Education and Empowerment Lead the Charge in The Children’s Hospital of San Antonio’s Battle Against Childhood Obesity

By Tiffany Parnell
Friday, September 22, 2017

The Children’s Hospital of San Antonio’s innovative Culinary Health Education for Families (CHEF) program combats childhood and adolescent obesity through education that combines the science of nutrition with the art of cooking.

Celina Parás, MSc, RDN, LD, assists a family during a CHEF Power Up with Breakfast class.

Texas childhood obesity rates have tripled since 1980, according to the Texas Department of State Health Services. Data compiled from a Centers for Disease Control and Prevention High School Youth Risk Behavior Survey reveals that approximately 31 percent of Texas high school students are overweight or obese.

The statewide incidence rate of childhood and adolescent obesity is similar to what physicians observe on a regional level. As many as one in three school-age youths in San Antonio are overweight or obese, according to Julie La Barba, MD, FAAP, Medical Director of CHEF and Assistant Professor in the Department of Pediatrics at Baylor College of Medicine.

Because overweight and obese children are more likely to remain obese during adulthood and often develop comorbid conditions such as Type 2 diabetes, preventing and addressing obesity throughout childhood is crucial to maintaining optimal health across the lifespan.

“In the primary care setting, it’s difficult to counsel families about nutrition. It takes time, and most pediatric offices are not set up to bill for that. We’re here to support pediatricians and effect change by showing people how to make affordable, practical meals with familiar ingredients.”
— Julie La Barba, MD, FAAP, Medical Director of the CHEF program and Assistant Professor in the Department of Pediatrics at Baylor College of Medicine

Addressing Nutrition Barriers

A mother and her son cook together during a CHEF class.

Many parents lack the necessary culinary skills to cook balanced meals, have difficulty making healthy recipe substitutions, or feel that fruits, vegetables and other nutritious foods are unaffordable. Providing families with vouchers and coupons for fruits and vegetables can help alleviate financial concerns, but the resources aren’t helpful if parents can’t successfully prepare these foods at home.

An initiative funded by a Goldsbury Foundation grant, CHEF is designed to eliminate obstacles that keep families from adopting healthier habits. The bilingual CHEF team, which includes a chef, pediatrician and a registered dietitian, not only teaches families the tenets of proper nutrition, but also provides hands-on learning through which children and their families develop the practical culinary skills needed to prepare balanced meals.

“Until people understand the skills and concepts that get them from the coupon to the grocery store to the stove and finally to the table, we’re not going to see lasting changes,” Dr. La Barba says. “We know that when people cook for themselves and eat at home, their health improves, but we also know that many people don’t feel confident in the kitchen. These two data points drive what we do here at the CHEF teaching kitchen.”

Building the CHEF Infrastructure

Dr. Julie La Barba watches on as a patient practices slicing a bell pepper.

CHEF began accepting patient referrals in January 2017. All classes are held in a 1,000-square-foot teaching kitchen in the hospital lobby, which was constructed as part of The Children’s Hospital of San Antonio’s recent $135 million transformation project. Experts from The Culinary Institute of America helped design the kitchen, which features one demonstration station, four participant stations, and utensils and equipment that are safe for school-age children ages 6 and older.

In addition to the development of the teaching kitchen, The Children’s Hospital of San Antonio is in the process of creating a 2.5-acre garden that will include an outdoor play area, prayer garden and culinary garden that will provide space to grow herbs, fruits and vegetables, which will complement the teaching kitchen.

“Our plan is to use the garden to educate children about how plants grow and illustrate the fact that we get our food from the ground,” says Maria Palma, CHEF Program Director and Chef at The Children’s Hospital of San Antonio. “We also want to show children what an herb or vegetable looks like while it’s growing and take children through the entire cycle of plant life.”

The Six-series Curriculum

CHEF classes are free of charge to San Antonio families but do require a physician referral. The majority of children are referred to the program because they’re overweight or obese. Other indications for referral include food allergies, celiac disease, Prader-Willi syndrome and Type 2 diabetes.

The CHEF Teaching Kitchen located at The Children’s Hospital of San Antonio.

Following referral, families are encouraged to complete six classes, which build upon one another. Each class can include up to four children, and each child can bring two family members to class. The one- to two-hour sessions, offered in English and Spanish, include nutrition education, a 20-minute cooking demonstration and a hands-on component during which families make a dish at one of the four cooking stations. Recipes used in the classes are low in fat, sodium and sugar, and most importantly, meet “DNA” criteria. “DNA” recipes are “delicious, nutritious and affordable,” according to Mark Gilger, MD, Pediatrician-in-Chief at The Children’s Hospital of San Antonio and Professor and Vice Chair in the Department of Pediatrics at Baylor College of Medicine.

The first CHEF session, “Cook Well, Eat Well, Live Well,” is an introductory course that teaches families about portion sizes, food safety and basic knife skills. During this class, children prepare a tostada, also known as a chalupa, and learn how to keep their fingers safe while chopping and dicing vegetables. Skills practiced include chopping onions, lettuce and red cabbage, smashing avocado, and poaching and shredding chicken.

Other modules teach children about plant-based proteins, the components of a well-balanced breakfast, and how to cook vegetables so they retain their color, nutrients, and texture. The recipes also give families lessons in nutritious substitutions. One of the most popular recipes — a healthy take on a dish that traditionally includes ground beef and potatoes — incorporates red and green bell peppers for an extra serving of vegetables and substitutes carrots for potatoes.

“In each of the recipes, we use many of the same ingredients, including different colored bell peppers, carrots, onions, garlic, celery, cabbage, broccoli and cauliflower,” Palma says. “These foods are available at most grocery stores, so the recipes are as accessible as possible.”

The core curriculum presented during each six-class series is the same for all participants, but recipes and nutritional messages may change slightly based on children’s specific nutritional needs. For example, if the team is leading participants with food allergies through a “Power Up with Breakfast” class, recipes may be tailored for children who have celiac disease, are lactose intolerant or have other types of food allergies.

“All classes are focused on balance, not fad diets, and are based on evidence-based nutrition,” says Celina Parás, MSc, RDN, LD, CHEF Nutrition Education Specialist. “Depending on the types of conditions we’re addressing, we may incorporate specific guidelines. For example, we include guidance from the American Diabetes Association in our Type 2 diabetes curriculum and elements of the USDA’s MyPlate in our weight-management classes.”

Children are encouraged to lead meal preparation during the class, with family members playing a supervisory role. After participants finish cooking the meal, families sit together at a large table in the teaching kitchen and ask questions or discuss challenges they’re facing at home.

“Children learn about healthy foods while having fun, which helps them feel confident and empowered to make healthy changes,” Parás says. “At the same time, parents meet other parents whose children have similar health challenges. The classes are a great support system for parents because they get to share experience and advice with others in their situation.”

Expanding CHEF’s Reach

The goal for CHEF’s first year is to see 500 families, and the team is currently on track to exceed this goal. As the program grows, plans are in place to expand indications for referral. In September, the team will begin offering prenatal nutrition classes and launch “Cancer Prevention with Nutrition,” a class developed in conjunction with April Sorrell, MD, pediatric hematologist/oncologist at the hospital’s Cancer Genetics Program.

From left to right: Celina Parás, MSc, RDN, LD, Nutrition Education Specialist; Julie La Barba, MD, FAAP, Medical Director; Chef Maria Palma, Program Director; Rebecca Vance, Program Coordinator.

Outside of the hospital, CHEF teaching kitchens are available at four organizations: the Boys & Girls Club of San Antonio, The Witte Museum, the Mays Family YMCA at Potranco and the San Antonio Botanical Garden. These community kitchens feature the curriculum provided by The Children’s Hospital of San Antonio’s teaching kitchen.

“Our goal is to reach as many families in the city as possible,” Dr. Gilger says. “People of all ages enjoy learning how to cook and prepare foods. We hope this will lead to a better understanding of what we eat and, in the long term, decrease the incidence of overweight or obese diagnoses throughout San Antonio.”

To learn more about the CHEF program or to download a provider referral form, visit