Senbagam Virudachalam, a pediatrician at The Children's Hospital of Philadelphia, is leading a study designed to give families the skills and confidence to cook at home. She's hoping that change will translate to better health for kids.
The idea began several years ago with a 5-year-old patient. At his latest check-up Virudachalam noted he'd grown too big. The boy was obese. She shared her usual laundry list of advice including: less TV, more fruits and vegetables, no soda. It's a talk she has with parents all the time.
About one-third of children in the United States are overweight or obese by the time they start school.
She sat down with the mother and they talked through the boy's diet.
"He was having cereal many days; those were often sugary cereals with whole milk," she said. "I would say a typical dinner was take out and even the food being cooked at home was often fried."
Mom and doctor set goals and hashed out a plan. But, Virudachalam says the advice didn't seem to stick until the two were chatting in the busy waiting room.
"She said: "Doctor tell me, what do you eat every day? What do you do when you wake up in the morning?' And I started to tell her, I get up in the morning, I brush my teeth, I put my oatmeal in the microwave. Within about 15 seconds, that waiting room was so quiet, you could hear a pin drop, every parent was listening to what I was saying," Virudachalam said.
"Even though I had given this mom reasonable guidance and advice, it wasn't really actionable for her," said Virudachalam, a health researcher in the Policy Lab at Children's Hospital.
Adding fun and ease to cooking
The Home Plate healthy eating study gathers the parents of preschool age kids for a fun cooking experience. Virudachalam wanted to hook parents into a new, fun habit... not just provide a lecture on nutrition.
"Our goal wasn't to turn everyone into a gourmet chef. It was to start where people were, move the needle a little bit toward preparing healthier meals but also preparing food more frequently," she said.
One of the favorite recipes was a skillet chicken simmered with onion, which came out moist and tender on the first try. The group served it with brown rice and arugula salad, Virudachalam remembers.
Peer mentors teach the cooking lessons. The group leaders were selected because they live in the same neighborhood—and have similar financial challenges—as the other parents in the class.
Virudachalam said the peer mentors provide extra-curriculum advice that she can't.
"I'm not going to say, 'if you go to this corner store on Tuesday, the broccoli's going to be on sale, or if you go to that butcher on Friday that's when certain cuts of meat will be available,' I don't have that information," she said.
Nine months after the class, the researchers checked back with parents who took the class. Completed questionnaires and diaries of the children's eating habits suggest that families who took the class now have healthier diets, compared with families who did not take the class.
The investigators did not measure the children's weight—so it's not clear if the change could be a tool in the fight against childhood obesity.
"We don't know for sure," Virudachalam said. Answering that question is on her to-do list.
The Aramark Charitable Fund is helping to pay for the next phase of the study, and the researchers plan to include a more objective gauge of success by tracking the children's weight over time.
"As a scientist if we find that it doesn't make a difference, we'll have to keep looking for other ways to help families eat healthier," Virudachalam said.
West Philadelphia mom Tameka Norman, 34, took the class, but with five people to feed, she says, frankly, fast food and carryout are always going to be more convenient.
"On every corner, we have either a Chinese store, or what we call the Papi store that does the fast food for you," Norman said. "And the pizza store delivers."
There is a pretty good grocery store—with a nice vegetable selection--just a few streets down, but here's the thing: Norman doesn't like to cook.
She did not change her mind after taking the cooking class, but learned the trick of make-ahead meals and how to make leftovers stretch. On a recent week this summer, she prepared two big dinners on Sunday, and on Tuesday night, the Normans were re-heating dinner.
Meatloaf, potatoes and peas were the main course. There was fruit salad for dessert. First grader Shayla heated up her plate in the microwave by herself, before sitting down at a small kids table with her 3-year-old brother Micah.
Shayla was disappointed there was no whipped cream to go on the strawberries, still everyone seemed pretty happy with dinner, and it all got accomplished without stopping for burgers and fries.
"One of the things that I was hoping people would gain, and I think they did, was a sense of being able to get home at the end of the day, look at what's in the fridge and the pantry and make something," Virudachalam said.
She says almost any meal--prepared from scratch at home—is healthier than takeout or processed frozen food. But food is just one part of her big plan to bring back family dinner. Routines are important for kids--and she hopes this one healthy routine will lead to other healthy routines at home, such as reading together, dedicated homework time and making sure kids get enough sleep.
"In order to get three square healthy meals a day on the table, a lot of other things have to be going right in a family," Virudachalam said.
Get Healthy Philly
In the fight against obesity, schools, the government and doctors are trying all sorts of things.
In Philadelphia, they've added fresh food to corner stores. Chain restaurants now list calorie counts on their menu. Public schools have banned soda in the vending machines and nixed deep fryers in the cafeteria. There's even a program to make Chinese takeout healthier.
Still about 40 percent of Philadelphia kids are overweight or obese, and that number is even higher in certain neighborhoods. Philadelphia's been working on its weight problem for more than a decade. Lots of kids are still too big, but there are signs of improvement. Obesity among city school children dropped by 5 percent between 2006 and 2010.
The city has made a big investment in farmer's markets—and stepped up its efforts to encourage low-income families to take part.
Farmer's Market food tour
On a Saturday this summer, Kasey Esposito from the Food Trust and cookbook author Leanne Brown led a tour of the market in Philadelphia's Clark Park.
The duo acted as tag-team pitchmen hawking the wonders of grilled asparagus and the benefits of seasonal fruits and vegetables.
Brown's cookbook "Good and Cheap" is for people who live on a food stamp budget and The Food Trust is on a mission to get nutritious food to more city people.
The duo introduced the crowd to some of the less familiar produce including garlic scapes and an apple turnip-looking, purple thing called kohlrabi.
On the tour, Esposito tried to dispel some myths about farmer's markets. People enrolled in the supplemental nutrition assistance program (SNAP)—sometimes called food stamps—can use their Pennsylvania ACCESS card at many produce markets. There is even a coupon program called Philly Food Bucks that gives SNAP users $2 in fruits and vegetables for every $5 they spend at the market.
"Even if they came just for bread and eggs, they have this free money and they are going to get some greens," Esposito said.
When Esposito talks to low-income people, she says, they often have pre-existing ideas about farmer's markets.
"They think the food is too expensive. They think the food is unfamiliar that it doesn't have a lot of the food they like, that they want to cook at home," she said.
When someone complains that they can't find a banana or pineapples or other tropical favorites, part of Esposito's sales pitch is to drum up an appetite for in-season, local produce which is inexpensive and plentiful.
"Why not get an amazing apple?" she said. "Or cherries are basically like candy right now."
Fresh vegetables are cheap eats, but Brown says that doesn't matter much if you don't know what to do with the produce and it ends up wilted and unused in the refrigerator.
"Have a plan for those turnips, have a plan for the blueberries—and carry it out," Brown said. "There's a lot that we can do with very little money if we are competent cooks. People think they're not good at cooking 'cause they have tried it once or twice, and it hasn't worked out, they burned something, it wasn't as good as it was at a restaurant or that time their mom or their dad made it."
Philly has doubled-down on farmer's markets. They're all across the region these days. Now some advocates say a next step is to actually teach people to cook.
The "Taste of African Heritage" program is another cooking course with that goal. The next round of cooking classes begins this week at the Free Library's Culinary Literacy Kitchen.