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.
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
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.