Losing weight is challenging. But as anyone who has ever successfully lost weight knows, it's avoiding weight re-gain that's the real challenge.

This is true no matter what method you follow to lose weight. For example, studies show that people who follow very low calorie diets (between 800-1,200 calories per day) regain between 26% and 121% of their lost weight five years after treatment. People who follow behavioral weight management programs (such as WW, formerly Weight Watchers) regain between 30-35% of their lost weight after one year.

Even people who use weight loss medications, such as Wegovy, are shown to have regained about two-thirds of the weight they lost one year after stopping the drug.

There are many reasons why we regain the weight we lose. First, maintaining weight loss is less rewarding than seeing the number on the scale decrease while you're losing weight. This makes it hard to maintain motivation and continue looking after your weight.

Second, it's often difficult to maintain the lifestyle changes we made in order to lose weight—especially if these changes are unrealistic and hard to stick with in the long-term (such as very low-calorie diets or cutting out whole food groups).

Third, weight loss can trigger increased production of hunger hormones—and can even slow your metabolism. These changes can make it difficult to resit overeating and can contribute to weight regain over time.

But while weight regain may be a common experience, that doesn't mean there aren't many evidence-backed things you can still do to prevent it in the long run:

1. Be flexible

It's important to understand that maintaining a healthy weight will require lifelong management—so having rigid expectations and thinking you'll always adhere perfectly to your lifestyle changes is unrealistic.

Don't feel guilty when you have a slip-up. Instead, make plans to get back on track as soon as possible. For example, if you think you may have overeaten on the weekend account for this by adding a couple extra walks into your routine the next week.

Doing this can prevent an "all or nothing" approach to weight management—whereby you feel guilty when you don't achieve your goals and so instead abandon your efforts.

2. Plan for disruptions

Recognize that there will be disruptions to your weight management efforts—such as holidays, weddings and birthday parties.

Plan ways to navigate these disruptions successfully. For example, losing a few extra pounds ahead of time may adjust for extra weight that may be gained during these occasions.

Or, if you're going to a barbecue, bring along a healthier option (such as vegetable skewers) so you have a lower calorie option to choose. Doing this will help you enjoy special occasions with less worry.

3. Be proud of your achievements

Our weight naturally fluctuates over time—and so being proud of yourself when you achieve your goals, regardless of the number on the scale, is important.

Research also shows that people who focus more on how they can achieve their goals—rather than the outcome—are more likely to stick to behaviors important for maintaining weight loss. This might be because they're less likely to be affected by setbacks (such as regaining some weight).

4. Make habits

Creating habits can help maintain weight loss. This is because habits are thought to be less affected by fluctuations in motivation.

This means that even when we can't be bothered, the habits we implemented to help us lose weight will be easier to stick with when trying to maintain weight loss. You could also create some new habits after losing weight—such as going for a walk after dinner or taking the stairs when possible.

5. Get active

A study which looked at people who successfully maintained their weight loss found that physical activity was the most important factor for keeping weight off. This is because physical activity can offset some of the calories we eat.

The best physical activity for maintaining weight loss is the one you enjoy doing most. This is because you're more likely to stick with it in the long-term if you enjoy it. But research suggests you should try to get at least 250 minutes of exercise each week to maintain weight loss.

6. Weigh yourself regularly

Weight fluctuates by as much as 1kg-2kg throughout the week. By weighing yourself regularly, you can develop a personalized weight range of your highest and lowest average weight. This will help you to keep track of your weight, and understand whether you need to make any changes to your diet and exercise habits in order to maintain your weight loss.

Research shows that people who use personalized weight ranges are better able to prevent large weight regain because they're able to adjust their behaviors when necessary.

7. Eat breakfast—and focus on fiber

Although the overall evidence on the importance of breakfast in weight management is mixed, one study found that almost 97% of people who kept their weight off reported having breakfast each day.

Another study also found that people who ate plenty of vegetables and high fiber foods—such as wholemeal breads, brown rice and oats—each day were more likely to avoid weight regain. Eating these types of foods means you feel fuller and are more likely to eat less.

Maintaining weight loss can be hard, but that doesn't mean it's impossible. And even if you're only able to maintain a small amount of the weight you lost, remember it can still be very beneficial to your health.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The International Organization for Standardization (ISO) 10993 series provides guidelines for the biological evaluation of medical devices, ensuring the safety from their intended use. This series outlines the various biological endpoints that need to be evaluated dependent upon the device type. A Biological Evaluation Plan (BEP) can help summarize which endpoints need to be addressed, alongside the corresponding laboratory testing. Using guidance from ISO 10993-17 and ISO 10993-18, a Toxicological Risk Assessment (TRA) can be used to evaluate the potential for acute system toxicity, subacute toxicity, subchronic toxicity, chronic toxicity, genotoxicity, or carcinogenicity that may be associated with the devices’ extractable chemical profile. While these biological endpoints can also be evaluated in vivo, ISO 10993-17 and ISO 10993-18 leverage chemistry testing to replace the need for animal testing.

ISO 10993-18 focuses on the chemical characterization of medical devices and provides guidance on the selection of appropriate analytical techniques, extraction solvents, and screening limits/analytical evaluation thresholds for the test methods. Each of these aspects must be taken into account when designing the study, meaning special care and expert design proves beneficial. The outcome is the possible identification and quantification of the chemicals present in the extracts from the medical device. These results are not a strict pass/fail and must be evaluated for patient safety depending on the intended device use, which is done through the TRA.

If Chemical characterization has already been completed, you may be asking yourself “I have an extensive chemistry report… now what?”

ISO 10993-17 provides guidance to evaluate the data set that is produced from the various analytical chemistry techniques. This standard focuses on the establishment of allowable limits and tolerable exposures for the extractable and leachable substances that may be exposed to the patient. Once the extractable chemicals have been identified, their toxicological profiles will be evaluated through literature research by a toxicologist. During this literature review, allowable limits for the relevant human exposures to the chemical constituents will be derived.

The process of establishing allowable limits for these substances involves a range of different factors: the intended use of the device, the populations who may use the device, the intended route of exposure, and the studies/literature used to derive said limits. Once these allowable limits are calculated for each constituent listed within the chemistry report, a full toxicological risk assessment is written. This assessment goes beyond what is outlined in ISO 10993-17 and ISO 10993-18; regulatory guidance is leveraged, with additional requirements from ISO 10993-1, ISO 10993-2, ISO 10993-3, ISO 10993-11, ISO/TS 21726, and ISO 14971.

The toxicological risk assessment includes the calculation of ‘margin of safety’ (MOS) for each chemical constituent. This is a numeric value, for the ratio between the tolerable exposure to the amount of constituent seen, where a MOS value over ‘1’ could be deemed safe for that population.  While there are more moving parts that go on behind the scenes, especially with determining a conservative tolerable exposure value, the MOS is the outcome that summarizes exposure to that chemical constituent. In addition, the toxicological risk assessment will provide an overall conclusion of the likelihood of an adverse effect from the device. By taking a comprehensive approach to evaluate the extractable substances, manufacturers can ensure that their device is safe for its intended use. It is therefore critical that these assessments are completed by seasoned toxicologists and biocompatibility experts with extensive regulatory experience. At Nelson Labs, extractable/leachable chemistry studies are conducted at one of two state-of-the-art facilities (Nelson Labs Salt Lake City and Nelson Labs Leuven) and the results are evaluated by our team of biocompatibility experts, including multiple board certified (DABT) toxicologists.

Medical Device & Diagnostic Industry Magazine
MDDI Article Index

An MD&DI  January 1998 Column

THERMAL MANAGEMENT

Choosing the right thermal control element helps ensure accurate functioning of complex electronic, imaging, and processing systems.

Equipment engineers seeking to develop faster and more accurate medical and laboratory products are beginning to recognize the importance of proper thermal management. The speed or accuracy of sensitive electronic devices such as microprocessors and lasers can be affected by thermal conditions, and cooling generally has a positive effect on equipment reliability. Chemical reaction rates are proportional to temperature, and the working time or shelf life of a biological trial or laboratory reagent can be increased by keeping the substance at an optimal temperature. Instruments such as DNA cyclers, tunable laser diodes, and thermal-stress analyzers all require a capacity for cycling an object or trial through a range of temperatures with speed and precision.

Heat sinks can be used with or without fans and offer considerable installation flexibility, but they cannot cool components below ambient temperature. Photo courtesy of Melcor Corp. (Trenton, NJ)

There are many different tools and methods for transferring heat. Which method is best depends on the temperatures and tolerances of the application. Simpler devices might function well enough with passive cooling elements such as heat sinks, while devices that operate in more demanding environments might require an active cooling method such as a compressor-based or thermoelectric system. A fan, for example, can be used to remove the heat generated inside an electronics cabinet. If the cabinet is sealed, a heat sink or heat pipe is needed. If the cabinet's temperature must be controlled, a heat pump or air conditioner is indicated. The best design will be determined by system needs and limitations. System needs would address the amount of heat to be added or removed to achieve the required temperature. Limitations might involve space, cost, allowable vibration, and available power. Once these factors are defined, the thermal engineering choices become apparent. The following is an overview of the thermal management technologies readily available to the engineer, listed from the simplest to the most sophisticated.

FANS AND BLOWERS

Fans operate by passing air over a hot component, absorbing the component's heat. Overall cooling effectiveness is determined by the air's flow rate and temperature together with the component's size and output. Typically, fans and fan trays are used in cabinets for bulk cooling of electronics. Fans and blowers are relatively inexpensive and provide a high measure of flexibility in installation. On the other hand, the constant exchange of air raises the potential for contamination from dust and moisture. Moreover, fans and blowers can prove ineffective for high-power devices and cannot cool an object at or below ambient temperature.

HEAT SINKS

Generally, heat sinks are made from aluminum because of the metal's relatively high thermal conductivity and low cost. They are either extruded, stamped, bonded, cast, or machined to achieve a shape that will maximize surface area, facilitating the absorption of heat by the surrounding cooler air. Most have a fin or pin design. When used with fans (forced convection), heat sinks can dissipate large amounts of heat while keeping the targeted components at 10°—15°C above ambient temperature. Heat sinks without fans (free convection) result in a higher component temperature because of the decreased impingement of air. Like fans, heat sinks are inexpensive and offer installation flexibility but cannot cool components at or below ambient temperature. Also, heat sinks do not permit temperature control.

Thermoelectric coolers made from semiconductor pairs between ceramic plates (Melcor Corp., Trenton, NJ).

LIQUID COLD PLATES

Liquid cold plates are typically made from copper, aluminum, or aluminum-clad copper tubing. Heat is absorbed by a liquid pumped through the plate, which is attached directly to the object being cooled. In an open-loop system, the liquid (usually tap water) runs through the plate and out through a drain. In a closed-loop system, a pump recirculates the liquid through a heat exchanger or radiator. Liquid cold plates are characterized by a small size (at point of attachment), and they offer effective heat dissipation. The devices are limited by the fact that they cannot cool below ambient (liquid) temperature and permit no temperature control. The potential for leakage is also a concern, and the availability of liquid sources can sometimes pose a problem.

The best design will be determined by system needs, such as the amount of heat to be removed, and limitations, such as space, cost, power, and permissible vibration.

HEAT PIPES

A heat pipe is a sealed vessel that transfers heat by the evaporation and condensation of an internal working fluid. Ammonia, water, acetone, or methanol are typically used, although special fluids are used for cryogenic and high-temperature applications. As heat is absorbed at the evaporator, the working fluid is vaporized, creating a pressure gradient within the heat pipe. The vapor is forced to flow to the cooler end of the pipe, where it condenses, giving up its latent heat to the ambient environment. The condensed working fluid returns to the evaporator via gravity or capillary action within the wick structure. Because heat pipes exploit the latent heat effects of the working fluid, they can be designed to keep a component near ambient conditions. Though they are most effective when the condensed fluid is working with gravity, heat pipes can work in any orientation. Using forced air at the condenser allows for larger amounts of heat dissipation. Heat pumps are typically small and highly reliable, but they can't cool objects below ambient temperature and do not permit temperature control.

COMPRESSOR-BASED COOLING

Compressor-based cooling systems, found in commercial refrigerators and air conditioners, contain three fundamental parts: an evaporator, a compressor, and a condenser. In the evaporator, pressurized refrigerant is allowed to expand, boil, and evaporate, absorbing heat as it changes from a liquid to a gas. The compressor acts as the refrigerant pump and recompresses the gas to a liquid. The condenser expels the heat absorbed (along with the heat produced during compression) into the ambient environment. Compressor-based refrigeration is effective for large heat loads (300 W or more) and can cool components far below ambient temperature. The technique also allows users to control temperature. These refrigerators must be used in their designed orientation, which limits installation flexibility. Maintenance and reliability are also compromised by moving parts. Compressor-based systems also tend to be bulky and noisy.

THERMOELECTRIC COOLERS

Thermoelectric coolers (TECs) are solid-state heat pumps made from semiconductor materials. They have no moving parts but comprise a series of p-type and n-type semiconductor pairs or junctions sandwiched between ceramic plates. Heat is absorbed by electrons at the cold junction as they pass from a low energy level in a p-type element to a higher energy level in an n-type element. At the hot junction, energy is expelled to a heat sink as the electrons move from the high-energy n-type element to a low-energy p-type element. A dc power supply provides the energy to move the electrons through the system. A typical TEC will contain up to 127 junctions and can pump as much as 120 W of heat. The amount of heat pumped is proportional to the amount of current flowing through the TEC; therefore, tight temperature control (<0.01°C) is possible. By reversing the current, TECs can function as heaters, which can be useful in controlling an object in changing ambient environments or in cycling at different temperatures. Sizes range from 2 to 62 mm, and multiple TECs can be used for greater cooling. Because of the relatively large amount of heat being pumped over a small area, TECs require a heat sink to dissipate the heat into the ambient environment. The modular units can be used in any orientation and are compatible with heat sinks, cold plates, and heat pipes. On the down side, TECs require a dc power source and are more expensive than passive components.

THERMAL COMPOUNDS

When mounting a cooling device to a component or assembling a cooling system, designers must select a thermal bonding material that will allow heat to flow out of the device with minimal resistance. Designers should take into account mechanical stresses at the interfaces caused by differing material coefficients of thermal expansion. The idea is to eliminate any air pockets between the two surfaces.

The most common interface material is thermal grease, typically made from zinc oxide in a silicon or petroleum base. There are also pastes available with thermal conductors such as aluminum oxide and aluminum nitride. Pads and foils are less messy to apply and can be cut to match the component footprint. Some pads are available with adhesive surfaces to allow permanent attachment. Aluminum oxide and aluminum nitride are used in thermal pads, as are sheets made from graphite, indium, and aluminum.

Thermal epoxies create rigid, permanent bonds. They are typically supplied as two-part systems comprising a hardener and a resin filled with silver, aluminum, aluminum oxide, or aluminum nitride. Because they are permanent, epoxies should be used only in areas that will not require future disassembly. Rigid bonds can also be achieved using solder. Eutectic and noneutectic formulations are available for use in a wide temperature range. Soldered surfaces offer a good rigid thermal joint and can be disassembled by simply reflowing the solder. As with all rigid joints, the effects of differing thermal expansions should be considered.

CONCLUSION

High-performance electronics, sensitive imaging equipment, and sample-processing systems all require proper thermal control to ensure accuracy and functionality. Design engineers need to identify temperature-sensitive components in order to create an integrated system with parts that are both compatible and economical. They should do this early in the design process; the sooner thermal limitations are identified, the more flexibility the engineer has in choosing from the available options. In the final analysis, retrofitting thermal products is usually not as effective and economical as generating a solid thermal design from day one.

Robert Smythe is vice president of sales and marketing at Melcor Corp. (Trenton, NJ).

Copyright ©1998 Medical Device & Diagnostic Industry

By Dr. Christine Manukyan, founder and CEO of STORRIE Wellness™.

Demand seems to be increasing for wellness at work.

We know that a focus on wellness is good for us—as individuals and as a society—especially when it comes to addressing mental health challenges like burnout, stress and depression. Employers are rightly feeling the need to make changes not just for the health of their workers but also for the health of their businesses.

After all, mental health is a pressing issue. Taking a proactive approach to mental and emotional wellness could help employees manage stress, burnout and anxiety.

As the founder and CEO of a company that offers breathwork services, I believe breathwork is one great tool to offer for employees looking to Excellerate their well-being.

Defining Breathwork

You may ask, "But Dr. Christine, don't we all breathe? So I am already doing breathwork, correct?"

Let's not confuse breathing with breathwork. On average, you take roughly 20,000 breaths per day. The primary goal of breathing is to supply oxygen to the body's cells and tissues, supporting various bodily functions. This typically happens subconsciously. On the other hand, breathwork is something you practice consciously and with intention.

Breathwork refers to a range of therapeutic techniques and practices that focus on conscious control and manipulation of breathing patterns. It encompasses a variety of techniques that are designed to cultivate self-awareness and promote physical, mental, emotional, cognitive and spiritual well-being. Some people in corporate America use breathwork to reduce stress and increase focus, retention and productivity.

Breathwork often involves intentional, deep and rhythmic breathing exercises. There are several types of breathwork, including diaphragmatic breathing, pranayama, holotropic breathwork and the Wim Hof method, each with its own specific methods and goals.

Getting Results

When we feel better, we do better... in life and at work. Additionally, supporting your employees during times of stress and overwhelm is a huge win. Employees are more than just corporate workers. They are husbands, wives, partners, mothers and fathers. It's important to support them in all areas of their lives.

Breathwork is believed to have various benefits, such as reducing anxiety, improving focus and concentration, supporting emotional release and enhancing overall well-being. However, it's essential to approach breathwork with awareness and caution, as altering breathing patterns may not be suitable for everyone, especially those with certain medical conditions.

How To Choose A Breathwork Practitioner

Despite what you think you may know about breathwork, starting is simple. But like anything else in life, it is a practice and is best practiced consistently for optimal results.

Working with an experienced practitioner is helpful. They will lead you and your employees to the best techniques and guide you through the process.

When choosing a breathwork practitioner for your company's wellness benefit, it's essential to consider several factors:

1. Qualifications and training: Look for a breathwork practitioner who has received formal training and certification in breathwork techniques from a reputable organization or school. Ask about their background and experience in the field.

2. Experience and reputation: Seek out practitioners with a proven track record and positive reputation. Read reviews and testimonials from previous clients to get a sense of their effectiveness and professionalism.

3. Safety measures: A responsible breathwork practitioner will prioritize safety during sessions. They should thoroughly explain the techniques, potential risks and guidelines for participants.

4. Ethical practices: Choose a practitioner who adheres to ethical standards and respects the privacy and confidentiality of their clients.

5. Client-centered approach: Look for a practitioner who tailors their breathwork sessions to the individual needs and goals of each client. They should be compassionate, empathetic and able to address specific concerns or challenges your employees may have.

6. Communication and listening skills: A skilled breathwork practitioner should actively listen to employees' needs, concerns and feedback. They should be open to answering questions and providing support as needed.

7. Integration support: A good practitioner should offer support and guidance for integrating the experiences and insights gained during breathwork sessions into employees' daily lives. This may involve post-session discussions or suggested practices for self-reflection.

Empowering And Encouraging Employees To Participate

Introducing breathwork as part of an employee wellness program can be a valuable option to support your workforce. To empower and encourage employees to participate in breathwork, consider the following steps:

1. Educate employees about breathwork: Begin by raising awareness about breathwork and its potential benefits. Use emails, posters and workshops to share knowledge about breathwork.

2. Offer workshops and training sessions: Organize introductory workshops or training sessions led by qualified breathwork practitioners. Make these workshops interactive and engaging to generate interest and enthusiasm.

3. Demonstrate leadership support: Leadership support plays a crucial role in promoting wellness initiatives. If managers and executives actively participate in breathwork sessions, they send a strong message to employees.

4. Create a welcoming environment: Ensure that the workplace is conducive to breathwork sessions. Designate a quiet and comfortable area for employees to practice breathwork or meditation. Encourage employees to take short breaks during the day for a few minutes of breathwork to recharge and refocus.

5. Flexible scheduling: Be mindful of employees' workloads and commitments, and offer flexible scheduling options for breathwork sessions. Consider organizing sessions during lunch breaks or before/after work hours to accommodate different schedules.

6. Incorporate breathwork in wellness challenges: Integrate breathwork into wellness challenges or programs that encourage employees to participate actively. For example, you could create a "mindfulness month" with weekly breathwork exercises or challenges.

7. Provide resources and apps: Offer resources, such as guided breathwork exercises (live or virtual) with breathwork practitioners or mindfulness apps, to support employees in their practice outside of formal sessions. Point them toward reputable apps or online platforms.

By following these steps, you can foster a culture of well-being and make breathwork an integral part of your employee wellness program. Remember that wellness initiatives tend to be most effective when they are holistic, inclusive and supported by leadership and the organization as a whole.

The information provided here is not intended as medical advice, diagnosis or treatment. You should consult with a qualified healthcare provider for advice concerning your specific situation.

By Bobby Wong, Renesas Electronics America

The advent of electronics has transformed medical devices to become smarter and more convenient to our daily lives. But accurate headlines of hacking point out a consternation of electronics. Medical device designers need to understand new tools and design techniques that can prevent hacking and illicit modification.

The issue of hacking and illicit modification is multi-faceted. Is the software protected inside a microcontroller? How can access to a chip be eliminated to prevent hacking? Is there a way to detect code modification? These are chip-level concerns. There are also system-level issues such as how to enforce an expiration date and how to authenticate genuine equipment. We will discuss several microcontroller features and modern design techniques that address these concerns.

Figure 1: Renesas Electronics, the #1 microcontroller provider worldwide, offers various microcontrollers with features that protect software integrity and prevent hacking.

Most modern microcontrollers utilize Flash memory to store software programs. To protect the software, designers must consider preventing unauthorized reading and modification of the software stored in the Flash. Unauthorized reading could potentially happen in two situations: during development and manufacturing and in the field. During development and manufacturing, designers should utilize an authenticated debugging capability, such as that supported in Renesas microcontrollers, to restrict access of software in the Flash through the debug interface. Developers and testers are required to enter a key for authentication before a debug session is allowed. The authentication is performed inside the microcontrollers. After the software is fully tested and the system is ready for deployment to the field, the debug interface must be disabled to eliminate further access. This can be accomplished by setting certain special registers inside the Renesas microcontrollers. At this time, designers also should review the microcontrollers’ Flash protection to prevent any modification of the software.

Microcontrollers have different levels of Flash protection. To essentially lock in the code, designers should look for the Erase Protection capability; after setting, the content in the Flash cannot be erased and cannot be re-programmed. In addition to authenticated debug capability and Flash protection, designers should also consider including an integrity check on the software before execution. The integrity test detects any abnormal change of code. Designers can use an on-chip CRC hardware to compute and compare a checksum during system start-up and before operation. If an unexpected modification is detected, the system can shut itself down and display a message that asks the equipment to be returned for further analysis.

Figure 2: Renesas Electronics offers BoardID and several other secure solutions that enable system-level needs such as authentication of genuine equipment and secure enforcement of expiration dates.

Beyond the chip-level protection, designers need to pay attention to other system-level issues. Many medical systems enforce an expiration date. For instance, some medical equipment may function properly and accurately for a limited number of hours. Typically, the sub-systems that have an expiration date are disposable. That means the accumulative hour is stored in the disposable sub-system, away from the main system. A typical design choice would be to use an EEPROM to store the accumulative hour. Although this solution sounds adequate, one could overlook the possibility that the disposed sub-system may be illicitly refurbished. A used EEPROM can be easily replaced by a new EEPROM. With a complex supply chain in the medical market, these illicitly refurbished components could show up in the market. A modern method to securely store the data is by using a secure MCU, similar to Renesas’ Board ID solution. The secure MCU is tamper-proof to physical attack. The data stored inside is encrypted. And the communication between the secure MCU and the application MCU requires public key/private key authentication; thus, preventing eaves-dropping. In addition to enforcing an expiration date, a secure MCU can also be used to authenticate genuine equipment. Authentication of genuine equipment has a financial impact to a company of which the disposable sub-systems generate a significant amount of revenue.

We have examined several layers of security, from software protection, to detection of modification and authentication of genuine systems. Designers need to utilize these techniques when designing safe and modern medical systems.

About the author

Bobby Wong is Medical Segment Marketing Manager at Renesas Electronics America. He has over 15 years of experience in embedded system/ASIC design. In his early career, he conducted architecture research at Intel and developed ASICs at several start-ups. Wong holds a BS EECS from UC Berkeley and a MSEE degree from Stanford University.

Expert advice on nutrition delivered to patients electronically saved physicians time, improved patient satisfaction, and was reimbursable by insurance, UT Southwestern Medical Center researchers report. The findings, published in Nutrients, showcase a new model developed at UT Southwestern to feed the growing interest among patients in learning how food can affect their health.

"Diet is the top risk factor for early death in the U.S., and the cost of diet-related diseases here is in the billions of dollars. Most patients are not getting the support they need to Excellerate their diets in the typical clinical model," said study leader Jaclyn Albin, M.D., Associate Professor of Internal Medicine and Pediatrics at UT Southwestern and a certified culinary medicine specialist.

"We have developed a feasible, scalable, well-received, and low-resource way to bring culinary nutrition advice to patients and build culinary medicine as a reimbursable service line."

Over the past decade, patients have increasingly sought advice on changes in diet to Excellerate outcomes for health conditions such as high cholesterol, diabetes, arthritis, and food allergies, Dr. Albin explained. There is also a desire for information about how to eat healthfully on a budget. Physicians typically don't have the time to answer these questions during a standard clinic visit, and most have no formal training in nutrition.

Sending these patients to a registered dietitian is important and should be utilized when available, but this process is often impractical due to accessibility of appointments and unreliable reimbursement by health insurers. In addition, Dr. Albin said, some patients' questions don't necessitate a full-length appointment.

Seeking a new way to get information to patients, Dr. Albin teamed up with UTSW registered dietitian Milette Siler to apply an established electronic consultation service, eConsults, to a new specialty—culinary medicine. Culinary medicine combines the expertise of physicians, registered dietitians, and chefs to help patients Excellerate their personal nutrition and ease health problems through delicious foods.

Culinary medicine takes many forms, Dr. Albin said, ranging from sharing recipes and cooking techniques during standard patient care encounters to hosting group cooking classes that can be billed as shared medical appointments.

The cornerstone of this new eConsult service is the partnership between two specialists certified in culinary medicine: Dr. Albin and Ms. Siler. The pair consulted with UTSW's institutional billing team and administrative leaders to design a request system for eConsults through the electronic health record.

When primary care physicians or other health care professionals at UTSW file a request for eConsults, the physician-registered dietitian team develops a personalized, lay language, single-page summary of the patient's health background and goals, personalized dietary recommendations, recipe suggestions, and tips for local resources to promote nourishing food access. The requesting physician then sends the eConsult report to the patient through the health portal.

During a pilot phase from Aug. 1, 2021, to July 31, 2022, the team recruited 11 primary care physicians to use the service. Dr. Albin and Ms. Siler delivered 25 eConsults—at least one per month and as many as four in a single month.

The primary care physicians who utilized this service reported in a qualitative survey that eConsults allowed them to provide necessary nutrition information to patients with a variety of health conditions, including diabetes, fatty liver disease, irritable bowel syndrome, eczema, rosacea, physical disabilities, and severe dietary allergies. The eConsults saved them time in patient encounters, the physicians said, and the feedback they received suggested that patients appreciated the expertise. The majority of these eConsults were covered by insurance.

One patient, a woman in her 60s, needed extra calcium in her diet to manage osteopenia, a bone-weakening condition that is often a precursor to osteoporosis. The eConsult service promptly delivered suggestions for adding high calcium foods to her diet, tips on avoiding side effects from calcium supplements, and other ways to Excellerate bone health, such as exercise, said her physician Bethany Agusala, M.D., Assistant Professor of Internal Medicine and Medical Director of the William T. and Gay F. Solomon General Internal Medicine Clinic.

"Dr. Albin and Ms. Siler were able to distill their expertise into an easy-to-read recommendation for my patient. It's a really helpful thing," Dr. Agusala said.

The culinary medicine eConsult service is offered for all UTSW patients through the request of their primary care or specialist physicians or advanced practice providers. The Culinary Medicine Program at UTSW also accepts appointments for in-person physician-dietitian consults at UT Southwestern Medical Center at RedBird and will soon offer group cooking classes at community kitchens.