A New Trend in Gastronomy - Culinary Medicine Chef

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International Journal of Gastronomy and Food Science 24 (2021) 100328

Contents lists available at ScienceDirect

International Journal of Gastronomy and Food Science


journal homepage: www.elsevier.com/locate/ijgfs

A new trend in gastronomy: Culinary medicine chef


Hayrettin Mutlu a, *, Murat Doğan b
a
Istanbul Health and Technology University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul, Turkey
b
Istanbul Gelisim University, Faculty of Fine Arts, Department of Gastronomy and Culinary Arts, Istanbul, Turkey

A R T I C L E I N F O A B S T R A C T

Keywords: The aim of this study was to determine the theoretical, practical, and conceptual framework of culinary medi­
Gastronomy cine, a niche emerging trend in gastronomy. The focus group interview method, a qualitative research design,
Gastronomy specialist was used, and the framework was evaluated with a total of ten participants in the study. The data obtained from
Dietician
the focus group interview were analyzed using content analysis based on gastronomy, nutrition, and food sci­
Culinary medicine
Culinary medicine chef
ence. After evaluation, the following three main themes emerged: Creating the conceptual framework of culinary
medicine chef; practical culinary medicine training for chronic patients and their relatives, and likely contri­
bution of gastronomy specialist to the health sector. The study revealed several formal, semantic, and technical
dimensions that affect the conceptual framework of culinary medicine chef. In conclusion, this study helped
determined several formal, semantic, and technical dimensions under the headings of multidisciplinary study,
the contribution of gastronomy to the health sector, practical culinary training, and public health promotion,
which affect the conceptual framework of culinary medicine chef.

Introduction knowledge regarding patient diet plans at home becomes a challenge.


So, more studies on gastronomy can contribute to the field of culinary
Gastronomy, a discipline under food and beverage management, medicine. Therefore, the dietitians involved in the diet treatment and
involves developing modern and classical cooking techniques to pre­ follow-up of chronic patients should practice the findings and sugges­
serve the nutritional value of food and work on better culinary culture, tions in some studies on gastronomy (Bartina, 2018).
which combines painting, sculpture, music, philosophy, and etiquette. Having an appropriate diet is one of the fundamental rights of
(Santich, 2004). The knowledge and practice of gastronomy are also chronic patients, and providing this diet timely can expedite their re­
employed in the field of health, especially as a tool for health pro­ covery as well as increase their quality of life. Schulze et al. (2018)
fessionals to develop dietary recommendations for the right food choices highlighted the need to provide an appropriate diet outside the hospital
or food patterns for chronic patients (Perisé and Serrano Ríos, 2018). as well as extend proper medical support to chronic patients at home
Hopefully, the dieticians and gastronomy specialists focusing on (Schulze et al., 2018). A diet meal is a healthy and nutritious meal
multidisciplinary studies through nutrition and food sciences may tailored to the health requirements of the patient; the taste and attrac­
significantly contribute to the proper maintenance of diet treatment tiveness of the food are important in adjusting the diet according to the
processes at home for chronic patients. The role of dietitians in the chronic disease (Ueland et al., 2020). Often, chronic patients need to
medical team in the treatment and follow-up of chronic patients is change their eating habits, so they may face difficulty in adapting to
gradually increasing (Gruia et al., 2018). For chronic patients to main­ changing diets and feel dissatisfied with their meals. So, they may
tain their healthy nutritional needs throughout their lives and meet their experience problems such as malnutrition and recurrence of diseases.
metabolic needs, they need to be provided a diet after best culinary Chronic patients without a diet specific to their diseases normally may
skills. Therefore, the application of healthy diets for chronic patients is not accept this change due chiefly to their dissatisfaction over the va­
important for meeting their energy and nutrient needs and thus pro­ riety, quantity, and taste of the food taken before the disease. Providing
tecting their health (Mauriello and Artz, 2019). culinary training by gastronomist under the leadership of dietitians to
Although diet plans prepared by dieticians in hospitals reduce the the patients for understanding and accepting change might reduce the
duration of hospital stay for chronic patients, the lack of adequate problem (Mauriello and Artz, 2019).

* Corresponding author.
E-mail addresses: [email protected] (H. Mutlu), [email protected] (M. Doğan).

https://doi.org/10.1016/j.ijgfs.2021.100328
Received 6 December 2020; Received in revised form 25 January 2021; Accepted 1 March 2021
Available online 5 March 2021
1878-450X/© 2021 Elsevier B.V. All rights reserved.
H. Mutlu and M. Doğan International Journal of Gastronomy and Food Science 24 (2021) 100328

The objective of the study was to determine the theoretical, practical, Table 1
and conceptual framework of culinary medicine chefs, a niche trend in Some focus group interview questions and overall evaluation results.
gastronomy. Hence, the focus group interview method, a qualitative Interview Questions Overall Evaluation
research design, was used in the study, and the interview data were
1 Is it possible to employ gastronomy Dietitians are hesitant about the work
evaluated using content analysis. experts in the health sector? If so, of gastronomy experts in the health
how? Can you tell us your thoughts? sector. However, they think granting a
Culinary medicine and culinary medicine chef nutritional education certificate for
chronic diseases can improve
gastronomy. Gastronomy experts think
With the “Let food be thy medicine” approach, Hippocrates high­ that they have sufficient knowledge
lighted the relationship between food and health and underlined the and skill sets to contribute to the health
importance of healthy food production and gastronomy (Hoffman and sector.
Murtzlufft, 2018). Today, expert doctors publish guidelines for dietary 2 Is it appropriate for gastronomy Dietitians consider it generally
experts to contribute to the inappropriate, but the gastronomy
recommendations for their patients, explaining the treatment protocols
preparation of diet and patient experts consider it appropriate.
as well as dietary requirements but giving no information on practical meals? If appropriate why? If not,
training. Culinary medicine chefs in some developed countries (e.g., the why?
USA and the UK) prepare diet meals for chronic patients. For decades, 3 Is it necessary for patients or Dietitians and gastronomy experts
diet cooks in the hospital diet kitchen have been preparing menus for caregivers to receive practical think that patients or caregivers should
culinary training before preparing receive practical culinary training.
patients without possessing any formal training on proper nutrition in meals specific to these diseases? If Practical culinary training can be
case of diseases. These cooks mainly prepare patient-specific food based necessary, how can they do this? Is it carried out in cooperation with
on dietitian’s recipes (Eisenberg et al., 2013). Due to the increasing in­ possible in today’s conditions? What dieticians and gastronomy experts. For
terest shown in healthy nutrition, culinary services are offered with would you suggest for this? this to happen, they will need to work
together at an advanced level.
special menus such as gluten-free, diabetic, or salt-free foods for chronic
4 Could you describe the concept of Culinary medicine chefs are trained in
patients, especially in hotel diet kitchens. However, chefs who do not culinary medicine chef? the field of nutrition and food science
have sufficient training work in these kitchens (Mauriello and Artz, and can develop disease-specific
2019). Correcting these malpractices depends on properly evaluating menus and prepare meals.
the concept of culinary medicine chef as a niche gastronomy field. Due
to rapid advancements in medical science and access to healthy nutri­
gastronomists were invited for the focus group interview, and a total of
tion to reduce diseases, the life expectancy of chronic patients is rising
10 participants (5 gastronomy specialists and 5 dieticians) accepted the
gradually. This could be accomplished by providing practical culinary
interview invitation. Prior permission was obtained from the Ethics
training as per gastronomic practices (La Puma, 2016).
committee of Istanbul Gelişim University (2020/32-54). Also, prior
informed consent from all the participants was obtained.
Culinary medicine chef application areas

In particular, patients with hereditary diseases (celiac, phenylke­ Data analysis method
tonuria, galactosemia, etc.) and/or chronic metabolic diseases (diabetes,
hypertension, etc.) are diagnosed and their physicians generally provide The content analysis method was used in the study. Content analysis
information about their nutrition. Chronic diseases are increasing all is a research technique based on a systematic analysis of a text and
over the world and the incidence of at least two chronic diseases in the obtaining repeatable and valid results. The repeatability of the research
OECD region is around 30% (OECD, 2019). On the other hand, in genetic means that the same analysis can be done at different times and con­
diseases, the incidence of genetic diseases that are especially needed in ditions. If another researcher can reproduce the same results under the
nutrition varies between 1‰ and 0,01‰, and there are 700 different same conditions after an objective evaluation, research is said to be
diseases. One of the syndromes is detected in an average of 1500–5000 valid. The study must be reproducible for obtaining reliable results. The
live births (Bower et al., 2019). The incidence of Phenylketonuria is method should be systematic and consist of determined processes.
between 0,34‰ and 0,005‰ (Lidsky et al., 1985; OECD, 2019). Therefore, the content analysis was done by four different researchers
Now very little practical culinary training is given for patients and (Assarroudi et al., 2018).
dietitians. It will take some time to provide widespread culinary training
to all. Practical culinary training by expert gastronomists will improve Results and Discussion
the health outcomes of patients. For this reason, gastronomy specialists
expertizing in culinary medicine and giving practical culinary training Conceptual framework
will contribute to the health sector (Larson et al., 2006, 2009).
Four main titles and ten subtitles were determined after content
Material and method analysis of the focus group interview for the concept of culinary medi­
cine chef (Fig. 1). Thus, many factors, including formal, semantic, and
Data collection technical dimensions, which affect the conceptual framework of culi­
nary medicine chefs, were identified.
In the current study, the concept of culinary medicine chef was The data and content obtained from the focus group interview were
evaluated using the focus group interview method, a qualitative analyzed based on gastronomy, nutrition, and food science, and three
research design. A focus group interview is a data collection method in main themes were reached, as shown in Table 2.
which people with knowledge about the research are interviewed
(Nyumba et al., 2018). .Table 1 presents several focus group interview Contribution of gastronomy to health sector
questions and overall evaluation thereof. Through the maximum vari­
ation sampling, a purposeful sampling method, focus group interview Content analysis of the focus group interview revealed that
participants were selected in the current study. Patton (2014) argued gastronomy specialist could work under the leadership of dieticians in
that in the maximum variation sampling method, it would be advanta­ the process of creating new diet recipes for special nutritional re­
geous to bring people from various specialties together to maximize the quirements and preparing dietary meals in hospital and other kitchens.
discovery of different ideas and suggestions. Totally, 12 dieticians and Culinary medicine chefs, especially in hospital kitchens, should be

2
H. Mutlu and M. Doğan International Journal of Gastronomy and Food Science 24 (2021) 100328

Fig. 1. Culinary medicine chef.

preparing customized nutritious foods for patients (Spence, 2017).


Table 2
Gastronomy specialists can make significant contributions in the prep­
Main themes of content analysis.
aration of diet, especially chronic patient meals, development of new
Main Themes and delicious recipes, planning of the menus, and presentation of the
1 The conceptual framework of culinary medicine chefs should be created under food. Thus, new recipes can be developed and diversified for chronic
the leadership of dietitians, together with gastronomy specialists. patients who constantly eat the same type of foods (Gruia et al., 2018;
2 Under the leadership of dieticians, gastronomy specialists should organize
Parks and Polak, 2019). and sometimes get bored.
practical culinary medicine training for chronic patients and their relatives.
3 Gastronomy specialists can contribute to the health sector, thereby improving
the public health level. Applied culinary medicine training
The conceptual framework determined as a result of the content analysis of the
focus group interview is detailed below. Today, there are diet kitchens for patients in hospitals where chronic
patients are trained on theoretical culinary medicine at home before
trained to prepare meals for chronic patients (Irl B. et al., 2019). discharge, and they are offered relevant information and training about
Furthermore, the health sector needs gastronomy specialists who can nutritious or non-nutritious patient foods. However, practical culinary
contribute to making more healthy, attractive, and tasty meals for the medicine training required for creating menus and preparing food is not
patients. New innovative recipes, especially the meals served in hospi­ given to the relatives of patients. This problem can be overcome by
tals, can be created. Gastronomy specialists should be actively employed designing practical medical kitchen video recordings for the patients
in catering services in the health sector. They must participate in the and their relatives. However, food preparation processes in the kitchens
menu planning and development stages with the dietician in hospital of chronic patients can be controlled and directed by appropriate
kitchens. The chefs need to perform sensory analysis and thus flavor the communication tools and online apps. With proper planning and more
meals to prevent malnutrition, which is frequently encountered by in­ studies, it should be ensured that chronic patients and their relatives
patients (Parks and Polak, 2019). receive practical culinary medicine training. After the diagnosis by a
Hospital kitchen chefs need to be gastronomy specialists with ample physician, chronic patients are directed to a dietician; their nutrition
knowledge of the taste and presentation of the foods required for pa­ programs are designed, and a procedure can be created to guide these
tients. Due to the lack of gastronomy specialists in culinary medicine, patients by the gastronomy specialist. Considering the importance of
people at home and in hospitals prepare patient foods under the guid­ multidisciplinary work, practical culinary medicine training programs
ance of dieticians. In the focus group interview, different suggestions should be planned for chronic patients and their relatives in cooperation
were made to bridge the knowledge gap of gastronomy specialists about with the Ministry of Health and hospitals, and gastronomy specialist
medical cuisine. The addition of elective courses such as anatomy, should be assigned (Polak et al., 2016) to hospitals and other places to
physiology, and nutrition in diseases to the gastronomy curricula of generate awareness about culinary medicine.
universities was the most important suggestion. Other suggestions were
as under: Gastronomy specialists and dietitians

1. Students of the gastronomy department should make a double major In the focus group interview, dietitians showed their concerns about
or minor in the department of nutrition and dietetics. gastronomy specialists replacing dieticians in the health sector. They
2. Organize certification programs in the field of nutrition and dietetics argued that gastronomy specialists should not take an active role in
for gastronomy specialists. hospital kitchens. The dietician group preferred training on gastronomy
and improved their skill sets in food preparation and cooking tech­
In this way, the gastronomy specialists may achieve expertise in niques. However, gastronomy specialists think that gastronomy and
nutrition science should work in unison and develop themselves in

3
H. Mutlu and M. Doğan International Journal of Gastronomy and Food Science 24 (2021) 100328

subjects such as anatomy, physiology, biochemistry, and healthy manner, the gastronomy specialists may specialize in food preparation
nutrition. Thus, gastronomy specialists would be able to work in culi­ in chronic and metabolic diseases. However, with the combination of
nary medicine (Garriga García and De Las Heras de la Hera, 2018). two disciplines, applied culinary medicine training given by culinary
medicine chefs after discharge will provide a sustainable quality of life
The concept of culinary medicine chef to the patients, and thus, public health will improve. In conclusion,
many factors have been identified, including the formal, semantic, and
A culinary medicine chef is defined as a person who has received technical dimensions, which affect the conceptual framework of culi­
extensive training in the field of health of gastronomy specialists, who nary medicine chief. Besides, this study also showed similarity in the
can prepare the meals of chronic patients and play a major role in the concept of culinary medicine chefs to the concept of diet kitchen chefs,
coordination of the preparation process. Thus, the culinary medicine though some differences were also present.
chef prepares the meals of the patients under applied medical nutrition
therapy according to the nutritional rules in chronic diseases. A culinary Implications for gastronomy
medicine chef, adequately trained in the field of nutrition and food
science, can develop disease-specific menus, prepare meals with the This study helped determined several formal, semantic, and tech­
right cooking techniques in sufficient quantity, and use appropriate nical dimensions under the headings of multidisciplinary study, the
materials. They can create disease-specific menus approved by the contribution of gastronomy to the health sector, practical culinary
doctor and dietician, prepare and guide the preparation of meals, training, and public health promotion, which affect the conceptual
thereby improving life-long sustainable lifestyle for chronic patients. framework of culinary medicine chef.
Thus, culinary medicine chefs are gastronomy specialists who manage
the process from food supply to patient presentation in the health sector CRediT authorship contribution statement
(Hauser, 2020).
Hayrettin Mutlu: Definition, Conceptualization, Formal analysis,
Job description of a culinary medicine chef Investigation, Writing – original draft. Murat Doğan: Methodology,
Validation, Formal analysis, Investigation, Writing – original draft,
Discussion of focus group interview specified the main job of culi­ Writing – review & editing.
nary medicine chef to develop and prepare diet recipes under the
leadership and guidance of dieticians and to satisfy the patients in terms
Declaration of competing interest
of taste and appearance. They show knowledge of the nutritional pat­
terns specific to diseases, prepare and develop recipes suitable for pa­
The authors declare that there is no conflict of interest.
tients, duly following the changes in diseases, flavoring the foods that
patients do not want with new recipes, and developing functional rec­
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