Lifestyle Medicine and Culinary Medicine: A Narrative Review of Important Synergies

Abstract

Chronic noncommunicable diseases remain the leading cause of morbidity and mortality worldwide, largely driven by modifiable lifestyle factors such as poor diet, inactivity, and stress. While Lifestyle Medicine (LM) provides an evidence-based framework for preventing and reversing chronic disease through six pillars—nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection—Culinary Medicine (CM) offers the practical, skill-based means to operationalize these behaviors. This narrative review explores the synergistic integration of LM and CM, highlighting how hands-on cooking, teaching kitchens, and shared medical appointments can translate lifestyle recommendations into sustainable action. CM interventions have been shown to improve diet quality, cooking confidence, clinical outcomes, and psychosocial well-being while enhancing clinicians’ competence in nutrition and behavior change counseling. By embedding CM strategies across all LM pillars, programs can promote whole-person care, social connection, and resilience. Implementation considerations include interprofessional collaboration, scalable delivery models, and outcome measures across multiple lifestyle domains. Future directions call for longitudinal research, competency-based curricula, and health system integration through reimbursement and policy initiatives. Together, LM and CM form a powerful, evidence-based approach to make food and lifestyle central to preventive and therapeutic care.

“Teams that bring together expertise in nutrition, culinary arts, psychology, and physical activity can expand both the reach and impact of a program.”

Introduction

Chronic noncommunicable diseases, notably type 2 diabetes, cardiovascular disease, obesity, and certain cancers, remain the leading causes of morbidity and mortality worldwide.^1,2 These conditions account for over 70% of all deaths globally, with the majority attributable to modifiable behavioral and lifestyle factors. ¹ Among these, poor diet is consistently identified as the leading risk factor for premature death and disability. ³ In the United States, suboptimal diet contributes to nearly half of all cardiometabolic deaths, surpassing tobacco use and physical inactivity as a cause of preventable mortality.^4,5

Despite the overwhelming influence of diet on chronic disease risk, medical education has lagged in preparing clinicians to address nutrition in practice. A 2019 systematic review found that although most medical schools report some nutrition content, training is often minimal, fragmented, and focused more on biochemical pathways than on applied patient care. ⁶ Recent data indicate that approximately 75% of U.S. medical schools do not require a clinical nutrition course,^7,8 and, on average, U.S. medical students receive fewer than 20 hours of nutrition instruction during their four years of training. ⁷ This is despite a longstanding recommendation that students receive a minimum of 25 hours during their pre-clerkship training alone. ⁹ After medical school, only 26% of residency programs have a formal curriculum. ¹⁰ Across multiple surveys, only 14% of physicians report feeling prepared to counsel patients on diet,^11,12 underscoring the persistent educational gap.

Parallel to these educational gaps are systemic financing barriers to nutrition-based interventions. Medicare coverage for medical nutrition therapy with a registered dietitian is currently limited to diabetes and renal disease, with strict caps on annual hours. ¹³ Most “Food is Medicine” (FIM) programs, such as medically tailored meals and produce prescriptions, lack sustainable reimbursement pathways and instead rely on research grants, state waivers, philanthropy, or organizational pilot funds. Yet modeling studies suggest that the nationwide delivery of medically tailored meals could reduce hospitalizations by millions annually and yield over $30 billion in cost savings. ¹⁴ Moreover, systematic reviews show that FIM interventions improve diet quality, food security, and health outcomes, but policy limitations hinder broad implementation. ¹²

These gaps between evidence and education and between demonstrated effectiveness and financing highlight the need for approaches that translate nutrition science into practical, actionable strategies for both clinicians and patients. Culinary Medicine (CM) has emerged as an evidence-based discipline that integrates nutrition science, culinary arts, and medical care to improve health through food choices, preparation, and behavior change. La Puma ¹⁵ first articulated CM as a practice that “blends the art of food and cooking with the science of medicine” to empower patients and providers alike. Newer definitions have emerged, including a recent consensus statement positing that CM for health professionals “bridges the gap between the most up-to-date, evidence-based nutrition science and culinary tradition…based on food is medicine principles: the augmentation of nutrition in health care to maintain health and prevent and treat disease.” ¹⁶ CM encompasses teaching kitchens; hands-on cooking classes; recipe modification, food budgeting, and ingredient procurement education; and culturally tailored meal planning delivered in a variety of settings—clinical, academic, community, and virtual.^17,18

Historically, food has been central to healing traditions, but the modern conceptualization of CM has developed over the past decade, catalyzed by teaching kitchen initiatives and curricular innovation in medical education. ¹⁹ Growing evidence demonstrates that CM curricula improve medical trainees’ knowledge, confidence, and counseling skills in nutrition, while patient-focused CM interventions improve diet quality, food literacy, and cooking self-efficacy.^20,21

CM is distinct from related fields such as dietetics, nutrition counseling, and community cooking programs by virtue of its clinical orientation. Whereas nutrition counseling emphasizes dietary advice, CM emphasizes skill-building, experiential learning, and behavior-change strategies rooted in medicine and health care.^22,23 This differentiation is key for closing the knowledge-to-action gap in nutrition, where patients and providers often understand dietary recommendations but lack the skills, confidence, or systems support to enact them.

Lifestyle Medicine (LM), defined as the use of evidence-based lifestyle interventions to prevent, treat, and at times reverse chronic disease, provides a natural framework for CM integration. As outlined by the American College of Lifestyle Medicine (ACLM), LM encompasses six interconnected pillars: (1) nutrition, (2) physical activity, (3) restorative sleep, (4) stress management, (5) avoidance of risky substances, and (6) positive social connection. ²⁴ Each pillar reflects converging evidence that lifestyle choices drive disease trajectories, and together they offer a whole-person, systems-level approach to prevention and treatment.

The integration of CM and LM is both logical and necessary. CM provides the practical, skill-based tools to operationalize LM’s pillars by bridging knowledge and action with hands-on practice. Group-based cooking and teaching kitchen programs not only promote healthy eating but may also foster social connection, reduce stress, enable mindful cooking and eating, and cultivate resilience by building self-efficacy. ²⁵ In this way, CM extends beyond dietary counseling to serve as a behavioral scaffold for LM in clinical contexts. ²⁶

This narrative review will describe how CM interventions can be used to operationalize each of the six pillars of LM. We will highlight strategies, evidence, and case examples of CM across nutrition, physical activity, restorative sleep, stress management, substance avoidance, and social connection. We will also examine cross-pillar synergies, implementation considerations, and research gaps, aiming to inform clinicians, educators, and policymakers about the role of CM in advancing LM.

Lifestyle Medicine and Culinary Medicine: Important Synergies

Pillar 1: Nutrition

Lifestyle Medicine Goals

Nutrition is the cornerstone of LM and is consistently recognized as one of the most powerful levers for preventing, treating, and, in some cases, reversing chronic disease. The ACLM defines its nutritional goal as the adoption of a whole-food, plant-predominant dietary pattern rich in vegetables, fruits, legumes, whole grains, nuts, and seeds and low in processed foods and animal products. ¹⁹ Such dietary patterns are strongly associated with a reduced risk of cardiovascular disease, type 2 diabetes, obesity, hypertension, and certain types of cancer.^27,28 Landmark studies, including the Lyon Diet Heart Study, the PREDIMED trial, and plant-based interventions such as the Ornish and Esselstyn programs, demonstrate improvements in cardiovascular outcomes and even evidence of coronary atherosclerosis regression.^29-31

Culinary Medicine Strategies

CM provides the practical, skills-based framework for implementing these nutritional goals in a variety of settings. Strategies include:

• (1) Hands-on skill-building: Teach patients and trainees how to shop for, store, and prepare meals made with whole and minimally processed foods ¹⁷

• (2) Translation of guidelines into recipes: Converting recommendations into culturally relevant, affordable, and feasible meals ¹⁸

• (3) Budget-conscious meal preparation: Addressing food insecurity through cost-effective strategies for preparing nutrient-dense meals ³²

• (4) Cultural tailoring: Respecting traditions and personal and cultural preferences to foster adherence to a health-promoting dietary pattern ³³

• (5) Behavior change frameworks: Embedding culinary interventions within social cognitive theory and transtheoretical model constructs to increase long-term adoption. ²⁶

Evidence Base

The literature consistently shows that CM interventions improve diet quality, cooking confidence, and clinical outcomes. For instance, in a large prospective study of over 1300 community participants, student-led CM classes were found to improve adherence to the Mediterranean diet. ²⁰ Randomized controlled trials (RCTs) report improvements in diet quality, nutrient intake, BMI, blood pressure, and glycemic control.^21,34 In medical education, CM integration enhances knowledge of nutrition, confidence in counseling, and skills.^19,35,36

Teaching kitchens are the central platform for delivering CM, combining experiential education, nutrition science, and behavior change within health care and community settings. The original conceptual model described by Eisenberg et al ³⁷ of the Teaching Kitchen Collaborative in 2019 outlined how teaching kitchens can function as “learning laboratories” for behavior change and health promotion. Traditionally, these teaching kitchens have been physical and in-person. However, a recent randomized trial demonstrated that a virtual, plant-based CM program significantly improved diet quality and cardiovascular risk markers among participants. ²¹ This highlights CM’s feasibility and effectiveness when delivered in either an in-person or virtual teaching kitchen.

Collectively, CM operationalizes LM’s nutrition pillar by translating dietary guidelines into sustainable, skill-based behaviors, enabling both patients and clinicians to address diet-related disease prevention and management more effectively.

Pillar 2: Physical Activity

Lifestyle Medicine Goals

LM embraces exercise as a core pillar, encouraging regular, purposeful physical activity for general health, managing and preventing chronic diseases like cardiovascular disease and diabetes, improving mental well-being, enhancing cognitive function, and maintaining bone health.^38,39 The correlation between physical activity and prolonged and sustained health, wellness, and physical and mental well-being is well established. Further, it helps reduce stress, anxiety, depression and improve focus, mental acuity, and emotional well-being. ⁴⁰ It is recommended that adults engage in 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week plus 30-45 minutes of twice weekly strength training. ⁴¹ Prescribing these goals for patients and helping them achieve and maintain them is critical for health. LM’s whole-person health approach embraces the interconnectedness of physical, mental, and spiritual health. This frequently includes movement practices such as yoga, tai chi, and Pilates. ⁴²

Culinary Medicine Strategies

CM readily embraces the concept of an interconnected mind, body, and spirit approach to health and wellness. Like healthy food and beverages choices, regular physical activity also drives healthy behaviors and is often done in group or communal settings. Further, physical movement activities are often coupled with social and educational events where food is present, offering an opportunity to connect LM’s principles of diet and physical activity. ⁴³

In LM, exercise practices are frequently combined with complementary therapies for chronic pain management (e.g., acupuncture, osteopathic care) and physical therapy to promote wellness. ⁴⁴ These principles are consistent with CM’s holistic approach to health and offer opportunities for experiences in how food choices can support the exercise-based management of pain, wellness, and sports injury rehabilitation.

Finally, CM shared medical appointments (SMAs) allow for a lifestyle-first approach to health that can incorporate motivational interviewing, sports recovery education, and strategies for coping with stressful life events. ⁴⁵ For instance, demonstrating cooking strategies for athletes and patients in rehabilitation programs to include higher nutrient and protein density in meals are easily within the realm of CM SMAs. ⁴⁶

Evidence Base

The research clearly demonstrates the roles of exercise and diet in optimizing exercise performance, the importance of nutrition in physical rehabilitation after surgery and physical injury, and the need for healthy food choices and physical movement to improve mental health and stress reduction.^47,48 CM offers the opportunity to pair food and physical movement as strategies to promote health and wellness through a wide variety of experiences.

Numerous studies demonstrate the effectiveness of CM interventions that combine nutrition- and exercise-based practices in improving weight-related comorbidities, the aging process, metabolic disease prevention, and overall quality of life.^49,50 CM provides the practical skills and knowledge for a healthy diet, while exercise fosters the physical capacity and motivation to be active. CM SMAs that address this combination can create a powerful feedback loop for sustainable healthy habits. ⁵¹ This approach may be especially beneficial for athletes and patients in rehabilitation programs. ⁵²

From a medical education lens, while exercise is a pivotal tool for the prevention and management of chronic disease and optimizing injury rehabilitation, there is little formal exercise education in medical education, and many medical trainees feel unprepared to effectively counsel patients about exercise. ⁵³ Incorporating CM and exercise education into medical school and residency training can help health professionals discuss nutrition and physical activity strategies effectively with patients. ⁵⁴ These interventions equip learners with the necessary skills to write nutrition and exercise prescriptions for patients while simultaneously emphasizing that both exercise and food are core and foundational medicine principles. ⁵⁵ Future studies should explore ways in which comprehensive and evidence-based nutrition and exercise curricula can be integrated into medical training programs. ⁵³

Pillar 3: Restorative Sleep

Lifestyle Medicine Goals

Sleep is one of the six pillars of LM, with the goal being to optimize conditions that enable seven to nine hours of high-quality sleep each night in support of the body’s recovery and reset processes. Sleep duration, quality, and consistency are closely linked to overall health and well-being. Disturbances, including insomnia, short or long sleep duration, and poor sleep quality, are linked to an increased risk of a variety of inflammatory conditions as well as higher all-cause mortality.^56,57 Insufficient or disrupted sleep is also associated with cardiovascular disease, diabetes, and major depression.^58,59

Culinary Medicine Strategies

CM provides a practical avenue for translating sleep science into everyday behavior change. Programs can integrate nutrition-sleep connections by educating participants on the timing of meals, the impact of caffeine and alcohol, and the functional role of various foods. Several CM initiatives already highlight the importance of sleep. For instance, the Fresh & Savory program incorporates sleep as a core component, with its participants citing the importance of sleep as a key takeaway. ⁶⁰ The Emory Healthy Kitchen Collaborative explicitly links nutrition, movement, mindfulness, and resilience practices to sleep health. ⁶¹ Likewise, the West Virginia University Culinary and Lifestyle Medicine Track integrates approximately 300 hours of experiential training, which includes modules on restorative sleep. ¹⁹ Although sleep is not yet a primary focus of most CM programs, these examples demonstrate the potential for CM to operationalize restorative sleep education within the broader framework of LM.

Evidence Base

The relationship between nutrition and sleep is increasingly supported by research, with growing evidence that both behavioral and dietary strategies can improve sleep outcomes. Cognitive behavioral therapy (CBT) for insomnia remains the gold standard, with multiple studies demonstrating its long-term effectiveness in improving sleep quality and reducing symptoms of insomnia. ⁶² In addition to CBT, several other behavioral approaches have been shown to support healthy sleep patterns. Relaxation practices, such as mindfulness, meditation, and slow breathing exercises, are associated with improvements in sleep quality and reductions in sleep disturbances. ⁶³

Lifestyle choices also play a critical role. Avoiding caffeine, particularly in the afternoon and evening, has been shown to reduce sleep latency and improve sleep efficiency.^64,65 Alcohol, while sometimes perceived as a sleep aid, disrupts sleep architecture by suppressing REM sleep and contributing to nighttime awakenings, ultimately lowering overall sleep quality. ⁶⁶ Physical activity is another important factor, as regular exercise has been linked to improved sleep duration and efficiency, with both aerobic and resistance training showing benefits across multiple populations. ⁶⁷

Nutrition-specific strategies further highlight the role of diet in sleep health. For instance, tart cherry juice has been shown to raise exogenous melatonin and improve sleep duration and quality in healthy adults. ⁶⁸ Magnesium may also support sleep by modulating neurotransmitters involved in relaxation, as evidenced by a double-blind trial in older adults that showed improvements in insomnia symptoms. ⁶⁹ A more recent review suggests that RCT evidence may support magnesium for insomnia symptoms, although the quality of this evidence varies. ⁷⁰ Beyond single foods or nutrients, the composition of a diet itself also matters. For example, one study found that a higher fiber and lower saturated fat/sugar intake is associated with deeper, more restorative sleep and fewer arousals. ⁷¹

Given the combined influence of physical activity, daily behavior, and dietary choices on sleep quality, CM provides a practical framework for fostering restorative rest. By incorporating evidence-based strategies, such as featuring sleep-supportive recipes, highlighting optimal meal timing, and demonstrating simple, repeatable skills, sleep health can be directly integrated into CM programs, empowering participants to apply these practices in daily life.

Pillar 4: Stress Management

Lifestyle Medicine Goals

This pillar recognizes a less tangible and often overlooked aspect of whole-person health: stress. Stress management, although less commonly addressed in the clinic, has been shown to improve wellness and resilience. ⁷² Modifiable and subjective stressful life behaviors lead to poorer health outcomes, ⁷³ and these may be improved with psychotherapy and other tension-reducing modalities. ⁷⁴ Chronic psychologic stress can lead to physiological issues, like increased inflammation, poor sleep, immune dysregulation, and an increased risk of chronic disease. ⁷⁵ Stress can also lead to burnout, impacting both a person’s physical and emotional well-being and further increasing the risk for illness. ⁷⁶ Therefore, it is a critical aspect of LM to incorporate stress-management techniques to bolster both resilience and overall health.

Culinary Medicine Strategies

CM interventions provide multiple avenues by which participants can address stress and anxiety, including the practice of mindful eating, improving their diets, and receiving psychosocial support. CM can enhance participants’ confidence in eating healthily, provide a social community/support network in which to engage, and improve learners’ self-efficacy through meal preparation, grocery shopping, and culinary education. ⁷⁷ CM can also improve psychological well-being by engaging the senses, fostering creative expression, and incorporating foods that enhance mood regulation, thereby stimulating positive mental and physical health. ⁷⁸

Nutrition-focused interventions have been extensively explored in patients with depression and eating disorders. ⁷⁹ By teaching sustainable lifestyle habits and modifiable cooking skills, CM participants may benefit from a sense of renewed hopefulness and a subjective increase in mood. CM also explores how the relationship between one’s diet and their brain and gut microbiome can positively impact mental health through stress reduction. ⁸⁰ For instance, among college students, consuming more fruits and vegetables and attending nutrition courses have been shown to decrease stress and improve well-being. ⁸¹ With multiple links to improved social connections, eating habits, food preparation skills, and subjective mood through the promotion of sustainable lifestyle modifications, CM interventions have great potential to help participants manage stress and foster resilience.

Evidence Base

There is deep and ongoing research to support the relationship between stress and emotional, physical, and overall health. This includes studies that associate cooking interventions with improved psychosocial outcomes. For instance, Lee et al ⁸² discuss the value of stress-management counseling in primary care as a therapeutic health intervention. As part of this approach, the authors encourage clinicians to discuss nutrition, physical activity, and meditation practices with patients to delay the onset and reduce the severity of chronic disease. Shchaslyvyi et al ⁸³ discuss the role of similar behavioral stress-reduction programs in mitigating disease and promoting patient wellness. Nutrition-specific lifestyle interventions have also demonstrated effectiveness in clients with substance use disorders, trauma, and other mental health conditions. ⁸⁴

Theoretical models, such as “PERMA” (Positive emotion, Engagement, Relationships, Meaning, and Accomplishment) have previously been used to structure CM interventions and have led to improved outcomes among participants. ⁸⁵ This model could be further expanded to impact new groups of learners, for instance, college students. Recently, Mousavi et al ⁸⁶ demonstrated that an increased consumption of fruits and vegetables increased feelings of wellness and decreased stress in college students.

CM offers rich opportunities to enhance wellness and resilience and to mitigate the negative impacts of stress on health. Across various study populations, the literature demonstrates that CM can effectively equip learners with stress-management strategies by integrating multiple LM pillars, including nutrition, physical activity, and social connectedness.

Pillar 5: Avoidance of Risky Substances

Lifestyle Medicine Goals

Consuming alcohol and use of other substances contributes to chronic disease, mental health burden, and social harms. Even modest, regular alcohol intake increases the risk of hypertension, some cancers, liver disease, and interactions with medications. ⁸⁷ Tobacco use, including vaping, has long been linked to chronic lung disease and multiple cancers, increased adverse cardiovascular events, GERD, anxiety, and a high disease burden.^88-90 Further, cannabis use has been increasingly associated with cardiac disease ⁹¹ ; mental health disorders, including psychosis in at-risk youth ⁹² ; and lower IQ. ⁹³ When taken in pregnancy, cannabis use increases the risk of premature birth, decreased birthweight, and cognitive deficits in the newborn. ⁹⁴ Cannabis use is also associated with worsening anxiety disorders, particularly in vulnerable youth. ⁹⁵

Substance use is often tightly bound to family genetics and environment, personal habits, stress management, social and peer rituals, social media use, and coping with unpleasant emotions. Addressing substance risk thus requires a broad LM approach to understanding the complex triggers for use and providing realistic alternatives and psychosocial support to replace the role substances play in people’s lives. CM provides a natural context in which to discuss alcohol, cannabis, and other substances within the overall context of promoting a healthy relationship with food and the environment.

Culinary Medicine Strategies

CM delivers insight about the role of food, alcohol, and other habit-based behaviors that are influenced by family, culture, emotion, and social setting. CM experiences typically provide facilitated group discussion about food and beverage choices and habits, including motivational interviewing and goal-setting. ⁹⁶ While drawing attention to the situations that may drive behavior toward less healthy choices, such as social or stressful life events, CM SMAs can deliver opportunities to explore alternatives to alcohol, cannabis, and other substances. These may include flavorful, non-alcoholic beverage options or non-substance-based approaches to celebration and relaxation.

For those needing to completely avoid alcohol, CM specializes in building confidence around substitutions and creativity in the kitchen, including modifying recipes that traditionally include alcohol. CM also welcomes opportunities to confront common diet and nutrition myths, such as the purported need for including alcohol in a Mediterranean dietary pattern. CM can also be structured on a group model similar to other programs that support alcohol and substance use recovery. ⁹⁷ Furthermore, SMAs offer an opportunity to build peer accountability, shared coping skills, and supportive communities based on common values.

Evidence Base

CM can play a key role in the avoidance of risky substances and management of substance use disorders by pairing motivational interviewing with hands-on practice, providing a more relaxed setting in which participants can explore why people may turn to alcohol and other substances, and offering attractive non-alcoholic beverage alternatives to prepare and sample. While not yet tested in a CM context, the provision of non-alcoholic beverages has been shown to reduce baseline drinking in at least one RCT. ⁹⁸ Other researchers have similarly found that offering alcohol-free alternatives can encourage reduced consumption in addition to providing social support, stress-management, and goal-setting. ⁹⁹

In a large cluster-randomized implementation trial, Lee and colleagues ¹⁰⁰ demonstrated that their multicomponent intervention significantly increased rates of screening for unhealthy alcohol use in primary care settings. However, it did not improve sustained engagement in alcohol use disorder treatment. This sets the stage for the potential augmentation of support by offering a group CM context. This aligns with the field’s current trajectory, as substance use recovery programs are increasingly utilizing group skill-building strategies that include nutrition and culinary training; this approach addresses both malnutrition, which is common in substance use disorders, ¹⁰¹ as well as helping participants to build new, healthier coping strategies.^102,103

In the inpatient psychiatry setting, patient workshops specifically focused on cooking have been shown to have a positive impact on mood. ⁷⁹ From a medical education lens, Cavallo and colleagues ¹⁰⁴ tested and recommend SMA participation as a training tool for health professionals learning how to treat substance use disorders. Incorporating CM into this approach would be a sensible next step to comprehensively integrate the six pillars of LM. Future research should further explore the potential of culinary medicine SMA models to improve alcohol and other risky substance use related behavior, promote recovery from substance use disorders, and build sustainable strategies for healthy self-management of stress, negative emotion, and social engagements.

Pillar 6: Positive Social Connection

Lifestyle Medicine Goals

Positive social connection is increasingly recognized as a powerful determinant of health, with social isolation and loneliness being associated with worse outcomes in chronic disease, mental health, mortality, and health care utilization. ¹⁰⁵ The health risks of social isolation are particularly prominent among older adults who simultaneously carry higher chronic disease risks associated with aging.^106,107 LM embraces the practice of strengthening positive relationships and community engagement as a core pillar, and CM strategies can be a powerful lever to foster community and connection through shared experiences over food.

Culinary Medicine Strategies

SMA interventions within a CM framework offer a promising way to counteract the risks associated with loneliness and social isolation. SMAs provide a clinical avenue for integrating nutrition and culinary education, FIM interventions, and chronic disease management. By bringing together groups of patients experiencing similar challenges, this model builds positive social connections, promotes accountability and collaboration, and enables emotional and behavioral support. CM SMAs can occur in a variety of settings, from pop-up kitchens to community kitchens to even virtual settings. ¹⁰⁸ Community kitchens may be particularly impactful in building social engagement due to their being a familiar setting to participants.

During SMAs, patients typically participate in an icebreaker or group discussion in which they can share both personal wins and recent challenges. Subsequently, CM SMAs typically include time for patients to cook and eat together while covering a lesson and addressing common questions with class facilitators. To foster connection, CM SMAs frequently employ a family-based meal approach, and they may strategically include patients from a similar age demographic or be multigenerational. Over time, this CM SMA approach has the potential to help reduce feelings of loneliness, foster new social connections, strengthen social networks, enhance self-efficacy for lifestyle changes, and potentially mitigate the downstream health risks associated with loneliness.

Evidence Base

Through CM classes, patients with similar health conditions have the opportunity to share their successes and challenges and build community and support in a group setting while simultaneously gaining valuable skills. CM clinical interventions, including SMAs, are well-received by patients and referring clinicians and receive typical evaluation and management reimbursement from payers. ²³ The Recipe4Health program showed that combining produce prescriptions with SMAs significantly reduced loneliness, improved self-reported social support, and decreased symptoms of depression/anxiety more than the benefits of the produce prescription program alone. ¹⁰⁹ Bharmal and colleagues ⁴⁵ similarly found that lifestyle‐focused SMAs that included nutrition and cooking education were well-received, with in-person classes facilitating peer support and communication.

While SMAs have been qualitatively described in multiple settings as improving patient satisfaction, reducing feelings of isolation, and fostering group sharing, challenges include adequate staff time for connection, overcoming cultural and language differences, and supporting patients who have discomfort sharing health information in a group setting. ¹¹⁰ Further research emphasizing quantitative metrics for social connection, such as validated loneliness scales and other tools, will inform ongoing program structure and how to overcome challenges and limitations, including cost and staffing across varied settings and patient populations.

Discussion

Implementation Considerations

CM programs offer a practical framework for teaching the six pillars of LM. In group visit settings, they create opportunities to integrate multiple health domains into a single experiential encounter. For example, sessions may begin with a mindfulness activity to support stress management and restorative sleep. They may then incorporate light movement before the meal to encourage physical activity, strengthen social connections through collaborative cooking and shared dining, and feature non-alcoholic beverages as healthier alternatives to alcohol. These components fit well in both clinical and community contexts, equipping participants with knowledge, practical skills, and behavior-change strategies tailored to specific health needs.

Programs can also be scaled based on available resources. At the simplest level, each pillar of LM can be introduced through resource-sharing, such as providing recipes alongside educational materials on nutrition, sleep, and exercise. With increased capacity, programs can incorporate hands-on elements, such as tasting activities, guided mindfulness exercises, and gentle movement sessions. At the most comprehensive level, subject matter experts can be integrated into the team to deliver individualized interventions and facilitate ongoing support groups. See Table 1 for other examples.

Table 1.

Strategies for Integrating Culinary Medicine into Clinician Practice by Lifestyle Medicine Pillar.

Pillar	Lifestyle Medicine Recommendation	Delivery Through Culinary Medicine
Nutrition	Consume a diet rich in fiber, antioxidants, and nutrients by emphasizing whole, minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds	Simple: Share recipes alongside nutrition education materials and counseling
		Moderate: Incorporate cooking demonstrations or tastings in waiting areas, lobbies, or as part of shared medical appointments
		Comprehensive: Integrate a chef or culinary dietitian into the care team and offer hands-on cooking sessions
Physical activity	Engage in regular and consistent physical activity, including strength, flexibility, and aerobic exercises	Simple: Share exercise handouts for patients to use at home as part of counseling materials
		Moderate: Incorporate brief movement or stretching exercises during class or session breaks
		Comprehensive: Integrate an exercise specialist or physical therapist into the care team
Restorative sleep	Optimize the conditions that allow for seven to nine hours of high-quality sleep each night to enable the body’s reset and recovery processes	Simple: Share a handout with practical sleep hygiene tips and evidence-based apps for relaxation and behavior change
		Moderate: Incorporate a brief deep-breathing or body-scanning exercise at the beginning or end of class to model an activity that participants can practice at home
		Comprehensive: Integrate a sleep specialist, psychologist, or other qualified professional into the care team
Stress management	Incorporate effective coping mechanisms and stress-reducing behaviors into daily life to manage negative stress responses	Simple: Share a handout with recommended guided meditation and/or sleep behavior change apps
		Moderate: Incorporate a short mindfulness exercise at the beginning or end of each class
		Comprehensive: Integrate a psychologist or mental health professional into the care team
Avoidance of risky substances	Reduce or eliminate the consumption of or exposure to substances that can cause harm, such as tobacco, opioids, cannabis, recreational drugs, and excessive alcohol	Simple: Provide a handout with evidence-based resources and apps for reducing or quitting risky substance use
		Moderate: Incorporate a brief discussion or reflective exercise during class to raise awareness and encourage self-monitoring of habits. Provide a tasting of non-alcoholic beverages
		Comprehensive: Integrate a behavioral health specialist, addiction counselor, or other qualified professional into the care team to support individualized interventions
Positive social connection	Strengthen and maintain meaningful relationships that provide purpose and support for overall health	Simple: Prepare and share a meal, sitting together, and provide a handout with tips and community resources for building and maintaining supportive relationships
		Moderate: Incorporate a brief group activity or icebreaker to encourage peer interaction. Start a private social media page to encourage group support and connection
		Comprehensive: Integrate a social worker, community health worker, or other professional to facilitate ongoing support groups and community engagement

The integration of additional LM pillars is enhanced through interprofessional collaboration. Teams that bring together expertise in nutrition, culinary arts, psychology, and physical activity can expand both the reach and impact of a program. Partnerships with community centers, health clinics, or fitness facilities, as well as engagement with professional networks, such as the ACLM, the Teaching Kitchen Collaborative, or The American College of Culinary Medicine, can strengthen this interprofessional approach and broaden opportunities for collaboration.

Importantly, when multiple curricular components are included, evaluation should extend beyond nutrition to capture outcomes across other lifestyle behaviors. Validated tools or adapted items can be added to assessments to track changes in domains. These include physical activity (e.g., the Exercise Vital Sign (EVS) ¹¹¹ ), sleep (e.g., the Single-Item Sleep Quality Scale (SQS) ¹¹² ), stress (e.g., the Perceived Stress Scale-4 (PSS-4) ¹¹³ ), and mental health (e.g., the Patient Health Questionnaire-2 (PHQ-2) ¹¹⁴ or General Anxiety Disorder-7 (GAD-7) ¹¹⁵ ).

Research Gaps and Future Directions

Although CM has gained rapid traction as a component of LM, several research and implementation gaps limit its full integration into mainstream medical and public health practice.

Limited Long-Term Data on Health Outcomes

Most published CM studies are of short duration, focusing on immediate gains in knowledge, attitudes, or short-term dietary behaviors.^17,20,21 For instance, the Teaching Kitchen Collaborative’s multicenter initiatives are greatly advancing standardized outcome measures, yet most are pilot or feasibility studies. ¹¹⁶ Longitudinal data examining sustained clinical outcomes, such as weight maintenance, glycemic control, lipid management, and health care utilization, are still scarce. Scoping and systematic reviews of CM interventions have found consistent short-term benefits in dietary quality and cooking confidence but call for large, longitudinal RCTs to evaluate impact on long-term cardiometabolic outcomes.^34,117

Need for Standardized Curricula and Competency Frameworks

Current CM curricula vary widely in scope, duration, instructor composition, and assessment methods. ⁵¹ While the ACLM and the American College of Preventive Medicine have previously published competencies for LM,^118,119 equivalent frameworks for CM remain in development. ¹²⁰ Standardization across teaching kitchens and medical education programs would enhance fidelity, scalability, and comparability of outcomes. For instance, although Humerick et al demonstrated the feasibility of a 4-year longitudinal CM–LM track, ¹⁹ curricular alignment across institutions remains inconsistent. Development of competency and accreditation standards through national organizations, such as those being pursued through the Teaching Kitchen Collaborative and the ACLM and its working groups, will be crucial for integrating CM into interprofessional health science education.

Opportunities for Integration into Medical Education and Public Health Policy

The growing recognition of FIM creates an unprecedented opportunity to embed CM into the continuum of medical education and health system policy.^121-124 Integration can occur at multiple levels: undergraduate and graduate medical curricula, continuing medical education, hospital-based teaching kitchens, and community partnerships with food systems and public health agencies. On the policy side, demonstration projects through Medicare Advantage and state Medicaid waivers show promise for reimbursing medically tailored meals and produce prescription programs. Linking these programs with CM-based education could amplify both clinical and cost outcomes. ¹²⁵ Future research should evaluate implementation using established frameworks, such as “RE-AIM” (Reach, Effectiveness, Adoption, Implementation, Maintenance), to guide translation into sustainable health system models. ¹²⁶

Conclusion

CM serves as a behavioral and experiential bridge that translates the science of nutrition and lifestyle into actionable practice. Across the six pillars of LM, nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection, CM provides the applied framework for teaching, modeling, and sustaining healthy behaviors. Through evidence-based, hands-on learning, it empowers both clinicians and patients to operationalize dietary and lifestyle recommendations in daily life.

The collective evidence demonstrates that CM improves diet quality, enhances cooking confidence, reduces cardiometabolic risk factors, and strengthens clinician competence in nutrition counseling. As health care systems pivot toward value-based care and chronic-disease prevention, CM offers a scalable, feasible, highly acceptable, and patient-centered strategy aligned with the goals of population health and health equity.

To fulfill its potential, the field must now focus on three imperatives: (1) generating robust longitudinal and cost-effectiveness data, (2) establishing standardized, competency-based CM curricula across health professions, and (3) embedding CM within public health and reimbursement frameworks as part of the broader FIM movement. Through these efforts, CM can become an integral component of preventive and therapeutic care, placing the kitchen at the heart of medicine and empowering a new generation of clinicians, patients, and community members to heal through food and lifestyle.

ORCID iDs

Farshad Fani Marvasti https://orcid.org/0009-0004-1586-1652

Jaclyn Albin https://orcid.org/0000-0001-9942-4353