As I wandered the hospital halls late one evening, I suddenly found myself in an all too familiar state — I was absolutely famished. At this hour, I knew my options were sparse. The hospital cafeteria had closed more than three hours earlier. There was a McDonald’s in the food court, but I knew a Big Mac would just make me feel worse. I snuck off to one of the supply rooms and grabbed that revered snack of residents across the country: individually wrapped, slightly stale graham crackers dipped in single-serve peanut butter. I would live to fight another day.
The next morning on rounds, one of our patients grumbled about the hospital food: “It comes late, it’s cold, it tastes horrible, and it is bad for me,” he explained. The patient after him, who was evaluated for hemoptysis just several days prior, was given red Jell-O and subsequently vomited a red substance overnight, muddying the clinical picture. Was it gelatin with red dye 40 or blood this time?
These experiences led me to question the current state of hospital food systems. After all, hospitals are supposed to be centers for healing, but unfortunately they do not always live up to this ideal. In medical school, when I first became acquainted with the lived experience of inpatients on hospital wards, I would joke that if I, a physically active and healthy young man, checked into a hospital for a week, I would come out the other end sleep deprived, physically weakened, and mentally exhausted. One reason for this, I deduced, was related to hospital food.
Over the last several decades, physicians, hospitals, and public health agencies have become increasingly aware of the contradiction between serving unhealthy food at institutions created to preserve and restore health. From 2010 to 2014, the New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative to improve the healthfulness of food served in NYC hospitals, with improvements in overall health food offerings across participating hospitals. In 2016, the Physician’s Committee for Responsible Medicine (PCRM), a nonprofit group composed of 12,000 doctors, issued a critical report about hospital food environments in the U.S. Following this, a year later the American Medical Association issued a policy statement that called for the reduction of sugar-sweetened beverages and processed meats, and an increase in the availability of healthful, plant-based foods in hospitals.
Hospitals are taking note. Over the last decade, many hospital systems have eliminated sugary beverages, fried foods, and trans fats from hospital cafeterias. Another strategy at hospital food courts has been to restrict what franchises are allowed to operate within the hospital. In a 2006 survey led by Dr. Lenard Lesser, 98 of 233 university-affiliated teaching hospitals (42%) had at least one fast-food franchise on campus. Yet over the last 10 years, PCRM reports that McDonald’s franchises have been closed in 15 hospitals across the nation.
Some hospitals are taking it a step further. In 2018, the UC Davis Medical Center hired a local executive chief to spearhead a “farm-to-fork” food program that emphasized locally grown whole-food and plant-based ingredients. The program won a James Beard Foundation award and continues to this day. Of course, with hospitals increasingly struggling to remain fiscally solvent, especially in the COVID-19 era, creating a financially viable and sustainable food program remains a challenge. Yet plant-based food, while often more expensive than packaged and processed ingredients, is still cheaper than meat. As large purchasers, hospital systems also have tremendous bargaining power, and this along with innovative systems and structures can be leveraged to keep costs in check. Besides, hospitals have strong incentives to set a good example, to keep patients healthy, and to promote public health.
There is also increasing recognition of the situational needs of patients. A patient with hemoptysis should not be provided red Jell-O. Diabetic patients should be offered a low carbohydrate diet. A patient with a chyle leak after a neck dissection should be able to stick to a zero fat diet to promote resolution of the leak. Patients with Celiac disease and vegans should have sufficient options. These many diet permutations are becoming more and more accessible. There is also increasing recognition that specific dietary prescriptions are an important part of a patient’s clinical care, with options within the EMR to target the many dietary particulars than can exist.
The importance of the hospital food environment extends beyond patients to hospital employees. Dining subsidies at hospital cafeterias, extended hours, and healthy vending machine options are all options that can improve the availability of nutritious options at work. One such program, Farmer’s Fridge, is now feeding over 30,000 meals a week to health care workers, a number that has been fueled in part by the COVID-19 pandemic. Additionally, many departments regularly order catered food for departmental meetings and conferences. This presents an excellent opportunity to advocate for healthier meals. As a busy resident, I know I often revert to whatever is most available and convenient, so these subtle changes within the hospital environment can make a huge difference.
I am a strong believer in leveraging hospital systems to not only provide quality medical care, but to serve as havens for wellness, centers for healing, and promoters of health. If and when I find myself admitted to a hospital, I am hopeful it will be a place that deeply promotes healing. I know having the opportunity to eat nutritious, minimally processed meals as I recover would be an instrumental part of that. After all, food is medicine.
Share your best (or worst) meal in the hospital in the comments.
Dr. Benjamin Ostrander is a current otolaryngology resident at UC San Diego. He loves beach days, long bike rides, cooking elaborate recipes, and playing music. Ben is passionate about art and design, creativity, surgical innovation, and global health. Ben is a 2021–2022 Doximity Op-Med Fellow.
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