When hospital food tries your patients
Hospital patients should be getting the most nutritious food available. But too often they’re not, experts say. Bridie Witton reports.
Nutritionist Gary Moller has seen everything over his 45 years in the business of health. But it wasn’t until he landed himself in hospital after a mountain biking accident that he experienced hospital food first-hand. He spent about five days in Wellington Hospital, and was less than impressed by what was on his plate. ‘‘The food was appalling.’’
Lunch included a white bread ham sandwich with margarine, which he described as having ‘‘nutrient-empty sugar’’ and ham soaked in ‘‘cancer-causing nitrates’’. The low-fat icecream was a ‘‘hit of sugar and flavourings’’, with fat emulsifiers that remove the protective mucus lining of the intestines, adding to gut disease.
The jelly was ‘‘artificial flavourings and colouring and yet more sugar’’.
Wandering around his cubicle, he saw many patients he believed were malnourished.
Moller brought in his own supplements and food, which meant he left hospital in half the time, he says. Four months later, the 66-year-old won an international mountain bike race for his age group.
He says providing the most nutritious food possible should be a priority for all district health boards.
Patients, as a ‘‘captive audience’’, could also be helped to make better food choices once they leave hospital, which will stop them coming back.
‘‘It’s a revolving door of patients.The doctors are managing disease, not curing disease, unless it’s an infection – and you need nutrition to get better.
‘‘You could almost take them to court and sue them – it’s a human rights issue. We should be providing food that meets what a human needs to survive.’’
Nutrition-related risk factors account for a substantial proportion of the chronic disease burden in New Zealand, according to the Ministry of Health. This includes diseases such as diabetes, heart disease and stroke.
Moller says DHBs could do more for those presenting at the hospital malnourished, and more could be done to stem the ‘‘tsunami of ill health’’.
‘‘When people are in hospital, the role of nutrition seems to be completely ignored.’’
He says patients eating lowfibre hospital food could be constipated within a week.
‘‘If you are coming in [to hospital] in a nutritionally pale state, in the course of a week eating hospital food you are going to be constipated on the third day.’’
This is even more pertinent when taking into account New Zealand’s high rates of bowel disease. Bowel cancer is the second-highest cause of cancer death in the country.
While no cancer is preventable, people can lower the risk of bowel cancer with a healthy diet and regular exercise – and it can be treated successfully if detected early.
And while older people are more at risk of a prolonged stay in hospital, ‘‘old age does not have to equal ill health’’, Moller says.
Grey Power board member
Roy Reid says he has not heard any concerns about hospital food for several years.
‘‘We are not hearing much at the moment. I have spoken to people who have been in hospital in Nelson-Marlborough and they haven’t complained about the meals.
‘‘It was an issue a couple of years ago.’’
Hundreds protested in 2016 when Southern DHB outsourced its meals to contractor Compass Group. Protesters described the food as ‘‘slops’’ and likened it to pig food.
The group provides patient meals, meals-on-wheels, cafeteria services, ward supplies and optional services to six DHBs: Auckland, Waitemata¯ , Counties Manukau, Hauora Taira¯ whiti, NelsonMarlborough, and Southern.
But a small number of DHBs supply their own catering, and can add some local flavour.
Last year Hutt Hospital near Wellington changed its menu for the first time in more than a decade to include dishes such as hangi, Samoan-style chop suey, mee goreng and rogan josh.
The move was reported to convey a message of acceptance of other cultures, which could have a bearing on the mental and emotional health of patients.
Speaking to Stuff at the time, Massey University food researcher Dr Rebekah Graham said the sociocultural importance of food often went unrecognised in New Zealand.
‘‘Food is more than just nutrition. It reminds us of who we are and where we are from, and reaffirms cultural identity.’’
Nutrition expert Julie Bhosale agrees DHBs could do a better job in serving nutritious meals, particularly at breakfast.
‘‘I don’t think you expect fivestar food. But you still need food of reasonable nutrition.’’
Typical breakfast options that include white bread, cereals and oats are not ‘‘remotely nutritious at all’’, she says.
Bhosale, who is also a health
researcher, says many mothers have to stay in hospital for an extended period of time around childbirth, with common complications including infections and blood loss.
She spent four days in the special care unit after the birth of her son. ‘‘That is the time that you need the most nutritious food you can get.’’
Good nutrition is also needed for breastfeeding. She advises mothers to bring their own food when going to hospital to give birth, particularly if they are heading to the hospital in the early hours, though she accepts ‘‘that’s not always easy’’.
‘‘What happens if you give birth at 3am? There is no food available other than the vending machines.’’
She advises mothers to bring in nuts, fruit, tuna and crackers. But all hospital patients, vulnerable because of illness and weakened immune systems, need healthy and nutritious meals.
And good food always costs time and money. But there is ‘‘definitely room for improvement without breaking the budget’’.
Spending more on nutritious meals would see fewer costs to the health service elsewhere.
Small changes such as ensuring breads are wholegrain, and getting rid of low-fat, highsugar dairy options and gut irritants, would mean an improvement, she says. ‘‘It is the old adage ‘food is medicine’.’’
Hospital food providers must adhere to nutritional standards, and serve food which is appealing. They also have to serve people with a wide variety of requirements – which can be challenging, says Capital & Coast DHB corporate services general manager Thomas Davis.
The DHB services a population of more than 318,000 people, as well as providing specialist services for patients from across the lower North and upper South Islands.
It is currently reviewing its food policy with plans for improvement, and all its menus designed with dietitians, Davis says.
‘‘We view meals as an important part of both a patient’s hospital experience and overall recovery, and our inpatient menu was designed in close collaboration with our dietitians. Our varied menu caters for patients with a variety of different nutritional and cultural requirements, allergies and other eating-related issues.’’
He says the food provider, Spotless, sources local products ‘‘wherever possible’’ and produces around 1800 meals at Wellington Regional and Kenepuru Community hospitals each day.
‘‘Work has been going on over the past year to review our food policy, again working closely with our dietitians.
‘‘Being able to meet highly complex eating requirements can be challenging. However, this review will make it easier to provide high-quality nutritious meals to suit multiple needs.
‘‘We will be making substantial enhancements to our inpatient menu this year to better reflect the various dietary, cultural, and other needs of our patients,’’ he said.
Canterbury DHB commercial portfolio manager Rachel Cadle says there would not be a DHB in the country that did not place a huge emphasis on nutrition.
‘‘I wouldn’t think there would be any hospital food service in the country [which works] without input from a dietitian.
‘‘We have three dietitians and are constantly looking at what the ingredients are and what we are offering.’’
The DHB brought its food service in-house in 2017, after contracting it out to Compass for 13 years.
But as the DHB owns the recipes, and has the capacity to cook bulk menu items, the service is the same.
‘‘Patients in acute hospitals probably wouldn’t notice a difference.
‘‘For patients in for longer stays in the hospital, it has gone down really well.
‘‘It is the same service. We already had a good service, and I cannot fault Compass. We have continued with that service.’’
Typical breakfast options include porridge, toast and spreads, cereals and juice or yoghurt.
Lunch could include a soup, or light meal such as salad, a light chicken dish or a sandwich.
Dinner could be roast pork, with apple crumble for dessert.
But nutritionists Moller and Bhosale both want to see improvements across the board.
‘‘We have got to take it more seriously,’’ Moller says.