Using the clout of his position—not to mention a reputation as one of the shrewdest businessmen in the world—New York City’s Mayor Michael Bloomberg has set out to obliterate obesity across his municipal domain.
While hizonor’s efforts to restrict “Big Gulp” soft drinks have garnered the most attention—with charges that he's out to create a "Nanny State" ruled by carrot-wielding "Food Police— the city’s many healthcare facilities and their foodservice offerings have not escaped his notice.
The result—New York City’s Healthy Hospital Food Initiative—may be a template for facilities elsewhere in the country, as Bloomberg established healthcare as a logical place to increase access to healthier foods.
In 2008, the program originally established food standards for healthcare facilities, consistent with USDA Dietary Guidelines. Then, last September, the City’s Health Department announced that over 30 hospitals (including 17 private hospitals) had agreed to meet them in its Healthy Hospital Food Initiative, “an unprecedented voluntary program [mandatory for public hospitals] that promotes healthier food choices in hospitals.”
A template for other hospitals?
If you’re like dining departments in many hospitals nationwide that are looking to reduce or eliminate items that are too high in sugar, salt, fat and cholesterol from your operation, the New York City Healthy Hospital Food Initiative (or parts of it) may serve as a template for your facility. Those in the City that have signed on to the program have agreed to meet healthy food standards in four areas—patient meals; cafeteria fare; food vending; and beverage vending—and earn “stars” (bronze, silver, gold and platinum) along the way.
Cafeterias/Cafés standards use a variety of techniques to make a healthy choice the easy choic. These include increasing the availability of fresh fruits, vegetables and whole grains; the promotion of healthy value meals; limitations on the promotion of high calorie beverages and the elimination of fried foods.
Standards for Beverage Vending Machines decrease the availability of high calorie beverages, including limitations on their placement in the hospital environment, and ensure that advertisements on fountain and other machines promote healthy choices.
Food Vending Machines have their own standards, that include nutrition requirements for calories, saturated fat, sodium, sugar, fiber and other nutrients in stocked products.
Standards for Patient Meals provide nutrition requirements for individual foods purchased as ingredients, such as sodium limits for bread and cereal, and for meals served, such as two fruit or vegetable servings at lunch and dinner.
All parameters for each part of the Initiative can be found on-line, as can sample color-coded planograms for vending machines that can be printed out.
NYC-based foodservice directors participating in the Initiative have looked for technical assistance in these areas by forging relationships with the NYC Department of Health's dietitians as well as their distributors. The Department of Health will provide nutritional analysis of "regular diet" patient and cafeteria menus as well as food/snack vend items, if requested. The initiative also encourages hospitals to work with vendors in identifying appropriate item substitutions where they are needed to meet the standards.
According to Erica Krepp, MS, CHES, with the Nutrition Strategy Program, NYC Department of Health and Mental Hygiene, "We certainly believe the Initiative is applicable elsewhere. We’ve developed Implementation Guides that are available on our website for vendors, food managers—whoever wants to implement the standards.
“We encourage operators to reach out to their own vendors, but we’ll research products from a variety of vendors for them if need be,” Krepp adds.
“Manufacturers have done a wonderful job [in meeting the Healthy Hospital Food Initiative packaging standards],” offers Sarah Morrison, healthcare account manager for US Foods, Metro NY region. For the past two years, Morrison has been a part of several NYC-based hospital teams working toward meeting Initiative parameters for its clients. (A nutrition breakout for each product listed in every category is available on the US Foods website.)
One such team worked closely with Betty Perez, RD, DHCFA, senior director of food and nutrition services at NYU Langone Medical Center, and her director of retail services and catering, Heather Walker-Pardo.
After they worked through the cafeteria items and identified the items that weren’t acceptable to the NYC Health Department, "my boss, Debbie Lanzidelle, LD, RD, PhD, director of healthcare and education for US Foods Metro NY reached out to manufacturers to get them to understand they had to meet the packaging standards and come down in size and fat content, calories, sodium, etc.," says Sarah Morrisson, US Foods' healthcare account manager for the Metro region.
In fact, when it comes to desserts, the US Foods system for New York City has automatically blocked operators from ordering items with trans fats for at least the past five years as a result of a prior Bloomberg initiative. “Therefore, we have items, such as apple pie—you bake it or heat ’n serve—that are trans fat-free,” she says.
Make it Delicious
Perez found that she and her team at NYU Langone Medical Center had already addressed many of the Healthy Hospital Food Initiative parameters. For this private hospital, signing onto the Initiative was voluntary; but following discussions with administration, NYU Langone decided to participate and signed the document.
Patient meals at NYU were already in alignment with the USDA Dietary Guidelines for Americans, 2010. In addition, “What made it an easier process for us is that we were lucky to have many talented chefs who do a lot of from-scratch cooking,” Perez says. “Especially in regard to sodium, we can make our recipes compliant with the standards versus using convenience items that have higher high sodium content.”
For café customer meals, Perez puts the emphasis squarely on her team of “innovative culinarians” to create the buzz and thus the sales at numerous action stations. Yes, the dessert portions that needed to be 200 calories or less have morphed into trendier “small bites.” Yes, as required, only “healthy options” are stocked near the entrance and cash registers. And yes, half-size sandwiches must be available in addition to full size offerings.
“All operators have to be very strategic,” Perez says. “You still have to reach your revenue goals and your customers still must choose to come to you, so you need to offer delicious food that happens to be healthy!”
Going the extra mile
Across town at Beth Israel Medical Center (a member of Continuum Health Partners) is follows the Continuum Wellness program. Even so, the facility’s vice president for human resources and wellness and its chief clinical nutritionist met with representatives of the NYC Department of Health and discussed the Healthy Hospital Food Initiative format.
“We didn’t sign on to the Initiative, but we’ve voluntarily met most of the parameters,” says Barry Schlossberg, director of food and nutrition services.
Sodium content of café and patient feeding items posed the greatest challenge, since Beth Israel is a glatt kosher facility. “Meats and poultry are higher in sodium content from the sodium baths required during processing,” Schlossberg explains. “Although we don’t use any additional salt in our cooking, it’s extremely difficult to meet the sodium standard.”
On balance, Schlossberg is pleased to report he’s serving 32% fewer sweetned drinks than in 2012 and that bottled water consumption from vending as well from the grab’n go area in the café “has increased dramatically.” Coca-Cola is the facility’s beverage vending partner and it has also helped rearrange the beverage selection within the café.
The changes "haven't hurt our sales at all,” Schlossberg says. “I do think we, as a healthcare facility, have an obligation to offer healthy hospital food.”
One of the most recent signatories to the Initiative is Brooklyn-based Kingsbrook Jewish Medical Center, which serves both acute care and longterm care resident patients. “Here in East Flatbush, we’re at the epicenter for diabetes, hypertension and stroke [obesity often plays a causative role in each], so our president and vice president wanted us to sign on,” says Frank Coffey, director of hospitality services at this 850-bed facility.
During the start-up phase with snack vending being scrutinized and revamped, Coffey also found himself in meetings with NYC Department of Health dietitians Erica Krepp and Alyssa Moran and he has worked closely with his long time outside vendor as well. After vending was revamped, resident patient meals went to the top of Kingsbrook's agenda.
“Residents have accepted this Initiative—we’ve discussed it with them and they understand," he says. At the same time, he expects the real challenge will be in the cafeteria.
“Here in Brooklyn, our employee population is used to a lot of fried food. Now, the fryers must be removed so we’ll have oven-baked alternatives. Since it’s more of a challenge, I’m saving it for last. It’s all about doing the right thing and it’s very important that we in healthcare set the example.”