Healthy Meals or Happy Meals at Hospitals?

By Ann Suk

Extensive evidence connects frequent fast food consumption to health concerns such as diabetes, metabolic syndrome, and cardiovascular disease. While healthier fast food options are sometimes available, many fast food meals contain no whole grains, no vegetables, and little fiber – not to mention they contain high levels of sugar, saturated fats, and sodium. With research linking sub-optimal diet to noncommunicable diseases, such as cardiovascular conditions and diabetes, proliferation of fast food is cause for concern.

At the same time, the US fast food industry spends billions of dollars a year on advertising, with much of it targeting children. All that investment has an impact, too; one study found that preschoolers preferred the taste of food if it came in McDonald’s packaging. Despite the children’s own affection for the golden arches, only about 3% of kids’ meals at eight common fast food chains meet children’s nutritional standards. Fast food is popular with adults as well; during 2013-2016, 36.6% of US adults had consumed fast food on a given day.

Fast food venues crop up in all sorts of places – but what about when they show up in hospitals? Is there an effect on patients and hospital staff, and what are the implications of having fast food for sale in a healthcare setting?

Recent research points to the impact of fast food in hospitals on the hospital food environment and patient food choices. In one study, researchers compared families’ attitudes about and purchases of fast food after pediatric outpatient visits at three children’s hospitals in Chicago: one with a McDonald’s on site, one with McDonald’s branding but no restaurant, and one with neither. They found that families surveyed at the hospital with the McDonald’s were four times more likely to have eaten McDonald’s food that day; they also rated the healthiness of McDonald’s food higher compared to survey participants at the hospitals with no McDonald’s. Another study assessed sixteen food-service venues (including not only fast food restaurants but hospital cafeterias as well) in California hospitals using the Nutrition Environment Measures Scale for Restaurants (NEMS). They identified 384 entrées across the venues; of these entrées, only 7% were categorized as healthy according to the NEMS scale – and half of the venues  offered no healthy entrées at all.

The proximity of fast food restaurants to hospitals impacts healthcare staff as well as patients. In a study of 3,132 registered nurses who worked at hospitals across five states, nearly two-thirds of the surveyed nurses reported eating fast food or snacks two or more times a week.

So are there any actions focused on improving the food environment in healthcare settings? In June 2017, the American Medical Association passed a Healthy Food Options in Hospitals resolution that focuses on the availability, accessibility, and affordability of healthy food options on hospital premises. The Physicians Committee for Responsible Medicine has an ongoing campaign to remove fast food restaurants from hospitals (check out their list of hospitals hosting fast food restaurants here), complete with a toolkit to support hospital employees in advocating for healthy food at their workplaces. According to Susan Levin, MS, RD, of the Physicians Committee, “For patients, visitors, and staff, greasy fast food should be replaced with tasty and affordable plant-based options that can prevent and even reverse diabetes, heart disease, and high blood pressure, among other benefits.” Last August a group of doctors held a protest at an Atlanta hospital to advocate for the closing of the on-site McDonald’s and to demand availability of affordable plant-based meals.

Though offering healthy affordable dining options in hospitals won’t resolve patients’ and healthcare workers’ food access challenges or prevent fast food industry advertising, at least hospitals can be more helpful in contributing to their patients’ nutritional health.


Peer edited by Ruixue Hou

Feedback from Tanvi Bagade and Deanna Wung

Image designed by Abrar Al-Shaer

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