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Lurie Children's Hospital is adding healthy food options
At Lurie Children's Hospital, the program is about “adding healthy options,” not limiting choices, a spokeswoman says.
Photo credit: Michael A. Marcotte

Nourishing change

Partnership enlists dozens of hospitals to put healthier food on their menus and kick junk food out of the cafeteria

By Jaimy Lee
Posted: October 6, 2012 - 12:01 am ET

More than 150 hospitals say they will get rid of deep fryers, boost the amount of fruits and vegetables they purchase, and stop promoting junk food at the cash register.

The commitment is part of a new program announced Oct. 6 by the Partnership for a Healthier America, a not-for-profit formed in 2010 by Kaiser Permanente, the Nemours children's health system and three other foundations. Within one year, the hospitals will offer adult and children's meals that meet certain nutritional standards and cost the same or less than other meal options.

They will also provide nutrition labeling on foods and buy more fruit and vegetables and “better-for-you” beverages.

“This is all part of a broader effort of hospitals, schools (and) restaurants to begin to offer alternatives and healthy options to customers,” said Larry Soler, Partnership for a Healthier America's president and CEO. “Our focus is to ensure that if people want to make a healthy choice, they can.”

The organization aims to increase healthy choices broadly as a way to address childhood obesity.

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A growing number of hospitals and health systems are increasing healthy food options as they seek to align food purchasing decisions with their mission to promote healthy choices in their communities. They are also responding to pressure from advocacy groups that see a disconnect between caring for sick people and the prominence of fries and Coke in hospital cafeterias.

The modest steps that hospitals are making reflect the challenges of providing food choices that make as much business sense as common sense. “It's a concern when you see unhealthy food sold in a hospital,” said Ana Garcia, deputy director of health policy for the New York Academy of Medicine. “A lot of hospitals are hearing the call to have an environment that promotes health and wellness.”

Taking small steps, such as removing trans fat, can still have a positive impact, Garcia said. “It's hard to ask for a dramatic overhaul of a hospital's food procurement practices.”

Two weeks ago, the New York City Department of Health and Mental Hygiene said 32 of the city's public and private hospitals participate in a voluntary program to boost healthy options in hospital cafeterias, vending machines and patient meals.

“We have an obesity problem,” said Antonio Martin, chief operating officer of the New York City Health and Hospitals Corp. “It is appropriate for health institutions to be true to their mission and promote healthy eating.”

As part of another initiative, launched by Health Care without Harm in 2005, nearly 400 hospitals have signed a healthy food pledge, promising to “treat food and its production and distribution as preventive medicine.”

However, none of the programs preclude hospitals from engaging or continuing in contracts with retail food chains, such as McDonald's, Starbucks or Au Bon Pain, or require them to remove all high-fat, high-sodium or sugary foods and beverages from their campuses.

Real-estate contracts and junk-food purchases have long served as revenue sources for some hospitals.

A 2006 study found that 89% of pediatric hospitals in the U.S. had some type of fast-food or restaurant chain in their facilities. McDonald's Corp. operates 26 outlets in U.S. hospitals, while Au Bon Pain, a large retail chain that markets to hospitals as part of its business strategy, has about 55 restaurants on hospital campuses. Hospitals that work with Sodexo, a large food-service provider, have access to contracts with Blimpies, Burger King, Chik-fil-A, Jamba Juice, KFC and Sbarro restaurants, according to the Sodexo website.

A spokeswoman for Health Care without Harm said hospitals can sign the pledge as they work toward providing more healthy food in their facilities, in part because most of the contracts that hospitals have established with certain chains are long-term.

“The pledge indicates that they are working toward sustainable healthcare, not that they have completely achieved that goal,” the spokeswoman said in an e-mail. “Certainly, fast food in hospitals is not in keeping with healthy food in healthcare.”

This year, not-for-profit watchdog group Corporate Accountability International urged 22 hospital administrators to remove McDonald's franchises from their campuses. The Cleveland Clinic, one recipient of the letter, had tried to terminate its contract with a McDonald's restaurant on one of its campuses several years ago.

The health system, which operates 12 hospitals in Florida and Ohio, is one of a few hospital systems in the U.S. to remove sugared beverages, which it did in 2010. It also banned trans fat in 2007 and rolled out a line of healthy meals that meet specific nutrition criteria in 2009. The PHA program “aligns very closely with wellness initiatives that we already had in place here, but we felt that being part of this larger group would then help to make such initiatives more widespread,” said Persis Sosiak, director of the Cleveland Clinic's public health and research department.

The changes have led to some small dips in revenue, although the difference is usually recovered within three months, Sosiak noted.

Other large health systems participating in the PHA program include Catholic Health Initiatives, Centura Health, Indiana University Health and Kaiser Foundation Hospitals.

Steve Kehrberg, senior vice president of supply chain for Catholic Health Initiatives, said the Englewood, Colo.-based system has made some small changes to food options, such as removing sugared beverages from vending machines in the corporate offices. But the commitments the system is making now are much bigger, he said. “This is new to us.”

When Catholic Health Initiatives decided to participate in the PHA program, it was also beginning a systemwide effort to standardize food purchasing for all its 55 hospitals. The standardization is expected to go into effect in January.

The system spends about $70 million a year on food. By standardizing the food it buys, Catholic Health Initiatives can save $17 million during the two-year implementation period through better rebates and efficiencies, a stronger production process and a standard food menu formulary. The savings will offset some of the revenue lost from impulse buys at the cash register as the system begins promoting healthy foods there, Kehrberg said.

Catholic Health Initiatives is also for the first time looking at the relationship between the cost and nutritional quality of the food it buys and plans to address the fast-food chains that have leases on some of its hospital campuses.

Getting rid of McDonald's

Hospitals to serve healthier food
Lurie Children's Hospital of Chicago, formerly Children's Memorial Hospital, was working on improving healthy food options when it had the opportunity to start from scratch when it opened a replacement 288-bed pediatric facility this summer and decided to participate in the PHA program.

“It's not been about limiting things, but more about adding healthy options,” said Mary Kate Daly, director of new hospital communications for Lurie Children's.

However, one thing that the new downtown facility does not offer is an on-campus McDonald's; the predecessor hospital hosted one of the burger franchises starting in 1997.

“This allows us to have more control over what we serve our patients and families and our staff,” a spokeswoman said in an e-mail. “It also ties in with our healthy hospital initiatives and is consistent with our education and advocacy efforts around good nutrition and healthy eating.”

Federal agencies and trade groups have been encouraging hospitals to take on a greater commitment to the health and wellness of their employees and visitors in recent years.

In a 2010 report, a panel convened by the Centers for Disease Control and Prevention convened a panel that recommended hospitals establish healthy food and beverage standards, as well as support business strategies that promote healthy eating, such as access, pricing, product placement and menu labeling.

“Overall, hospitals have the potential to be large food procurers and powerful community citizens, employers and role models by providing the healthiest food venues possible for their employees and community,” the panel said in the report.

The following year, the American Hospital Association called on hospitals to become leaders in creating a “culture of health” and suggested they could remove “environmental inconsistencies” such as unhealthy foods served in hospital meetings, vending machines and cafeterias. “Hospitals are also encouraged to go a step further and make smoking cessation mandatory for all smokers and subsidize and/or only offer healthy food options in all hospital cafeterias and vending machines,” the report said.

The AHA now says that more hospitals are addressing the health and wellness of employees, as well as visitors and patients, but hospitals may have been limited in their ability to take some actions because of existing vendor contracts.

“This is both strategic and a cultural approach for hospitals,” said Maulik Joshi, the AHA's senior vice president of research. “As we talk about the new models of care and delivery and ACOs, health and wellness is a big part of it.”

TAKEAWAY: Peer pressure is mounting on hospitals to promote health with the food they serve.

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