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Robert Graham, MD, MPH, is board certified in integrative medicine and internal medicine, and is also trained as a chef. It is part of the growing culinary medicine movement that integrates the art of food and cooking with medical science.
Graham, who eats primarily vegetarian, has spent years trying to convince doctors, hospital administrators and insurance companies that nutrition can prevent and control chronic diseases like diabetes.
In the year In 2010, while working at Lenox Hill Hospital in New York City, he began cooking his first plant-based meals for medical residents. The class was so popular that it soon attracted nurses, hospital chefs and administrators and continued for 7 years.
Graham has made food a priority at his integrative medicine practice, FRESH Medicine, which he started with his wife, Julie, in 2016.
Medscape recently spoke with Graham about his work and how he uses his culinary training to promote health.
Medscape: What made you pursue chef training?
Dr. Robert Graham
GrahamLooking back on my career, I used to think of lifestyle as medicine, but food as medicine was the missing ingredient in my ability to manage chronic disease. I was really inspired by farmer, activist and author Wendell Berry, who said, “People are fed by the food industry, which has no regard for health, and treated by the health industry, which does not pay attention to food. .”
MedScope: He trained as a chef at the Natural Gourmet Institute in New York City. Why did you choose that school?
GrahamI am a vegetarian who eats a little animal protein when I go out. I chose NGI because of its focus on plant-based sustainable cooking, which is more in line with my philosophy and the direction I want to take as a chef than traditional French cooking methods.
MedScope: What was the most important thing you learned?
Graham: That food must taste good! I learned that you can make even vegetables delicious. We learn how to choose the freshest, most delicious fruits, vegetables and animal proteins that separates the cook from the chef. The best ways to prepare and cook them; And the most beautiful way to present them.
MedscapeHow did you use your chef/foodie training?
Graham: I have consulted with food companies and most recently became the Chief Health Officer of Performance Kitchen, where I act as a consultant and design medically tailored meals for patients with chronic diseases. The study found that patients who ate medically tailored diets had fewer hospital and skilled nursing admissions and fewer total medical costs.
To be financially sustainable, we need to partner with health care facilities – I’m talking to a few of them – and with health insurers. Last year, Anthem Florida (Blue Cross Blue Shield) provided Performance Kitchen meals to more than 100,000 plan participants through the Chronic Meal Benefit for more than 100 diagnosis codes, including kidney disease and type 2 diabetes. Other health plans are running pilot projects using our food.
Some Medicare Advantage plans cover medically tailored foods but Medicare does not. Representative James McGovern (D-MA) introduced a bill in Congress last year that would require the Centers for Medicare and Medicaid Services to conduct a demonstration program to allow hospitals to provide meals tailored to medical needs, chronic diseases and daily living conditions for Medicare beneficiaries at home. The bill has not yet passed the House.
MedScope: Are you teaching experienced physicians how to cook healthy and delicious meals?
Yes, lifestyle medicine physician Rani Pollack, MD, and I taught the first class on food therapy at the 2015 American College of Lifestyle Medicine in Nashville. Since then, I have taught additional culinary classes at ACLM, the American College of Preventive Medicine, and the Society of General Internal Medicine.
MedScope: Your practice is called hot medicine. What does the acronym FRESH mean?
Graham: FRESH refers to the five ingredients in our recipe for health: food, relaxation, exercise, sleep and happiness. We put food first because we know from research that food plays an important role in the gut microbiome and the expression of disease.
The acronym FRESH was symbolic for me personally because I wanted a fresh start in my career. After working for a large healthcare facility, in 2016, I decided to start something new where I would take the time to listen and honor the bond between me and my patients.
MedScope: You started a new company with your wife. The online program and who uses it?
We have created an e-learning portal that anyone can access on their own time. Free 6-part Hot Guide and Hot Course packages are available.
The course is popular with companies looking for portable and virtualized security offerings. The idea for the online program came from our experience with our first corporate client who had over 1000 employees scattered throughout New York City. We realized that we couldn’t get together for a “lunch and learn” in one conference room.
MedscapeWhat is your business model for FRESH Medicine?
Fresh Med U?
GrahamWe continue to explore hybrid forms of payment. Our first corporate client of FRESH Med U is the CEO of PSK Supermarkets, who hired me as a health and safety consultant and pays us to provide security services and health services that FRESH Med U pays us to provide, including monthly in-person meals. Meditation, chair yoga, sleep hygiene 101 and happiness seminars.
Also, my employees could see me at my private practice and the CEO paid 70% of their expenses because I was an out-of-network provider. We also offer a sliding fee scale for employees who wish to continue to see us after their contract ends. We are negotiating to renew security services for PSK.
We plan to hire a Family Medicine Nurse Practitioner who will increase access to primary care patients. That opens up another opportunity for integration with traditional reimbursement models that accept full insurance for primary care services.
MedscapeYou are self-employed since 2016. Was that transition challenging and how do you feel now?
GrahamAt first, it was difficult to navigate this new world and learn the business side: branding, marketing, social media platforms and hiring and firing employees.
I can tell now that it is emotionally, spiritually and financially rewarding. I have more autonomy and creative time; I make a lot of money and work less, and when I work, I spend time with the person I love – that’s the holy trinity of success.
MedscapeAre you helping low-income communities eat healthier?
Graham: Yes, I am a paid medical wellness consultant for a local senior community center in the Bronx. During the pandemic, I offered a 6-month virtual course on Food for Health, Eating for Longevity, Blue Zone 101, Eating for Gut Health, Eating for Depression, How to Enjoy Your Age, and Happiness as Medicine.
I personally support two local charities in distressed neighborhoods growing sustainable community gardens: The Green Bronx Machine and Harlem Grown.
Christine Lehmann, MA, is a senior editor and writer for Medscape Business of Medicine, based in the Washington, DC area. She has been published in WebMD News, Psychiatry News, and The Washington Post. Contact Christine at clehmann@medscape or on Twitter @writing_health
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