Abstract
BackgroundHospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served.Community ContextThe New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafés. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafés.MethodsHospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafés were evaluated at baseline and at the end of the HHFI to assess changes.OutcomeSixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15).InterpretationMost New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments.
Highlights
MethodsHospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff
Hospitals serve millions of meals and snacks each year; hospital food is often unhealthy
New York City (NYC) government has transformed the institutional food environment by improving the healthfulness of foods served in schools [3], limiting sugary drinks in childcare settings [4], and issuing mandatory standards for foods purchased and served by government agencies, including public hospitals [5]
Summary
The standards used in the HHFI include more than 60 criteria that aim to comprehensively improve the hospital food environment by addressing the nutritional quality of food and beverages purchased and served. Between baseline and end line, a substantial number of hospitals implemented the breakfast pastry and dessert standards (15 [54%] for each), removed unhealthy foods and beverages from the entrance and checkout of the cafeteria (18 [64%]), offered proportionally priced half-size sandwiches (17 [61%]), offered only soups that met the sodium limit (11 [39%]), and labeled all menu items with calories (11 [39%]). Using the standards provided by the health department, hospitals made substantial healthy improvements in their cafeterias, including labeling items with caloric information, reducing availability of sugary drinks, increasing whole grains in sandwiches and entrees, and reducing sodium. Few hospitals tracked nutrient content of foods purchased for the cafeteria or had nutrient analysis of the cafeteria menus at baseline, requiring an intensive investment of staff time and technical assistance from health department dietitians. The HHFI shows that hospitals are willing to partner with local government to voluntarily implement rigorous nutrition standards, which can lead to significant changes in hospital food environments
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