Friday Favorites: Just How Bad Is Hospital Food?

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Hospital food needs a revolution. I was surprised to find out that most inpatient meals served in hospitals are not required to meet any sort of national nutrition standards for a healthy diet. And indeed, an analysis on the nutritional value of food served to patients in teaching hospitals found that many did not meet dietary recommendations. “Warning,” read the headline, “Hospital food bad for health.”

A registered dietitian wrote in to defend the hospitals, saying that at least over half the hospitals met at least over half the guidelines. And hey, they’re so stringent anyway. Some eggs and dairy, and you could blow through your limits. “The provocative conclusions of [their analysis] only lead the media and the public to conclude that we are a bunch of dunces who have no understanding of the relation between nutrition and disease prevention.”

Well, if the white coat fits…

Look, we spend a fortune on training doctors; so, you’d think we could follow through on some of the simplest things, like food. “Good diet is as necessary to recovery of health as [anything else], and it is folly to pretend that it is beyond the power of our profession to change this” is a line written 75 years ago.

And still, there’s pushback. “Perhaps, we should question whether a ‘healthy diet’ given to a helpless patient during a 2- to 10-day hospital stay benefits anyone or anything other than the dietitian’s sense of ‘doing good’,” responded one doctor, adding he is always bothered when patients are deprived of a desired morning egg because a “healthy” diet has been ordered. I mean, what’s a few days of a little heart-unfriendly diet in the scheme of things?

But it’s the message we’re sending. “The presence of foods on the [hospital] tray sends a message to patients as to what is healthy and acceptable for them to eat,” responded the researchers that did the hospital foods analysis. “We still can think of no better place or opportunity to set an example of good nutrition than when patients are in hospitals.”

After all, public schools in California have banned the sale of soda for over a decade. Why not children’s hospitals? In a study of California healthcare facilities serving children, three-quarters of foods and drinks wouldn’t have been allowed in schools. We’re talking soda and candy. Having unhealthy items in healthcare facilities and seeing staff consume these products contradicts the hypercritical nutrition and health messages children may get from healthcare providers.

On adult menus, nearly all meals contained excess salt, with 100 percent of daily menus exceeding the American Heart Association’s recommendation for staying under 1500mg of sodium a day. This means meals offered to patients may actually contribute to the exacerbation of the very conditions that may have led them to the hospitalization.

But if hospitals stuck to the recommended limits of salt, the food wouldn’t taste as good, responded an executive from the Salt Institute, to which the researchers replied: Taste as good? We’re talking about hospital food—it doesn’t taste good no matter how much salt you put on it.

At the very least, we should prepare all meals low-sodium and then, if they want to add salt, it’s their choice. If they want to get someone to wheel them out into the parking lot and smoke, that’s their business, but we shouldn’t be blowing cigarette smoke into people’s rooms three times a day, whether they want it or not. Interestingly, studies suggest that when individuals are allowed to salt food to taste, they rarely add as much as often comes prepackaged within the food. Check it out. Switch people to a low-sodium diet, and sure, they use their salt shakers more, but overall, their salt intake dips way down. And the study subjects said it tasted just as salty, because salt added to the surface of foods makes it taste saltier. But when a hospital meal comes to you pre-salted to the hilt, inpatients may not even have the option to consume healthier levels.

In defense of their unhealthy food, one hospital food service provider explained that they’re just giving people what they want. Are we really going to deny people who are going through difficult times any small comfort that they may get?

That’s one of the reasons why this clinical director sends candy bars and ice cream to cancer patients. You know what else might help take the edge of? A nice long drag on a cigarette. “Here you go Timmy, try this.” Hospitals used to sell cigarettes, primarily for “patient convenience.” “I don’t think I can deny a paying patient the right to smoke a cigarette,” said one administrator, “I will have to insist we have cigarette machines in the hospital, as a service to the patient.”

But some made the radical suggestion that tobacco products should not be sold in the hospital. And this wasn’t from the 1950s, but from the 1980s. Yet, the irony of hospitals allowing the sale of the major cause of preventable illness and death in this country had rarely been discussed in the medical literature, and it’s especially ironic that smoking was, of course, permitted in the doctors’ lounges.

To their credit, though, U.S. hospitals underwent the first industry-wide ban on smoking in the workplace by the mid-90s. Well, now “[h]ospitals again have the opportunity to take the lead and create food environments that are consistent with their mission to cure the sick and to promote health. Through the simple act of serving food that meets national nutritional standards, our hospitals will act in the best health interests of their patients, and their staff, and will undoubtedly again be leaders in our ongoing dialogue on how to improve our food supply, which, in turn, will improve the health of us all.”

Strict antismoking regulations were often criticized as being too harsh, as if disease and premature death brought on by smoking were any easier. Think my smoking-diet parallel is hyperbole? Well, guess what. Today, the major cause of preventable illness and death in this country is no longer tobacco. The leading cause of death in America is now the American diet. Hospitals in the United States serve millions of patient meals each day and are optimally positioned to model a healthy diet.

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• Walker C. Hospital food needs a revolution. Paediatr Nurs. 2010;22(9):3.
• Moran A, Lederer A, Johnson Curtis C. Use of Nutrition Standards to Improve Nutritional Quality of Hospital Patient Meals: Findings from New York City's Healthy Hospital Food Initiative. J Acad Nutr Diet. 2015;115(11):1847-54.
• Singer AJ, Werther K, Nestle M. The nutritional value of university-hospital diets. N Engl J Med. 1996;335(19):1466-7.
• Bowman L. Warning: hospital food bad for health. San Francisco Examiner. November 9, 1996. A-7.
• Porter C. Hospital food. N Engl J Med. 1997;336(17):1262.
• Kidd M. Simple stuff. CMAJ. 2010;182(15):1696.
• Who should feed the sick? Lancet. 1945;245(6332):19-20.
• Hanauer L. Hospital food. N Engl J Med. 1997;336(17):1261.
• Sriram K, Ramasubramanian V, Meguid MM. Special postoperative diet orders: Irrational, obsolete, and imprudent. Nutrition. 2016;32(4):498-502.
• Fellers RB. Should hospital diets meet the dietary guidelines for healthy persons? J Am Diet Assoc. 1998 Dec;98(12):1401-2.
• Wojcicki JM. Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity. Acta Paediatr. 2013;102(6):560-1.
• Lawrence S, Boyle M, Craypo L, Samuels S. The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program. Pediatrics. 2009;123 Suppl 5:S287-92.
• Arcand J, Steckham K, Tzianetas R, L'Abbe MR, Newton GE. Evaluation of sodium levels in hospital patient menus. Arch Intern Med. 2012;172(16):1261-2.
• Bibbins-Domingo K. A call to our hospitals: please hold the salt!: comment on "evaluation of sodium levels in hospital patient menus". Arch Intern Med. 2012;172(16):1262-3.
• Satin M. Hospital salt. JAMA Intern Med. 2013;173(5):391-2.
• Beauchamp GK, Bertino M, Engelman K. Failure to compensate decreased dietary sodium with increased table salt usage. JAMA. 1987;258(22):3275-8.
• Shepherd R, Farleigh CA, Wharf SG. Limited compensation by table salt for reduced salt within a meal. Appetite. 1989;13(3):193-200.
• Jilcott Pitts S, Schwartz B, Graham J, et al. Best Practices for Financial Sustainability of Healthy Food Service Guidelines in Hospital Cafeterias. Prev Chronic Dis. 2018;15:E58.
• Chima CS. Should hospital diets meet the dietary guidelines for healthy persons?. J Am Diet Assoc. 1998;98(12):1400-2.
• Berman EJ, Richards JW Jr, Fischer PM, Creten DA. Tobacco in hospitals. JAMA. 1985;254(24):3420.
• Hospitals act to curb cigarette sales, smoking. New York Times. February 9, 1964.
• Ho AM. Reducing smoking in hospitals. A time for action. JAMA. 1985;253(20):2999-3000.
• Fee E, Brown TM. Hospital smoking bans and their impact. Am J Public Health. 2004;94(2):185.
• US Burden of Disease Collaborators, Mokdad AH, Ballestros K, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444-72.

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Motion graphics by Avocado Video