Who We Are
The University of Texas Southwestern (UTSW) Medical Center in Dallas, Texas serves a diverse population across North Texas and beyond. We serve patients from all backgrounds, including many who face food insecurity alongside chronic diseases.
At UTSW, our mission is to promote health and a healthy society that enables achievement of full human potential. We achieve our mission in three ways: educate, discover, and heal. We believe our work in Food is Medicine and Culinary Medicine aligns perfectly with the overarching goals of the organization. Disease and sickness rob people of their potential. Empowering individuals and communities to have a healthier relationship with their food and enabling access to nourishing food – including knowing what to do with it once they have it –is essential to human thriving.
We formally established our Culinary Medicine program in 2017, beginning with the education of health professional students. The program has grown over the past eight years to include multiple collaborative research efforts that study Food is Medicine strategies in a variety of patient populations and communities. The educational programs have expanded to serve not only students but also residents, fellows, and other health professionals across training programs. Building long-term partnerships with community organizations and learning about their strengths and needs led to expansion from occasional community programs to a sustainable, replicable clinical program rooted in community collaboration. The community-based clinical program launched in 2022 continues to expand, with a focus on sustainability and infusion of community expertise.
How We Think of Food is Medicine
Food is Medicine is a tool to provide people and communities with education and access to affordable, nutritious food in order to prevent, manage, and treat many diet-sensitive diseases while promoting overall well-being. FIM takes a holistic view of our relationship with food – it’s personal, cultural, emotional, and physical. FIM programs include promoting high quality food access in a variety of ways, ranging from food and meal prescriptions to partnership with community-based organizations to deliver consistent, structured support.
While often neglected in FIM conversations, the integration of nutrition education and culinary literacy strategies are essential, especially if the long-term goal is to empower patients to build and maintain a long-term healthy relationship with nourishing food. This foundation is the focus of our programs because it invests in people and communities in a way that equips them to sustain the FIM movement after initial behavior change and increased food access. These nutrition education strategies are not transactional but partnership-based. That necessitates leaning into the expertise of community organizations and people in them.
Food is Medicine encourages the integration of nourishing food into patient and community lives as an addition to medical and public health measures, which work synergistically. We would be remiss if we denied the remarkable public health progress that has been made with various therapeutic interventions in addition to food. In 1900, infant mortality was nearly 100 infants per 1000 live births, and up to 30% of children died before their first birthday. Such realities are unfathomable in modern times because of medical advancements such as antibiotics. Food is Medicine does not try to replace those advancements. Yet while these scientific advancements have allowed almost all of us to live into adulthood and old age, we are still plagued by chronic diseases that often result from neglect of practical domains like sleep, movement, stress management, and food. The beauty of these basic disease risks is that they are relatively modifiable risk factors!
How We Put Food is Medicine Into Action
We primarily implement Culinary Medicine, which is a nutrition and culinary literacy program that offers hands-on, evidence-based education that combines the overall medical care plan and nutrition science with practical culinary instruction. At UT Southwestern, we launched what is to our knowledge the first Culinary Medicine clinical service line, which includes registered dietitian and physician collaboration in the delivery of Culinary Medicine; eConsults; individual patient coaching consults; and shared medical appointments in community teaching kitchens.
What makes these programs unique is that they are reimbursable by health payers, ranging from Medicare to various managed commercial plans to even Medicaid and Marketplace plans. This enables our program to work right now in a real-world setting, without additional research funding. Patients can sign up for Culinary Medicine courses after seeing us independently in the Culinary Medicine clinic to establish care or by being referred by their primary care doctor. Shared medical appointments require being an established patient so that we understand a patient's health history, food history, and unique story before having them receive care in a group setting. Based on payer criteria, anyone established in the same department can participate in a shared medical appointment, so we take referrals from primary care colleagues who have established care. We work closely with primary care teams to coordinate care needs that patients bring to us, working to be part of the overall team that is essential to support many of our patients. Our programs are open to patients with a wide range of conditions including diabetes, obesity, hypertension, dyslipidemias, GI illnesses, cancer, autoimmune disease, inflammatory disease, and other diet-related illnesses. The billing model we currently use is physician-only using specific codes as designated by CMS for eConsults (also described here) and typical evaluation and management codes for 1:1 visits (usually 99204 if new and 99215 if established, based on time spent with patient, documenting the visit, and coordinating same-day care in partnership with the culinary dietitian) and SMAs based on medical complexity (usually 99213 with some 99214 for more complex patients).
Our signature Culinary Medicine program typically consists of a multi-session series implemented as a shared medical appointment (SMA) with six classes over about eight weeks. Our curricular strategy is loosely based on the American College of Culinary Medicine’s community curriculum, which we have adapted to meet the food preferences and access needs of our local community. This flexibility is essential. There isn't a one size fits all approach, because food is personal, hyper-local, and necessarily tailored to the community one serves.
In our program, the kitchen spaces we utilize for SMAs are actually in local community organizations with whom we have developed partnerships to not only lease their kitchen spaces, which then become a site of clinical service, but also to leverage their feedback and insights as fellow stakeholders in improving community health. Patients who come to Culinary Medicine classes build community and feel less alone in their efforts to change their dietary pattern in a world that is not set up to support them.
In summary, we provide cooking classes (ranging from two to six classes in a series); nutrition counseling with a medical, food relationship, and culinary lens; and connections to community resources addressing food insecurity, such as food banks.
How We’re Funded and How the Future Looks
Our work is funded through a blend of clinical billing revenue, institutional support, research grants, philanthropy, volunteer efforts including service-learning (educational engagement of students seeking service opportunities), and community partnerships. We find that diverse domains of support are essential to sustain these programs.
While funding can be a challenge, we are optimistic about the future of this work as the evidence base grows and interest in Food is Medicine increases nationally. Sustainable funding models remain an ongoing priority, and we are exploring opportunities such as interprofessional reimbursement pathways including the ability to bill for BOTH physician and dietitian time; expanded partnerships with community-based organizations as well as other programs in our health system; and additional grant funding for our research efforts to ensure that our models are data-driven. We want to be sure we are always improving as we learn.
Which Metrics and Outcomes We Track
In the earlier stages of this novel program, our initial tracking focused on feasibility and participation metrics: Could we bill classes easily? Did the teams understand how to schedule group care? What was the waiting list for clinic visits? And we focused on engagement/retention metrics: Once scheduled, how many patients actually show up? How many complete a six-class SMA series?.
Then we evaluated other pragmatic measures to understand who we were serving: demographics including age, gender, race/ethnicity, and their specific health needs such as referral diagnoses as well as billing diagnoses in the Culinary Medicine clinic). We also track the important metric of payer types (Medicare, HMO and PPO commercial plans, Medicaid, Tricare, etc.) and reimbursement as contracted as a percentage of total charge, which is contracted by the health system with each payer.
In addition to our initial tracking of process and financial metrics, we are beginning to track biometric data (weight, blood pressure, A1c, dietary behavior changes as measured by surveys, and, through a series of qualitative focus groups, patient-reported outcomes . Tracking can be challenging due to limited integration of Culinary Medicine data into the electronic health record (EHR) and resource constraints. For example, collecting data at the beginning and end of an intervention such as a six-class SMA series isn’t possible without research funding: the laboratory data would generate a co-pay or full financial responsibility for patients if the series is off-cycle from the usual care cadence. Similarly, collecting survey data without research team support is often challenged by poor patient completion, lack of linkage to pre/post evaluations for the same patient, and incomplete surveys.
Easier EHR integration and dedicated staff for data management would make this easier. Despite these challenges, we have seen high participation and engagement, successful payer reimbursement, meaningful improvements in dietary habits, and patient satisfaction among participants.
Lessons Learned
- Community partnerships are essential to success and sustainability; we can’t do this work in isolation. To understand the work that needs to be done and the programs that will succeed, you must dedicate time to a needs assessment to see what exactly your community needs and what their strengths and areas of improvement are. Many skip this step and then wonder why their programs are not successful. It is critical to understand what’s already happening, who the key leaders and stakeholders are, and what gaps need to be filled. Listening to community experts about these domains sets the stage for partnering to build effective, desirable, accessible programs.
- Hands-on, culturally relevant, and practical education resonates most and drives behavior change. Very few people change behavior with a list of foods, a lecture, or even a stack of recipes. The hands-on component is time and resource intensive, but in the broader picture may be the key that unlocks long-term behavior change since it’s rooted in patient empowerment, community building, and habit formation.
- Flexibility and creativity are key. Meeting patients where they are, both literally and figuratively, allows us to address barriers effectively. It’s great to go into things with a lesson plan, recipes, and teaching points. But you have to be willing to go with the flow. You must listen when people give feedback. And you must be willing to constantly adapt, grow, evolve, and move forward in a way that lacks rigidity and instead sees the beauty in the process.
Why We Want to Keep Providing Food is Medicine
This work has deeply enriched our organization by aligning with our mission to improve human health. The focus on both prevention and care integrates seamlessly into existing models without waiting for everything to change. Some like to focus on everything that’s wrong with our current healthcare system, and they are mostly outsiders. Those of us who grew up (i.e. trained for 10 or more years!) inside that system understand that many incredible things it has to offer alongside the many gaps and misalignments that need to be addressed. Like a messy family, you have to take the good with the bad if you hope to be part of it and make it better.
Food is Medicine provides a tangible way to address chronic disease and health inequities and offers trainees and clinicians an innovative model for patient engagement and empowerment. Food is Medicine work enhances the well-being of patients, learners, and communities alike, and we are committed to expanding it. Ultimately, Food is Medicine and Culinary Medicine saved us from burnout and has become a beacon of hope for all that is possible in our quest to change the trajectory of health in the US and globally.
References
- Econsults: Albin JL, Siler M, Kitzman H. Culinary Medicine eConsults Pair Nutrition and Medicine: A Feasibility Pilot. Nutrients. 2023 Jun 20;15(12). doi: 10.3390/nu15122816. PubMed PMID: 37375720; PubMed Central PMCID: PMC10301967.
- CM Service Line: Albin J, Wong W, Siler M, Bowen M, Kitzman H. A Novel Culinary Medicine Service Line: Practical Strategy for Food as Medicine. NEJM Catalyst Innov Care Deliv. 2025; 6(9). doi: 10.1056/CAT.24.0347
- Food pantry partnership for research: Albin J, Leonard T, Wong W, Siler M, Haskins C, Turcios J, Pruitt SL, Bowen M, Pezzia C, Ford A, Schinzer B, Hollis-Hansen K. Providing medically tailored groceries and food resource coaching through the charitable food system to patients of a safety-net clinic in Dallas, Texas: a randomised controlled trial protocol. BMJ Open. 2025 Jan 2;15(1):e096122. doi: 10.1136/bmjopen-2024-096122. PubMed PMID: 39753253; PubMed Central PMCID: PMC11749760.
- Additional References - opinion pieces: