Well, hello, everyone, and welcome to today's webinar entitled Get Cooking, Culinary Medicine's Powerful Impact on Nutrition and Health for Patients and Clinicians. Our featured speaker today is Ronnie Polak, MD, MBA, whom I will introduce momentarily. I'm Dr. Angela Mikolaj, the Vice President of Programs and Education at the American College of Preventive Medicine. ACPM is a professional medical society of approximately 2,000 physicians dedicated to improving the health and quality of life of individuals, families, communities, and populations through disease prevention and health promotion. Our members are licensed medical doctors who possess expertise in a broad range of health care skills, including biostatistics, epidemiology, management of health care organizations, research, and the practice of prevention in clinical settings. They work in a variety of settings, including hospitals, government at the local, state, and national levels, the military, laboratories, business, and academia. Just a few housekeeping reminders for today, please stay in listen-only mode. We will be posting this recording in the ACPM Learning Management System in a day or so, so if you'd like to watch it again or share it with friends, please do so. As we're going through the presentation today, please begin to type your questions in the Q&A box, and we'll address them towards the end, and in addition, we'll have an evaluation survey sent to you, so please fill it out so we can continue to improve our offerings. It gives me great pleasure to introduce Dr. Ronnie Pollack, who is the founding director of both the Culinary Health Care Education Fundamentals Coaching Program, or CHEP, at the Institute of Lifestyle Medicine Spalding Rehabilitation Hospital, and the Center of Lifestyle Medicine at Sheba Medical Center in Tel Aviv, Israel. He is a research associate at the Department of Physical Medicine and Rehabilitation at Harvard Medical School as well. Prior to this position, Dr. Pollack completed a research fellowship in lifestyle medicine at Jocelyn Diabetes Center, Harvard Medical School, and a residency in family medicine at the Hebrew University Medical School in Jerusalem, Israel. Ronnie had the good fortune to be the founder of the Hadassah Healthy Cooking and Lifestyle Center and the Israeli Society of Lifestyle Medicine. His first lifestyle intervention won the Hebrew University's Kay Award Prize for innovation, and his book, Delicious Diabetic Recipes, is a gold bestseller. Dr. Pollack's focus, along with clinical care, is on nutrition education and on clinical and translational research related to culinary medicine and medical education. His current work is concentrated on the culinary coaching approach, which aims to improve nutrition through culinary training combined with health coaching principles. This approach was used through the patient chef's coaching telemedicine program aimed at improving eating behavior of patients with cardiometabolic risk factors. This was implemented at home base, Harvard Medical School, the Massachusetts General Hospital, and at dozens of practices nationwide. In addition, Dr. Pollack founded the clinician chef coaching tele-training program aimed at teaching clinicians on how to provide effective culinary health care education. This was implemented in the Yale Preventive Medicine Internal Medicine Residency Program, Spalding Rehabilitation Hospital, and was recently approved by the Harvard Medical School for continuing medical education credits. In addition, our speaker today has had his work featured in many prestigious media outlets, including Scientific American, the Herald Tribune, the Jerusalem Post, and USA Today. Dr. Pollack, I turn the microphone over to you. Thank you so much for the nice introduction, and thank you for inviting me to talk about this topic, which I think is very, very important. So we can continue. So I think I will start with describing this emergent field of culinary medicine. And I think you're all here because you understand that nutrition is important. And you can keep on with the slides, please. That nutrition is important. And it's associated with 26% of death and 40% of disabilities in the US. So we all know that. But it's also important to understand that this day, in these circumstances of the COVID-19, and please give it another click. And we know that obesity, which is highly related to nutrition, is the number two risk factor for COVID-19 related morbidity and mortality. And this is actually the first risk factor after age, like the only risk factor that or the most important risk factor that you can modify. Please go on. But there is a small piece of nutrition that was neglected in the past few years, and only in the recent decade started to get attention. And this is home cooking. And can you please click another one? And look at this data, which is really, really interesting. If you look at the last 40 years in the US, there is a decrease in 23% in the food that people prepared at home. If you look at the opposite behavior, eating away from home, you can see a tremendous increase of 42% in the past 40 years. So this is like 23% in food preparation, 42% in eating away from home, but mostly because the measurements are different. The first study looked at total energy, and the second study looked at dollars. But I think that the most important message is that our patients are eating more and more outside, eating more and more ultra processed food, and cooking less. So, you know, you can ask, OK, so what, why this is so important to cook at home? So let's dive into that. And this is the first study that I would like to share. And this is an analysis from the ENHANCE, like the US National Survey. And you can see that in the first line, they analyzed one question, which was, how do you that they ask in the ENHANCE? How many home cooked dinners do you consume per week? And they analyzed that with calorie consumption. And surprisingly, they found that as much as people consume more home cooked food, they actually consume less calories. So how many of your patients are trying to consume less calories and making effort to decrease fat and to decrease carb? And, you know, they can just cook at home and their calorie will decrease. And you can also look at the second line here, which is even more interesting, because they did a sub analysis of people that responded to another question that they do not want to lose weight. I mean, they don't care about their nutrition. And you can see that even in this group, as much as people consumed more home cooked food, they actually consumed less calories. And I would like to highlight that they didn't look at healthy home cooking. They didn't look at cooking with lots of vegetables. Just cook food prepared at home. Please continue. And this is another study this time from the UK. I don't know if we have people here from outside of the US, but they did quite a similar study. They looked at a large cohort of over 11,000 people, and they looked at those who consumed less than three home cooked dinners per week, three to five home cooked dinners per week, and over five home cooked dinners per week. And they saw that the difference is not only in the calories. You can see that as much as people cook more, sorry, you don't need to cook, you need to consume home cooked food. And they found that as much as you consumed home cooked food, you consume more fruits, you consume more vegetables, and either your diet is more aligned to a healthy diet. You are most likely to be aligned to the DASH diet and to the Mediterranean diet. So again, I mean, how many of your patients are trying to increase their vegetable consumptions? So just by home cooking, they are likely to do so. And let's move on and look at health outcomes. Health outcomes. And again, this is a very interesting study that analyzed, I think, two of the major nutritional cohorts, like the North Health Study and the Health Professional Follow-Up Studies from Harvard. And this time they looked at lunches and dinners, not only dinners. So like the max is 14. And they found that eating 11 to 14 meals prepared at home, like MPAH per week, had a 14% lower risk of developing type 2 diabetes. So if you cooked more at home, you were less likely to develop type 2 diabetes. And this is most probably because of less weight gain. Can you keep on, please? OK, so next question would be why eating home-cooked food is important. And a very interesting food classification is being used in the last few years, the NOVA food classification. And this is so interesting because this classification looked at the number of people who were eating at the level of the food process and not on the macronutrient composition of the food. You know, this is the first, I think, the first food classification that you can find vegetables and beef in the same group if they are minimally processed. So let's look at this classification for maybe one to two minutes. So there are four groups. Please keep on. So the first group is unprocessed or minimally processed food. And again, as you can see, vegetables, beef, same group, OK? And all the food items that are minimally processed will be here, such as grains, such as vegetables, such as beef, such as fish, such as chicken. The second group is, keep on, please, is processed culinary ingredients. So those would be a modified version of group 1 foods that mostly are used for cooking in a small quantity, such as sugar, such as salt, such as fat. Keep on, please. The third group is processed food. And processed food are food that made essentially by adding food items from group 1 and 2 usually not more than two, three, maybe four ingredients. You know, bread, cheese, canned fish, maybe canned fruit, and so on. And the fourth group is the ultra-processed food. And again, you can find here food items that are considered by many healthcare professionals as healthy, such as, you know, like vegan beef or protein bars or low sugar. But the definition of the ultra-processed food group is formulation that made mostly or entirely from all kind of substance that derived from food and food additives, such as soft drinks, wheat, savory packaged snacks, all kind of nutrient that usually you cannot find in food that you made at home, such as extra gluten, such as casein, all kind of items that drive from further processing of the food, such as high fructose corn syrup, food additives, etc. So let's look at recent science that started to look on eating habits with the lens of the NOVA food classification. And again, this is a very unique frame, because it's the first frame that go behind the macronutrient composition of the food. So let's look at a few studies. The first one, which is, I think, the most important, ultra-processed food and mortality. BMJ from 2019. And you can see that the higher consumption of ultra-processed food was associated with increase of all-cause mortality. If you want to be more precise, for each additional serving of ultra-processed food, all-cause mortality increased by 18%. Next question is, why? What are the diseases that are related to ultra-processed food? Two examples. The first one, again, BMJ, this time from 2018. Ultra-processed food increased the risk of cancer, mainly breast cancer. And of course, ultra-processed food increased the risk of cardiovascular disease. Again, the proportion of ultra-processed food in diet was correlated with the hazard ratio to get cardiovascular disease. But this study is even more interesting, because you could say, well, I mean, it's not new. I mean, you don't bring new science, because ultra-processed food is high in sugar, high in sodium, high in saturated fatty acid, low in fibers. So of course, it's less healthy. Of course, it will increase mortality. Of course, it will increase cardiovascular disease. But this study stratified for all these variables. And they found that ultra-processed food is related to cardiovascular disease after stratifying to saturated fat, after stratifying to sodium, to sugar, to dietary fibers. So there is something in ultra-processed food that is not healthy for us. And there is something in home cooking that is healthy for us. And let's try to understand even further where we are with the science these days. So this is a study that was published in 2019 in Cell Metabolism from the NIH. And they did a very interesting study. They recruited only 20 patients. But they admitted them for four weeks. And then they divided them into two groups. And the first group received for 14 days ultra-processed food. And the second group received for the same 14 days minimally-processed food that have the same calories, sugar, fat, fibers, all the macronutrients, just the same. There was one difference, ultra-processed food versus minimally-processed food. And after 14 days, they switched between the group. So the group that received the minimally-processed food then received minimally-processed food. And the group that received minimally-processed food changed to ultra-processed food. And so let's see what happened. They have two groups that each received for 14 days ultra-processed food and for 14 days minimally-processed food. And you can see that from some reason, from some reason, during the 14 days of the ultra-processed food diet, participants consumed more calories, 500 calories more per day. And from some reason, during the 14 days of the minimally-processed food, they lost, on average, one kilo. So look at how amazing it is. With eating as much as you want, you're losing weight. And you can see that during the 14 days of the ultra-processed food, they gain approximately the same amount. They gain one kilo. So let's continue asking, what is it in the ultra-processed food that is not healthy? What is it that causes weight gain? Next, please. So ultra-processed food has thousands of food additives, of all kinds of food items. Maybe a decade ago, everybody talked about the trans fat. And at the beginning, we thought that, oh, this is amazing. We have trans fat, which is healthier than saturated fat. We find the solution to saturated fat. And then we understand that it is not healthier at all than saturated fat. But there are actually thousands of other food items that we consume. And this is one example, again, a recent study from 2019 published at Science Translational Medicine. And what they did in this research, they did a reanalysis of the DIRECT study. The DIRECT study is an England Journal of Medicine study that was published I think like five, six, seven years ago, that looked at differences between diets. So they took all the data from all the diets and only looked at one food additive on propionate. So this is a preservative, a very, very common preservative. And they found, interestingly, that as much as people consume more propionate in their diet, their insulin resistance was higher. Very interesting. So, you know, this is where the science is. There are many other food additives that we are not sure exactly their impact. But I think we know that ultra-processed food is related to disease unrelated to the macronutrient composition of the food. And we know that home cooking is related to decrease the risk of many diseases. Next, please. So within this environment, there are more and more researchers that think that home cooking is an important topic to focus on. And we call this field culinary medicine. I shared a few definitions. This is what happened when the field is new and we don't have an agreed definition yet. I really like the definition on the ACPM website, the practice of helping patients use nutrition and good cooking habits to restore and maintain health. Next, please. So, you know, if home cooking is so amazing, so let's see if we can help people to improve their health by teaching them how to cook. Next, please. So, two systematic reviews was published in the last decade. Very interesting because the same group of researcher published the same, the two systematic reviews, same PubMed research criteria. And it's beautiful to see that when they look between 1980 to 2011, they found only 28 studies. And then from 2011 to 2016, they found 34 studies. So only from this data, you can see that the literature is really growing in this field. And what they found in the systematic reviews, next, please, is that we can definitely say that home cooking interventions improve cooking knowledge, improve cooking skills, confidence, attitude, and also improve diet quality. But still, we do not have consistent health outcomes. And the conclusions of the two studies is that we really need high impact studies that will evaluate the impact of home cooking interventions. So, there are few, next, please. So, there are few groups globally that looked at, you know, these questions at these days. One group is my group at Spalding Rehabilitation Hospital and in Sheba in Tel Aviv. And we are conducting a multicenter randomized controlled trial that looked at one year follow up on 72 patients with overweight and obesity. And our primary outcome is 5% weight loss in six months. So, just as a reference, 5% weight loss is usually what the FDA is looking at when they approved, when they consider to approve a weight loss medication. So, this is why we chose 5% weight loss. Next, please. And what we do, we, the intervention group, meet with a clinician that we call a culinary coach. So, this is like a provider that we train. And the culinary coach work with the participants on culinary training combined with health coaching principles. In every meeting, participants set culinary goals. They brainstorming for culinary solutions. The culinary coach provide tips, help with recipes, help with videos. And at the end of the meeting, the participants set two, three, four culinary goals. And, I mean, we don't have final outcome yet, but I would like to share with you preliminary outcomes from this study. Next, please. So, as I shared, the primary outcome is weight loss at six months. And the last time that we did intermediate analysis of our data, we had 11 participants from the intervention at six months, and we had 13 participants from the control at six months. And you can see the amazing difference. The intervention group lost 4.2% versus less than 1% in the control. And even with this 11 versus 13 participants, the data was significant. And we also have 11 participants that arrived to the one-year point. And you can see that even in one year, they maintain the weight loss 4.2% at six months and 4.1% at one year. And again, only with this small number of participants, we already show that this difference is significant. Next, please. So, you know, the next question would be, what is the potential mechanism for the weight loss? And as you can see, the huge difference in the ultra-processed food consumption of the intervention versus the control, 775% gram per day, the intervention, and double like 1,500 grams of ultra-processed food in the control group. Next, please. And, you know, it's also interesting because when you look at the calorie consumption in our study, although there is a trend to less calorie in the intervention group, the calorie consumption is no different. And I think this is consistent with what we know, that there is something in ultra-processed food that cause weight gain. And if you change your diet to a home-cooked food, you start to lose weight. And this is behind the difference in the calories. Next, please. And another click, please. We also looked at the emotional well-being of our participant. You know, we had the COVID in the past year. And although we started this intervention before the COVID, like it was like telemedicine, it was home cooking, and it was really hard to ignore the fact that there is a huge stressor around us. So, we add another component to our study, and we try to see if the intervention help people to cope with the stress of the pandemic, and if we help them to be more resilient to the stressors around them. And we actually found that participants in the intervention group use more self-care and home cooking as a coping strategy during the pandemic. And we also found that those participants were more likely to be more resilient to the stress around them. Next, please. So, you know, I hope it was convincing, and I hope that you will consider including home cooking discussion the next time you are working with your patients. And therefore, culinary coaching, we think that culinary coaching is important also for clinicians and not only for patients, because we want you as a change agent, but also because we care for you, because people that clinician that join a culinary medicine programme improve their health. Next, please. So, this is a training that we deliver at Boston. We call it the chef coaching training. The chef coaching training train clinicians with the knowledge that I shared with you and with the knowledge about how to change their patient's home cooking habit, how to help their patients to home cooking habit, how to help their patients to adopt home cooking habits. The training has two modules, chef coaching the basics and chef coaching beyond the basics. You have here also the number of the graduates of the programme. As you can see, you can take chef coaching the basic also live online or as enduring material and chef coaching the basics only live online. Next, please. And we also show that clinicians that join the chef coaching training improve their own self-care, improve their cooking confidence and also improve their competencies to prescribe culinary medicine to their patients. Next, please. This is the certificate that graduates receive. And you have here the link if you would like to receive more information and to join our next cohort start next month, next September after Labour Day. Next, please. So, I mean, I would like to finish with a few culinary medicine tools with few culinary medicine tools that you can use with your patients. So, first, next, please. Please go to the ACPM website. And I think it was three years ago when we developed eight culinary medicine videos, like eight recipes that can be freely shared, actually can be used by you and can be freely shared with your patients, recipes that teach how to use fruits, how to use legumes, how to use vegetables. And there are also three videos that discuss three important culinary medicine concepts, such as batch cooking, how to cook in large quantity and to save time, and so on. So, this is one resource that can be used by you. Next. Next, please. This is the chef coaching website. And I shared it because one of our mission is to is to curate and collect resources that people can use. And so, again, this is free. You can go into our website and look at all the resources that we collected. You know, the web is rich with tons of recipes and videos. And we try to help with evaluating the, you know, the good website and share it with the public. So, please feel free to share. Next, please. Next, please. Another important resource is peer-reviewed recipes. And I think our publication from 2015 was the first peer-review recipes. It was in clinical diabetes. It's a whole manuscript that discuss how to how to buy legumes, how to store legumes, how to cook legumes. This is like an open access publication. You are more than welcome to download it and to share it with your patients. And like two years ago, we founded a culinary medicine column on the American Journal of Lifestyle Medicine. And every two months in each of the column, we share the peer-reviewed recipes. So, if you download all the column and collect all the recipes, you can have a culinary medicine collections of peer-reviewed recipes that you can share with your patient. Next, please. And, you know, if you want to be more sophisticated and if you would like to learn more about home cooking, about recipes, how to become a better cooker. So, there are many online schools. This is just one example. The Culinary RX is a culinary school that work with the American Journal of Lifestyle Medicine, sorry, with the American College of Lifestyle Medicine and have like few nutritional leaders in their leadership and they do a good job. Next, please. And of course, there are lots of resources for specific population. This is again from our website. There is a section on cooking on a budget. Next. And if you would like to receive more resources, you are more than welcome to text ILMLifestyleMed to this number. We are sharing a quarterly newsletter with recipes, with recent science, with tools, or you can follow me on Twitter or you can follow the Chef Coaching on the Facebook page. We are sharing again recipes, resources, and we are sharing a lot of information. Resources, etc. And before I finish, I would like just to share. Next, please. Before I finish, I would like to share maybe one concept that can be helpful for you and for your patients and the concept is batch cooking. So, if you take few seconds and think what will help you to cook more at home tomorrow, okay? And many, many studies ask this question in many countries and in many populations. And the number one answer is time. If I would have more time, I can cook more. And therefore, if you would like to help your patients to do more home cooking, any important tools that you can teach them is how to be more efficient in the kitchen, how to use less time and produce more food. And batch cooking is a concept that say, okay, whatever you cook, cook more. Store it and use it next day, next week, next month. A few examples. On the upper left-hand side, you can see black lentils. So, think about a recipe that asks for one cup of black lentils. So, how much time it takes you to cook one cup of black lentils? It takes you the same amount of time to cook the whole bag. And then you can freeze what's left and you can defrost it whenever you would like to do another recipe with black lentils and save time. You can also do batch cooking with the entire meal. And look on the right-hand side, there are two soups. You can make four servings of soups and you can make eight servings of soups. Making eight servings of soups doesn't take double time than making four servings of soup. So, almost any time I go to the kitchen to make soup, I always take the biggest pot that I have and make as much soup as I can. I eat the portion that I want and I freeze what's left. And then, within a week, within a month, there's always a time when I'm coming back home with zero energy to cook. And then I open the fridge and say, okay, what can I eat today? And I'm always happy to see that I have a whole meal in the freezer just waiting for me to defrost and to eat. And of course, there is in between. I mean, you can do batch cooking of one portion of the recipe. And if you look on the lower left side, you can see ice cubes, like red ice cubes. And the red ice cubes are ice cubes of tomato sauce. So, you know, now it's summer, is the season of the tomatoes. The tomatoes are relatively cheap, colorful, flavorful. You can make a whole pot of tomato sauce and you can freeze it in ice cubes container and use cubes whenever you want to enrich your food when you cook at home. Next, please. So, I think this is it. This is the team that helps me to do this amazing job. We have the research team that helps with the research. We have the educational team that helps to deliver the professional training. And of course, we have strong admin support. And I'm happy to take any question you have. And again, thank you again for inviting me and for highlighting this important topic. Thank you so very much, Dr. Pollack, for a very well-researched and presented talk this afternoon with lots of practical advice for the listeners. I have several questions that are beginning to populate in the chat feature, and please continue to answer your questions. Have you been able to track the long-term effects of the weight loss by the individuals after the six-month period ended? So I'm not sure what you consider a long-term impact, but in our study, we look at one year, which is quite good, I think. So not all our participants finished the six-month period, the one-year follow-up, but when we analyzed those who finished the one-year follow-up, we found that the weight loss remained the same. It was exactly as it was in six months. And, you know, we really hope that we, like home cooking, provide, you know, really the hook and not the fish. Like, you know, provide tools, how to continue maintain healthy diet. And another question relates to, how do you recruit the individuals who participate in the program, and do they have to pay a fee to participate? So I'm not sure which program the question refer to, but if you ask about the study, so of course people do not need to pay. Actually, people receive compensation when they joined the study. So the criteria to join the study was consuming less than five home-cooked dinner per week. So we look to recruit people that, between not cooking at all to not cooking much. I mean, we didn't look at people that cooked a lot and just want to improve their skills. We really want people that don't cook and we wanted to help them to start cooking. So those were the people that we looked at. And of course, we made sure that they are not on weight loss medication and, you know, all the research stuff. But if you ask about, I mean, about the preliminary behavior of the participant, so those were participants that didn't cook a lot, didn't consume a lot of home-cooked food. Okay. Here's another. Have you found that making food at home is more expensive than fast food? Oh, that's... Sorry. For addressing any perceived cost barriers. So in our study, we didn't look at the cost of, at the difference of the food cost. I mean, other studies looked at that and actually they didn't found, they found a minor increase. Not like, I think there is a study that I remember that found like $1 per day difference. I don't know if you consider that a significant amount. $1 more to eat at home? A day, yeah. Well, you save on gas, at least $1. Here you go. Right? And for those people who are staying at home and bringing food in, here's another question. Would meal delivery services count, especially the ones produced with a registered dietitian on the team? So, you know, I think the quality of the food depends. I mean, if you deliver ultra processed food, if you deliver food, which is mostly ultra processed, so I would say it's not considered like minimally processed food. However, if you deliver, for example, if you deliver companies such as the Blue Apron and you deliver the food ingredients and you cook at home, so that would be considered, of course, home cooking. I think that the disadvantage of this behavior or, you know, if you can flick the coin and say that the way the food delivery can be improved is, you know, we are not recommending to cook every day. Of course, I mean, I wouldn't say we're not recommending. Like most of the people cannot cook every day because of time. And therefore, when we teach people how to be more efficient in the kitchen, so we actually teach them how to cook maybe once a week or twice a week and have enough home cooked food for the entire week. And this is something that the food delivery systems I don't think knows how to do yet. And this next question may relate to the chef program. Do you provide the advice yourself to patients and how do you think your advice may compare to referring your patients to a nutritionist? So that's a great question. So if you looked at health coaching, like pure health coaching, so health coach do not provide advice. Health coach help the participants to find the advice that good for them. If you looked at pure culinary training, so it's not patient centered. It's, I mean, you teach people how to cook and that's all. And the culinary coaching approach combined between the two. So we do provide knowledge, but we also provide patient with the tool to find the knowledge themselves. We provide patient centered knowledge. We provide the knowledge that people ask to learn. So it's a combination between health coaching and culinary training. Thank you. And here's another. How do you bill a patient's insurance if you want to provide a culinary medicine session training or advice? So that's a very important question. And if you join any lifestyle medicine conference or any lifestyle medicine training, so this is one of the hot topics. I mean, how to bill for lifestyle medicine services and home cooking is just one of them. And I think that the most popular way to bill for home cooking education is by short medical appointment. And if you want to learn more about it, there is a great manual on the American College of Lifestyle Medicine website. I don't know, maybe the preventive medicine has as well, but I'm familiar with the one of the American College of Lifestyle Medicine. And last year, if the first code for health coaching approved and health coaching codes are starting to spread and people that do culinary coaching usually can bill on the health coaching codes. Well, we have been, the American College of Preventive Medicine has been partnering with the American College of Lifestyle Medicine on a lifestyle medicine core curriculum. And we have both of those courses, 32 hours in credit length are housed on both of our websites. And we are now in the process of updating each of the modules and we'll be getting alpha testing. So by the end of the year, we'll have brand new modules for use with the latest and greatest scientific evidence in it. So I encourage our listeners today to be on the lookout for that. So here's another question. We've all been experiencing the COVID-19 pandemic and we've been fearful of going to restaurants, going out to places where we might contract the virus. What do you think has happened in terms of increases in home cooking and how that might impact population? Great question. So what's the science show is that the COVID-19 has like had tremendous impact on people nutrition. In a very interesting way, they were participant that gain weight because they were at home and lots of stress and they ate more than they eat outside and their eating behavior become worse and they gain weight. On the other side, there is a group of people that lost weight and used the free time that they have at home to practice home cooking and to practice healthy nutrition and to lose weight. So if you look on literature from many countries and the last year, many publication in that area came up and you again and again see that there is a nice number of people that gain weight and a nice number of people that lost weight and almost no one remained the same. And I think that now that we understand that the COVID is still here, I think this is an important opportunity for us as clinician to discuss it with our patient and to see if being at home is an opportunity for them to practice home cooking or to practice exercising or to practice stress management, whatever. And I'm a home cooking agent, but home cooking is very important but home cooking is not the only important thing. Yeah, I think that's a very unique opportunity. Thank you so very much for this wonderful presentation. We have no more questions in the box but I have a few announcements to make. First of all, to once again, thank you for all the work that you're doing in culinary medicine and in population health. And not only are you working in the States but also internationally and there's so many opportunities for our listeners to get involved in the work that you're doing. We have several events upcoming. The two most recent ones will be a presentation on developing your leadership acumen on August 23rd at 11.30 a.m. Eastern time. And a second one is on innovative technologies in preventive medicine on September 21st at 2 p.m. Eastern. Please look out for the event survey coming shortly and please do log on to the ACPM website in the education slash events section. We have literally hundreds of archived courses and webinars that you can use to earn your CME credits and to just improve your clinical practice and your research in your own settings. So with that, I thank you all for participating today and look forward to seeing you the next time. Thank you. Thank you so much.

Culinary medicine

Home cooking

Weight loss

Disease prevention

Overweight

Emotional well-being

High-impact studies

Culinary coaching training

Batch cooking