Mark Stevens finally got his appetite back a week after heart bypass surgery last year, but he couldn’t eat the hospital’s food. “Even the nurses cringed when they saw the so-called chicken,” says the 58-year-old New York writer and entrepreneur. “It looked like plastic painted with shoe polish. I needed cheering up, but that chicken said, ‘Go pray for your life.’ ”
Despite a wealth of research over the past three decades showing that fresh, well-prepared food is packed with natural disease-fighting nutrients to speed healing and prevent illness, hospital food has hardly been a model of healthy eating. “There’s been a bit of a disconnect between what the medical literature says about nutrition and what you get served in the hospital,” says Carolyn Lammersfeld, director of nutrition at the Cancer Treatment Centers of America. Studies indicate that many hospitalized patients don’t eat enough of the food to adequately nourish their bodies. A 2003 article in the journal Nutrition, for example, showed that hospitalized patients worldwide are malnourished, and rates of undernourishment in some U.S. hospitals were as high as 41 percent.
Today, however, nutrition experts, doctors, hospital administrators, food service companies and patient advocates are working together to make hospital food healthier, better-tasting and a key part of the healing process. Ronald M. Davis, M.D., president of the American Medical Association, in an article for the AMA’s April newsletter, called on hospitals to “buy meat and poultry raised without nontherapeutic antibiotics, use milk produced without recombinant bovine growth hormones, and replace unhealthy snacks found in many vending machines with healthy choices.”
Gerard Mullin, M.D., director of Integrative GI Nutrition Services at Johns Hopkins Hospital in Baltimore, points out that “food has biochemical benefits beyond just calories. Having the freshest food available to preserve the bioactivity of those nutrients is very important for healing sick patients.”
Hospital food’s need for reconstructive surgery has led 127 facilities to sign a pledge to serve primarily organic and chemical-free food, produced locally. Kaiser Permanente, the nation’s largest health care system, has adopted similar healthy-food guidelines, declaring that its hospitals will work with local suppliers and other vendors to serve food that is “fresher, tastes better, and is associated with increased consumption of fruits and vegetables.”
Initiated by the nonprofit group Health Care Without Harm, the pledge campaign has thus far convinced hospitals in 21 states, ranging in size from 25 beds to 900 beds, to serve more local fruits and vegetables, hormone-free milk, meat raised without antibiotics or hormones, and eggs laid by cage-free hens.
The movement to overhaul hospital cuisine goes far beyond the pledge, says William Notte, president of the American Society of Healthcare Food Service Administrators (ASHFSA). “It is huge,” Notte says. Most hospitals are looking to buy fresher and less processed food, he says, because patients are demanding it. Lammersfeld of the Cancer Treatment Centers says, “Our meats and dairy products are free of chemicals, our luncheon meats are nitrate-free, and we serve as much organic produce as possible.”
The new culinary consciousness has meant accepting the idea that food offered in hospitals should be nutritionally superior to junk food sold at shopping malls. Medical staffs were mortified in 2006 when a research letter appeared in the Journal of the American Board of Family Medicine, showing that 42 percent of large U.S. teaching hospitals had brand-name fast-food franchises right on hospital grounds. The most common fast food sold in hospitals? Krispy Kreme doughnuts.
“This is terrible,” laments Johns Hopkins’ Gerard Mullins. “The hospital should be setting a standard of nutrition for the community.”
Kaiser Permanente is trying to do just that. It hosts farmers’ markets at 29 hospitals to encourage residents to eat more locally grown fruit and vegetables, just as its hospitals are serving more fresh produce.
Food management companies with hospital clients are also coming on board. “Food is absolutely an important factor in accelerating the healing process,” says Richard Schenkel, president and CEO of Unidine, which in May became the first food-service company to sign Health Care Without Harm’s pledge. Discussions with other large food management firms are under way, says David Wallinga, M.D., a physician with Health Care Without Harm.
Even with much progress, there are still roadblocks to improving hospital food. The biggest is cost. The American Society of Healthcare Food Service Administrators’ Notte, who also is director of food and nutrition services at Shands Hospital at the University of Florida, says the average cost of patient food ranges from $6 to $8.50 a day.
Cancer Treatment Centers spends about $7 per patient per meal, or $21 per patient per day. Lammersfeld says the hospital system has instituted new inventory control and other cost-cutting efforts in order to spend more on food.
Other hospitals that are improving their food services also seem to be shifting costs to pay for it, says ASHFSA’s Notte. In addition, says Leo Dorsey, head of food service at Johns Hopkins Hospital and an executive at Sodexho, the nation’s largest food service company, food costs go down because “patients are getting only what they want.”
Food service managers who have made improvements say that fears of rising costs for patients and insurance companies are unfounded. “The food service is part of hospital room and board. So there is no additional cost depending on the type of food, or the way it is served,” explains Swedish Medical Center’s nutrition director, Kris Schroeder. “As hospitals look at their budget, the nutrition service is such a small piece of the overall hospital budget.” Generally, it’s only about 1 percent.
In the end, those hospitals that have dramatically improved their food services find that the benefits are worth the effort. “In general, we have patients who gain weight during treatment because they say the food is so good,” adds Lammersfeld. For cancer patients, who often have to force themselves to eat, this is high praise indeed.