In a recent MedPage Today blog, Dr. Rajasree Pai bemoans the miserable food served in hospital cafeterias, and the even more miserable eating habits of his colleagues.¹ Pai, Rajisree, MD. “Cafeteria Face Off: Google Vs. Hospitals.” 23 September 2014. MedPage Today. 24 September 2014. http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/47784?xid=nl_mpt_DHE_2014-09-24&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g643423d0r&userid=643423&email=hiyaguha%40gmail.com&mu_id=5775831&utm_term=Daily “In hospital cafeterias,” he writes, “overweight and obese staff stand in long lines for entrees like mac-n-cheese and chicken wings. White coats run away from the salad bar, fearful of outbreaks of enteroviral infections from unhygienic handling of raw food. They also skip meals daily or even more frequently, sustain themselves on chips and sodas from vending machines.”

Dr. Pai compares the hospital environment to that offered to employees of Google, where the cafeteria offers organic products as well as low-fat, low-carb, and high-fiber delicacies and where employees get loaner bicycles to maneuver around the company grounds and to ride to and from work.  “The paradox is shocking,” he concludes. “Other sectors can focus on health promotion, but the healthcare sector itself lags behind. Health promotion at work should be a necessity, and it should begin within the healthcare field.” Then again, how much of a surprise can this be? As Jon Barron has explained previously, Doctors Don’t Know Diets.

Certainly, if you’ve visited someone in the hospital and needed a meal while there, you know what the good doctor is talking about. Not only is the food served in the main cafeteria typically unhealthy, but some hospitals even have fast-food restaurants installed right on the premises. That’s right: you can eat a Big Mac with fries while visiting your relative who just had a stroke.² “Group Pushes To Oust McDonald’s From Hospital Lobbies.” CBS DFW. April 16, 2012. (Accessed 26 Sep 2014.) http://dfw.cbslocal.com/2012/04/16/group-pushes-to-oust-mcdonalds-from-hospital-lobbies/ Or, better yet, if your cardiac-afflicted relation craves some Kentucky fried, you can oblige without even stepping outside the hospital. (The same person who founded the Hospital Corporation of America, Jack Massey, also bought Kentucky Fried Chicken from Colonel Sanders in 1994 and owned one of the largest Wendy’s in the nation.)³ Wikipedia, http://en.wikipedia.org/wiki/Jack_C._Massey

Likewise, the food served to patients is notorious, and not just in the US. For example, an article in the Daily Mail Online featured disgusting photos of food from healthcare settings all over the UK.⁴ http://www.dailymail.co.uk/health/article-2740139/The-horror-hospital-food-Last-week-Mail-printed-shocking-images-hospital-dinners-Health-Secretary-Jeremy-Hunt-vowed-act-But-crisis-bigger-thinks.html

A national survey in Britain found that prisoners typically are “better nourished than hospital patients,” and that most hospital entrees reviewed contained more sodium than a Big Mac.⁵ Friedman, Lauren F. “Hospital Food Not Only Tastes Horrible but Actually is Horrible For You.” 19 December 2013. Business Insider. 24 September 2014. http://www.businessinsider.com/some-hospital-food-worse-than-mcdonalds-2013-12 Likewise, a Canadian study of three hospitals, published in JAMA, found that the meals reviewed exceeded the daily recommended sodium limit 100 percent of the time.

Back home, the Physicians Committee for Responsible Medicine (PCRM) surveyed 110 hospitals across the US in 2011 and then issued a report noting the hospitals with the least healthy food. At the bottom of the list, St. Luke’s Episcopal in Houston-which houses Texas Heart Institute and the Texas Children’s Hospital-offers four fast-food restaurants inside its facilities, as well as a fried chicken bar. At the Hospital of the Medical University of South Carolina, there are five fast-food joints, and country-fried steak is a staple on the cafeteria menu. The highly esteemed Duke University Hospital in Durham, North Carolina, also made the worst-of-the-worst list, with three fast-food restaurants on the premises.

Although most hospitals do not boast fast-food restaurants, the fare served may not be much better. It’s typical to find items like hotdogs, fries, and processed meats on offer at the cafeteria, with vegetables and fruits in short supply. Meanwhile, patients receive food that not only fails to support healing, but actually can worsen critical conditions. The PCRM report describes, for instance, an ICU heart unit at Cleveland Clinic in Florida serving fatty meat in a thick gravy to patients.

Specific data on food served at hospitals across the US is nearly impossible to come by. While governments in countries with socialized medicine monitor hospital food, as happens in Great Britain (not that it does any good, as noted above), the US hospitals are independent and largely private, meaning that each hospital sets its own food standards. No regulatory body tracks what’s on the menu, and other than for rare anecdotal reports such as the one completed by PCRM, it seems that nobody else does, either.  Questions like how many calories a typical hospital meal contains or how many hospitals give patients processed meats remain unanswered. Likewise, there’s no “Yelp” list rating hospital food.

Still, of late, there have been some serious initiatives to raise the standard of hospital meals. An organization called “Health Care Without Harm” drafted a pledge to encourage hospitals to move toward providing healthier food.⁶ “Healthy Food in Health Care.” http://noharm-uscanada.org/sites/default/files/documents-files/637/Healthy_Food_in_Health_Care.pdf Among the items on the pledge: increase fruits and vegetables on the menu while decreasing unhealthy fats, sugars, and refined items; source food from local farmers and producers; identify and adopt sustainable food procurement practices such as offering rGBH-free milk and fair-trade coffee. So far, an impressive 500 health-care organizations have signed the pledge.

Unfortunately, although the 500 hospitals that signed the healthy food pledge might have had good intentions, in reality, intentions don’t necessarily add up to good practices. For instance, Kaiser Permanente hospitals in the Western Regions are on the pledge list, but a recent visit to a Kaiser cafeteria shows that a “wise choice” meal includes two scoops of white rice and chicken smothered in a heavy sauce. Yes, French fries have been replaced with oven fries, “pop chips” have replaced potato chips, and granola bars sit alongside the regular cookie fare (if you consider granola bars “healthy”), but you can still buy high-cholesterol breakfast pastries in the morning and coffee comes standard with artificial creamer. Healthy choices include such items as artificially sweetened yogurts, and it’s nearly impossible to find anything vaguely healthy in the vending machines.

Likewise, New York City, so often ahead of the curve health-wise, has issued a Healthy Hospital Food Initiative. The initiative includes standards for cafeteria meals, patient meals, and onsite vending machines. More than half of the city’s hospitals have pledged to make efforts toward compliance, and some actually are making good on that promise. Montefiore Medical Center in the Bronx, for instance, has reduced sodium in meals, removed a popular “munchie bar” full of fried foods and replaced it with a vegetable bar, and restricted vending machine items to 200-calories tops.

But hospitals that promote healthy eating habits for staff and patients alike are still as rare as lottery winners. Until it becomes profitable for healthcare institutions to care about health enough to feed people food that’s good for them, that’s likely to remain the case. Here’s a cynical thought: while Google may have a vested interest in keeping its people vibrant so they can get the job done, hospitals need to keep people sick in order to stay in business. Just saying!