Beyond Nutrition: Embracing Food as Medicine, Identity, and Power with Dr. Kofi Essel

What if the intersection of food, culture, and community holds the key to solving some of the more pressing health challenges facing youth?

In this conversation we dive into how nutrition is more than science, it’s personal. We explore how food traditions can both nourish and shed light on barriers, how systems of inequality influence what ends up on the plate, and why improving youth health starts with understanding the full context behind every meal.

Together, we unpack why 'Food as Medicine' is about more than nutrients or advice, it’s about working alongside communities to create access, empowerment, and honoring the lived experiences of families.

Transcript

C.J. Stermer (00:00)
Hi, Kofi, thank you so much for joining me today.

Kofi Essel (00:02)
Of course, course it's a pleasure to be here. Really excited to have this conversation with you.

C.J. Stermer (00:06)
Likewise, likewise. So, Kofi, you're an MD, you have a master's in public health, you've been working in this field for a long time and lots of knowledge in terms of nutrition and food insecurity. what inspired you to go in this route

Kofi Essel (00:20)
Yeah, I always start with my childhood. I hate to go back too far, but ⁓ my grandmother was the sort of matriarch of food as medicine for me. What does that mean? So I saw how my grandmother used food to bring our family together, how she used food to bring joy on our faces, how she used food to heal our bodies. She was an amazing chef and cook and just sort of leader in

C.J. Stermer (00:25)
You

Kofi Essel (00:45)
our family and that's always been of interest to me and how she led that and did that. And over the years, food has just been part of who I am. Like many of us can say, it's been part of our identity to some degree. I think later on when I got into college, I actually started to get some extra training in the area of food and nutrition. I studied anthropology, human anthropology, biology, studied cultures and how people were eating all around the world. And I also became a peer educator

And I started to talk a lot about food and nutrition with my colleagues and friends and and I realized I'm really passionate about this. I'm really excited about this work the funny thing I always say is I ended up deciding to go to medical school and I Thought that you know all this passion and interest that I had in this arena I would have to put away because doctors they don't engage the topic of food and nutrition That's not what a doctor does so I kind of hit it to the side didn't mention anything about it

and I remember planning for my first summer of medical school. This summer where people say, you gotta pick the right thing to do. If you don't, the rest of your career is gonna fall apart. So there's all this pressure of picking the right thing to do, and I'm like, I go into orthopedics? Do I go into some kind of allergy medicine? All kinds of stuff I was interested in. And I remember talking to one of the leaders and they said, what do you wanna do? And I said, you know.

kind of have this interest in food and nutrition, but doctors don't really engage the topic of food and nutrition, right? She said, I don't know. I said, I don't know either. So we went on a formal primary resource page, and the resource was called Google, and we Googled an opportunity, and we came across this amazing fellowship through the American Society of Nutrition. It was a clinical nutrition internship program. I was selected for the program and got to pick one of 60 different mentors who were

MDs or PhDs around the country who are doing work in this space. And I got to work with a great mentor of mine in Connecticut and it was fantastic from there. I knew that I can create a career in this space. I knew that this could be something that would have to be different than the traditional pattern, but I knew it had a role to play in the future of the work that I did with patients and families. And so that sort of sparked me to move this work into an overlay

into the work I do in medicine now.

C.J. Stermer (03:03)
Food is identity. I relate to that, especially as someone who likes to eat. I name a better inspiration than mom's in the kitchen. I relate to that, too. Something that you said that sparked in my mind is is there's all kinds of intersectionality when it comes to health and food.

It's not just, we have to be nutritious and eat right for health reasons. But what does that actually mean? And I think the term that I hear sometimes is food as medicine. Right. And I'm not sure that we always know what that means

Talk to me a little bit about that. what exactly does food as medicine mean when it comes to young people and eating right?

Kofi Essel (03:40)
Yeah, great, great, great question. So the terminology food is medicine is really interesting because a lot of times the conversation is really talking about adults. And I think, you know, as a community pediatrician myself, I always like to bring things back to families and children, recognizing that we cannot give up on the next generation because if we give up on the next generation, we're going to see these cycles continue over and over again.

To be able to address this issue that we're seeing across the country, these rising rates of diet-related chronic conditions, to be able to address them more effectively, we got to start younger. We can't just think about them when individuals get older. So food is medicine, some terminology. One of the definitions that I tend to use is that these are like interventions or programs or approaches that work with health care that are focused on providing high-quality nutrition education and high-quality food.

focus primarily on three things, prevention, management, and treatment of disease. So with Food is Medicine, we're thinking about how we can create programs with healthcare, so in conjunction with healthcare, to prevent, to manage, treat disease. And so that's one of the ways to think about Food is Medicine. And I think that, you know, it's short-sighted if you think about food.

only as medicine. I think that that's not the goal of the terminology. So you'll hear other people saying other phrases like food is medicine, food as medicine. You'll see food is or as health as well. So I like food as medicine because it indicates that there's a lot of other roles that food can play as well. But needless to say, when I think about the role of food, I think about culture. Again, I studied anthropology. I studied cultures and human beings and looking at

C.J. Stermer (04:56)
Hmm.

Kofi Essel (05:22)
different patterns all around the world. And the interesting thing to me is that we all have different patterns to how we engage food. But food means so much to each and every one of us, no matter our culture or our subculture. It means so much to us. And we cannot separate the experience of food with the experience of our day-to-day lived experience. And I think that's an important piece to kind of keep in mind. So when I think about the role of food, I think about food being a deeply personal experience.

I think about food playing a role in, for many of us, as a tool of joy and happiness in social settings and bringing us together. But I also think about food, for many of us, being used as a tool of punishment. And unfortunately, right, being used as a tool to reprimand us and to make us feel that we're lesser than we are. And stripping away foods from cultures that actually, again, it's part of our identity.

⁓

So I think that food plays a big role. There's a questionnaire that sometimes I talk about the meaning of food and life questionnaire This is a study that was done looking at a number of different people around the country and it said hey What does food mean to you and people said what food meant to them and there's many different domains that came up Food was very moral to some people. It was a right or wrong thing for some people food is aesthetic It's about how it looks I know many of my young people who may be even listen to this today or parents who may be listening to

this. You know that some kids don't want their food to touch. They don't want their food anywhere in the vicinity of another food item. And that's part of the experience of eating with especially young people. Even as young people become older people, that's sometimes that deeply held belief and experience. And there's nothing wrong with that. We all have our own sort of quirks in our engagement with food in different ways. And I think that's an important thing to understand. For many of us, food is very sacred. It's a spiritual experience. many of us, food is a

C.J. Stermer (06:48)
Right.

Kofi Essel (07:12)
social experiences I mentioned, and for many of us food is health, right? And so I think it's important as when we talk about food as medicine to realize the multiple domains that we need to understand that food can play and not separate them and also recognize that we're talking about food.

We're talking about food, right? It's easy to hit you over the head saying you need more vitamin D and calcium and protein and macros and micros get your omega-6s, your polyphenols. I can talk about that all day, but when we're talking about this in a way that resonates with people across the board, we need to talk about food more than we talk about nutrients. And I think that that's a big piece with food as medicine as well.

C.J. Stermer (07:39)
Hmm.

That is fascinating. There's a couple of things that you said that really gave me some aha moments I want to back up and sort of ask a question because I also don't think that

A lot of folks will necessarily think of like food to combat even maybe even preventative when it comes to chronic illnesses. Are we seeing a rise in chronic illnesses in kids and young people?

Kofi Essel (08:07)
So great question. The answer to that is yes. ⁓

There's a reason for that, right? There was a recent CDC statistic that came out a few months ago that highlighted one in three teens now have been diagnosed with prediabetes, or have prediabetes rather. One in three teens have prediabetes. Now, when you look at adult statistics, it's quite interesting. There was another statistic, I think it came out in April, highlighting some 2023 data and showing near 76%.

C.J. Stermer (08:26)
Wow.

Kofi Essel (08:40)
of US adults have at least one or more chronic conditions.

Now that's all adults. That's all adults, right? So when you look at the younger adult population, you're looking at around 60%. When you go to the older age, above 65, I believe that number was 93%. So we see 93 % have at least one or more chronic conditions. Now again, the numbers over time, we see as people age, it does appear that the default of life is that people are gonna get these conditions, one in two adults.

C.J. Stermer (08:45)
That's a big number.

93 %?

Kofi Essel (09:14)
have hypertension. One in two adults have pre-diabetes or diabetes. So when we talk about these things, we gotta realize there's a root to these things. They don't just come out of nowhere. They start earlier on and they continue to build over time and they get worse and worse and worse. So I think one of the things we have to think about is what are some of these root causes? What are some of these reasons and the root causes that are triggering these conditions? And again, we sometimes say children

and are resilient, which they are to some degree. But I don't think we can treat these early years as forgotten years. I think we should be serious, be intentional about how we as a country and as systems and as programs and as health care and all the other industries are working with and caring for and valuing the children that are in this country.

C.J. Stermer (10:02)
Right. So to that point, it's not just like a doctor issue where we're talking about nutrition and kids you got to eat right. what you said earlier. And it gets to this cultural level and we need to back it up in time, swim upstream to get to the root cause of what that actually means and why it's starting to correlate at a younger age with chronic illnesses and then sticking with them because it becomes behavioral and cultural. Right.

So when we swim upstream and you talked about food education, do you think that's one of the big tools to help identify sort of a solution to what that might look like preemptively at an early age, is education one of the things that we should be looking at?

Kofi Essel (10:42)
Great question. So I'll say two things. So one, let me respond to your comment about doctors. I think doctors, oftentimes we get a bad rap like, you all should be doing more and talking about food and nutrition and you should be getting more education and medical training and this and that. And I think it's important and I'm a big proponent of more nutrition education and medical training. We only have a short period of time with patients and families. Let's just highlight that. There's a short period of time. There's a thousand things that we're doing. As a pediatrician, I always say this, like as a pediatrician, there's so many things

C.J. Stermer (11:03)
Right. That's a good point.

Kofi Essel (11:11)
that are being added to our plates, right? So I started doing fluoride treatments in the dental and in the clinics as well, because, so I'm a dentist now, right? I do, you know, I sometimes serve as a social worker and a community health worker. I sometimes serve as a psychologist. we are doing a lot of things in that short period of time. And it's hard, especially in the community setting. It is hard, especially with less resources and clinical practices. So yes, it's valuable if I can add a few positive comments and help families go in the right direction.

C.J. Stermer (11:18)
interesting.

Kofi Essel (11:40)
But to really take advantage of the concept of food as medicine, to really take advantage of using food as a powerful, transformative tool, it has to be in conjunction with and not alone. It cannot just be providers just doing this. We don't have time for that. So I think that that's a key thing to keep in mind. The other thing that I will highlight is I think that you mentioned education. I think education is key. But I also don't like to...

have this false pretense to believe that education by itself is the great solvent of all of our troubles that we see today. I think education is important, but I think there are so many other factors that influence behavior.

C.J. Stermer (12:14)
Right, right, interesting.

Kofi Essel (12:20)
outside of what you know. Knowledge by itself does not change behavior. You have to have a combination of efforts to help families move in that right direction. I say the word families because I don't think the whole effort is on the child. And I also wouldn't directly say it's all on the parent either. I say there are systems at play that influence our behavior, right? So like, if, you know, I talk a lot about this concept of food insecurity.

for example, CJ, and you've heard me talk about it a little bit, but just to highlight it for the audience, food insecurity, oftentimes people describe as hunger. But food insecurity is when all members in a household don't have consistent access to enough food to live an active and healthy lifestyle. Food insecurity can often turn into hunger, but by itself, it's this constant perseveration, it's constant, it's a preoccupation with where one's next meal's gonna come from. I'm worried, I'm constantly worried about this, right?

C.J. Stermer (12:56)
Hmm.

Kofi Essel (13:16)
The

thing about food insecurity is that it's quite prevalent in children, in households with children. So you see about one in six households with children experience food insecurity. These rates are quite high. When households experience food insecurity, there's a lot of things that occur in that household. For example, families or especially adults become perseverative over their next meal. Those things happen, yes, and adults try to protect their children at all costs. But at end of the day, what will tend to happen is that families will start to cope with this

C.J. Stermer (13:27)
That's high.

Kofi Essel (13:44)
a worsening access to food for their household and they'll start to purchase foods that are higher in caloric density, lower in nutritional value, foods that are less diverse and more simplified, foods that they know that when they purchase a child is gonna eat and they're gonna eat. And so it really shrinks that palette and they end up leaning towards a lot of ultra processed foods as well, especially in the United States because these foods are super accessible. They're highly palatable. They're designed to be incredibly tasty.

and enjoyable. They're colorful. They invite you in and they're convenient and you get these foods and you eat them and you're like, oh, I want more of those. Right? So you see this pattern of consuming these foods, but a lot of it is because these are foods that are available, they're accessible, they're convenient, they're incredibly designed to be tasty.

And it's like, why wouldn't I consume those foods? When the body's under increased stress, the body will gravitate towards foods that are higher in caloric density, higher in fat, higher in salt, higher in sugar. These foods just happen to be designed to be that way. So you're dealing with families under a ton of stress, whether food insecurity or not, right? There's also other stresses that other families face who may not be experiencing food insecurity, right? Families face stress. And it's like, yeah, why would I waste time in preparing this meal when I could get these other items that can save me time, maybe a

C.J. Stermer (14:37)
Hmm.

Kofi Essel (14:58)
me to spend more time with my family. Maybe allow me to spend more quality time with my family. You all saying, I need to spend more time with my family. I'm trying to do that, right? This is how I get to do that. But just so happens that these same foods that allow us to save time now can really hurt us in the long run, right? Are associated with more negative health consequences in the long run. And that's something that I think it's important to keep in mind as well. So I think food education is a part of it, yes. But it cannot be considered all of it. I think we have to

C.J. Stermer (15:06)
Right.

Okay.

Kofi Essel (15:27)
think

about environment, the way we price things, we have to think about things like, you know, I mean...

There's a reason that certain foods cost more than others. And it goes to our subsidies, our agricultural subsidies, and these kind of things as well. So we have to think about these from multiple different tiers. Not taking all the hope away from people on the ground, because there's hope there that we can instill and say, hey, you can make better decisions. This is how you do it. This is how you can take over your taste buds. X, Y, and Z, key. But also, we have to realize that is going to be part of the component with a systematic change as well.

C.J. Stermer (16:01)
Fascinating. So many correlations and just this plethora of intersectionality when comes to food that I honestly have never even thought of before. So it's really interesting to see yes, education is important, but it's such just a small variable of such a larger equation. How do we start solving for that? How are some ways that you've started to proactively approach these problems?

Kofi Essel (16:23)
So I get a chance and the opportunity to work with families who are

oftentimes experiencing significant marginalization. They're experiencing significant burden on their finances, on their homes, on their environment. that's true about my families that I work with, but at the same time, these families are incredibly resilient, incredibly gifted and talented, and they also are able to navigate scenarios that most would never be able to

navigate. And so one of the things that I think is key in working with the families that I work with from a healthcare perspective is yeah like I get a chance to you know as a pediatrician I talked to families about you know starting early right so we know that in the womb

a child or the fetus is starting to taste and smell and really be able to appreciate flavors at the second and third trimester. And it's starting to really adapt their palate earlier on, right? After the child is born, the child, if the parent chooses to breastfeed or if they do formula feeding, there's different flavors that they're getting exposed to at that time as well. And then also with early infant feeding, right? So like when you think about like around the age of 16,

C.J. Stermer (17:17)
I didn't know that.

Kofi Essel (17:38)
months when you start to introduce different foods, there is a desire to potentially consume foods that the child smiles with. We all have a predisposition to enjoy foods that are high in sugar and high in salt and have more of an umami-like flavor. If you give that child that sweet juice or that sweet treat and they smile and it gives you a sense of joy, then I'm going to give more of that because I'm a good parent.

more of that. But at the of the day, that's where some education can come in, in addition to some tools. Now, what are some of the tools that we can provide? I think some of the tools that we can provide from the health care perspective oftentimes fits into that arena of food as medicine. For example, one of the initiatives that I helped to start at Children's National Hospital

C.J. Stermer (18:06)
All

Kofi Essel (18:24)
was a food as medicine program working with a number of different organizations. So I worked with a food hub called 4P Foods, which is phenomenal organization. And I worked with some local community organizations, the YMCA, the American Heart Association. And we all kind of came together and designed this intervention and this program for families, working with local farmers and providing fresh produce for families who are experiencing food hardship, food insecurity, and other diet-related chronic conditions. And we were able to provide that food to their doorsteps

and they were able to then start to tweak their palates. What do I mean by that? Well, I talked about earlier, when families experience food insecurity, oftentimes they'll start to reduce the variety of foods they're consuming, right? Because they don't want to waste food, they want to get foods that they know they're going to consume. Oftentimes, their cognitive bandwidth, their ability to shift and focus on many things becomes hindered because of the toxic and palpable stress

food insecurity of financial challenges and the many other challenges that go along with that. So they have these challenges, it increases stress and families are trying to figure out how to navigate around it. But what tends to happen is again, they decrease the variety of the foods that they're eating. So that means less fruits and vegetables as well, right? Because fruits and veggies, sometimes they just don't last. You know, and we all have tricks and you can say you can put this in the refrigerator or wrap the top of the banana with some plastic or whatever it is. Great, you get an extra day or two, but when it comes down

C.J. Stermer (19:35)
Right.

Right.

Kofi Essel (19:43)
to those cookies at that store, that frozen product, compared to that banana that gives me another two days, it doesn't compare, right? So I have to think about that for myself and my family, and that's a key thing. So one of the things we did was a produce prescription initiative. This simply is providing fresh produce. Produce prescription can be fresh, frozen, or canned, but we provided fresh produce from local farms, supporting local economies, supporting local communities as well, to our families, and families were just loving this.

experience right because they were getting fresh beautiful produce delivered to their home and they were like ooh I love these things I don't know if I love these things or not but guess what I can try them now without the risk and the threat of not

If I don't like it, then I've wasted money. So they were able to try them and then adapt them into their food habits. So they were adding them to their different dishes and learning how to really consume them in different ways that they can enjoy. And we provided cooking classes with it and everything. And families felt great. They felt activated to be able to incorporate these different things and describe these improvements in their health. And that was powerful. Not only that,

at the end of the program families were describing, hey,

I now consume a variety of different foods that I wasn't consuming before. And guess what? I'm also purchasing different foods as well because now when my child, little Kofi, tugs on my pant leg and they say, want that over there, I can now say, you know what? I'm gonna get it because I'm not wasting money. I know how to consume it. I know how to prepare it. And I know this child and myself and other people in the home are gonna consume it as well. So why not? We're not wasting money anymore.

So now we're expanding our palette. We're now getting back to the point of improving our food security and our home in that kind of way and improving what we would describe as our nutrition security and getting better quality of food as well.

And that in itself, it liberated them. And that is incredibly powerful to hear, that they felt liberated. They felt that before they were

locked in to this experience of having to eat certain types of foods because that's all they thought their children would eat. I mean, you think about this concept of kids' meals. What is a kids' meal? I'm grateful and blessed to be in my family. We didn't have much money growing up.

what we did have was that 50 pound bag of rice on the side. We did have, you know, my grandmother was there. She was preparing foods, you know, whatever we had, she was preparing. you know, whether it was the can of spam, some corned beef, whatever it was, we were eating foods that were being prepared in the home. And it allowed me to be frustrated that I wasn't getting access to some of the kids' meals that some of my colleagues were getting in the classroom. Like I would see these,

little packets where they had little pockets of different, they had some crackers and some meats and some this and some that. I was like, I want that mama, I want that. And my mom would say, you're not getting that, we don't, we can't afford that. little did I know that that was protecting me. But at the time it was like, the experience is, look at the commercials, look at the joy people have, I want that experience. And so it's so powerful to be

able to take control back and say, hey, we're going to prepare foods for our families so our families can thrive Not only nutritionally thrive, but emotionally thrive, spiritually thrive, physically thrive. All of these ways of thriving is key.

C.J. Stermer (23:02)
Right. Liberation and thriving. I love how you describe that. Yeah. How do we empower the folks that are listening, you know, maybe educators or people just work in a variety of way of public health or health care. how do we empower others to maybe think differently about what they're doing to help try and create solutions to similar issues?

Kofi Essel (23:05)
Yeah, yeah, I love that.

Yeah, thank you for this. I like the word activate.

I like the word activate because I oftentimes believe that a lot of those we work with, the families, the patients, the communities that we work with, they have all the skills, oftentimes activating through the chaos and the murkiness of the complexities of societies. So what we often are doing are activating those skills to come to life so that they can take better control over their health.

And I think that that's key. I think for me, all of this starts with our posture. What is the posture that we're taking into this work that we're doing? And oftentimes if I'm talking to community health workers, I'm talking to different team members that I'm trying, or medical students or faculty or whatever it is that are working with a number of patients and families, I always say,

Hey, let's start with our posture. How do we look at those that we are working alongside? Do we have this top down model?

Do we look at this as working alongside them? Do we look at them as being weak, as lacking, as insecure, as having all these deficits and these gaps? Or do we also, at the same time, be able to hold this concept of they are gifted, they are talented, they do have strengths, They do have an opportunity for hope.

Do we recognize that within them? Because if we don't, we're always going to be having this top-down approach, and we have to really change that posture. So I think that that's first thing for me. Change your posture, how we're looking at working alongside versus fixing people and trying to, you know...

make people to be something that they're not. So I think that that's key. So definitely working alongside families. And then the other thing I would say, sort of on the more practical tip, is just really understanding the complexity of lived experience and recognizing that it's tough. It is tough to navigate, you know.

hard decisions, day-to-day decisions, around food and nutrition, when there so many other complexities at stake. So it's really valuable when we can figure out ways to understand the day-to-day lived experiences of those that we're working with. Sometimes this means doing interviews. Sometimes this means doing a lot of work in the beginning to understand better the communities that you're working with, to understand some of the hardships, the pain points, to be able to navigate through

those things a little bit better. Not bringing one-stop-shop solutions that this is the way I've done it, so this is the way you should do it. That's not going to help, especially when you want to translate this into different settings. So I think making sure that we're adaptable, we're flexible, we're meeting people where they are, and we're working alongside people on a journey towards improved health. Not a microwave, but a journey. Microwave, boop, boop, boop.

You one minute, everything's done. When I talk to you about this, you know, you should be fixed. No, no, no, no, no. Let's not think of it that way. Let's think about this as a journey. took a journey to get to our states of health that we're in now. What does it look like to go alongside this journey to help move us towards improved health? Again, multi-tiered, multi-faceted, one-on-one education, group education, changing systems in the community, working with our local policy offices, making sure that we can do all these different efforts to work

C.J. Stermer (26:04)
Hmm.

Kofi Essel (26:33)
together to improve health outcomes for children and families.

C.J. Stermer (26:37)
Wow, fascinating. You have given me so much to think about and I'm sure the folks listening also recognizing the difference of just all these intersectionalities. I like how you put that it's multi-tiered, multifaceted through the entire journey of this process and working alongside people. Kofi, thank you so much. This has really been eye-opening for me. So I really appreciate your time today and lending us your expertise on how we can think differently about

isn't just medicine, but it's a whole lifestyle.

Kofi Essel (27:04)
Awesome. No, I really appreciate you all having me. This has been a pleasure. If I had to leave you with one final comment, I would just emphasize that food can play a powerful role in improving our health. We cannot sleep on that. We cannot forget that food can play a powerful role in improving our health, preventing, managing, treating disease. But don't lose sight of the role that food plays in our culture, in our personal experiences, in our habits, in our lifestyles.

C.J. Stermer (27:32)
Right, wow. Thanks again, Kofi, I really appreciate it.