Food for thought: Nutrition at hospitals

Hospital food is notorious for being bland and tasteless. But is it healthy?

A study scored food options available at cafeterias, gift shops, and vending machines in select Southern California hospitals and found that vending machines offered healthier options.

In fact, several hospitals have been called out for contracting with fast food restaurants. Some argue that hospitals have a fiscal responsibility to generate revenue to sustain the operations of the hospital – and food vendor contracts are a means to financial sustainability.

However, according to the American Medical Association, “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and betterment of public health.”

Does this responsibility apply to the hospital, the organization, where the physician works, or are food choices the responsibility of the individual?

Consider the following groups of individuals. What responsibilities, if any, does a hospital have to:

Hospitalized patients

Many hospitalized patients in the U.S. are malnourished, affecting health outcomes.

Visitors

Hospitals are perceived as an emblem of health and on-site food options may be recognized as hospital-approved healthy foods.

Employees

Employee wellness programs promote a healthy workforce that can be beneficial to the employee and the  employer.

 What are ‘healthy foods?’
Another layer of complexity is composed of conflicting reports on what counts as healthy foods. Advocates of paleo, Mediterranean, and plant-based diets point to different studies and each critique each other’s claims.

This is exemplified by the response received to several articles published in a 2019 issue of Annals of Internal Medicine that contradicted the World Health Organization’s conclusions on the risk of consuming red meat. Even the existence of the famous quote – Let food be thy medicine and medicine be thy food – is contested.

Fueling the mixed messages on nutrition is the difficulty of conducting nutrition studies, which are often criticized for recall inaccuracies, confounding factors, and potential conflicts of interests. Despite the confusing data, recent efforts promoting healthier foods options resulted in  bills in California and New York that mandate certain hospitals to offer a plant-based option to patients.

In addition to questions about whether a paternalistic or individual choice approach is most appropriate, hospitals face a challenge in making evidence-based decisions to inform procurement of healthy foods. Even so, offering more fresh fruits and vegetables is a safe bet.

-By Angela Villanueva, M.P.H., research associate in the Center for Medical Ethics and Health Policy at Baylor College of Medicine