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Healthy eating at hospitals: What's our obligation?

June 5th, 2014

by Scott Kashman and Larry Altier

Here's our simple question. Forget for a moment your own personal beliefs on whether you think we should eat healthier as a society. As healthcare leaders, do you think it's our obligation to offer healthier options in our healthcare organizations?

In September 2013, a bombshell report from Credit Suisse's Research Institute brought into sharp focus the staggering health consequences of sugar on the health of Americans. The group revealed that approximately 30 percent to 40 percent of healthcare expenditures in the United States help address issues that are closely tied to the excess consumption of sugar.

The figures suggest our national addiction to sugar runs us an incredible $1 trillion in healthcare costs each year. The Credit Suisse report highlighted several health conditions, including coronary heart diseases, type 2 diabetes and metabolic syndrome, which numerous studies have linked to excessive sugar intake. ("Bitter Truth About Sugar")

Here's a suggested approach for your consideration and feedback. Focus on the following five areas: Nutrition science, access, policy, price and education.


Should we offer more whole foods (no labels needed since the actual food is the only ingredient) and healthier options (non-genetically modified, few additives such as sugar, lower sodium, etc.)? Can we provide better access to get more whole foods and healthier options in our cafeterias, wellness centers and outpatient centers? Can we provide whole foods and healthier choices at lower cost than the comparable unhealthy choice? What's your healthier alternative for hamburger, chips, cookies and soda? How can you educate your patients, physicians, staff and visitors about nutrition?

What do you stand for as it relates to health, wellness and well-being? Do you have policies reflecting your organization's beliefs? That includes what you serve, the access you provide, the education and price. The alternative is just offering what you think people want as opposed to what you want to represent. There is not necessarily a right or wrong. It takes about two minutes for our community to understand what we stand for in an organization, whether it comes to service, care, safety and healthier living.

Our organization has made strides towards these areas above and it's just a start--we have a long way to go. Here are some of our efforts:

Applied nutrition science: We made several changes resulting in an increase in sales. We apply this mindset to our offerings and research better sources of "sustainable" products less influenced by pesticides, antibiotics and additives.

  • Increased the percentage of whole foods and healthier options, including a salad bar and smoothies made right off the salad bar selection. There are zero added sugar products in these smoothies.
  • Added grass-fed and lean bison burgers.
  • Removed the fryers and started baking french fries and tater tots, although offered on limited days.
  • Reduced carbonated soda, resulting in almost $300,000 in cost savings.
  • Added healthier vending machine options and reduced the overall vending machines hospitalwide.
  • Increased the percentage of food from local providers.


  • Expanded access in our cafeterias and wellness center cafe. We also added a weekly farmers market during "seasonal" months.
  • Added more grab-and-go healthier items for people to take home for dinner.
  • Collaborated with a local health food grocer to provide more alternatives for those we serve.

Policy and price:

  • Adopted an organizational philosophy towards optimal nutrition and defined what it meant--supporting whole foods while avoiding highly processed foods and concentrated sugars.
  • Promoted newborn breastfeeding. We do not provide marketing materials from formula companies, but instead great services to help mom and baby connect and promote breastfeeding. We also became the first hospital nationwide to provide a gentle caesarian section to triplets.
  • Agreed to provide whole foods and healthier options at a lower cost to take the cost factor out as a reason people would not eat healthier.
  • Participate in the Healthier Hospitals Initiative to leverage knowledge and success stories.


  • Prepared to start our first stage of our "Pathway to Discovery," supporting an optimal healing environment and focus on health, wellness and well-being. It will provide a pathway around our campus and include an outside therapy area for patients needing physical and occupational therapy. It will include a teaching garden to educate children about nutrition and staying healthy.
  • The Pathway will be open for our entire community and support a positive environment for prevention and improvement of the major chronic health concerns, including heart disease, diabetes, hypertension, chronic obstructive pulmonary disease, obesity, osteoporosis and mental health.
  • Partnered with some key physicians to educate our medical staff on engaging nutritionists to tailor patient care plans.
  • Worked to add more labels specific to calories, sodium, fat content, sugar and cholesterol.
  • Added a red-yellow-green sign around our salad bar to promote a higher percentage of veggies in our smoothies.

Our organization is just in its infancy towards these changes. As healthcare leaders, do you think it is our obligation to offer healthier options in our healthcare organizations? We look forward to hearing your perspective.

Scott Kashman serves as the Chief Administrative Officer of Cape Coral Hospital, part of the Lee Memorial Health System in southwest Florida.

Larry Altier has served as System Director of Food and Nutrition for Lee Memorial Health System, employed since 1999. He has a B.S. in Hotel and Restaurant Administration from Florida State University and has been involved in the culinary arts his entire career.


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