A Physician-Chef Promotes Health Through Food in His Business

Christine Lehmann

January 06, 2023

Robert Graham, MD, MPH, a board-certified physician in integrative medicine and internal medicine, is also trained as a chef. He's part of the growing culinary medicine movement that blends the art of food and cooking with the science of medicine.

For years, Graham, who eats mainly vegetarian, has been trying to convince doctors, hospital administrators, and even insurance companies that nutritious food can prevent and control chronic conditions like diabetes.

He started the first plant-based cooking class for medical residents when he worked at Lenox Hill Hospital in New York City in 2010. The class became so popular that it soon attracted nurses, hospital chefs, and administrators and continued for 7 years.

Graham also made food a priority in his integrative medicine practice, FRESH Medicine, that he started with his wife Julie in 2016.

Medscape recently talked with Graham about his career and how he uses his culinary training to promote health.

Medscape: What led you to pursue training as a chef?

Dr Robert Graham

Graham: Looking back at my career, I really valued lifestyle as medicine, but food as medicine was the missing ingredient in my ability to manage chronic conditions. I was truly inspired by a quote from farmer, activist, and writer Wendell Berry, who said, "People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food."

Medscape: You trained as a chef at the Natural Gourmet Institute in New York City. Why did you choose that school?

Graham: I am a vegetarian who eats a little animal protein when I am out. I chose NGI because of its emphasis on plant-based sustainable cooking, which aligns with my philosophy and the direction I wanted to go in as a chef rather than the traditional French culinary methods.

Medscape: What was the most important thing that you learned?

Graham: That food has to taste good! I learned that you can make even vegetables taste delicious. What separates the cook from the chef is that we learn how to select the freshest, most delicious fruits, vegetables, and animal proteins; the best ways to prepare and cook them; and the most beautiful way to present them.

Medscape: How have you used your chef/culinary medicine training?

Graham: I consult with food companies and recently became the chief health officer of Performance Kitchen, where I act as an advisor and design medically tailored meals for patients with chronic diseases. The research shows that patients who ate medically tailored meals had fewer hospital and skilled nursing admissions and overall medical spending.

To be financially sustainable, we need to partner with healthcare institutions — I am in discussion with a few of them — and health insurers. Last year, Anthem Florida (Blue Cross Blue Shield) provided Performance Kitchen meals to over 100,000 plan participants through its Chronic Meal Benefit for over 100 diagnosis codes including kidney disease and type 2 diabetes. Other health plans are conducting pilot projects using our meals.

Some Medicare Advantage plans cover medically tailored meals but not Medicare. Rep. James McGovern (D-MA) introduced a bill in Congress last year that would require the Centers for Medicare & Medicaid Services to conduct a demonstration program so hospitals can provide medically tailored, home-delivered meals to Medicare beneficiaries with chronic diseases and daily living limitations. The bill hasn't passed the House yet.

Medscape: Are you teaching practicing physicians how to cook healthy, delicious meals? 

Yes, lifestyle medicine physician Rani Polak, MD, and I taught the first class in culinary medicine at the 2015 American College of Lifestyle Medicine Conference in Nashville. I have since taught more culinary classes at conferences by ACLM, the American College of Preventive Medicine, and the Society of General Internal Medicine.

Medscape: Your practice is called FRESH Medicine. What does the acronym FRESH stand for?

Graham: FRESH stands for the five ingredients in our recipe to health: Food, Relaxation, Exercise, Sleep and Happiness. We put food first because we know from the research that food plays an important role in the gut microbiome and the expression of diseases.

The acronym FRESH was also personally symbolic because I needed a fresh start in my career. After working for a large health institution, in 2016, I decided to start something new where I could take my time to listen and honor the bond between me and my patients.

Medscape: You also created a new company FRESH Med U with your wife. Can you describe the online program and who uses it?

We created an e-learning portal that anyone can access on their own time. There is a free 6-part FRESH Guide and FRESH course bundles.

The course is popular among companies that are looking for portable and virtual wellness 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 we could never get them together in one conference room for a "lunch and learn."

Medscape: What's your business model for FRESH Medicine and

Graham: We continue to explore hybrid forms of payment. Our first corporate client for FRESH Med U was the CEO of PSK Supermarkets, who hired me as their health and wellness consultant and paid us a retainer for providing wellness services and FRESH Med U. The wellness services included hosting monthly in person classes on nutrition, meditation, chair yoga, sleep hygiene 101, and seminars on happiness.

In addition, employees could see me in my private practice and the CEO paid for 70% of their expenses because I was an out-of-network provider. We also offer a sliding fee scale to employees who wanted to continue seeing us after the contract ended. We are negotiating a renewal of wellness services for PSK.

We also plan to hire a family medicine nurse practitioner to work for us who will increase our access to primary care patients. That will open up another opportunity to integrate with conventional reimbursement models who accept full insurance for primary care services.

Medscape: You've been self-employed since 2016. Was that transition challenging and how do you feel now?

Graham: In the beginning, it was difficult navigating this new world and learning the business side: the branding, marketing, social media platforms, and the hiring and firing of employees.

I can say now that it's been rewarding emotionally, spiritually, and financially. I have more autonomy and time to innovate; I make more money and work less, and when I work, I spend time with the person I love — that's the holy trinity of success.

Medscape: Are you helping low-income communities to eat healthier?

Graham: Yes, I am a paid medical wellness consultant to a local senior community center in the Bronx. During the pandemic, I presented a 6-month virtual course on food for health, eating for longevity, blue zones 101, eating for gut health, eating for depression, how to relax as you age, and happiness as medicine.

I personally support two local nonprofits in highly disadvantaged neighborhoods that are 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, Psychiatric News, and The Washington Post. Contact Christine at clehmann@medscape or via Twitter @writing_health

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