Cooking in dietetics – core or complementary?

In a project related to a study funded by the BDA General and Education Trust, researchers from King’s College London have interviewed nutrition and dietetics practitioners and educators about whether there is a role for cooking in dietetics practice and education. 

Culinary nutrition, defined as “the integration of culinary arts and nutrition that applies practical knowledge and skills to improve food and nutrition-related health”,1 is an area of growing research in response to the UK’s ‘culinary skills transition’.2 

The diminishing intergenerational transference of cooking skills in the home 3 has contributed to the population-level decline in these competencies. This has been exacerbated by the inconsistent and often inadequate culinary education provided in UK schools.4

In secondary education, home economics, the subject through which cooking skills were traditionally taught, has been restructured within certain curricula, focusing on food design skills for industry rather than basic life skills4 and removed as an examinable A-level,5 reducing the opportunity for UK students to learn cooking skills through the educational system.

Together, these factors have contributed to the reduction in home cooking and increased reliance on convenience foods, which have been implicated in the decline of diet quality in the UK6 and the rise in the associated burden of non-communicable disease. 

In response to these challenges, culinary nutrition – or ‘cooking’ – research has explored alternative means to provide culinary education to both children and adults and a range of interventions has been developed, varying in setting, approach and duration. Current evidence suggests that taking part in cooking programmes can provide a range of benefits for dietary behaviours, such as intake and food choice.7, 8 

Research has also found participation may provide additional social and psychosocial benefits,7, 8 highlighting cooking as more than just a pathway to a better diet. The ability to translate nutritional information into ‘practical guidance’ is foundational in dietetic practice to provide support and improve individual quality of life. Given their expertise, dietetic professionals could be well positioned to deliver nutrition education alongside the development of cooking skills and are expected to have the capabilities to advise on aspects such as food preparation and processing.9

However, this may hold an underlying assumption that all dietitians can cook and have the skills and confidence to pass on this knowledge to others. Despite promising evidence from culinary nutrition research, the inclusion of culinary nutrition as part of dietetic practice is limited,10 which raises the question: is there a role for cooking in dietetics practice and education?

To explore this question, we conducted a series of interviews with 28 nutrition and dietetics practitioners and educators to understand their perspectives on the role of cooking within dietetics and how this could evolve in the future. 

Perhaps unsurprisingly, dietitians described witnessing first hand a decline in the cooking skills of the populations they interact with over time. External pressures such as rising food costs and food poverty were seen as limiting the ability to purchase fresh food, with the cost of a healthy basket “significantly” increasing over the last couple of years.

Financial pressures, combined with lack of time due to work and family demands, were seen to have increased dependence on “easy, accessible” convenience foods, like takeaways and ready meals, further compounded by a breakdown in the sharing of cooking skills within households and a general lack of interest in cooking.

These sentiments are reflected by research showing that around 11% of UK households are food insecure, with rising prices causing households to cut back on food shopping11 and the purchase of fresh ingredients in favour of shelf-stable alternatives requiring less preparation.12 Lack of time, finances and perceived effort are also known barriers to cooking from scratch.13 Overall, the amount of support and education needed by the population around healthy cooking was felt to be high. 

A key consequence of this challenge was the need to understand an individual’s cooking ability and access to equipment or facilities during dietetic consultations, although this can be constrained by consultation length.

Sensitive conversations to understand cooking confidence and uncover barriers to cooking were seen as essential for delivering effective advice and making any necessary adjustments to fully tailor nutrition support. For many, the primary goal of integrating culinary nutrition into training was to equip trainee dietitians to deliver this advice, with a strong link between the theoretical clinical content and practical component of dietetics courses.

However, for some, knowledge alone was not enough, and richer first-hand experience was seen as increasing integrity when giving advice. Encouraging trainee and practising dietitians to prepare and try diet modifications relevant to their area of expertise may be a means to increase the acceptability of these recommendations for patients and empathy for their related concerns. 

Cultural competency underpins service user focus.14 However, this was raised as a vital but underdeveloped area of culinary nutrition practice, with limited cultural diversity during cooking practicals leading to a lack of dietitian confidence in adapting recipes or providing appropriate advice for different cultural food practices.

More broadly, a lack of cooking skills was seen as a key barrier to delivering appropriate practical advice for patients, and dietitians highlighted a false assumption that all dietetic students have skills or interest in cooking, a challenge exacerbated by reduced exposure to quality culinary education in UK schools. 

Contrasting with a consensus on the importance of culinary nutrition for underpinning practical advice, views on its role within clinical dietetics practice were mixed. The relevance of culinary nutrition activities in acute, “medicalised” settings was called into question, with the passing on of competencies to patients in this context seen by some as unlikely.

The focus on shifting care into the community, as outlined in the recent 10 Year Health Plan for England,15 was seen to reduce the relevance of culinary nutrition interventions in clinical care moving forwards. Time constraints in consultations, lack of space, cooking facilities and funding, and the focus on short-term healing care were all cited as barriers to including cooking in clinical practice, as was the need to accommodate varied patient groups.

For others, the lack of culinary nutrition in clinical settings reflected the movement of dietetics practice away from “the fundamentals of food and nutrition”, with missed opportunities for intervention, such as at patient discharge. Involvement of dietitians within the broader clinical food environment, such as hospital menu design, was described as relatively infrequent and dependent on the scope of individual roles. 

Running online cooking sessions was suggested to negate the need for onsite kitchen facilities or specialist in-person equipment in hospital settings, leveraging the existing integration of technologies such as Microsoft Teams or Zoom into other aspects of patient care. However, online approaches may not be suitable for all population groups, particularly older adults. 

In contrast to acute care, the role of culinary nutrition within public health dietetics is more established. Community cooking programmes were seen as valuable, particularly focused on simple, low-cost meals, and receive positive participant feedback.

Training individuals within the community (e.g. teachers, staff in community organisations) to deliver programmes was seen as effective, with dietitians being less relatable and aware of environmental challenges facing community members.

However, ensuring programmes are delivered thoroughly and in line with evidence-based practice is a major barrier in the train-the-trainer model. Programmes face additional barriers, such as lack of funding, time (both for delivery and training) and access to adequate facilities, although successful programmes adopted collaborative approaches with local charities to help overcome these hurdles. 

Some felt the role of dietitians in public health has been historically overlooked, with limited placement opportunities and a lack of focus on equipping trainees for this role. Those who had experienced culinary nutrition-focused teaching, including chef-taught modules or mass catering placements, expressed this as providing a valuable “added dimension” in their education.

Additional focus on budgeting, meal planning and sustainable cooking was seen as important to empower the next generation of dietitians to assume these roles. Importantly, specific training on how to communicate and teach cooking and food skills is needed to produce trained dietitians able to deliver culinary nutrition interventions confidently. 

So, is cooking in dietetics core or complementary? Findings suggest that cooking plays an essential role in equipping dietitians with the skills to translate nutritional information into clear, relevant, practical advice. Broadening dietetic training in culinary nutrition to encompass greater cultural diversity and competencies to effectively teach and communicate cooking skills could produce a more effective future generation of dietitians, equipped to engage with the diverse challenges faced in practice. 

Community cooking programmes already hold an established place in public health dietetics, but they may need greater resource to meet the demand of rising health and food security challenges.

The constraints of the current clinical dietetics system present significant challenge for the integration of culinary nutrition activities and interventions. The planned shift of more patient care into the community suggests that complementarity between culinary nutrition and dietetics practice may be achieved by strengthening the connection between clinical and community dietetics, leveraging referral to create an integrated approach which uses culinary nutrition to provide exceptional end-to-end care.

References

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