Can you eat a healthy diet in a hospital?
Say goodbye to fast food, trans fats
When health care workers take a break from caring for patients with heart disease, diabetes, or other diseases influenced by diet, what food choices do they have? A vending machine with potato chips and chocolate bars? A cafeteria with fried chicken and French fries?
Hospitals around the country are re-creating their cafeterias as they strive to become healthier places to work. Kaiser Permanente in Oakland, CA, opened farmers' markets at hospitals to provide fresh fruits and vegetables for employees and visitors and added healthy selections to vending machines. The Cleveland Clinic eliminated trans fats from the cafeteria and patient meals and removed snacks with trans fats from the vending machines.
"Kaiser Permanente is about health care, not just sick care. We try to focus on prevention," says Preston Maring, MD, associate physician in chief at Kaiser Permanente Medical Center in Oakland, who set up the hospital-based farmer's markets. "What better place to focus prevention than on your own employees? Without healthy employees here at work every day, my patients don't get taken care of."
Fast-food restaurants are not permitted on Kaiser campuses. Cleveland Clinic CEO Toby Cosgrove, a cardiac surgeon, questioned why the medical center had a McDonald's in its lobby. Ultimately, the McDonald's stayed, but changed its menu to offer more healthy choices and eliminated all trans fats.
"That doesn't mean you can't buy something unhealthy on campus," says Michael Roizen, MD, chief wellness officer at the Cleveland Clinic and author of several best-selling wellness books, including YOU: The Owner's Manual with co-author Mehmet Oz (Collins, 2008). "We're trying to make [good choices] more available to our employees who [want to be] healthy."
'Dr. Broccoli' promotes healthy eating
As a physician specializing in obstetrics and gynecology, Maring had spent much of his career counseling patients about diet and nutrition. In his spare time, he enjoyed cooking and he shopped at farmers' markets. So, about six years ago, he came up with the idea of hosting a farmer's market at the hospital.
He started with seven vendors, who sold organic produce in front of the hospital. "It was like a block party. Staff people came out, local neighborhood people came over, patients came out," he says.
The success grew. Today, there are 30 farmers' markets in Kaiser facilities in five states.
The markets have three guiding principles: They provide certified organic food; they don't sell food that requires refrigeration, such as meat or dairy; and they are designed as a complement not a competition to on-site cafeteria food.
Maring posts a recipe every week on a Kaiser blog. "It's something that I personally have cooked," he says. "I'm not a trained chef. If I can cook this, anybody can cook this."
With all the talk about healthy eating, some employees dubbed Maring "Dr. Broccoli." They stop him in the hallway to tell him about the new recipe they tried or a new salad they made.
"I think I've had much, much more impact with this than I ever would have had in my entire life as a doctor," he says.
In a survey of 1,200 shoppers at the farmers' markets, 71% of respondents said the markets have influenced them to eat more fruits and vegetables. "Having the market there puts the fruits and vegetables right in front of the employees when they came to work," says Maring. "It's awful hard to walk past a fresh peach in the middle of summer."
Maring's mission is "making good fresh food easily accessible to people." That includes patients' menus, which now include fresh foods from pesticide-free local farmers.
'Healthy picks' in vending machines
If you want to help employees make healthy food choices, you need to give them information about nutritional content. That is the concept behind a new "healthy picks" program at Kaiser facilities.
Fifty percent of the items in vending machines must be healthy juice instead of soda, an apple instead of chips.
The vending companies were skeptical at first, and worried that vending sales would drop, says Jan Sanders, RD, director, national nutrition services in procurement and supply at Kaiser Permanente. Kaiser created a task force and pilot tests of vending machines with 100%, 75%, and 50% healthy items. The 50% mark seemed best, she says.
When the switch was made, vending sales actually went up. "We feel we need to be a leader in supporting the health of our members as well as our staff and even beyond that, trying to support the health of the communities that surround our facilities," Sanders says.
Kaiser cafeterias also offer "healthy picks" and are eliminating items with trans fats. In a pilot program, some facilities provide information about nutritional content in the cafeterias.
Give employees a healthy choice
In this new emphasis on healthy eating, "choice" is the key word. The Cleveland Clinic's "Go Foods" program, for example, highlights food choices that meet certain criteria, such as having no saturated fat and fewer than 4 grams of added sugar.
The health system should give employees the information they need, says Roizen. "We believe that is it our responsibility to help our employees choose lifestyles that are healthy," he says. "We don't believe it is our responsibility to tell them what to do."
Sanders notes that some employees are physically fit and don't have a weight problem or other diet-related health concerns. Should they be restricted from the occasional cheeseburger and fries?
"We don't want to police the food choices and we don't want to create resentment. Education is the way to go to help employees," she says.
Meanwhile, other hospitals have begun to rethink their on-campus food choices. In 2005, the American Medical Student Association launched its "Healthy Foods in Hospitals" campaign and in 2006 reported that 42% of 234 hospitals surveyed offered brand-name fast food.
As fast-food leases expire, some hospitals have decided not to renew them. For example, the University of Michigan Health System in Ann Arbor replaced its Wendy's. A "Healthy Heart Café" in the cardiovascular center was designed with strict nutritional guidelines.
It's a paradox when physicians tell patients that a healthier diet is critical but the cafeteria choices are high in sodium, saturated or trans fat, and sugar.
"A lot of people eat at hospitals every day staff, visitors, patients [who come] for routine appointments," says Lenard Lesser, MD, a family medicine resident at Tufts University and the Cambridge Health Alliance in Malden, MA. "The quality of the food offered at the hospital can have a large impact on the health of the community as a whole."
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