Issue link: https://viewer.e-digitaledition.com/i/696420
RESE ARCH LINKING A POOR DIE T TO A VARIE T Y OF HE ALTH CONDITIONS IS OVERWHELMING, SPURRING SOME HOSPITALS TO RE VAMP THEIR MENUS AND ELIMINATE FAST FOOD. AS IT TURNS OUT, THOSE CHANGES DON'T HAVE TO BRE AK THE BANK. SUCH A SHIFT isn't without precedent. In 1994, more tha n 96 percent of hos- pit a l s i n t he Un it ed St at es a dopt ed strict smoking reg ulations to protect patients and staff. Hospita ls and clinics stopped selling ciga rettes in gif t shops and restricted smoking to outdoor loca- tions or forbade it on ca mpus entirely. Un h e a l t h f u l f o o d s h a v e n o t y e t met that fate. In 2015, the Physicia ns Committee for Responsible Medicine found that 20 percent of 208 hospita ls sur veyed housed fast-food restaurants. In addition, hospita l ca feteria s of ten produce mea ls loaded with fat, sodium a nd suga r. "We have signifi cant evidence that this food ca n lead to chronic diseases like cardiovascular disease and cancer," says Shilpa Ravella, MD, Assistant Professor of Medicine at Columbia Universit y. "Hospitals have an ethical responsibility to promote hea lth a nd wellness — a s much as they did two decades ago when they ended smoking in hospita ls." However, more wholesome, fresher foods are typica lly more expensive than their packaged a nd processed counter- pa r ts, a nd hospita ls frequently rely on prof its from contracts with fa st-food compa nies a nd vending machine sa les. So how do hospita ls promote good nutri- tion without blowing their budgets? MAKING THE SWITCH C l e v e l a n d C l i n i c a n d M o n t e f i o r e Medica l Center in Bron x, New York, a re a mong the ea rly adopters of more hea lt h f u l eati ng on t hei r ca mpuses. Clevela nd Clinic got sta r ted by ending its ties with McDonald's, notes a recent article Dr. Ravella wrote for The Atlantic. Meanwhile, in an overhaul that began in 2005, Montefi ore started by removing saturated fats from its menu. Since the process began, each organization has been taking it one step at a time — replacing poor food options with better ones. "At the beginning, there was a lot of resistance," says Chris Trivlis, Director of Food a nd Nutritiona l Ser v ices at Montefi ore Health System. "But slowly, through education and classes, ... the culture changed. Now we're getting more requests to go to plant-based diets and healthier foods." Research from the Har vard School of Public Health estimates that a more hea lt h f u l d iet cost s $1 . 50 more per person, per day, tha n a n unhea lthful diet. That, paired with potential losses in vending and fast food sa les, can be fi nancially daunting for hospitals. But maybe it shouldn't be. Montefi ore has actua lly seen a rev- enue boost, Trivlis says. Increases in its retail operations o set losses in vending machine sales. "Looking at the numbers today, we are up by 3 percent," Trivlis says. "We added a noodle bar that became very popular. We added juice and smoothie bars that became very popular. " It 's a process," he a dds. " We w i l l get bet ter a nd bet ter at it. This is the culture of the hospita l." ■ " Changing patients' mindsets will take some work — not just promoting healthy food, but educating patients and staff on how to continue the changes." • SHILPA RAVELLA, MD, ASSISTANT PROFESSOR OF MEDICINE, COLUMBIA UNIVERSITY Hospital Food — on a Budget BY TREVOR WILLINGHAM HOMING IN ON 1 8 1 8❱❱❱❱❱ B U S I N E S S O F M E D I C I N E