Healthy Hospital Food Initiative
A Survey and Analysis of Food Served at Hospitals by the
Physicians Committee for Responsible Medicine and ADinfinitum
The survey instrument, which was developed by PCRM and ADinfinitum, can be found in Appendix A. When a hospital or system had more than one foodservice establishment, the administrator was asked to fill out the questionnaire and provide a menu from the “main” or “busiest” cafeteria, café, or restaurant.
Spirit of Women, a national network established to motivate women to make healthy changes in their lives, distributed the questionnaire and a request for menu information to 40 hospitals or hospital systems in their nationwide network. The hospitals surveyed were medium to large community hospitals with 100 beds or more, and academic medical centers with at least 500 beds. The surveys were sent to each hospital’s “Spirit of Women Coordinator,” who was also contacted by a staff member at Spirit of Women to encourage participation. Data collection occurred between December 1, 2004, and January 31, 2005.
Questionnaire results were tallied and are presented in Table 1.
The menus were evaluated based on the following questions:
- Were the healthier items marked?
- Was there a daily salad bar?
- Were there daily healthy entrées?
- How many healthy side dishes were available each week?
- How many bean dishes were available each week?
- Healthy items were presumed to be high in fiber and low in fat, saturated fat, and cholesterol.
The recipes were analyzed by a registered dietitian using Nutrition Data Systems for Research (NDSR). Results are summarized in Table 3. Recipes were given one point for meeting each of the following criteria:
- deriving less than 30 percent of calories from fat
- deriving less than 10 percent of calories from saturated fat
- having less than 50 milligrams of cholesterol per serving
- having more than 4 grams of fiber per serving
- having less than 400 milligrams of sodium per serving
Twenty-five hospitals or hospital systems from 17 states returned the surveys (a 63 percent response rate). Of these, 13 (52 percent) were from predominantly urban areas, 9 (36 percent) were from suburban areas, and 2 (8 percent) were from rural areas. The remaining hospital system spanned all three types of areas. Together, the hospitals that responded serve more than 9,000 beds.
Forty percent of responding hospitals or systems had only one foodservice establishment. The others had two or more. Seventeen percent of respondents had one fast-food establishment in the hospital or hospital system in addition to the hospital café or cafeteria.
The findings from the questionnaire are presented in Table 1. In brief, all the hospitals that responded to the survey reported offering at least one reduced-fat product and one fresh or cooked vegetable side dish daily. Eighty percent or more of responding hospitals also reported offering whole-grain products, sugar-free snacks, fresh fruit, and, on a daily basis, a low-fat entrée or side dish.
Fewer hospitals offered a daily vegan entrée, and many that did offered only salad. Forty-four percent of hospitals reported offering a high-fiber bean dish on a daily basis, although this figure was inconsistent with the sample menus submitted. Only two (or 10 percent) of the submitted menus featured a dish containing beans. (Discrepancies between answers to survey questions and empirical data suggest limits to respondents’ knowledge of or memory about actual menu items served in a given week.) Low-fat, cholesterol-free vegetarian items (vegan entrées) and bean dishes are important in helping people meet weight goals and reducing the risk of diabetes, heart disease, and cancer.
Only 28 percent of hospital foodservice establishments offered soymilk, which is preferred by many people, including those who are health-conscious, lactose-intolerant, or allergic to dairy products; only 16 percent used any organic ingredients in foods offered.
Sixty-four percent of hospital respondents said that the best-selling entrée was a chicken dish (tenders, fingers, strips, baked, roasted, herb-baked, fajitas, or fried). Fried chicken was the top-selling entrée in 24 percent of hospital cafeterias surveyed, while hamburgers were the number-one selling entrée in 12 percent of cafeterias. Other top sellers were pizza, enchiladas, meatloaf, catfish, sandwiches, and hot bars (Mexican, Asian, Italian, and baked potato and salad bars).
Analysis of “Healthiest” Main Dish Recipes
Seventeen hospitals or hospital systems submitted one or more examples of their “healthiest” cafeteria main dish menu items, for a total of 23 recipes. Of these, 21 recipes met the criteria for a “main dish” item and were analyzed. Nutrient analysis and recipe point scores are presented in Table 3. Thirteen (62 percent) of these “healthiest entrée” offerings derived more than 30 percent of calories from fat; four of them—baked chicken, chicken cacciatore, pork carnitas, and meatloaf—derived more than 50 percent of calories from fat. Thirteen of these entrée items were chicken dishes, three were vegetarian, and two featured pork, while fish and beef were featured in one dish each.
The mean fiber content for these 21 main dish recipes was 1.1 gram, and fiber content ranged from 0 to 4.7 grams per serving. Therefore, these “healthiest” entrées on average were inadequate for helping individuals meet the recommended 20 to 25 grams of fiber per day. Only two entrées contained more than 4 grams of fiber per serving: a meatless Boca burger and a sesame chicken with broccoli dish.
Sodium content per serving of these entrée items varied widely, from 61 milligrams per serving for herb-baked chicken to 1,450 milligrams per serving for Chef Marcos’ herb chicken breast. The three vegetarian entrées, such as the oven-roasted vegetables, had little or no cholesterol, while the meatloaf tipped the scales at 155 milligrams of cholesterol per serving, with many of the chicken dishes following close behind with up to 110 milligrams per serving.
Analysis of Menu Offerings
Nineteen respondents submitted one or more weeks of menus (see Table 2). Three submitted a one-day menu. Of these 22 hospitals, six (27 percent) offered a salad bar daily. Twenty-one percent appeared to offer at least one low-fat, cholesterol-free entrée on a daily basis. Sixty-eight percent offered a healthy entrée less than once a week. Most (84 percent) offered at least one healthy vegetable, grain, or bean side dish each day, but only half offered at least 14 such side dishes per week. Menu items made with beans, lentils, or black-eyed peas were offered infrequently, with only 21 percent of hospitals offering legume-containing soups, side dishes, or entrées five or more times per week. Only one hospital offered a legume-containing menu item each day. One-third of hospital cafeterias identified “wellness,” “lower fat,” or “heart healthy” items on their menus.