Healthy Hospital Food Initiative

The Physicians Committee

Healthy Hospital Food Initiative

A Survey and Analysis of Food Served at Hospitals by the
Physicians Committee for Responsible Medicine and ADinfinitum

September 2005

Intro: Methods and Findings | Background
Survey Details and Results | Discussion | Recommendations
References | Tables | Questionnaire 


The majority of hospitals surveyed were giving some attention to offering healthier food choices to customers. One or more low-fat products or menu items were available at all hospitals surveyed—all offered at least one reduced-fat product, and 88 percent provided a low-fat entrée or side dish option daily. Most also offered fresh fruit and one fresh or cooked vegetable side dish daily to customers. Eighty percent of hospitals surveyed also reported offering sugar-free snacks, and 88 percent offered whole-grain products.

While these are important steps—and some hospitals around the country are doing an admirable job of offering healthy choices to their customers—ample opportunity exists for improving the health-promotion value of food served in hospital cafeterias. In particular, survey results showed that a majority of hospital foodservice establishments are not yet providing a daily salad bar, low-fat vegetarian options, non-dairy milks and other alternatives to dairy products, sufficient legumes to help meet daily fiber requirements, point-of-purchase nutrition information, or organically raised foods.

Healthy Vegetarian Offerings
Fewer than one-third of hospitals surveyed had either a daily salad bar or a daily vegetarian entrée. Diets based primarily on whole grains, legumes, fruits, and vegetables provide sound nutrition while reducing the risk of weight gain, diabetes, heart disease, hypertension, and several types of cancer. Research shows that people who consume vegetarian diets are slimmer than people who consume an omnivorous diet.8 A healthy and easy way to reduce overall calorie intake is to serve vegetarian foods. Low-fat and very low-fat diets are effective for weight loss because they lead to a reduction in calorie intake and an increase in fiber, which can help people feel fuller longer.9 On the other hand, high-protein, high-fat dietary patterns, when followed over the long term, are associated with increased risk of colorectal cancer,10 cardiovascular disease,11 impaired renal function,12 osteoporosis,13 and complications of diabetes.14

With heart disease remaining the number-one killer in America, an emphasis on vegetarian meals in hospitals could have beneficial effects on the average cholesterol level in hospital staffers and other customers. For example, one study showed that people who adopted a vegetarian diet reduced their saturated fat intake by 26 percent and achieved a significant drop in cholesterol levels in just six weeks.15 Very low-fat vegetarian diets, both as part of a comprehensive lifestyle change and without other lifestyle modifications, have been shown to be instrumental in reversing heart disease.16 Replacing animal protein with vegetable protein also helps decrease the risk for heart disease.17,18 In addition, a diet built from plant foods that limits or avoids animal products has been associated with a reduction in ovarian,20 prostate,21 colon,10 and breast cancer risk.22

The Importance of Beans
Beans and other legumes were offered infrequently in most of the hospitals surveyed. Menu analysis revealed that only two hospitals surveyed offered a daily dish containing beans. Studies have shown that consumption of beans, particularly soybeans, is associated with both cardiovascular and renal benefits.23 A reduction in the risk of coronary heart disease is also seen with legume consumption, as reported in the NHANES I Epidemiologic Follow-up Study.24

In addition, diets high in legumes typically are adequate in fiber, unlike other common food offerings. The current survey identified only two entrée recipes containing more than 4 grams of fiber per serving. Bean dishes typically contain about 7 to 8 grams of fiber in a modest-sized serving. The new U.S. Dietary Guidelines recommend 14 grams of fiber per 1,000 calories. For most people, this works out to about 25 to 42 grams per day. Fiber facilitates the movement of waste, including carcinogens, out of the digestive tract and promotes an environment within the colon that appears to be protective against cancer.10

Non-Dairy Options
Fewer than one-third of hospitals surveyed offered soymilk or other non-dairy options. Providing alternatives to cow’s milk and other dairy products promotes health for several reasons. First, approximately 90 percent of Asian Americans, 90 percent of Native Americans, 50 to 80 percent of Latinos, 60 to 80 percent of African Americans, and 6 to 22 percent of Caucasians are lactose-intolerant. Symptoms, which include diarrhea and other gastrointestinal problems, result from an absence of the lactase enzymes that break down the milk sugar lactose. In addition, several cancers, such as prostate and ovarian cancer, have been linked to the consumption of dairy products.20,21 Calcium is available in fortified soy and other non-dairy milks, green leafy vegetables, fortified juices, and other foods with health advantages milk lacks. Offering these non-dairy foods in hospital cafeterias will demonstrate to doctors and other customers the wide variety of calcium-rich foods available in a healthy diet.

Consumer Education and Nutrition Information
Two-thirds of hospitals surveyed did not mark the healthier items on the menus submitted. Yet research shows that even very simple nutrition information offered at point-of-selection (i.e., on the menu or on information cards in the cafeteria line) influences a significant number of consumers to make healthier choices.25 In addition, foodservice professionals and customers alike benefit from point-of-selection nutrition information. For example, most of the best-selling entrées in these hospital cafeterias were high-fat, high-cholesterol, fiber-less dishes—with fried chicken being the top seller in one in four hospitals. Worse yet, many of the recipes submitted as “healthiest” menu items topped the nutritional scales for fat, saturated fat, sodium, and cholesterol. Most were extremely low in fiber.

Many people believe that by substituting chicken, turkey, and fish for red meat, they are following a diet that will keep their arteries clear and reduce their risk for chronic diseases such as heart disease, cancer, and stroke. In fact, poultry and fish pose many of the same health risks as red meat. A 4-ounce serving of either chicken or beef contains about 100 milligrams of cholesterol. So, ounce for ounce, chicken holds about as much cholesterol as beef. Overall, the leanest chicken with the skin removed contains only slightly less fat than the leanest beef—deriving 23 percent of its calories from fat as opposed to the 29 percent of calories from fat in lean beef, much of which is saturated fat. Instead of replacing the hamburger with chicken cacciatore, patrons should be encouraged to opt for the veggie burger to keep fat and cholesterol levels low enough, and fiber intake high enough, to foster good health.