Doctor’s Orders: Eat Well to Be Well


From NYT
Thanks to Janie Sheppard

Oakland–Dr. Preston Maring was striding along a hospital corridor at double speed on a recent Friday morning, his tall frame, white hair and frequent gesticulations prompting waves of greetings from colleagues, who also took care to sidestep his forward momentum. His destination was the weekly farmers’ market he started in 2003, just outside the front door at the Kaiser Permanente medical center here.

“Since it’s mine, I made the rules — all organic,” he said as he skimmed by a line of stalls where fresh fruits and vegetables are sold to hospital workers, passers-by and even, he said, those bringing patients to the emergency room.

Dr. Maring, 64, a gynecologist and obstetrician with three decades as a surgeon, is well known as a former physician in chief at the hospital, the man who spearheaded the creation of its new pediatric neurosurgery unit.

But increasingly, his reputation and perpetual motion revolve around his conviction that in the health professions, the kitchen must become as crucial as the clinic. Food is at the center of health and illness, he argues, and so doctors must make all aspects of it — growing, buying, cooking, eating — a mainstay of their medical educations, their personal lives and their practices.

Though Dr. Maring blithely refers to himself as “that food nut around the hospital,” he is serious about the role he believes doctors should play in creating awareness of healthy food choices. To that end, he has worked to obtain fresh local food for hospital trays and in cafeterias. He began a Web site and blog that offers recipes and advice on meal planning and budgeting. He spent the summer working on a series of three-minute Web videos to explain the basics of shopping for healthful foods and efficient preparation techniques.

He also created a kind of culinary road show, which regularly takes him to health care institutions around the country, toting a PowerPoint presentation, a couple of plastic vegetable knives (“one of the great technological breakthroughs”), some salad ingredients and the makings of a vinaigrette.

“I like to put doctors on the spot,” he said, referring to his penchant for hauling a senior clinician up to the front of the room to chop vegetables with him. “We tend to be exalted, and I want to show the staffs that many of us don’t know how to mince garlic.”

If there was ever a time when doctors need to be as handy with a peeling knife as they are with a scalpel, this may be it. The draft version of the federal government’s 2010 Dietary Guidelines, which will be formally released in December, identifies obesity as the nation’s greatest public-health threat. It also notes the relationship of fast food (and physical inactivity) to unhealthy weight gain and emphasizes the importance of plant-based foods in the diet.

Despite evidence that doctors have a greater life expectancy than average, they don’t necessarily look after their own dietary health, said Dr. Walter Willett, chairman of the nutrition department at the Harvard School of Public Health. “You’ll have a pretty hard time these days finding a doctor who smokes, but not nearly as hard a time finding one who eats terrible food.” He recalled a major breakfast gathering he attended several years ago: “I came in a bit late and was struck by the surreal image of senior scientists feeding on junk while discussing solutions to national nutritional problems.“

Dr. Willett cited surveys showing that during examinations of obese patients, doctors often don’t remark on overweight as a health issue. “Many of them just avoid it,” he said, either because they doubt their counsel will be heeded or because they don’t know the issues well enough themselves, leading the patient to underestimate the gravity of the situation.

For many doctors, an uneasy relationship with nutrition starts as early as medical school. Long hours and ready access to fast food, often on the hospital grounds, tends to undermine students’ best dietary intentions, said Dr. Robert F. Kushner, a professor at Northwestern University Feinberg School of Medicine, where he directs the Center for Lifestyle Medicine. “Even the ones who come in excited about eating well and exercise find that good habits are harder and harder to maintain as time goes on,” Dr. Kushner said.

Dr. Maring’s son, Ben, 30, a fourth-year medical student at New York University School of Medicine, hopes to change that. Mr. Maring has developed a series of cooking classes that incorporate salient aspects of nutrition and clinical medicine. He named his scheme CHEF — for Cook Healthy, Eat Fresh.

In 2009, he began lugging duffel bags filled with cooking implements and ingredients from his Brooklyn apartment to the medical school campus on East 31st Street in Manhattan, where he commandeered a spare lounge and taught fellow students simple preparation techniques, introduced guest speakers in specialties like diabetes and endocrinology, and handed out reams of recipes.

“I thought it was important for medical students to learn how to cook and eat well,” he said. “I also thought it was important for us to walk the walk when it comes to counseling patients about the importance of diet. We get so little training in nutrition that I wanted to provide some basic knowledge.”

Dr. Maring said: “You should have seen him trying to drag a convection oven into a taxicab. We cooked together as a family when he was a kid, but he blew past me a long time ago. Now I’m his sous-chef.”

Ben Maring, who has his father’s imposing build and forceful personality, but with a quieter, more scholarly mien, first planned on a career as a chef and did a post-culinary-school apprenticeship at Thomas Keller’s Per Se restaurant in Manhattan in 2005.

“It was very much like the world of a hospital, where you’re on your feet the whole time, you have to make the right decisions very quickly, and you have to be highly self-motivated while also working as part of a team,” Mr. Maring said. Nor was Mr. Keller’s keen appraisal of the neophyte’s technique unlike the scrutiny he now endures on hospital rotations. “I remember being at the pass” — the area closest to the dining room — “about to sauce a plate, and Keller came and stood right next to me,” Mr. Maring said. “I was so nervous. I was trying to artfully drizzle a broken foie gras vinaigrette, and my hand was just shaking. He jokingly asked if I had had too much caffeine.”

Mr. Maring is encouraged that CHEF’s feedback surveys show students are developing confidence in their cooking skills, making better food choices and feeling more comfortable talking to patients about the links between diet and health. He is developing recipes geared to the seasonal offerings at a new farmers’ market at Bellevue Hospital Center, adjacent to the N.Y.U. medical campus, which was begun in July by Aviva Regev, 24, a third-year student and CHEF participant.

Mr. Maring has another ally in Benjamin Navot, 25, a third-year student who entered medical school directly after graduating from the French Culinary Institute in Manhattan and has taught some CHEF classes. Mr. Navot acknowledged that, like Mr. Maring, his perspective on food is greatly influenced by his previous experience. But he, too, senses a widespread interest in food and healthy eating among his peers.

“This is a generation that cares a lot more and knows a lot more about the importance of diet,” he said. “We need a system that educates physicians about nutrition, and we’re the ones who are going to have to fight for it.”

But the older generation can pick up a few new tricks, too. Preston Maring said that in some ways, his attempts to get more fresh local foods into hospitals have been reminiscent of his days as a young resident at Kaiser, particularly the need to climb a steep learning curve.

“I became the person who asks dumb questions constantly,” he said of the time he has spent over the last couple of years studying the technical aspects of food-distribution systems. “I just learned, for example, that cherry tomatoes with the stems still on are a no-go in an inpatient setting, and that at Kaiser there’s a specific size limit for an apple on a tray, because they’re stacked vertically for delivery.”

Kaiser Permanente, which is a provider and an insurer, is the largest nonprofit health care system in the country, with about 8 million members, 15,000 doctors and 170,000 employees, predominantly in western states. The sheer scale of Kaiser, which holds farmers’ markets at 30 sites, makes changing the way food is bought a challenge, but also an opportunity.

“We can leverage our size to create greater demand for healthy food,” Dr. Maring said. Kaiser Permanente Oakland, for example, serves 6,000 inpatient meals a day, 80 percent of which have no special restrictions.

“It’s difficult for farmers to crack the institutional supply chain,” he said. “We need a ‘universal adapter’ that can pair small producers with big customers.” Toward that end, he helped start a regional growers’ cooperative and joined the board of the nonprofit entity that administers it, the Community Alliance With Family Farmers.

Dr. Maring also envisions Kaiser’s role expanding into areas like environmental stewardship, and he has carved out a kind of subspecialty in institutional real estate, with the goal of eventually putting some of Kaiser’s undeveloped land into agriculture.

“As someone who relies on evidence-based medicine, it bothers me that we don’t have clear metrics to guide these food-related initiatives,” he said. “But for now, I remind myself of the enduring value of another care-giving principle: common sense.”
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