Columbia hospitals move toward healthier foods in cafeterias

Wednesday, July 13, 2011 | 7:14 p.m. CDT; updated 5:27 p.m. CDT, Tuesday, July 19, 2011
Intended to offer healthy food options, Essentials in University Hospital opened in the summer of 2010. New to University Hospital dining services, Essentials includes nutritional information on its menu items.

COLUMBIA – Biscuits and gravy and Kellogg's Corn Pops cereal. 

That's what Danny Decker chooses for breakfast at University Hospital's cafeteria, The Grille Downstairs. Decker, a pastor from Warsaw, Mo., visits the hospital often to be with church members having surgery.

Hospitals serving up change

Truman Veterans Hospital Canteen Service has made available:

  • Calorie information for foods at the hospital

  • Calorie, fat and carbohydrate information for the foods of the week online for employees

  • Pocket-sized nutritional booklets for general use

In the fall, the VA Hospital's Canteen Services will get new cash registers that will print calorie, fat and carbohydrate content of each food on receipts. 

Boone Hospital Center offers:

  • Nutritional information on both permanent and counter menus
  • Educational presentations and free medical screenings for employees
  • A 15 percent discount on nine healthy entrees

MU Health Care plans to provide nutritional listings in all hospital dining locations, spokesman Matt Splett said. For now, it offers:

  • Nutritional listings on counter menus in University Hospital's Essentials Cafe, but not in The Grille Downstairs
  • Educational and wellness programs to encourage healthy eating

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Rachel Figard and Cecilia Botero try to eat healthy options. Figard, a nurse with MU Healthcare, eats a lot of salad. Botero, a pharmacist for MU Health Care, gets the Southwest chicken with carrots and mashed potatoes.

Both say that working in a hospital has made them more conscious of what they eat.

"We become very sensitive to eating healthy," Botero said. "I try and stay away from unhealthy things."

It's an idea hospitals in Columbia want to instill in their workers and patients.

A 2008 study surveyed 760 nurses across the country and found “almost 54 percent were overweight or obese,” according to the May volume of the Journal of the American Academy of Nurse Practitioners.

Though healthcare workers are key to educating patients on healthy living, the authors wrote, “anecdotal observation suggests that nurses, advanced practice nurses and nurse educators may exhibit a higher incidence of obesity than the general population.”

The authors continued, “As obesity becomes an alarming health problem nationwide, diet, exercise and weight management become increasing priorities for all healthcare providers.”

Jon Larson, director of nutrition and food services at Boone Hospital Center, said he believes people are willing to choose healthier foods.

"They have it in their demeanor – they want to try and eat healthy, and the hospital is going to do the things that they can do to help," he said.

The hospital decided to emphasize healthy foods and educate employees and the public after hospital dietitians began seeing more overweight people in their outpatient weight reduction clinics.

"If we are going to be the nutritional experts, we need to start doing this in our own facility," he said.

Changes began soon after, among them educational programs for employees, offering nutritional listings on menus and subsidizing certain healthy entrees. Other area hospitals have been doing the same, focusing on educating employees and others on the benefits of healthy living and providing healthy food options in their cafeterias.

Despite hospitals' commitment to healthy living, employees and visitors like Decker may be tempted into less healthy options by the generally lower pricing of less healthy foods.

Figard said prices may affect the choices people make at the cafeteria. She said her decision to buy healthier foods sometimes comes down to whether she has "extra cash."

Decker said cost has no impact on his decision.

"I know what I want," he said: sugary cereals and biscuits with gravy.

Healthy foods cost more

Adam Drewnowski, the director of the Center for Public Health Nutrition and professor of Epidemiology and Medicine at the University of Washington in Seattle, has studied the correlation between poverty and obesity. He found that diets composed of things like "fast foods, snacks, caloric beverages, sweets and desserts" are more affordable than diets based on lean meats, fish, fresh fruits and vegetables.

That reality is reflected in the prices on lunch menus at The Grille Downstairs in University Hospital.

At the salad bar, customers can pay $4.80 for a pound of salad. At the grill line a few feet over, a cheeseburger costs $1.90. 

Matt Splett, a spokesman for MU Health Care, said that several factors are taken into consideration in the pricing of food. He said that labor — paying workers to prepare and serve food — and the cost of ingredients have an impact. 

Larson agreed that cost can be a factor when it comes to healthy foods. He said a few of the healthier foods the hospital serves are more expensive and that the increased price has caused customers to shy away from buying them. The list includes salmon, stuffed sole, turkey and black bean burgers, among others.

"People pick their lunch in the cafeteria based on cost," he said. "That restricted some people's ability to buy them – because of that high cost."

The hospital has tried to change this by subsidizing nine healthy entrees with a 15 percent discount. The discount has made choicessuch as a 4-ounce portion of salmon more affordable, he said.

The response has been good, and sales of these entrees has increased, he said.   

The Veterans Canteen Service, the division of the Veterans Administration responsible for food service nationwide in hospital cafeterias, has a similar program to make healthy food more affordable. The program offers healthy meals that are priced for the volunteers that work at the hospitals. They're called "Smart Choice" meals.

"So it's a healthy meal, but it's also priced well so that volunteers at our hospital, caregivers, can get a meal at a good price," said Stacy Papachrisanthou, marketing operations specialist for the Canteen Service's Central Office.

But prices and portions may still favor unhealthy eating. A hamburger, for instance, costs $2.69, while a 12-ounce salad costs $4.68.

Customers who do purchase healthy foods may also have smaller portions.

"If you're talking about a mini salad compared to a cheeseburger," Papachrisanthou said, "the prices are comparable." 

A larger salad, she said, would cost more.

The same goes for some healthier foods at Boone Hospital Center. Some of the hospital's new healthier snack options "come in a smaller package because the healthy items do cost more," Larson said. 

He doesn't feel that this phenomenon is exclusive to hospitals though and said the food market often dictates higher prices for things that are "fresh."

"It's a sure thing in any food venue – there are things you are going to have to pay money for," Larson said. "It's a difference in quality."

Some customers are willing to pay for that quality, though. Employees have taken to healthy changes on the menu at University Hospital, Splett said. Sales at the upstairs restaurant, Essentials, rose 10 percent after a renovation last year brought healthier foods and extended hours.

Essentials opens every day from 6:30 a.m. to 8 p.m. and another shift was added a year ago from midnight to 2 a.m., providing balanced meals to night shift workers who, before, had limited options.

“Our overnight hours have been a huge success simply because there was no restaurant service available prior to our opening of Essentials," Splett said.

MU Health Care's Becky Hassinger, manager of dining and nutrition services, intends to renovate the 404 Diner at the MU Women's and Children's Hospital next fall.

Some customers still opt for junk food

When Larson first implemented a healthy eating program at Boone Hospital Center's cafeteria in 1990, workers complained. 

"At first, employees hated it," he said. "They thought it restricted their choices."

The program, which he called "Good Hearted Cuisine", was multi-dimensional but had an emphasis on providing healthy foods and recipes to customers. Over two decades later, he is confident that this perception among workers has been "turned on its head."

"We take criticism now if we don't have a good, heart-healthy selection at the cafeteria from employees," he said.  

While customers may look forward to these specials, they do sometimes want less healthy foods.

Fried chicken is still the hospital's best-selling entree. When it is served once every month, the kitchen will go through anywhere from 400 to 500 servings in a day, Larson said.

And people still want cheeseburgers and soda, Larson said. The latter is in such high demand and the hospital has to provide it, though Larson said he drew the line at providing cups larger than 16 ounces. The hospital also does not sell bottled soda in its cafeteria, he said.   

Richard Sheff, the principal marketing consultant to the canteen services, is familiar with the conflict between healthy choices and customer preference.

"When the tire hits the road, there are times where customers are going to say, 'You know, I really want a hamburger' – and they're just going to buy one," he said.

On a national level, he said hamburgers were still one of the top sellers at VA hospitals.

And while many customers may prefer the taste of less healthy foods, Sheff stresses the need to provide healthy options. 

"It's important, and there's an obligation for health institutions to have these options and make them available," he said.

Larson echoed this sentiment, saying it was a hospital's responsibility to provide nutritional entrees and education to employees and the public.

"We're a hospital food service – our business is health," Sheff said. 

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Harold Sutton July 14, 2011 | 6:45 a.m.

Hey! A hamburger can be somewhat healthy especially if the salad type fixings that come with it are generous.

(Report Comment)
Mark Foecking July 14, 2011 | 7:52 a.m.

Acttually virtually all foods are "healthy" if enjoyed in proper moderation. Te main reason we're all busting our belts is the portion sizes of calorie dense foods.

Exercise (and a good bit of it) is the single biggest factor in overall health. Even people who are obese can enjoy good cardiovascular and endocrine health if they exercise enough.


(Report Comment)
Gregg Bush July 14, 2011 | 2:57 p.m.

"Acttually virtually all foods are "healthy" if enjoyed in proper moderation. Te main reason we're all busting our belts is the portion sizes of calorie dense foods."

Your "portion size" argument is simplistically inaccurate. Portion sizes get bigger because when there's no nutrition in our food, we still crave. Many foodstuffs are unhealthy - our grocery stores are filled with them. Even a little bit of poison is still poison. The real measure of healthfullness of foods is the nutirent to calorie ratio. Consuming high nutrient density, low calorie density foods at a moderate pace leads to satiety. It is a rare disorder that causes a body to ignore satiety cues.
Couple consumption of nutrient-less calories to satisfy "mouth hunger" with sedentary activities, you get an explosion of type 2 DM.
I'm proud to see our hospitals taking more interest in the health of their workers, visitors, and customers. Just like the airline attendents remind us, place your own oxygen mask before assisting others.

To shift gears, I read these and thought of you - interested in hearing your thoughts.

(Report Comment)
Michael Williams July 14, 2011 | 3:24 p.m.

Gregg says, "Even a little bit of poison is still poison."

I'm going to nitpick just a little bit and say, "Be careful of that particular statement."

There is now abundant evidence from the toxicology world that, in some cases, a little bit of poison is actually healthy. Let's take a couple of common examples....UV radiation IS a "poison", but a little bit of exposure causes tanning which protects against UV radiation. Lifting weights causes detrimental breakdown of muscle fibers, yet the body responds by making even more muscle. You get an injection against a disease, in some cases an attentuated live virus, and gain lifetime protection from that disease. And, there is good evidence that certain toxins, including man-made chemicals, actually stimulate your liver P-450 detoxification enzymes and give you protection against higher doses.

You also need to understand that ALL organisms in nature have defenses. Some have teeth or thorns, some can run, some can fight, some can hide, some taste bad, and most plants have chemicals (alkaloids come to mind) that are sequestered in their vacuoles just waiting for some animal to crunch down on the leaves, releasing those toxins.

INO, if you are eating plant food, you are ingesting toxins.


I understand the above arguments are a bit off-topic re: nutrition. But it's important you understand that the definition of "poison" MUST have some identification of "dose" for the word "poison" to have applicability.

(PS: For the toxicologically-inclined, the structure of dose response curves of % harmed versus dose has been the subject of debate for years, especially near the zero dose/zero effect graph origin. That is, does the curve intersect zero (meaning even 1 molecule can have a toxic effect), or does it intersect the y-axis at a positive Y value (meaning there are some negative effects observed even in the absence of a toxin)? Or, does the curve intersect the X axis at a positive dose value, which means you can get "some" dose without a negative effect...that is, a threshold above which you get a negative effect. For the latter case, there are some large studies that indicate that a very low dose near zero actually has a beneficial effect by activating the body's defenses. It is only when that dose threshold is exceeded that negative effects are observed.)

(Report Comment)
Gregg Bush July 14, 2011 | 8:37 p.m.

"There is now abundant evidence from the toxicology world that, in some cases, a little bit of poison is actually healthy."

So what's the optimum amount of mercury in the body? How about benzene or DDT? Or is it like being a "little bit pregnant" or having "just a touch of rabies"?

Nitpick all you want, sure cyanide is a product of some body reactions, and people can vomit from too much chocolate.

You and I both know that UV assists in generation of Vitamin D, but UV radiation is not food.

"But it's important you understand that the definition of "poison" MUST have some identification of "dose" for the word "poison" to have applicability." And when I talk to Poison Control - they always ask the amount ingested.

But, I'm not convinced that it has anything to do with "virtually all food is healthy in moderation."

(Report Comment)
Michael Williams July 14, 2011 | 10:49 p.m.

Gregg: You said even a little bit of poison is still poison.

I simply wanted you to understand that your statement is not quite correct and that you need to be careful using it if you want to be taken seriously among those who know better. In its current form, it sounds like a "sound bite" without meaning. You end up looking like someone regurgitating internet nonsense.

And your use of the word "optimum" has nothing to do with the discussion. The words "toxicologically insignificant" ARE appropriate. How much mercury, benzene, and DDT are toxicologically insignificant? Well, I'd have to look them up, but there are generally accepted numbers because YOUR body has the ability to detoxify and eliminate (safely, I might add) each and every one of your certain concentrations.

Whether you believe it or not.

PS: And, yes, virtually all food is healthy in moderation...for many of the reasons I've listed above. Your body is an amazing organism, especially your liver, and it's been detoxifying stuff in food for you and your ancestors for 10s of thousands of years.

Quit listening to internet crap, grab a good UMC tox book, and learn something on your own....

PSS: If you are worried about eating toxins, don't eat peanut butter, corn, or rhubarb that's not quite cooked.

(Report Comment)
Gregg Bush July 15, 2011 | 6:22 a.m.

I recognize your memo from the Distracting Condescention Bureau of the Department of Redundancy Department.

(Report Comment)
Mark Foecking July 15, 2011 | 6:29 a.m.

Gregg Bush wrote:

"Portion sizes get bigger because when there's no nutrition in our food, we still crave."

We're evolutionarily programmed to crave fat and sugar because they're calorie dense, and give the body a lot of energy. Whether the fat or sugar is associated with other nutrients is purely a function of where it comes from. Sure, there are better fats and sugars than others, but all of them (in moderation, again) can give the body energy that would require a lot more food to get from other sources.

I become more vegetarian at this time of year because of my gardens and the farmer's market. I find I have to eat a very large amount of vegetables (often) to get sated, where if I eat a winter diet of, say, a bowl of oatmeal with nuts, brown sugar and milk, and later a 6 oz piece of sausage (venison or pork), bread, greens of some sort and a canned vegetable or two, I feel more sated longer. For me, the calorie dense foods "stick to my ribs" better and with about the same amount of calories.

The fact that a bunch of people eat empty calories (because they taste good) doesn't mean the calories (or anything else) are necessarily harmful in smaller amounts. Ther overwhelming risk of disease from food is microbiological, not chemical.


(Report Comment)
Mark Foecking July 15, 2011 | 6:31 a.m.

(from above)

Michael Williams wrote:

"There is now abundant evidence from the toxicology world that, in some cases, a little bit of poison is actually healthy."

The proper name for that is "hormesis", and it's also been observed with alcohol and ionizing radiation. The body has a lot of protective mechanisms that can be regulated depending on the level of a stressor.

When you talk about very low doses of harmful substances, it becomes very difficult to statistically define a level of "no risk".

Say someone studies a group of a million people for evidence that X pesticide causes Y condition, and finds a twofold increase in condition Y at some level of pesticide X. That is often reported by the media that pesticide X doubles the risk of condition Y, and people freak out. The critical piece of perspective that's often missing is how common condition Y is in the first place. If there's only a million to 1 chance of developing condition Y in the absence of pesticide X, than I haven't increased my absolute risk very much even if it's 2 in a million. Two times next to nothing is still next to nothing.

And there may be real benefits (increased availability of a desirable food, lower price, higher quality) that might make the use of pesticide X rational even if it carries some risk (everything does, BTW).

Here's a paper by a respected scientist in the area of mutagenesis (he developed a bacterial test for mutagenesis that bears his name) in which he argues that the tests we use to determine carcinogenicity are inappropriate for the conditions that humans are usually exposed, and we have unnecessarily banned useful chemicals because of a vastly overestimated risk:


(Report Comment)
Mark Foecking July 15, 2011 | 6:51 a.m.

Gregg, as far as the solar articles:

I've observed solar module prices going down also. I could have saved about $3,000 on my installation if I had installed it today. I'm not sure how much that will help us replace fossil fuels or meet climate targets, because manufacturing capacity is still very limited with respect to the amount of solar we need. Moreover, any large increase in demand for panels (Germany may drive this in their push for renewables) will push the price up.

Grid parity, really, is a very complicated thing to determine. One cannot compare solar or wind to coal or nuclear without accounting for the lack of dispatchability of the former, and that's a more critical deficiency than a lot of people realize. Sure, wind and solar can complement each other to some extent, but there are times they can't, so a fairly large amount of natural gas or hydro has to be maintained in reserve for those times. This has to be added to the costs of wind and solar, plus the increased number of transmission lines needed. Transmission lines for wind and solar are also more expensive per energy unit because they have to sized to carry maximum output, but rarely do.

Also, in order to store energy effectively using existing hydro facilities (as pumped hydro - to back up a nationwide grid of renewables), downstream reservoirs have to be built and pumps sited. The idea is to convert the nation's dams from producing 10% of electricity all the time, to producing 40 or 50% of it for a few hours a day. This will also require quadrupling (or more) generating capacity at these dams, which may not be practical for many of them.

The reason my system is dispatchable is I have a several day battery backup for clouds. If we had this situation on a national level WRT hydro, we wouldn't need wind and solar at all - we'd have enough hydro to power our country without it.

I still think we need nuclear in addition to as much wind and solar as we can install. We won't meet climate targets without it (and probably not even with it, but that's another discussion).


(Report Comment)
Michael Williams July 15, 2011 | 7:44 a.m.

Mark: The overwhelming risk of disease from food is microbiological, not chemical.

Me: I completely agree. Having worked in the ag chemical industry generating data for assignment of risk levels, I decided to worry one helluva lot more about whether my eggs and hamburgers were well-cooked. Pesticide and chemical residues seldom worry me; in fact, the main risks associated with pesticides are for those who (1) make it, (2) mix and apply it, and (3) do field reentry. It's a "quantity" thingie.

Mark: Two times next to nothing is still next to nothing.

Me: You're onna roll. Assessing what is going on very near the origin of a response versus dose curve is damned difficult simply because you need LOTS of sampling (N) in thousands or more likely millions.

Yes, I've heard Dr Ames lecture on this very topic. Very informative fellow.

In short, I agree with all your comments.

I had no idea you, too, were a card-carrying member of the Distracting Condescention Bureau of the Department of Redundancy Department. ;^)

(Report Comment)
Ellis Smith July 15, 2011 | 8:26 a.m.

"I still think we need nuclear in addition to as much wind and solar as we can install."

Agreed, but what we NEED at all times going forward is sufficient electrical generating capacity to meet demand - whatever the generation sources may be.

[What that needs to be anyone can find using a search engine and accessing current and projected requirements, which WILL CONTINUE TO INCREASE ANNUALLY.]

I agree that if we can meet the rising demand without sources that create carbon dioxide, so much the better (but don't hold your breath in the short term).

I realize what I am about to say I have said before, but I've experienced what it's like to work and live in a situation of serious and repeated electrical blackouts. The personal frustrations, technical problems and economic consequences are ugly.

(Report Comment)

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