In an era when rates of obesity, diabetes, and other lifestyle-related diseases challenge medical educators and governments worldwide, it is necessary to consider novel educational strategies, both didactic and experiential, whereby current and future health professionals can be better prepared to proactively advise and teach patients enhanced self-care skills (e.g., diet, movement, stress management, and enhanced behavioral change).In this Perspective, the authors summarize current circumstances involving rising rates of obesity and diabetes worldwide, the lack of nutrition- and lifestyle-related curricular requirements for professional medical certification, societal trends regarding modern food culture and food availability in health care settings, and the misalignment of financial incentives to promote health.The authors assess what elements of self-care should or should not be required within future curricula and certification exams. They consider how best to educate trainees about diet and how to "translate" nutrition, exercise, and behavioral science knowledge into practical advice. They explore several ideas for reforming nutrition education, including "teaching kitchens" as required laboratory classes for nutrition and lifestyle instruction, wearable technologies for tracking behaviors and physiological data relating to lifestyle choices, and the prospect of hospitals and other medical venues serving as exemplars of healthy, delicious food options. Finally, the authors argue that "salutogenesis"-the study of the creation and maintenance of health and well-being-should assume its rightful position alongside the study of "pathogenesis"-disease diagnosis and treatment-in medical education and practice.

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Introduction:Diseases linked to obesity such as cardiovascular disease, diabetes, degenerative joint disease, gastroesophageal reflux, and sleep apnea constitute a large portion of primary care visits. Patients with these conditions often lack knowledge, skills, and support needed to maintain health. Shared medical appointments (SMAs) that include culinary skills and nutrition education offer a novel, cost-effective way to address these diseases in primary care.Methods:Adult patients in a primary care practice at a large academic hospital in Boston, Massachusetts, who had at least 1 cardiovascular risk factor were invited to participate in SMAs that included cooking demonstrations and teaching about nutrition in addition to medical management of their conditions. Sessions were conducted by a physician and an assistant in a conference room of a traditional primary care practice as part of a pilot feasibility project.Results:Seventy patients, contributing a total of 156 patient visits, attended 17 nutrition-focused SMAs over a 4-year period. Patients were surveyed after each visit and indicated that they enjoyed the SMAs, would consider alternating SMAs with traditional one-on-one visits, and would recommend SMAs to others. Half would pay out of pocket or a higher copay to attend SMAs. Financially, the practice broke even compared with traditional one-onone office visits.Conclusion:In this feasibility study, chronic disease SMAs conducted with a culinary/nutrition focus were feasible, cost-effective, and well received by patients. Follow-up studies are needed to evaluate short- and long-term outcomes of this SMA model on obesity-related diseases.

Which of the following represents a potential mechanism by which exercise may have neuroprotective effects?A. Reduced neuroinflammation. B. Upregulation of neurotrophic growth factors. C. Potentiation of remyelination. D. All of the above."Miguel" was 16 years old when he was referred to our clinic after social anxiety and depression evolved into signs of early psychosis. He had been in care for 2 years in private practice and was treated with various antidepressant medications and psychotherapy. During this time, he developed the perception that people strongly disliked him once they got to know him. He also heard his name called loudly from behind several times at school when no one was there. His community psychiatrist added risperidone, which suppressed the voices but led to lethargy and weight gain. A trial of aripiprazole was not effective, so he returned to taking risperidone along with escitalopram, gabapentin, and lorazepam. He was referred to our early psychosis program because of worsening symptoms and suicidal ideation despite this treatment. On initial evaluation by our team, Miguel described extreme sadness and self-hatred associated with suicidal ideation. He was preoccupied with disliking his appearance, discomfort in social interactions, and feeling "stupid" in class relative to his peers despite receiving good grades. He feared impulsively acting on suicidal ideation. He reported that his friends at school could see and hear his thoughts when he was at home. He was sure that comments friends made at school confirmed that they knew his private thoughts. He also reported being watched in his room by schoolmates who wanted to catch him doing something embarrassing, and he had to position himself away from the window to avoid being monitored. He described intrusive fears of close family members being harmed or killed. He had a family history of schizophrenia in a second-degree and a third-degree relative. Miguel met the threshold for "severe and psychotic" on the Structured continued See related features: Clinical Guidance (Table of Contents), CME course (p. 293), and AJP Audio (online)