Given the obesity epidemic among the nation's young, one might hope that children's hospitals would serve as a role model for healthy eating. But hospitals in California fall short, with only 7 percent of entrees classified as "healthy," according to a new study published in the journal Academic Pediatrics.
Researchers from UCLA and the RAND Corp. assessed 16 food venues at the state's 14 major children's hospitals and found much room for improvement in their offerings and practices.
"As health professionals, we understand the connection between healthy eating and good health, and our hospitals should be role models in this regard," said Dr. Lenard Lesser, the primary investigator on the study and a physician in the Robert Wood Johnson Foundation Clinical Scholars Program in the department of family medicine at the David Geffen School of Medicine at UCLA. "Unfortunately, the food in many hospitals is no better -- and in some cases worse -- than what you would find in a fast food restaurant."
The study authors developed a modified version of the Nutrition Environment Measures Study for restaurants (NEMS-R) as an assessment tool for rating the food offerings in hospital cafeterias. This measurement system takes into account pricing, the availability of vegetables, nutrition labeling, combination promotions and healthy beverages.
Overall, the average score for the 16 hospital food venues was 19.1 -- on a scale of 0 (least healthy) to 37 (most healthy). Of the total 384 entrees and sandwiches the hospitals served, only 7 percent were classified as healthy according to the NEMS-R criteria. And while nearly all the hospitals offered healthy alternatives such as fruit, less than one-third had nutritional information at the point of sale or signs to promote healthy eating.
Other key findings included:
- All 16 food venues offered low-fat or skim milk and diet soda.
- 81 percent offered high-calorie, high-sugar items such as cookies and ice cream near the cash register.
- 25 percent sold whole wheat bread.
- Half the hospitals did not provide any indication that they carried healthy entrees.
- 44 percent did not have low-calorie salad dressings.
Since no one had previously documented the health of food in these hospitals, researchers provided hospital administrators with their scores to encourage improvement. Since the study was conducted, in July 2010, some of the hospitals surveyed have taken steps to improve their fare and/or reduce unhealthy offerings. For example, some have eliminated fried food, lowered the price of salads and increased the price of sugary beverages or eliminated them altogether from their cafeterias.
"The steps some hospitals are already taking to improve nutrition and reduce junk food are encouraging," Lesser said. "We plan to make this nutritional quality measurement tool available to hospitals around the country to help them assess and improve their food offerings."
Researchers said hospitals can improve the health of their food offerings by providing more fruits, vegetables, whole grains and smaller portions; shrinking the amount of low-nutrient choices; utilizing low-cost options, such as signage, to promote healthy eating; and keeping unhealthy "impulse" items away from the checkout stand.
"If we can't improve the food environment in our hospitals, how do we expect to improve the health of food in our community?" Lesser said. "By serving as role models for healthy eating, we can make a small step toward helping children prevent the onset of dietary-related chronic diseases."
Hospitals the researchers surveyed were: Children's Hospital Central California; Children's Hospital Los Angeles; Children's Hospital of Orange County; Children's Hospital and Research Center at Oakland; Loma Linda University Children's Hospital; Lucile Salter Packard Children's Hospital at Stanford; Miller Children's Hospital; Rady Children's Hospital-San Diego; Mattel Children's Hospital UCLA; University Children's Hospital at University of California, Irvine; University of California, Davis Children's Hospital; University of California, San Diego Children's Hospital; University of California, San Francisco Children's Hospital; and Children's Center at Sutter Medical Center, Sacramento.
The Robert Wood Johnson Foundation funded this study. In addition to Lesser, researchers were Dana E. Hunnes, Phedellee Reyes, Robert H. Brook and Lenore Arab, all of UCLA, and Gery W. Ryan and Deborah A. Cohen, of the RAND Corp.
The research findings presented here are those of the researchers and are not necessarily the views of the Robert Wood Johnson Foundation.
The RAND Corporation is a nonprofit institution that helps improve policy and decision-making through research and analysis.
The Robert Wood Johnson Foundation Clinical Scholars program has fostered the development of physicians who have been leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles for three decades. Through the program, future leaders learn to conduct innovative research and to work with communities, organizations, practitioners and policymakers on issues important to the health and well-being of all Americans.
The UCLA Department of Family Medicine provides comprehensive primary care to entire families, from newborns to seniors. The department also provides low-risk obstetrical services and prenatal and in-patient care at Santa Monica-UCLA Medical Center and Orthopedic Hospital and out-patient care at the Les Kelley Family Health Center in Santa Monica and the Mid-Valley Family Health Center, located in a Los Angeles County Health Center in Van Nuys, Calif. The department is also a leader in family medicine education, for both medical students and residents, and houses a significant research unit focusing on geriatric issues and health care disparities among immigrant families and minority communities in Los Angeles and California.
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