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Food served in children's hospitals rated largely unhealthy

Given the obesity epidemic among the nation's young, one would 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 Academic Pediatrics.

Researchers from UCLA and the RAND Corporation assessed 14 food venues at the state's 12 major children's hospitals and found there was a lot of 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, primary investigator and a physician in the Robert Wood Johnson Foundation Clinical Scholars Program in the Department of Family Medicine, 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 Scale for Restaurants (NEMS-R) as an assessment tool for rating the food offerings in hospital cafeterias. This measurement system takes into account pricing, availability of vegetables, nutrition labeling, combo promotions and healthy beverages.

Overall the average score for the 14 hospital food venues was 19.1, out of a range of 0 (least healthy) to 37 (most healthy). Of the total 359 entrees the hospitals served, only 7 percent were classified as healthy according to the NEMS criteria. And while nearly all the hospitals offered healthy alternatives such as fruit, less than one third had nutrition information at the point of sale or signs to promote healthy eating.

Among the other key findings:

All 14 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 has 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 either 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; shrink the amount of low-nutrient choices, and utilize low-cost options to promote healthy eating such as signage 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 & 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; Children's Center at Sutter Medical Center, Sacramento.

The Robert Wood Johnson Foundation funded this study. In addition to Lesser, researchers on this study were Dana E. Hunnes, Phedellee Reyes, Robert H. Brook and Lenore Arab of UCLA; and Gery W. Ryan and Deborah A. Cohen of the RAND Corporation.

The research findings presented here are those of the researcher and are not necessarily the views of the Robert Wood Johnson Foundation.

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.

The Robert Wood Johnson Foundation Clinical Scholars® program has fostered the development of physicians who are 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 this program, future leaders learn to conduct innovative research and to work with communities, organizations, practitioners and policy-makers on issues important to the health and well-being of all Americans. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decision-making through research and analysis.

Enrique Rivero | EurekAlert!
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