Changes in the Kitchen: Reimagining the Path Forward for BMC’s Teaching Kitchen, Where Food is Medicine

Boston Medical Center has long stood by the belief that food is medicine. For years, the hospital has been committed to nourishing the community by providing access to healthy food options for its patients. BMC’s three-prong model for food access and utilization began with the creation of the first hospital-based therapeutic food pantry in the country. Originally formed in response to food insecurity among expectant mothers and mothers of young children in BMC’s Grow Clinic for Children, the Food Pantry became a substantial way to connect patients in need with nutritious, wholesome food. From there, BMC went on to establish its Teaching Kitchen as well as its Rooftop Farm, a 7,000 square-foot green space located three stories above BMC’s power plant that grows fresh, healthy produce.

BMC’s Teaching Kitchen hosts nearly 300 classes for more than 2,000 patients and staff every year, and serves as a valuable resource to learn about healthy meal preparation and how to make sustainable nutritional changes to one’s diet—all with food directly sourced from the Food Pantry and Rooftop Farm. Teaching Kitchen is currently led by Culinary Nutrition Director Olivia Weinstein, MS, RD, LDN, and was founded by dietitian and chef Tracey Burg, RD.

“Tracey built the program, she was the heart and soul of this [program], and what I’m now trying to do is integrate it more into practice. So my focus has been more on medical intervention and how to incorporate it into clinics because I think having a teaching kitchen in the center of a hospital is a cool opportunity to make part of the medical model,” explains Weinstein.

Now a team of two, Weinstein and Kate Donovan, MS, RD, LDN, pediatric dietitian, offer an array of classes catered to a variety of different groups. These include: classes which serve individuals at community centers like Boston Healthcare for the Homeless and the substance use treatment facility Hope House; classes designated for employees and students; and classes dedicated to patients with specific medical diagnoses.

“The schedule is really expansive. There’s something for just about everyone. Our bariatric weight loss surgery class is actually a required step before the clinical portion. We have quarterly intensive interventions for pregnant women with diabetes. We have monthly classes for kids with barriers to eating led by a multidisciplinary team, including a speech pathologist, psychologist and a dietitian, which is really fun,” notes Weinstein.

Each class is also led with cultural sensitivity, intentionally keeping BMC’s diverse patient population in mind. Cultural awareness is addressed in all areas of the program—from what is distributed in the Food Pantry to the produce grown on the Rooftop Farm. Patients also have the opportunity to use what Weinstein calls the “swap-out method,” giving them the choice to exchange certain items for alternatives from the Food Pantry. “Instead of being given rice, they could swap it out for potatoes or if they were given chicken, they could swap it out for ground turkey. It is important they have some autonomy over what they bring home based on what they’re most comfortable with,” says Weinstein. This exact method is also used by the Teaching Kitchen with recipes, allowing patients to have a choice in what they want to prepare. “[We allow choice to be] culturally sensitive, but also to be sensitive to socioeconomic backgrounds. We don’t always know what is affordable or not affordable to most families so we try to be extremely conscious of that,” explains Weinstein.

While the team works diligently to be reflective of different cultural preferences in their recipes, Weinstein also recognizes there is still a ways to go:

“There is definitely a learning curve and it’s hard to be an expert on every culture, which is why our classes are more group-oriented and why people are encouraged to [voice their opinions]. Sometimes a patient will even end up teaching the class, showing their way of cooking something and I think that is really cool. A lot of time we’re figuring out how to best make a change together.”

Since the start of the COVID-19 pandemic, the Teaching Kitchen, like many other programs and services at BMC, was forced to make significant adaptations. With tightened hospital restrictions, a major concern became how patients would continue to access food. Quickly, the idea to make home food deliveries through the Food Pantry was hatched. The Teaching Kitchen team supported the program by including recipes with each delivery based on the items being delivered. Meals centered on staple foods and other nonperishable items to help families reduce trips to the grocery store.

Classes were also forced to go fully virtual, both in live and prerecorded formats. Weinstein took the abrupt change with stride, forming a weekly series on BMC’s Instagram titled, “Thursdays in Kitchen.” The new program hoped to reach a wider community, and saw great success. In a paper published in the American Journal of Public Health, Weinstein and colleagues detailed COVID-19 adaptations and outlined how classes initially decreased during April and May of 2020, but eventually returned once redesigned to accommodate the new virtual normal. In response, participation rates also increased from an average of eight participants to an average of 15 per class, with many participants reporting they enjoyed being able to cook from their own homes. However, like most new things, the virtual format came with its own set of challenges. The inability for patients to swap out food items from deliveries due to concerns around virus transmission was a cause for frustration. Additionally, fewer people reported actively cooking during virtual classes because of lack of specific ingredients or scheduling conflicts.

Lessons learned have prompted the team to consider a new approach for the Teaching Kitchen schedule, post COVID. “Moving forward, we will always have an element of virtual learning for patients who prefer that model, and we will also have some in-person classes for those who prefer that model. I think it’s all about finding the right balance to make it work for all,” explains Weinstein.

Though the pandemic has shifted the operations of Teaching Kitchen indefinitely, one thing remains certain—Weinstein and her team would not be able to do this important, life-changing work without philanthropic support. “The fact that I am able to be adaptive based on what patients need and want is critical. Philanthropy allows us to do that,” says Weinstein. Thanks to this support, the free program serves as a critical tool for departments throughout the hospital—something Weinstein is passionate about expanding. “We often piggyback on interventions and I think that’s the perfect modality for this type of work. We can just be ready to jump in and help in treating all patients with all different medical backgrounds,” concludes Weinstein. “That’s really important to me and I’m excited to further this work.”