Hospital cafeterias overhaul their offerings to promote more healthful eating habits among staff, visitors and patients

By HIRAN RATNAYAKE, The News Journal
Posted Tuesday, March 29, 2011

 

  Debi Langshaw, a respiratory care assistant at Christiana Hospital, makes a salad at the salad bar in the West End Café, the hospital's main cafeteria. Food choices at hospitals have become better aligned with their overall mission of health promotion. 
 
  Gilda Dillard, a cook at Kent General Hospital in Dover, prepares a Signature Strawberry Salad. 
  Gilda Dillard, a cook at Kent General Hospital in Dover, prepares salads that will be served in the cafeteria. 
 
  Veronica Norville-Harvey of Christiana Hospital dumps food scraps in a recycling bin. The scraps will be composted and used in the hospital's gardens.(Buy photo) The News Journal/ROBERT CRAIG 

Driven by hunger to the Christiana Hospital cafeteria, Debi Langshaw walked past the burger patties and french fries, and headed toward the salad bar.

She piled some Caesar salad onto her plate and topped it with carrots  and raisins, low-fat cottage cheese and a three-bean salad dressing. She also had ordered a piece of wheat-crusted pizza topped with tomato slices and basil leaves.

To Langshaw, a respiratory care assistant at the hospital, a cafeteria filled with nutritious foods means she's more likely to dine there. What's more, it helps patients, visitors and employees recognize the link between good nutrition and good health.

"Some of the patients we see, if they lost weight they wouldn't suffer from their asthma so badly," she said. "If they were not obese, they probably would eliminate some of their medical needs with COPD. That extra fat makes it harder to breathe."

Yet for decades the food  served in the cafeterias of most health care institutions flew in the face of the message hospitals were trying to deliver to patients. High-fat, high-calorie and heavily processed fare was the norm. Staples included items such as red gelatin, trans fat-filled cakes and red meat dishes.

But that's changing as hospitals offer up more nutrient-rich food options to employees, patients and visitors. Helping to drive the change is the movement to serve food that is not only nutritious but also safely grown, locally harvested and free of chemicals. Additionally, hospital kitchens are being retooled so more items are grilled  instead of fried, for instance.

Besides simply promoting better health, hospitals have another key incentive to transform their cafeteria menus : health insurance costs. Health care workers who have healthy diets are less likely to develop chronic diseases that can be costly.

"A lot of what the hospitals are doing to change food service is in looking at how they can improve employee health," said registered dietitian Lona Sandon, spokeswoman for the American Dietetic Association. "We have to change the environment to continue to change people's behaviors. A lot of these changes are coming from a wellness perspective of companies trying to figure out how to keep their employees healthier."

Walking the talk

There's no shortage of jokes about the bland taste of hospital food served to admitted patients; the fare is often prepared under the direction of registered dietitians and is, among other things, low in sodium. But the state of hospital cafeteria food, where the diners are mostly staff and visitors, is "the irony of all ironies," Sandon said, considering that doctors preach the consequences of poor nutrition, including heart disease, cancer, obesity and asthma.

"You can't serve that kind of food and not have higher obesity rates and higher rates of cardiovascular problems," said Sandon, also an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center. "In a hospital, you need to walk the talk."

A study published in the Journal of the American Medical Association in 2002 found that six of the 17 hospitals considered the best hospitals in the United States  had fast-food franchises on campus.

Food service directors from several hospitals in Delaware said the reason fried foods are offered is because they're big moneymakers. They are considered comfort foods, and patients, visitors and employees may gravitate toward those foods because of the stress of their jobs or present circumstances.

"Typically, some of the fried foods are a little cheaper and have better margins for the hospital, and maybe that's why they've sold better," said Craig Alan Ross, who is contracted to manage the food and nutrition services at Bayhealth Medical Center. "Hospitals weren't trying to push the fried food, though."

Hospitals also had been reluctant to change business as usual, said Lucia Sayre, co-coordinator of Healthy Food in Health Care, a program that works with health systems to improve the ecological sustainability of their food service. The program is an initiative of Health Care Without Harm, an international coalition focused on sustainable health care practices.

"You would think it would be a no-brainer, since part of the mission for hospitals is to keep people healthy, that the food served would be in line with that mission," Sayre said. "It makes sense, but these are institutions that are entrenched in purchasing practices that have been one way for 40 years."

The momentum to adopt new practices picked up in 2005 during the first FoodMed conference in Oakland, Calif. The biannual conference, which will be held again this October in Seattle, was organized by Healthy Food in Health Care and focused on identifying ways to improve both the nutrition and safety of hospital cafeteria food.
 

Even more hospitals took notice after a pilot study at four San Francisco-area hospitals concluded that they could save hundreds of thousands of dollars by reducing their meat and poultry purchases. A report on the study was released last April by the Johns Hopkins Center for a Livable Future.

"Meat is one of the most expensive things in the hospitals, and in a lot of areas you can reduce the amount of meat across the board and still save money," Sayre said.

Changes in cooking

Today, many hospitals nationwide and in Delaware are expanding their nutrition options.
 
At Christiana Hospital, one of the recent menu specials was Vegetable Tomato Chowder, which contained 7 grams of fat and 152 calories. A stand near the cash register offered an assortment of nutritious chips: vegetable, baked, soy, plantain and no-salt. Shelves near the entrance were stocked with 99-cent salads, fruit and several flavors of light yogurt.

Hayley Rose, a third-year student from Jefferson Medical College, grabbed a salad mixed with cucumbers , beans and brown rice during the lunch hour. 

"It's nice to have this kind of variety in the salad bar," she said. "Obviously, policy is always slow to catch up with the widely held belief that obesity is a problem in America. ... You have to give patients a choice on what healthy options are out there."

As part of its wellness initiative for employees, Christiana Hospital also routinely gives out free samples of nutritious foods to cafeteria patrons.

"There's been an overall realization that we need to be a leader in the community for nutrition, just like we need to be for exercise," said Mike Frawley, nutritional services procurement manager for Christiana Hospital.

Grilled salmon and baked tilapia are commonly served at Bayhealth Medical Center, which oversees Kent General Hospital in Dover and Milford Memorial Hospital. Both Bayhealth and Christiana Care Health System, which oversees Christiana Hospital and Wilmington Hospital, advertise the nutrient contents of each cafeteria dish they serve.

Change also is afoot in the way foods are cooked. Christiana Care has replaced many of its deep fat fryers with steamer ovens, a healthier way of cooking since it preserves the vitamins and minerals. Beebe Medical Center in Lewes has eliminated all trans fats  from its cafeteria foods. Nanticoke Memorial Hospital in Seaford -- overseen by Nanticoke Health Services -- uses healthier oils instead of butter in cooking and is preparing more food items from scratch.

"When I got here, it was pretty much a 'thaw-and-serve kitchen,' and now we're a 'cook-serve kitchen,' " said Frederick Lee, who has been contracted to manage the food and nutrition services at Nanticoke Health Services for the past year and a half.

Local and organic 

Locavores -- advocates of locally produced food -- have been the force behind another hospital phenomenon: to make food safer. Nearly all the local hospitals work with farms in Delaware and surrounding states to obtain organic foods, whether it's seasonal produce or meat. "More of the food is locally grown, and that's where we've seen more of a switchover in hospitals," said Lee, who, like Ross, is employed by the food services company Aramark.

Christiana Care and Alfred I. duPont Hospital for Children are composting their food scraps to be used in gardens right on their campuses. Both of Christiana Care's hospitals and duPont Hospital also offer produce from on-site farmers markets during the warm weather months. And Nanticoke Memorial has started the construction of a nearby garden. The herbs harvested from that garden will be used in foods prepared for residents, patients, visitors and employees. 

"We're going to be planting by mid-April," Lee said.

Christiana Care is one of more than 300 hospitals nationwide that have pledged to offer milk free of the hormone rBGH, and the health system is purchasing meat produced without the use of hormones or antibiotics.

Just like nutrition is valued by doctors, so are efforts to reduce antibiotics in meat products, due to the growing trend of antibiotic resistance among patients, Sayre said. 

"Antibiotic resistance is something that clinicians, as well as food service, can very much get behind," she said. "What we're seeing is a combination of public health and environmental health concerns."

Langshaw, the respiratory care assistant, said she hopes there comes a day when fried foods are treated with as much disdain as smoking by hospitals.

"I hope we stop serving Philly cheesesteaks and fries," she said. "As a hospital, we're incorporating people to eat healthy, and you cannot incorporate one thing and do another."

Contact Hiran Ratnayake at 324-2547 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it . 

 
ONLINE RECIPE 

The Women's Health & Environmental Network offers a collection of recipes on nutritious and flavorful hospital foods. Two recipes are from Christiana Care. To learn more, visit www.when.org  and click on "Download here" under the picture of the carrot. 

 

 

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