverse disease. RDN-led CM initiatives can also educate health care providers on evidence-based, actionable nutrition messages to share with their patients.

FIM is defined as a spectrum of programs, services, and other interventions that recognize and respond to the critical link between nutrition and health. ² The focus of FIM initiatives can vary from general health and wellbeing, disease management and treatment, or nutrition security and food safety. It should be noted that nutrition counseling and education, which RDNs are uniquely qualified to deliver, are critical components to the success of all FIM interventions.

Scope and Standards of Practice for Registered Dietitian Nutritionists

The education and skills of RDNs, combined with LM training, position them to effectively extend their scope of practice and serve as leaders in the LM and CM fields. To become a credentialed practitioner, RDNs must obtain a graduate degree from an accredited dietetics program, complete a minimum of 1000 hours of supervised practice, pass a national board exam, and participate in ongoing professional development activities. ³ Credentialed RDNs demonstrate competency in the specific areas outlined in the scope and standards of practice defined by the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics. These competencies define both the competent level of practice as well as the depth and breadth of practice for RDNs. They promote evidence-based, ethical, safe, timely, efficient, effective, equitable, person-centered care, and individual professional advancement. ⁴ In addition, many RDNs competencies align with the interventional (curriculum design and delivery, facilitation and provision of medical nutrition therapy (MNT)) and operational (business and operations, marketing and recruitment, kitchen and food safety, research and evaluation) components necessary to deliver and direct effective LM and CM initiatives. These competencies serve as a solid foundation for RDNs looking to expand their practice into LM and CM (Table 1).

Table 1.

Commission on Dietetic Registration and American College of Lifestyle Medicine Competencies.

CDR Competencies (TYPE)	Overlapping ACLM Competencies
Ethics (Core)
Health Equity (Core)
Communications (Core)
Leadership and Advocacy (Core)	Leadership
Critical Thinking and Decision Making (Core)	Assessment Skills
Research & Scholarship (Core)
Quality Management (Core)	Management Skills
Food, Nutrition, Dietetics (Core)	Knowledge
Education and Counseling (Core)	Management Skills
Clinical Care (Functional)	Assessment Skills
Foodservice Systems Management (Functional)
Organization Management (Functional)	Management Skills, Office and Community Support

Expanding the Registered Dietitian Nutritionist Scope of Practice

While the baseline knowledge and skills of RDNs provide a solid foundation for expansion into LM and CM, to lead in those spaces, RDNs require additional training and skill development. For RDNs looking to expand their scope and excel in LM, ACLM provides evidence-based education resources and the opportunity to pursue board certification. This training builds on the RDN core competencies and increases evidence-based knowledge in restorative sleep, physical activity, stress management, risky substances, and social connection.

Although some dietetic programs incorporate a formal CM focus, CM education is not a current requirement to become a RDN. For RDNs desiring to attain the additional knowledge and skills to effectively lead CM initiatives, there are many certification programs and continuing education opportunities available. However, these offerings vary in CDR accreditation status, price, contact hours, hands on learning opportunities, and the competencies and skills taught. This variation makes it difficult to ensure RDNs receive consistent, comprehensive CM education and strengthens the argument for the inclusion of specific CM competencies in the RDN academic pathway. ⁵

Registered Dietitian Nutritionist-Led Programs Support the Quintuple Aim

Capitalizing on the skills and expertise of RDNs trained in LM and CM is an effective strategy to arrest the rising prevalence of lifestyle-related chronic diseases and their associated costs. An RDN-led approach to LM strongly aligns with the Quintuple Aim of better health outcomes, lower cost, improved patient satisfaction, improved provider wellbeing, and advancement of health equity (Figure 2).

Figure 2.

American College of Lifestyle Medicine Quintuple Aim. ⁶

RDNs are trained in motivational interviewing (MI) and are effective at helping patients connect with their internal motivation for change. This is crucial for the successful long-term behavior change that leads to better health outcomes and improved patient satisfaction. LM and CM trained RDNs incorporate MI and MNT into their programs and interventions. Research shows that MNT, which RDNs are uniquely qualified to provide, has the potential to delay disease progression, improve efficacy of medical treatment, and improve patient quality of life—particularly for patients with obesity, diabetes, hypertension, and cardiovascular disease.^7-10 Additionally, MNT is a billable medical service which can support the financial viability of RDN-led LM and CM initiatives.

Connecting Culinary Medicine to Community Needs

Currently, over 60% of U.S. adults have one or more diet-related chronic disease. ¹¹ Ample evidence proves a whole-food, plant-forward dietary pattern is critical for the prevention, treatment, and reversal of these chronic conditions. Despite this evidence, many medical professionals, and their patients, struggle to translate dietary recommendations into practical, daily actions. This challenge was evident when the THAA LM Department received repeated requests for culinary education resources from patients, other hospital clinics and departments, and the hospital’s farm share participants. To address this gap in culinary knowledge, and provide physicians with a trusted referral resource, the establishment of a virtual community CM course was explored.

To ensure the envisioned program aligned with community needs, the UNITE Community Health Needs Assessment (CHNA)—a joint project of THAA, University of Michigan Health and Chelsea Hospital was reviewed.^12,13 Food insecurity—inconsistent access to safe, nourishing, culturally appropriate food in the amount needed to support normal growth and development and a healthy, active life—emerged as a top concern for the community served by THAA.

Food security can be influenced by a variety of factors including, but not limited to, financial hardship, physical access to food, and adequate knowledge and resources to select, prepare, and safely store food. Outside of comprehensive policy change, food and nutrition security is best addressed through a combination of food provision and nutrition and culinary skill-building. The UNITE CHNA implementation plan included strategies to address physical food access but nothing to address nutrition or culinary literacy. A scan of community education resources also identified a lack of accessible nutrition and CM programs. This gap in the CHNA implementation plan and community resources highlighted an opportunity to support community needs through an accessible CM program.

Examining the national health care landscape also provided justification for the development of a CM program. In September 2022, the White House Conference on Hunger, Nutrition and Health convened experts from across the country and launched a national strategy to address food and nutrition security and health. ¹⁴ This strategy included a focus on nutrition education and catalyzed actions that renewed interest in strengthening medical provider nutrition knowledge and FIM interventions. Complementing this national momentum, a review of the CM literature revealed robust evidence that these interventions reduce health care costs, improve patient outcomes, and are effective in both virtual and in-person formats.^15-22 These findings underscored the critical need for an approachable, evidence-based CM program at THAA.

Cooking With Plants: a Practical and Effective Culinary Medicine Solution

Community need, the national landscape, and CM literature all supported the addition of a CM program to the THAA LM Department. In January 2023, a virtual CM series, Cooking with Plants, was launched. The goals of the ongoing series are to support attendees (patients, community members, Trinity Health providers and colleagues) in increasing the quantity of whole, plant foods on their plates, be an accessible referral resource for physicians, and to improve physician knowledge of, and confidence with, basic nutrition.

The Cooking with Plants series is free and offered monthly via a virtual meeting platform to increase accessibility for a broad audience. The virtual format eliminates transportation barriers, allows for the use of closed captions, and makes it possible to record classes for sharing publicly via free streaming tools.

Each 60-minute class is taught by a LM board-certified RDN. Instruction includes a 10-to-20-minute nutrition lesson followed by culinary demonstration of three to six plant-based recipes. The series sequentially builds knowledge while remaining impactful for single class attendees. The curriculum focuses on whole-food, plant-forward eating and the foundational nutrition and culinary knowledge needed to incorporate these foods into daily meals. To further support accessibility, all recipes are easy to prepare, use commonly available low-cost ingredients, and require limited equipment. Class topics include stocking your pantry, adding flavor, plant-based proteins, using whole grains, cooking with “unique” vegetables, fermentation, and more.

Over 1,000 individuals from 19 different states have participated in the Cooking with Plants series to date. Participant feedback is overwhelmingly positive and comparison of pre and post participation surveys highlights the program’s positive impact on behavior change. As a result of attending the 2024 Cooking with Plants classes, 67% of attendees demonstrated increased consumption of vegetables and 64% increased their plant protein intake. Nearly 90% of participants tried a new plant-based food and stated increased motivation to eat more plant-based meals. Culinary skills and confidence increased in 82% of attendees. The series also had a positive impact for Trinity Health colleagues. In both 2023 and 2024, nearly 25% of participants were Trinity Health colleagues and a majority stated that their participation in the series positively influenced their patient care.

Starting a Virtual Culinary Medicine Program

There is no “one size fits all” approach to delivering CM programming. If you are considering initiating your own program, speak with a diverse group of CM practitioners to learn the best practices and strategies that will work for your particular situation. What follows are recommendations based on two years of experience delivering the virtual Cooking with Plants program at THAA.

Initial Considerations

Before creating any program, determine how it will meet community needs or provide solutions to problems experienced by your stakeholders. If your health system or local health department completes a CHNA, review this tool to identify your community’s most pressing health concerns and align your programming to address them. Framing your program as an effective solution to community challenges will help you clearly justify its existence to funders and leadership.

Review your skills to determine the need for additional education to successfully implement a CM program. Consider if you will deliver the program yourself, or if there are other professionals (RDNs, chefs, physicians trained in CM, etc.) you can partner with who have skills and expertise that complement your own.

Program Funding

Ongoing funding for Cooking with Plants is provided by the health system as part of our community benefit commitment. Under the Affordable Care Act, non-profit health systems are required to prove they positively impact their communities to maintain their tax-exempt status. ²³ Aligning Cooking with Plants with THAA’s CHNA priorities allows program costs to be captured as community benefit and supports the maintenance of the health system’s non-profit status.

This strategy is not available in every health system. Other strategies to generate funding include grants, sponsorships, charging class fees, and medical billing. The national momentum around FIM, which culinary and nutrition education is central to, continues to grow and funders are excited to support these interventions. Local grocery stores, community foundations and national, health focused foundations can be valuable sources of grant funding. Soliciting sponsorships from local or national corporations with an interest in food, nutrition, or community health can also be an effective funding tactic. Depending on your community, charging for courses through sliding scale or set fee models may also help generate revenue and offset program costs.

While reimbursement for LM and CM programs remains a challenge, creative billing strategies exist. RDN-led group programs can bill in person and virtual classes using group MNT CPT code 97804. However, coverage for this service varies and is not available for patients with Medicaid or Medicare unless they have a diagnosis of diabetes or chronic kidney disease. ²⁴ Expansion of coverage for MNT under Medicare and Medicaid is an ongoing opportunity for advocacy that can improve accessibility and sustainability of LM and CM programs. ²⁵ For CM programs that include physician partnership or oversight, shared medical appointment billing is a possibility. ²⁶ Another novel approach for expanding access to, and capturing revenue from, CM education is the CM e-consult. ²⁷

As the health care landscape continues to evolve, there are opportunities to influence reimbursement models. For example, Coding4Food is spearheading the creation of Health Care Common Procedural Coding System (HCPCS) codes for FIM and CM programs that could be adopted by payors. ²⁸ Many states also have Medicaid Section 1115 Demonstration or In Lieu of Service pilots that include FIM and nutrition education reimbursement that could be scaled to a national level.

Technology and Culinary Equipment

Successful virtual programming does not require expensive equipment. Basic technology like cell phones, web cams and ring lights are adequate for producing high-quality digital content. When starting any new virtual program, begin with basic technology and add more advanced tools as your program evolves. Basic tools to consider:

• • Secondary Laptop (for verifying audience view)

• • Ring Light

• • Phone Tripod

• • Computer Stand

• • Virtual Meeting/Streaming Tool (Zoom, Teams, etc.)

Similarly, commercial grade culinary equipment is not a prerequisite for delivering effective culinary education. In fact, using equipment common to the home kitchen extends the impact of your education by familiarizing participants with tools they may already have access to. Fundamental equipment for instructing a culinary class includes (but is not limited to):

• • Portable induction burner

• • Chef knife

• • Paring knife

• • Cutting boards

• • Box grater

• • Sheet trays

• • Towels and hot pads

• • Measuring cup set

• • Measuring spoon set

• • 10 or 12″ skillet

• • 3 or 4 quart saucepan

• • Mixing bowl set

• • Silicon or wooden spatulas and mixing spoons

• • First aid kit

Physical Space and Classroom Set Up

A commercial kitchen is not a necessity for delivering impactful culinary education, especially if you are instructing a virtual class. Whether in-person or virtual, successful culinary classes can be taught in settings as diverse as conference rooms, classrooms, gymnasiums, home kitchens and more. The only requirements for your space are access to basic culinary equipment (above), ample outlets and power to run your equipment and technology, good lighting, and adequate counter or table space to safely prepare your recipes.

When setting up for your class, ensure that you have ample room for your technology, culinary tools, waste, dirty dishes, and recipe ingredients. An example of a classroom set up for a virtual class can be seen in Figure 3.

Figure 3.

Cooking with Plants virtual class set up.

Curriculum

The foundation of any education program is its curriculum. You can develop your own or utilize one of the many robust CM curricula that already exist. The Cooking with Plants curriculum was developed by a LM board-certified RDN and drew inspiration from ACLM, Health meets Food, Oldways, and other CM resources. Recipes used in Cooking with Plants classes are whole-food, plant-based and focus on readily accessible, cost-conscious ingredients. Recipes are also designed to be quick and easy to prepare and include elements of familiarity to increase audience acceptability and adoption.

Marketing and Promotion

A robust marketing plan is a cornerstone of successful programs. Work with your organization’s marketing team to develop press releases, targeted emails, social media posts and printed materials and pitch stories to local news outlets. Consider creating smart phrases in your EMR to allow providers to easily share program information with patients.

Evaluation and Data Collection

All effective community-based programs have thoughtful evaluation and data collection plans. Evaluation verifies the direction, and depth, of your program’s impact and provides valuable feedback for enhancing program content and delivery. It also provides crucial information to support funding advocacy and the development of champions within your organization’s leadership team.

You do not need expensive tools, or statistician support, for the basic data collection needed for quality improvement and advocacy. Cooking with Plants uses Microsoft Forms surveys at registration, and at the end of the program year, to collect participant demographic data (zip code/state, gender, age, race) and changes in dietary habits, food literacy, and culinary skills.

Survey data is aggregated, reviewed for trends and summarized. Applicable changes are implemented, and a summary of the enacted changes is emailed to program participants. This communication validates the participants’ feedback and encourages continued program engagement.

Registered Dietitian Nutritionist as Leaders in Culinary and Lifestyle Medicine

Capitalizing on the skills and expertise of RDNs trained in CM and LM is an impactful, cost-effective strategy to arrest the rise in lifestyle-related chronic disease—the leading cause of death in the United States. The LM and CM movements are critical for preventing, treating and reversing chronic disease and RDNs have training and expertise that, when combined with culinary and lifestyle medicine education, uniquely qualifies them to expand their scope of practice and lead LM and CM interventions. CM education can increase the adoption of the whole-food, plant-forward dietary pattern recommended by LM for disease prevention, treatment, and reversal and increases community food literacy and the success of FIM interventions.

RDNs interested in leading CM initiatives should begin by assessing their competencies in this area and consider additional training, as needed. Formal training opportunities, such as the American College of Culinary Medicine’s Certified Culinary Medicine Specialist certification or Harvard’s CHEF program, vary in scope and cost. Carefully review syllabi and select courses based on their ability to fill your specific knowledge gaps. See Table 2 for additional resources.

Table 2.

Culinary Medicine Resources.

		Culinary Medicine Resources
		Resource Type
		Culinary Medicine Curriculum(s)	Continuing Education Credits	Annual Conference	Culinary Medicine Certification Program	Webinars, Toolkits, Research and Other Culinary Medicine Resources
Organization	American College of Culinary Medicine	x	x	x	x	x
	American College of Lifestyle Medicine	x	x	x		x
	Harvard: CHEF		x		x
	Oldways	x	x			x
	The Teaching Kitchen Collaborative		x	x		x

If formal training is inaccessible, informal culinary education can also improve culinary competencies. Informal education can include working in a restaurant with a scratch kitchen, shadowing local culinary professionals, watching free online culinary skills videos, reading cookbooks from the library, and increasing time spent cooking in the home kitchen.

For health professionals looking to start CM initiatives, include RDNs in the development of your program and consider supporting their leadership in additional CM programming. The nutrition expertise, specialized competencies, and MI skills of RDNs are invaluable assets that enhance the efficacy of any CM intervention.

Ethical Statement

Ethical Approval

This article describes a program, not a research study with human participants. No informed consent was required.

ORCID iDs

Kelly Wilson https://orcid.org/0009-0007-3282-5735

Abigail McCleery https://orcid.org/0009-0008-4319-5633