Avi sets out to buy figs for his grandfather. Crossing the road is easy enough when the traffic policeman is on duty. But on the way back, the crossing has changed. The policeman is gone. Cars zoom forward, scooters weave around, and even cycles seem ready to jab with their handlebars. Avi freezes on the edge of the road, unsure how to step into the chaos.

Just then, a cheerful “Hanuman” appears — not the mythic hero, but a kind stranger who shows Avi how to cross safely and confidently.

Can a city be kinder to its pedestrians? This story introduces young readers to simple road rules and the everyday realities of walking in a busy Indian street.

Story: Vijee

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We had reached the theater late that day. A temple procession on the main road made it impossible for our scooter to pass. Daring shortcuts brought us to the theatre a few minutes past the official show time.  Fortunately, the show had not sold out. The usher turned on the flashlight and led us to our seats solicitously with his “paathu vaanga.” After all, Perippa, my uncle, was an old regular.

On screen, Mussolini invaded Libya. Omar Mukhtar, a bespectacled schoolteacher led the resolute local resistance which had few resources. Tanks rolled in the Sahara. The warm sands made me thirsty. Perippa bought me a bottle of soda with a marble stuck in its throat. I took nervous sips because I was convinced the marble would come unstuck and lodge itself in my throat.

After twenty long years of struggle – little less than an hour in movie time – the Libyan forces lost. The fascists executed the Lion of the Desert in the public square. A little boy bent down to pick up the dead hero’s glasses. I furtively wiped my eyes before the lights came on.

“That boy is their next leader. He grows up and leads his people to victory,” Perippa said in his usual boisterous manner as if he had watched the sequel. I felt reassured. Years later, when I read the Boston Globe column that mourned the passing of Anthony Quinn, one thought flashed through my mind. “Omar Mukhtar is Dead.”

—-

Every summer we went to my father’s hometown, Madurai, to spend our vacations with our grandparents. Just as we thought we’d die of the heat and sheer boredom, Perippa, my father’s older brother, would make good on his promise to take us to the movies. Local films were not good enough for us, it was almost always a Hollywood film. Cowboy Westerns, thrillers, and the occasional martial arts films by way of Hong Kong — we saw them all.

Back then, films were not dubbed, nor did they have subtitles.  What use were subtitles anyway? Many filmgoers could barely read Tamil. Perippa had taught himself American English from paperback novels and with help of a pocketbook edition of the Oxford English Dictionary. He read everything he could about the movies as well.

But for Perippa, my brother and I would not have watched anything except films shown on Doordarshan. My father seemed to dislike movies as much as his brother liked them though he did make a concession for Tamil film songs. He, however, would not be caught dead talking about anything related to films. “Even if he knows something about actors or films, he won’t let on” Perippa would say of his brother, with amusement. “It is below his dignity.”

When we went to the movies, Perippa had an entourage of five – three sons, my brother and me. As the youngest, my brother and I got on the scooter with Perippa. My cousins took the rickety silver-gray downtown bus. Our theatre excursions were spontaneous. Perippa did not believe in the concept of advance booking. If we got fewer than six tickets, the cousins would be sent home. We always got to stay.

Going to the theatre was quite an experience. How do you hold seats for your cousins, or for Perippa, if he had to step out for a minute? If you left your handkerchief on the seat, they’d know it was taken — you didn’t have to say a word. (Watching a rerun of the Seinfeld episode reminded me of this. Elaine Saves Seats At The Movies.) This was code which all moviegoers in Madurai understood. Even the ones who whistled at the family planning ads. Or those who read every word on the screen out loud for the benefit of their less-fortunate brethren. Before the movie started, the slides- ads for local businesses – came up one by one. After that, came the newsreels. The opening credits would be greeted with applause and loud whistles.

Perippa would give us a quick rundown of the plot if the movie had been reviewed in The Hindu. Otherwise, he would keep up a steady narration — so we could follow what was happening on screen, after a fashion. Those in the nearby rows also turned to him for an explanation. Sitting right next to Perippa, I basked in the glory of this interpreter of foreign films.

The martial arts flicks were the easiest to follow, but here too we got off-screen outtakes. “See, it is like this. If you kids lift a calf every day, why, as it grows, so will your strength. One day you will effortlessly lift the cow off the ground”, Perippa had told us. “Devoted practice is key.” For the longest time I believed it was possible for me to carry a cow. I just had to be disciplined about the whole thing — work to a plan.

As we got older, the boys went to the movies on their own. A couple of them went to study outside Madurai, as did my brother. But Perippa kept our summer tradition just for me. I realized, by then, that his telling deviated from the script. If the onscreen version was different, it didn’t matter – a parallel narrative made everything more interesting. Our trips to Madurai finally came to an end when my grandparents died.

Perippa himself passed away in his seventies – till the end, he went to family gatherings, enjoyed books and, of course, watched movies. He missed the age of Netflix and subtitles, yes—but what I miss more is watching a film beside him, hearing his asides in the dark, his voice weaving a world within the world on screen.

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Even a donkey that grazes exclusively on cinema posters would not have starved in this city. Madurai, my father’s hometown, was dotted with that many cinema halls! And the owners of the movie halls plastered walls of the city with movie posters to draw in the crowds. Madurai was also once home to Asia’s largest cinema, Thangam Theatre, which, by many accounts, could seat a little over 2500 people. Even in a city with many, many movie theatres, superlatives do count for something.

Every summer, we went to Madurai to spend school vacations with our grandparents. Back then, we lived in Bombay — wasn’t every other place in India supposed to be boring by comparison? But my brother and I did have something to look forward to in this city of ancient temples. While Appa disdained films Perippa, my father’s brother, was one of Madurai’s many movie-crazy residents. In those hot summer months, Perippa took us to the cinema theatre to watch Hollywood films. During the rest of the year, he watched films in other languages – Tamil, Hindi, and Chinese martial arts films, dubbed in English.  He never missed anything film-wise or so we thought, but recently, thanks to a short video on YouTube, I realized that as a teen, Perippa had missed a landmark Tamil film, screened in his very backyard.

The year was 1952.C. Rajagopalachari, “Rajaji,” was the Chief Minister of Tamil Nadu. By all accounts, he did not think much of the new medium of the movies. Many conservatives thought films would corrupt young minds. My grandparents who lived in Kakkathoppe Street in Madurai had much the same views on films. Despite the misgivings of the conservatives in the Kakkathoppe Street who were worried about the influence of the movies on the younger generation, there was no denying the buzz as Thangam Theatre came up in this neighborhood – the construction went on for two years. Thangam opened for business right around October 17, which was Deepavali Day that year. Tickets for the best seats in the house were printed on blingy gold foil – “thangam” means gold in Tamil.

No one could have predicted this on opening night, but Sivaji Ganesan, making his debut in Parasakthi, would skyrocket to fame. Unlike the beloved film star and politician MGR, who toiled for a decade as an extra, Sivaji arrived fully formed. To this day, Sivaji is the voice of Tamil to many speakers of the language worldwide. The film’s scriptwriter, M. Karunanidhi, would go on to be elected Chief Minister of Tamil Nadu five times. Parasakthi was not just a film—it was a vehicle for the ideology of the Dravida Munnetra Kazhagam (DMK), a political party formed in 1949. It is no exaggeration to say that the film reshaped Tamil Nadu’s political landscape—and the destiny of Tamil people in post-independence India.

Set in the tumultuous years of World War II, Parasakthi tells the story of a young woman whose three older brothers live and work in Burma. Because of the war, they are unable to attend her wedding. Soon after, the sister becomes a mother—and a widow—in quick succession. She suffers great hardship as a woman with no male protectors. When she tries to kill herself and her infant son, she is arrested—the life of citizens belongs to the state, she is told. In a conventionally happy ending, she is reunited with her family. There is no personal rebirth, no remarriage—only a return to the fold. The privileged family resolves to serve the less fortunate in their land of birth.

The character played by Sivaji — he is the youngest of the three brothers — channeled the simmering resentment of Tamil people toward entrenched privilege. In 1947, the British left India, but to many, it felt like one set of callous rulers had been replaced by another. Parasakthi demanded reform. In the city of Madras, the film said, there should be no one sleeping on sidewalks, no human-pulled rickshaws, and for the common people, taps of potable water that would never run dry. (Later, DMK did manage to achieve one of these three goals.) The film ran to a full house for over 100 days in Thangam Theatre.

Because Thangam theatre was not soundproof initially, people who lived nearby could hear the songs from Parasakhti, though incendiary dialogue was drowned out by the sound of applause. My father still sings that song in praise of the sharing ways of crows, with the refrain Kaa Kaa Kaa and the whirly O Rasikum Seemane, featuring the danseuse Kamala Lakshman in a proto-item number. Then there are the serious songs. Nenju Porukkuthillaiye, fashioned from Bharathiar’s verse, says the poor cannot figure out why they are trapped in some endless famine; Porule Illaarkku asks if the have-nots can ever get a shot at making a good life. In short, someone has to help the poor find a way out of poverty. The film ended with a cinematic call to action, a song that translates to “Everyone Should Prosper,” with stock footage of Dravidian leaders.

The conservatives of Tamil Nadu were scandalized and asked the Central Board of Film Certification for a reappraisal of the film — they wanted the movie banned. Rumors were rife that the movie would be pulled from theatres any time. Theatre owners, being the shrewd businessmen they were, capitalized on the rumor. The feared ban never happened. Instead, the public flocked to the theatre in record numbers. The film would sweep in the winds of change — social movies were in, the old Raja, Rani movies set in some nameless kingdoms of yore were out.

Parasakthi was a dream debut for the cavernous new theatre. Perippa must have most certainly pestered my grandparents for money to go watch the much talked-about film. In response, I can picture my mild-mannered grandfather clucking no; my grandmother whacking her eldest son hard with her palm-leaf fan. They did not give him money for the cheapest ticket because there was none to spare and not just because they were killjoys. When Perippa started earning money, he was a “first day, first show” kind of guy and eventually graduated to film buff. The man did not just watch movies — he read everything he could about them. I dare say he would have read the articles on Baradwaj Rangan’s blog too. Big words never fazed him.

When the 1990’s got under way, inexpensive video players, and the rise of television channels devoted exclusively to movies, led to the demise of many theatres worldwide. Madurai, the city of cinema theatres, was no exception. In the end, Thangam’s size was its undoing — it had become something of a white elephant. The crowds thinned out, and it was curtains for the theatre in 1992 — the last movie to be screened there was Nagarjuna’s Eshwar, a film, dubbed from Telugu. Since the mid 1980s, it had operating half-heartedly on temporary licenses.

The once popular theatre stood forlorn and derelict for two decades.

In 2011, Demolition Day finally arrived. Movie-goers gathered in the old Kakkathoppe neighborhood to pay their final respects to the theatre. An entire generation of filmgoers had not watched a film in this grand old theatre — so those who had gathered were mostly old movie buffs, mostly men. Many wept openly. Audiences did not think of old movie theatres as mere buildings. For many, a place like Thangam Theatre had provided a temporary refuge from the battle which is life — all for the price of a movie ticket. In a scene right out of a melodramatic film, clouds gathered overhead and kept up a steady unseasonal drizzle in sympathy with all those old patrons of Thangam. I can imagine Perippa standing in that crowd, not even trying to hold back the tears.

There is another thing they say about the donkeys of Madurai — that the creatures never quite manage to leave town. It may be more than metaphor — it has something to do with the way the old temple town was planned. Perippa lived and died in his hometown Madurai in 2016. And Madurai has no special meaning for me now because the people who made the town special to me are all gone.

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Many health-conscious beer lovers looking for suds without the hangover simply haven’t found the right brew.  Lower-alcohol alternatives don’t taste like the real thing — not even close. Point Five, a new pilsner with alcohol “gently removed,” has been creating a buzz among beer lovers since its launch in Boston in December. The name comes from the American definition of a nonalcoholic beer — it must have less than one-half of 1 percent alcohol.

“Nonalcoholic beers just haven’t tasted that great,” says Ronan McGovern, the scientist-entrepreneur behind Point Five. When he was a graduate student at the Massachusetts Institute of Technology, he developed an energy-efficient desalination process. Brewers, he thought, could use the same separation technology to remove water from beer and save on transportation costs. In 2015, when he was a postdoc at the same institute, he launched the startup Sandymount Technology.

Soon, some clients began to ask whether he could remove the alcohol as well — without altering the taste. Once he proved that the bulk of the alcohol could be removed without stripping flavor, McGovern went on to launch the brew. The pilsner is made by Matt Brewing Company in upstate New York. “I am not a big juice or soda drinker, and I do like beer,” says McGovern. Also, McGovern knew of the recent surge of sales of nonalcoholic beers (NAB) in his native Ireland, where beer is a popular alcoholic drink.

By all accounts, people the world over are looking to drink less alcohol for a variety of reasons. Health-conscious millennials consume less fat and sugar and look for choices with fewer calories in both food and drink. They don’t want to drink and drive. For a business lunch, this option works better than regular beer. The increased interest in non-alcoholic beer is a very recent phenomenon in the United States. In 2019, the prestigious Great American Beer Festival brought back nonalcoholic beer as a competition category, after a long hiatus, says Ann Obenchain, marketing director of Brewers Association, which organizes the festival. (In 2006, the category had been scrapped due to lack of interest or participation.)

Some of this recent interest, industry watchers say, is “producer push” as much as “consumer pull.” For instance, Heineken, which saw Heineken 0.0 do well in Europe, poured money into marketing in the United States last year. While there are many factors in the resurgence of nonalcoholic beers, “People want to be part of the crowd, but not get drunk,” says Steven Wilkinson, general manager of Supreme Liquors. Not too long after Point Five’s December launch, customers came in asking for the beer, even before he had a chance to stock the item in all the stores in his chain. Initially, Wilkinson thought the buzz for Point Five was because of social media. “In the past, customers have not always liked nonalcoholic beer once they’ve tasted it,” he says. But they have kept coming back for Point Five.

There are different approaches to making nonalcoholic beer. Brewers could arrest the fermentation process — think partially fermented grape juice instead of red wine. Another method is to brew a conventional beer and later remove the alcohol by distilling it off with heat, or by a cold filtration process. Either way, the fresh fermented notes of the original beer are typically lost because the more volatile aromas tend to evaporate.

This is where the Point Five innovation is a careful cold filtration process in which there is no need to add flavors back. “Here is how you make great nonalcoholic beer,” says McGovern. “Fermentation, which makes beer taste like beer, followed by a careful separation of alcohol that keeps all the key aromas in the brew.” This process distinguishes the product from what is already out there.

“Point Five is a nonalcoholic with global appeal,” says Roy Desrochers, the sensory practice leader at the University of Vermont Extension. He is a professional beer taster with over 35 years of experience teaching beer flavor around the world. In his assessment, Point Five retains the aromas and flavors of the original brew. It has no off-putting features, no burnt taste or “wet-cardboard” staleness. “Point Five will meet the expectations of beer-drinkers who want to drink nonalcoholic beer but don’t drink it currently,” he predicts.

What began as a membrane-separation problem in an MIT lab has ended up reshaping a corner of drinking culture that had long been stuck in place. Point Five shows what happens when precision engineering meets a simple human desire: to enjoy the ritual without the regret. If the beer world has been slow to imagine that possibility, drinkers seem ready for it now.

THE ORIGINS OF POINT FIVE

by Ronan McGovern

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One evening in a summer of record high temperatures in 2019, I went on a free public tour of a large rooftop farm in the heart of our fair city. To reach this destination, I took the orange freight elevator three stories up at the power plant building of Boston Medical Center (BMC). The farm, which yields produce for the hospital’s patients and staff during New England’s brief growing season, has already received a fair bit of press. So, this was not some secret oasis. Yet the sight of the greenery, in the middle of a brick-and-concrete jungle, took my breath away. It also had me breathing fresh air in greedy gulps.

Lindsay Allen, farm manager at BMC, ushered us into the lush, green space. Thanks to a slight breeze, nasturtium, calendula and other edible blossoms seemed to be nodding their heads in greeting. About two dozen varieties of plants—herbs, leafy vegetables and fruits—were thriving in planters arranged in neat rows over a carpet of AstroTurf. We might have missed the two brightly painted wooden bee boxes whose residents help pollinate crops in this mini ecosystem, but Allen pointed them out to us. “Bees are the unsung heroes of the food system,” she said.

Some numbers: In the first two years of this farm’s existence, the hospital harvested about 6,000 pounds of food, on average, annually. The roof is 7,000 square feet in total area, but the growing space is approximately 2,700 square feet. The bulk of the produce, growing out of about 2,300 milk crate planters, goes to low-income patients in the community. The rest of it is used in the hospital cafeteria and goes into food trays of inpatients. Evidently “food is medicine” is not just some mantra here, it is a guiding philosophy. I had to return with my reporter’s notepad.

The story of this rooftop farm begins not in the sky, it begins below.

Down in the Basement

This time I headed to a room in the basement at BMC, the place where it all started. In a historic first in the nation, BMC set up an in-house pantry in 2001. The therapeutic pantry was the brainchild of Deborah Frank, a pediatrician at the hospital, who realized that some mothers in the community they served could not afford to buy healthy food for their malnourished infants and children.

Among adults, the biggest killers in the community were diet-related ailments. “If doctors ask such patients to eat healthier and if they don’t have the money to buy the proper food, the prescription will go unfilled,” says Latchman Hiralall, food pantry manager at BMC. “But doctors can send them to pick up food from the pantry, free of cost.”

Twice a month, patients who have limited or no money to buy nutritious food can pick up provisions from the pantry for the whole family. As part of the care prescribed by the provider, the package is customized to their medical condition, their taste and cultural preference.

Apart from canned goods, the pantry supplies perishables such as meat, fish, milk, eggs and green groceries. Families are looking for more green vegetables and fresh fruits because such produce is expensive to buy in the market, says Hiralall. By growing more produce in-house, the rooftop garden helps narrow the gap between supply and demand for these valued items.

A local garden used to supply some vegetables before, says David Maffeo. This senior director of support services, along with visionary colleagues, wanted the hospital to do better in the fresh produce department.

To meet the growing demand for fresh produce, BMC decided to cultivate its own.
Growing a Rooftop Garden

In 2017, Maffeo’s group approached Higher Ground, a company that helps institutions make the most of their growing spaces. “BMC decided to do it big and do it right,” says Allen, the public face of the farm. As an employee of Higher Ground, she conducted light studies to find the best place for the farm within the BMC premises.

Somerville-based Recover Green Roofs designed the farm and took less than half a day to install the containers filled with a soil blend from Vermont Composting Company. The high quality of the soil could be one reason why the yields from the BMC farm are so high. “Just like we are what we eat, our plants are what the soil is,” Allen explains. She recalls her initial surprise when the farm started yielding produce a month or so after the installation. These plants were flourishing on the rooftop.

The fertile patch has a high-tech watering setup. The irrigation system tied in with a weather sensor delivers water directly to the roots of the plants. Rain in the forecast? The system skips a watering session. On blazing hot weekends, Allen can do an extra round of watering from home, via her smartphone. “Watering plants is one thing I don’t need volunteers for,” she says.

But there are other tasks. Given the small size of the crates, it is hard to use implements. Seeding must be done by hand. There are no rabbits or deer on rooftops, but there are small-sized pests. Birds, and the wind, bring in weeds. Hospital employees, especially those who see the garden from a distant window, have been happy to pitch in at the farm. Physicians and cooks, lab technicians and physical therapists, people whose paths never cross in the premises below, have met on the roof. And it is not just BMC employees. “We have a waiting list for volunteers,” says Allen, “and this is a good problem to have.”

Beyond nutrition, the rooftop farm also plays a role in BMC’s environmental mission.

A Greener Hospital

Because space is a constraint, Allen prefers to grow salad greens and leafy vegetables, like collards, kale and chard, which can be harvested continuously. Cabbage or broccoli sit around for a while before they are ready to be picked, but peppers, carrots, tomatoes and cucumbers are favorites. The farm also brings the center closer to its goal of being the greenest hospital in the nation by 2020, says John Stoddard, the founder of Higher Ground. Rooftop farming is also a climate change intervention, he points out, because the insulation reduces the electricity needed to heat or cool the building. “On a [formerly] barren surface, you now have carbon-breathing plants,” he says. Plus, the soil can absorb and slow down stormwater that would otherwise pick up a host of pollutants before it drains into large water bodies. Reduction in food miles is another bonus. While the average vegetable travels some 2,000 miles to reach the consumer, produce from the farm travels 3,000 footsteps or less, depending on where it is going—the food pantry, the cafeteria kitchen or to inpatient units. On Tuesdays, there is a farm stand in the cafeteria. People often start to line up even before the setup is complete, says Allen.

But growing food is only half the story—helping people use it is the other.

Reaping the Harvest

Each month, the pantry serves over 7,000 people in the community. While clients are happy to receive seasonal produce at its prime, they may not always know what to do with it. Some people could be seeing rainbow chard, zucchini and other varieties of squash for the first time. This is where Tracey Burg, registered dietitian and chef, has a crucial role to play. To entice clients, Burg who heads the Teaching Kitchen at BMC, leaves samples of dishes featuring these new vegetables—particularly “hard-sell” items like rutabaga, beets and kale—at the pantry, along with printouts of recipes.

Like a kind and knowledgeable aunt, Burg shows folks what to do with unfamiliar produce, step by step in the Teaching Kitchen. For the demonstration, she’ll have the vegetable sitting on the table, unprepped and whole, waiting to be introduced to the class. Then, she teaches them to cook the vegetable using different techniques like roasting, sautéing and steaming. Similarly, Burg shows people who hate eating plain fruits and berries how to make them part of wholesome desserts.

This summer, the kitchen’s lessons were tailored to younger palates.

Eating Rainbows

One July morning, as we wait for a bus that’ll bring grade K–2 children from Boston Public Schools to a culinary class, Burg tells me about her work at the Teaching Kitchen. The classes she teaches are free for BMC patients and staff. There are classes for patients with specific ailments, including diabetes, heart disease or cancer. There are fun classes for those want to cook healthier meals on a budget. Getting more of the target audience to come in and benefit from all the free classes is still a challenge. This summer, however, the programming focus is strictly on schoolkids.

When the bus finally arrives, Burg leads her group into her kitchen. There, she points to a poster which says, “Catch a Rainbow Every Day!” and asks the children what they think it means. They piece together the idea that fruits and vegetables come in various colors. And that it is good to eat as many plant-based treats as possible daily—five colors, at least. To this end, Burg plans to teach them to make a colorful salad. The interns pass out paper chef hats to the kids. “Vinaigrette is just a fancy term for salad dressing,” Burg tells the children. She demonstrates how the dressing is made by shaking together oil, vinegar, herbs and seasoning. Each group of three gets to make its own salad dressing. In every group, the kids take turns to shake the bottle well. They rinse the greens, help toss the salad, and eat small bowlfuls of the salad they’ve helped create. For dessert, they get one chocolate-covered strawberry each.

Then the children get ready for their tour of the rooftop garden—the source of salad greens and herbs.

Before they head out, one little boy makes a show of putting away his paper chef hat carefully. “I’ll wear this when I make a salad for my mama,” he tells the teacher who has accompanied the group. His declared intent makes me smile.

I, too, want to create rainbows for my family. Who wouldn’t, after such a delightful session? 

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InvertedRoofGarden

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Physician-chef Rani Polak explains why clinicians should learn cooking skills—and teach them to patients.

Midway through medical school in Jerusalem, Rani Polak had doubts about his chosen path. He decided to quit and pursue a different passion, cooking, at Le Cordon Bleu academy in Sydney. It was among the pots and pans that he began to see a way that he could help people lead healthier lives—through food, but in the role of a physician. He completed his medical degree, and today is a leading physician-chef in the burgeoning field of culinary medicine.

In 2014, Polak started a telemedicine program based on an old-fashioned idea now supported by growing evidence: when it comes to health, home cooking matters. While many doctors may agree, most don’t have the training to teach patients how to cook healthy meals for themselves. To help other physicians, Polak founded and directs the Culinary Healthcare Education Fundamentals (CHEF) Coaching program at the Spaulding Rehabilitation Hospital in Boston, which helps clinicians lead patients to build healthier—and often tastier—habits around food.

Q: What is culinary medicine?

A: The American College of Preventive Medicine calls it “the practice of helping patients use nutrition and good cooking habits to restore and maintain health.” How is this new? Well, until recently, most studies and medical advice about food addressed specific nutrients—this is good for your body, that is not.

What’s new is the understanding that food is a behavior that requires skills to maintain. If you want people to adhere to a diet, you need to offer them ways to behave around food—and that includes tools and solutions for mealtimes. If you want a person to cut down on one food, you’ll have more success if you can suggest a flavorful, healthy alternative. And if we teach people to cook those better foods themselves, they’ll start eating in a healthier way, almost by default.

Q: How does that work in practice?

A: One of my first patients in Boston was a physician with type 2 diabetes. The lunches he bought near his office were mostly unhealthy, so we talked about meals he could prepare at home. He felt confident about making sandwiches but didn’t have time to buy fresh rolls every morning. We discussed how to freeze and defrost fresh bread for use, and that led to major improvements in his diet. If people know what to buy at the grocery store, how to make a meal and make more time to cook, they can make very important changes.

Q: Isn’t food the domain of the dietitian or nutritionist?

A: Usually only people with certain health conditions are sent to that kind of specialist. But most patients can benefit from a change in their diets. Clinicians should also know how to talk about food. If they had training in culinary medicine, they could plan interventions to improve their patients’ eating habits—working together with dietitians and nutritionists to achieve better outcomes. It might take only a minute to ask the patient questions and prescribe culinary videos and then to follow up on future visits. Doctors can do this even if someone has simply come in for an annual physical or has the flu.

Q: How did you get started?

A: For my medical school thesis, I developed a culinary medicine program for patients with inflammatory bowel disease in Israel. Then in 2013 I came to Boston to pursue a fellowship at the Institute of Lifestyle Medicine, which was then located at the Joslin Diabetes Center. I wanted to invite patients into the kitchen and cook with them. But like most hospitals and medical schools around the world, we didn’t have a teaching kitchen. They are expensive to build and maintain.

As part of my fellowship, I received training in online coaching, and immediately saw the possibilities of using telemedicine to teach food habits. I worked to develop the CHEF Coaching program—a combination of culinary training and health coaching principles, delivered through the internet.

The program works mainly with clinicians. We have cooking videos that clinicians can review in their own time and prescribe to patients, and doctors can join us live from their own kitchens for cooking classes. The idea is that once providers learn, they can lead those under their care to better health. But we also work with some patients. We are starting a three-year randomized controlled trial at Spaulding soon to study the impact of our telemedicine program on overweight and obese participants.

Q: You place a huge emphasis on home cooking. What does the research tell us?

A: It is a worldwide epidemic: People cook significantly less today than they did 30 or 40 years ago. But study after study shows that home cooking results in better nutritional intake. Even when people say they are not trying to lose weight, and they eat anything they want from their own kitchens, they still do better than they would in a restaurant—but cooking instead of eating pre-prepared foods is better in general. We use fewer fats and sugars in our own kitchens than commercial kitchens do.

Ultimately, home cooking is a behavior, not a skill. It is not simply about picking the right raw ingredients, or knowing to roast vegetables. It is about making the time to cook, gaining some basic skills and having the confidence to enter the kitchen and come out with something you’d like to eat. So those are the skills that our program tries to build.

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