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What do children's hospitals and fast food restaurants have in common? The quality of food served and the marketing environment in which it is offered.
That is the surprising finding of a new study by Lenard Lesser, MD, MSHS, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2009-2012) at the University of California in Los Angeles (UCLA).
Hospital cafeterias are not much healthier than fast food restaurants, and some are worse, Lesser and his colleagues found in a study of food served at California's children's hospitals. Overall, only 7 percent of 384 entrees and sandwiches served by the hospitals were considered healthy, and 50 percent of the hospital food venues offered no healthy options at all.
"Hospitals are missing the opportunity to be exemplars of healthy eating," Lesser said. "Hospital cafeterias should provide patients, staff and visitors with an opportunity to learn healthy eating habits so they can take those lessons home with them so they can lead healthier lives."
The benefits of healthy hospital meals go beyond patient visits, Lesser said. Studies show that parents are more likely to consider hospital food "healthy," even if it is fast food, and that food offerings and environments influence diet and, therefore, health. That means hospitals that serve healthier food have the potential to change diets and improve health, Lesser said.
Health care providers and hospital staff would also benefit from healthier options. "Thousands of people eat in hospitals every day," Lesser noted. "Healthy hospital food has the capacity to influence a lot of people's health."
Some Hospitals Stand Out
So why do hospitals, which aim to improve health, offer the kind of food that can undermine that goal? There are many reasons, Lesser said, including: customer demands, hospital priorities, financial concerns, and the lack of facilities needed to make healthy foods. The reasons depend on an individual hospital's circumstances.
But Lesser said some hospitals have found innovative ways to sell meals made from whole grains, fruits and vegetables and low-calorie drinks. The UCLA cafeteria, for example, found that decreasing salad bar prices significantly increased sales. Other hospitals have made similar improvements.
Lesser became interested in the subject as a medical student, when he and his colleagues had trouble finding healthy, nutritious meals for themselves and their patients. "I thought hospital cafeterias should follow the mission of the hospital itself: better health and health care."
For this new study, Lesser tweaked a widely used nutritional scale to assess food offerings and environments at California's 14 children hospitals. The majority of venues offered healthy items such as low-fat or skim milk, fruit without sugar and non-fried vegetables, he found. But more than 80 percent placed high-calorie impulse items like ice cream, cookies and candy near the cash register; half offered attractive "combo" meal pricing options; and 38 percent posted signs promoting high-calorie items and other unhealthy eating choices.
Most food venues received a mid-range score, a few points ahead of or behind a fast food restaurant like McDonalds, and have "considerable room for improvement," Lesser and his co-authors write. They also note that most hospitals do not take advantage of inexpensive ways to promote healthy food consumption such as posting nutritional information and signs promoting healthy choices. However, one hospital scored in the high range, showing that health food offerings and environments at hospitals are possible.
The study was published on Dec. 1 in Academic Pediatrics. Coauthors are Dana E. Hunnes, RD, MPH; Phedellee Reyes, MPH; Lenore Arab, PhD; Gery W. Ryan, PhD; Robert H. Brook, MD, ScD; Deborah A. Cohen, MD, MPH.
A previous study measuring hospital food options and environments relied on interviews with hospital food service directors. In this study, Lesser and his colleagues visited hospitals to make their own objective observations about food options and food messaging and marketing.
One limitation of the study is that it did not measure actual food consumption. Lesser is now working with hospitals and hospital organizations to document food consumption patterns. He hopes to use that data to help hospitals across the country become "model food laboratories" that promote healthier eating for patients, staff and visitors.
"This is one area where health professionals have the direct opportunity to improve the food landscape in the United States," Lesser and his colleagues write. "Achieving ideal children's hospital food environments would be one small, but significant, step in changing the quality and quantity of what our children eat and preventing the onset of dietary-related chronic diseases."