Cooking Up Health in the NIH Clinical Center

Nicole Farmer’s Research Model of Focusing on Cooking Is Transforming NIH’s Nutrition Research into Real-World Health Outcomes.

BY JENNIFER HARKER, THE NIH CATALYST

When Nicole Farmer’s patients told her that her nutrition advice was inspiring but tricky to carry out at home, she listened to them.

“They would say, ‘This is great information, but I do not know what I am doing in the kitchen. So, unless I know it will taste good and my family will like it, I am not going to spend the time and money,’” she recounted. That feedback ignited what has become her signature research focus at the NIH Clinical Center: Integrating cooking interventions and behavioral science into a research program and community engaged protocol called DC COOKS.

Healthy eating is full of flavor, not deprivation

Farmer began by holding small cooking classes for patients in her clinic’s break room. With seed funding, those sessions grew into dynamic, interactive medical appointments in which she blended culinary training with preventative medicine. In addition to healthy eating and cooking habits, she spoke with her patients about physical activity and sleep health and their role in obesity and diabetes prevention, as well as about cardiovascular health.

Farmer also dispelled myths about healthy eating. “One of the things that we say in integrative medicine is that health is not the absence of disease; and one of the things I think about in terms of healthy eating is that healthy eating is not the absence of butter,” she said.

Instead, healthy eating is the addition of flavors and colors—such as colorful vegetables—and learning good cooking and shopping methods (PMID: 40554551). Patients come in expecting bland meals, but they are surprised when the food is just as tasty—or even tastier—than their usual home-cooked meals. Farmer said her work helped her patients reset taste preferences and create lasting healthy eating habits.

In 2017, Farmer was recruited back to NIH to formally study how cooking behaviors shape health outcomes and now serves as section chief of the Translational Biobehavioral and Health Promotions Branch at the NIH Clinical Center. Farmer’s introduction to NIH came through a two-year IRTA fellowship at NIDDK in the early 2000s, which set her on her path to Howard University College of Medicine (Washington, D.C.), and then practicing primary care in Gaithersburg, Maryland.

Implementation science

Scientific evidence supports the health benefits of the DASH and Mediterranean diets (PMID: 33113837) and limiting ultra-processed foods (PMID: 40443924). However, as Farmer noted, if people don’t follow those diets, where is the usefulness in preventing chronic disease?

“Implementation science remains underdeveloped. That gap between knowledge and practice is where prevention succeeds or fails,” she explained.

Farmer’s research reframes cooking as not a barrier but as an implementation vehicle. “Through fostering social support, building self-efficacy, and engaging in the behavior of cooking, we actually see improvements in cardiometabolic health,” she said (PMID: 33088581).

Clinical Center collaborations

Farmer almost immediately began to collaborate with the occupational therapy department because cooking is an activity of daily living. Sure enough, cooking groups were being held every Friday.

“I went to observe them because I wanted to get an understanding about how I could start to design group interventions,” Farmer recalled. “What I found fascinating was that the NIMH patients who were coming to the cooking groups were not only engaged in the behavior of cooking, but they also practiced recognizing and responding to social cues, socialization cues, and following intricate recipe directions.

“Their self-regulation to get through the planning phases was similar to what I noticed in my patients in clinic, so I talked to the occupational therapists, and I asked, ‘Is this what you routinely see?’ And they said, ‘Yes, we see this in the kitchen, but it is not present in other settings.’ So, part of the work that I have done for the last four years with OT has been on understanding the psychological and neurological mechanisms, and behavioral activation, that occur with cooking that could explain some case studies that have been put out in the rehabilitation medicine literature,” Farmer said (PMID: 29121776).

For example, case reports show post-stroke patients demonstrate improved cognition through cooking classes, and brain imaging has even revealed cerebellar structural differences between chefs and non-chefs. “All of these pieces are in the literature, but the actual mechanisms are missing. So, we have a protocol pending approval now so that we can start diving into this more,” she added.

Looking forward

Farmer’s research positions cooking not just as a domestic chore but as a bridge between biomedical evidence and daily life.

“NIH has invested millions into nutrition research,” she said. “Exploring cooking as a behavior that can drive implementation of higher quality diets is about making sure that investment pays off. The Clinical Center is unique in its ability to integrate research with patient-centered interventions (PMID: 40423611). Understanding the role of cooking on health is about translating science into real-world practice so people can learn the tools, skills, and confidence to bring the science to their own tables.”