Should Hospitals Take the Lead in Changing our Food Environment?

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Last December, President Obama announced a historic climate accord between 195 nations. This accord represents the first time in world history where countries have united to defeat the danger posed by global warming. During his announcement, President Obama said, “We’ve shown that the world has both the will and the ability to take on this challenge.”

With so many delegates in agreement, this accord marks a moment in time when where activists and politicians have come together to shape the future of our ‘macro-environment.’

But, it is also important to consider our ‘micro-environment.’ By that I mean the smaller scale, more local environment we live in — our homes, workplaces, schools, shopping malls and stores, public facilities — and their effects on the way we and our families live our daily lives.

Dr. Thomas Farley, a pediatrician and former commissioner of health of New York City, wrote a New York Times piece where he underscored the importance of adult interventions in curbing the obesity epidemic. Dr. Farley noted that while childhood obesity rates are falling and research dollars continue to pour in, we still live in a society where seven out of ten adults are overweight and 80 % of obese adults were not obese as children. Is it possible that our food environment promotes adult obesity?

Food is everywhere. And processed, calorie-dense food is becoming even more visible and more abundant. Unhealthy food is available practically everywhere we turn, on our college campuses, in our neighborhoods and in the airports. Processed foods are simply unavoidable.

In addition, food is advertised continuously on TV, in grocery stores, on public transportation and even on your computer. The power of our food environment should not be under estimated. Our brains are constantly bombarded, consciously and subconsciously, by food stimuli — Would you like a donut with your coffee? Do you want bread with that? — When that happens, it is only natural that we purchase them, even if we are not really hungry or needing food.

If there is any food environment which should encourage healthy eating, it should be our hospitals. Hospitals should be a safe place, where health is encouraged and healthy food is available. Hospitals should set an example of healthy living and lifestyle to the community they serve.

As a medical student, I have been struck with how much food, especially the unhealthy kind, is available in the hospital and other clinical settings. Anyone who walks the hospital halls can see lines of vending machines filled with sugary calorie-dense foods, fast food restaurants hospital food courts,, or unhealthy options (burgers and fries) on their inpatient menu. Clearly, these hospitals are doing a disservice to their patients.

To fight the obesity epidemic in adults, Dr. Farley recommends our society to remove unhealthy food from our daily ‘micro-environment.’ What is our role as future physicians? We are beginning to understand that certain foods can lead to disease, but what is the best method of confronting these foods? If we eliminate certain foods, we risk facing a backlash from our hospital employees, doctors, nurses, technicians, and many others who keep the hospitals running, as well as alienating patients, and their families. How we can we deny hospital workers who are under enormous amounts of stress the foods they crave?

But at the same time, how can we, as physicians, justify providing them subpar nutrition? Not too long ago, we risked alienating hospital workers, patients and their families by banning cigarette smoking in hospitals. We recognized that cigarette smoking is unhealthy and a public health issue that contributes to serious cardiorespiratory disease, including lung cancer. Should we be thinking about unhealthy food and diet choices the same way, given our concerns regarding the morbidity and mortality associated with obesity, and diabetes?

The Centers for Disease Control has tremendous resources for hospital-wide initiatives, including a “ToolKit for Creating Healthy Hospital Environments,” where they provide resources on how to conduct environmental scans, educate patients on healthy eating, and work with colleagues to enact hospital wide change. Healthier Hospitals, an organization that seeks to shift hospitals towards a more sustainable business model by pledging to have healthier food, create less waste, purchase safer chemicals, and have engaged hospital leadership. Healthier Hospitals has engaged about 1,300 hospitals, which is a great start to creating healthier environments.

The hospital food environment will affect all of us for our entire careers. It’s likely that finding the right solution to this problem will take time, patience, and a lot of collaboration between administrators and clinical staff. But in order to deliver a coherent health message to the public, all hospitals should be on the same page.

When you are on call working an overnight shift, what sorts of foods do you want available? How will you shape your food environment?

Ethan Litman

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