The Inadequacy of Hospital Food Jeopardizes the Health of Recovering Patients

Written by Blake Ashley Frino-Gerl; Edited by Nicki Steinberger, Ph.D.

Originally published by A Voice For Choice Advocacy on March 8, 2024.

EDITOR’S SUMMARY: In some cases, hospital food has improved. There is an eye toward using higher-quality ingredients for the benefit of patients’ health, as well as staff, and doctors themselves. Sugar consumption has decreased, as has ultra-processed foods. On the other hand, the number of hospitals moving in this direction is low—as few as ten percent have stepped forward. The majority continue to serve meals containing plenty of harmful additives and preservatives. It’s not uncommon to see fast food outlets housed directly inside hospital buildings.

If you’re accustomed to eating food with “life force” at home—fresh, organic, unprocessed, pasture-raised, and grass-fed/finished—prepared without industrial seed oils or chemical-infused spices … don’t expect similar quality at the hospital, or you will surely be disappointed. 

The American College of Cardiology on the importance of offering healthy foods in hospitals today:

“Hospitalization can be a “teachable moment” for patients who are ready to embrace nutrition as part of the healing process. It is important that the hospital food service be ready, too, with food offerings that support a healthful prescription. Healthful foods are also important for staff and visitors and reinforce the ‘culture of health’ recognized as vital in the workplace today.”

Unfortunately, hospital food isn’t known to be healthy. The systems in place operate at a fast-pace with little focus on nutrition. However counterintuitive it is, doctors and nurses as well gravitate toward fast food and vending machines to quickly satisfy their hunger. Of 384 meals served and analyzed at 14 children’s hospitals in California, only seven percent were deemed healthy. 

While it would certainly be beneficial if healthcare systems existed as practical teaching platforms to showcase how food could be used as medicine, integration is inconsistent. One might argue not doing so disregards patients’ recovery. Even those in the medical profession liken hospital food to that served in prisons.

According to the Journal of the Academy of Nutrition and Dietetics, “Hospital Nutrition Care Betters Patient Clinical Outcomes and Reduces Costs: The Malnutrition Quality Improvement Initiative Story”:

“Disease-associated malnutrition and malnutrition-associated diseases and conditions are common among hospitalized patients, yet all too often such malnutrition goes unrecognized and untreated. As a result, patient quality outcomes worsen, excess costs of care are incurred, and patients and their families are disappointed and alarmed by slow, stalled, or no recovery from illness or injury.”

The food prepared in modern hospitals fails you in two major ways—its lack of nutritional quality, and poor sensory appeal. While staying at the hospital, you expect to be well-cared for; this includes the food you eat. Sadly, this is not usually the case. Much of the food served contains additives and processed ingredients—unfit for you whether you’re sick, healthy, or recovering from a procedure.

Molly McClusky’s article in the Huffington Post blatantly states: “The terrible food in hospitals has long been one of the greatest contradictions in health care.” In fact, nutrition is a neglected tool in hospital facilities, yet has the ability to accelerate recovery, prevent chronic disease, and decrease mortality and morbidity rates. On the other hand, it is well-documented that the impact of inadequate nutrients in your diet increases your risk of heart disease, specific cancers, type 2 diabetes, and death. The Lancet agrees: From “Bad Diets Are Responsible For More Deaths Than Smoking, Global Study Finds”:

‘"This study shows that poor diet is the leading risk factor for deaths in the majority of the countries of the world,"’ says study author Ashkan Afshin of the Institute for Health Metrics and Evaluation at the University of Washington. Unhealthy diets are ‘"a larger determinant of ill health than either tobacco or high blood pressure,"’ he says.”

David Eisenberg, adjunct associate professor of nutrition at Harvard T.H. Chan School of Public Health, said American medical schools do an inadequate job of teaching future doctors about nutrition. He noted that students learn more about the biochemistry of food than on how to advise their patients to eat healthier. This may be a contributing factor to the absence of high-quality food at hospitals. However, limited education in nutrition isn’t the only reason for this deficit. Major fiscal and operational challenges are at the helm of this situation as well. 

Large food manufacturers who cater to public schools also provide service to hospitals. Most hospitals and healthcare facilities in the United States have contracts with industrial food corporations such as Aramark, Sodexo, and Compass Group. In addition, a number of hospitals in the U.S. partner with fast food establishments serving “food” inside the hospital building. Even though these large culinary teams with over 600 registered dietitians strive for menus that are appealing, while meeting dietary needs, the large corporations and fast food establishments fail to provide nourishing meals for recovering patients.

Budget plays a significant role for every plate served; hence their partnerships with corporations who provide price cuts. Notoriously, hospitals have struggled to serve healthy, nourishing food due to their limited budgets. They are simply underequipped with the resources needed to provide nutritive foods. Healthcare dietitians want to feed patients meals with sustenance, but struggle to do so because of the limitations on available funds, as well as increased yearly costs. The distribution of allocated money is a large obstacle.

From “How hospital food budgets affect patients”:

“Budgets and how they are administered are among the biggest barriers to scratch-made, wholesome food versus the pre-packaged, reheated food a lot of hospitals serve today. Carson outlines the following example: the foodservice operating budgets in most health-care institutions are 70 per cent salaries and benefits, and 30 per cent supplies, including food. 

‘"Too often when it comes to finding efficiencies, foodservice managers will avoid the 70 per cent and focus on the 30 per cent. As managers, we need to address and manage the 70 per cent more effectively to make significant financial improvements to our bottom lines and leave the 30 per cent alone,"’ Carson says. That’s because any support service not directly related to patient care will likely get hit first. Apart from housekeeping and laundry, this includes food services.”

A plate full of food additives

Junk Food: Easy, Quick, and Laden With Chemicals

With a large number of hospitals utilizing fast food chains to feed their populations, food depleted of nutrients and heavy in additives have become the norm. From AMA Journal of Ethics, “The Ethics of Hospital Cafeteria Food”:

“A recent study in California’s children’s hospitals rated hospital cafeterias on a healthiness scale from 0 to 37, where 0 was least healthy and 37 was the healthiest possible. The average score for California was 19.” A hospital serving fried, fatty food (typically trans “bad” fats) to patients is not uncommon for a number of hospitals in the U.S.

Fast food restaurants are located under the same roofs as surgical units, diagnostic services, blood labs, and trauma centers, and cater to employees and guests. In addition, it’s not uncommon for those visiting loved ones to purchase fast food meals for their relatives and friends who are patients in the hospital. Chick-fil-A is established across the U.S. in the following health facilities: Duke University Hospital Complex in Durham, North Carolina; the University of Alabama Birmingham Hospital; Grady Memorial Hospital in Atlanta; Texas Children's Hospital in Houston, and the University of Mississippi Medical Center in Jackson, Mississippi. 

McDonald’s is in the Naval Medical Center San Diego, Tampa General Hospital in Florida, Northside Hospital in Atlanta, and Texas Children’s Hospital in Houston. And Wendy’s is located in DMC Harper University Hospital in Detroit, Ohio State University Wexner Medical Center in Columbus, and Virginia Commonwealth University Medical Center in Richmond. 

Thankfully, some hospitals are aware of the need for healthier food options, and have closed down McDonald’s in their facilities. Included are Children’s Hospital Los Angeles (2015), Children’s Hospital of Georgia in Augusta (2021), Driscoll Children’s Hospital in Corpus Christi (2015), and Riley Hospital for Children in Indianapolis (2013). From 2012 “Advocacy group asks children's hospitals to remove McDonald's”:

‘"Kids are being treated for diet-related conditions like diabetes on one floor in the hospital and given the wrong message by being offered the world's most recognized junk food brand on another floor in the hospital," said Dr. Francine Kaufman, former president of the American Diabetes Association and professor emeritus of pediatrics and communications at Children's Hospital Los Angeles, one of the hospitals with a McDonald's. "The practice earns McDonald's an undeserved association with healthfulness among parents and children alike...and it should be curtailed."’

Serving junk food in hospital cafeterias sends an opposing message to patients, staff, and guests. Wholesome, healing foods play a role in helping to sustain your immune system, and if that isn’t achieved, recovery can be difficult. According to Excel-Media, addressing meals at hospitals:

“Most [hospital] meals contain processed meat, artificial sweeteners and sweetened drinks. Some of these foods have been linked to cancer. Foods containing these ingredients can make you more vulnerable to infection, delay or even prevent your recovery.” 

And what about hospital food in Europe? You might think it’s got to be better. After all, the European Union (EU) is known for having higher food standards and robust regulations on varying food additives and chemicals. However, this is not always the case. 

The European Society for Clinical Nutrition and Metabolism (ESPEN) aims to provide evidence-based recommendations regarding the diets needed in places such as hospitals “to improve the prescription of hospital diets,” so that patient healing is significantly fast and long-term. But regarding guidelines on hospital nutrition, they had this to say:

“Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status.”

To further the ESPEN mission, the Czech Republic has set a standard in creating a principle-based document in hopes to help their hospitals organize nutritional care in line with the ESPEN. This is to provide an overview of nutritious hospital meal plans that align with common nutrition guidelines for a healthy population.

Of equal importance are patients who are unable to chew or swallow food, and are fed through feeding tubes. Many ingredients in these formulas are subpar, such as corn syrup solids, fructose, corn-derived (GMO) maltodextrin, soy protein isolate, and carrageenan, and pose known health risks. Since these meals are liquid, they are predigested, similar to a blended drink or smoothie. The broken fiber walls speed up the digestion process, so the synthetic substances make a straight shot into your bloodstream. 

Liquid Hope was developed by Functional Formularies, as the first “shelf-stable, organic, whole foods feeding tube formula and oral meal replacement” for adults. Chef Robin Gentry McGee created the formula after her father needed to be on a feeding tube, and there were no organic, nutritious options. She produced the formula that helped her father’s lungs clear. She then went on to formulate Nourish, a pediatric whole food formula that is used either parenterally (outside the intestine) or as a meal replacement. The formulas, shelf-stable for up to two years, are ready-to-use and can be paired with a variety of pump systems.

Forward Thinking

Fortunately, hospitals are taking initiatives to increase healthier meal plan options. For instance, beginning May 2013, Indiana University Health, following guidelines established by the Partnership for a Healthier America, removed all sugar-sweetened beverages from cafeterias, vending machines, and gift shops at two of their hospitals. They also pledged to remove all deep-fat fryers from their health facilities.

Center of Science in the Public Interest (CSPI) retains a list of hospitals that enforce healthy policies. Included was the University of Michigan Health System who implemented a healthier beverage program, removing sugar-sweetened beverages from coffee kiosks, cafeterias, and vending machines. They implemented the same for inpatient dining at hospitals, as well as health centers, administrative buildings, and medical schools. They also adopted nutrition guidelines specifically for patients with heart disease. 

Under the new regulation, beverages must not contain added sugars, additives, or dyes. Milk and milk alternatives must be nonfat or low-fat (regrettably perpetuating the fat myth based on outdated, faulty research from the 1950s), and a healthy source of calcium. [In this case, it should be noted it would be in patients’ best interest to consume healthy fats—organic, whole, raw, and grass-fed/finished.] 

Nutrient minimums were also enforced on calories, added sugars, sodium, and trans fats in foods including baked goods, breads, cereals, bars, chips and pre-packed snacks, fruits, main and side dishes, animal and plant-based proteins, salad dressings, condiments, soups, and vegetables. 

Gradually, hospitals throughout the country are starting to utilize locally-grown fruits and vegetables. Susan Levin, registered dietitian with the Physicians Committee for Responsible Medicine stated:

“Hospitals are also increasingly providing a la carte menu options – so if you’re vegetarian, or even vegan, you’re not just going to just get a peanut butter and jelly sandwich.” 

Approximately ten percent of all hospitals nationwide, from giant Kaiser Permanente, to smaller systems such as El Camino Hospital in Silicon Valley, CA, have committed to healthier food standards. Partnership for a Healthier America believes the food served in healthcare institutions should have a positive impact on your body: 

“The Hospital Healthier Food Initiative ensures that hospital patients, their families and all the people who care for them have healthful meal options that meet high standards for nutrition, labeling, marketing and food preparation.” 

At Stanford Hospital, colorectal surgeon Cindy Kin, M.D., ran prehabilitation studies in which patients participated in a three-week program of exercise, and decreased refined sugars before undergoing surgery. They found that by eating whole foods and moving their bodies, they had more energy and felt significantly better. 

Interestingly, they moved protein options to the end of the line in the buffets. While the intention was to have patients fill their plates with vegetables and whole grains first, this begs the question: “fat myth again, or financial priorities?” Arguably, grains and veggies cost a lot less than high-quality proteins. While there is no one-size-fits-all approach to nutrition, there is plenty of research confirming the importance of consuming high-quality proteins for healthy musculature and steady metabolism.

From Nutrition and Metabolism, “A high-protein diet for reducing body fat: mechanisms and possible caveats”: 

“The authors conclude that subjects in the high-protein group had beneficial effects on total cholesterol and triacylglycerol and achieved greater weight loss and better lipid results.”

Two leaders at Stanford Health Care who are committed to the transformation of hospital food services, Jodi Krefetz and Helen Wirth, have to consider costs. Nonetheless, they are passionate about making hospital food tasty and healthy at the same time. This is a challenge when cooking approximately 2,000 meals for patients per day (accounting for specialized diets), and providing food for employees and visitors. 

A rarity for hospitals indeed, they created a house-made smoothie and soup as whole foods alternatives. These are a far cry from supplements such as Ensure, which is highly-processed with corn syrup, corn (GMO) maltodextrin, and a list of additives too long to list.

The women note: From Stanford Medicine, “Rethinking hospital diets: personalized, healthy, real food”:

“It's been a fun journey, considering opinions from surgeons, from patients, from dieticians and from the people in the kitchen, who are making it happen. I don't know if that's been done before -- to have clinicians and dieticians come into the kitchen to test products.”

The American College of Lifestyle Medicine is trying to bring in healthy, enticing meals. When Northwell Health, New York State’s largest health care provider learned that patients were reporting their food as inedible—stale and overly-processed—they knew changing the food program across 21 hospitals serving more than 10 million meals a year would be difficult but necessary. 

Fortunately, there are initiatives in place to provide healthy and nutritious foods to hospitals. According to Georgie Hursts’ Food Tank article on bringing better food to hospitals: 

“The cost of procuring healthy, locally-sourced and sustainably-grown foods is often the greatest barrier for hospitals with limited budgets. But leaders across the healthcare system are pushing for reform in the quality and procurement of hospital foods, and finding innovative ways to make these foods more accessible.” 

Community Alliance with Family Farmers (CAFF) works on building sustainable food and farming systems in California. Through advocacy and programming they seek to help schools, hospitals, and universities throughout the state provide local food to consumers. Healthy Food in Health Care (HFHC) is helping more than 1,000 hospitals across North America to market an environmental nutrition framework. Hospitals can also sign the HFHC Pledge to demonstrate their own commitment to food sustainability, and promote healthy foods as preventative medicine.

At the 2023 Annual Recognition Meeting, 50 hospitals within 26 counties in Pennsylvania were recognized for their participation in the Good Food, Healthy Hospitals program. Hospitals in Pennsylvania served as leaders in their communities by providing balanced and locally-sourced meals to their patients, visitors and staff. The initiative, administered by The Hospital Healthsystem Association of Pennsylvania (HAP), is aimed at improving the health of communities through better nutrition.

Be Prepared

Number one: Do your best to stay out of hospitals. Granted … At times it simply may not be avoidable. Whether you have a hospital stay scheduled, or you land there unexpectedly, you can get prepared now. Get your point person lined up. Think of them as your assistant or advocate. This lovely  person is going to bring you your meals.

That’s right, you are allowed to eat your own food while being cared for. In most cases, you’ll need to check with the nurse on duty for any dietary restrictions listed on your chart by your doctor. Beyond that you are good to go. Do you prefer organic, colorful salads, avocado on sourdough with a pinch of sea salt, garlic, and fresh basil? How about grass-fed ribeyes, wild Alaskan salmon, sweet potatoes with real butter, and San Pellegrino sparkling water with lime? … 

The choices are yours. Your meals can also be brought to you by delivery services such as Uber Eats, DoorDash, GrubHub, Postmates, and Instacart. Make sure if you or your point person orders from restaurants, to choose the healthiest options. Otherwise, it defeats the purpose altogether.

Written by Jillian Levy, CHHC, for Dr. Axe, “The Truth About Hospital Food, Plus What to Eat at the Hospital”:

“Your best bet when it comes to making sure your family members staying in the hospital eat well? Take initiative and bring healthy food in for them! Relying on the hospital to provide all meals and snacks to patients for several days could spell disaster: salt, hidden sugar, refined vegetable oils, additives, preservatives, food colorings, farm-raised animal products and chemical flavoring are found in far too many hospital meals.”

Make requests: As a patient, you have the right to request the types of food that are most aligned with your dietary preferences, health goals, and ethical values. That’s not to say the hospital kitchen will always provide what you’re seeking, but you’ll never know if you don’t ask. Having nourishing foods to help you recover, boost your immune system, and sustain your time in the hospital is necessary under all circumstances.

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