Just Because Your Cafeteria Has A Salad Bar Does Not Make It Healthy

A few months ago I visited the Ottawa Hospital's Civic campus and decided to have a peek over at the cafeteria.

It won an award you see, an "Award of Recognition" to be exact, which according to the plaque was for,

"significant achievement in creating a supportive, healthy, nutrition environment across hospital retail food settings"

A supportive and health nutrition environment you say?

Um, about that:

Sigh

Texas Hospital Feeds Cardiac Patients Doritos and Oreos?

Thanks to Daniel Nelson for sending me this photo of the meal served to his girlfriend following her admission to Plano's Texas Health Presbyterian Hospital for a heart problem.

Clearly this isn't healing food.

Is this a shocking one-off, or is this the norm?

I'm betting that for many North American hospitals, it's the latter not the former.

How Is It Possible Reebok Banned Soda Sales Before Hospitals Did?

Seriously.

Today Reebok announced that it'll no longer be selling soda at its headquarters. Why? Here's President Matt O'Toole,

“The goal for us here at Reebok is simple - to be the very best fitness brand in the world and to inspire everyone who touches our brand - consumers, fans, and employees – to reach their potential. And our mission starts right here, with our own people ... we felt removing sugary products from our HQ was simply the right thing to do. As a fitness company, we know how important it is to move – to use our body as it was meant to be used - but what we put in our bodies is equally as important.”

That hospitals haven't yet figured this out is beyond shameful.

Nova Scotia hospitals ban Tim Hortons! (Sorta)

For me, this is a bittersweet story.

Back in 2008 my colleague Rob Stevenson and I wrote an editorial for the Canadian Medical Association Journal calling for the reform of hospital cafeteria food.

It was met with a great deal of word of mouth support, but very little in the way of feet on the ground (except Quebec whose Health Minister Yves Bolduc quickly banned the use of deep fryers in hospitals).

Perhaps with the gentle encouragement of Rob (he's much nicer than me), Nova Scotia's Capital Health hospitals followed suit, and in September 2009, they also banned deep fryers.

With both of us being quite busy, I don't hear from Rob too often, but just last Friday he sent me a copy of a memo penned by Nova Scotia's Capital Health hospital's vice president of sustainability. The memo explained Capital Health's next move, one that will see Tim Horton's (a Canadian donut/coffee icon), forbidden from selling donuts and muffins that don't meet Capital Health's healthy food guidelines.

Capital Health nails the "why" argument with their explanation,

"One way Capital Health is working to improve the health of our community is by making healthier choices the easier ones in the food we sell to the staff, patients, families and visitors that use the restaurants in our facilities day in and day out."

Indeed! Hospitals should not be profiting off the sale of unhealthy foods and instead should serve as role models for their communities.

So what's going to be left on Tim Horton's Capital Health shelves?

Hard to say with certainty, but this line,

"baked goods such as doughnuts and those muffins that do not meet Capital Health’s healthy food guidelines will no longer be sold"

certainly suggests that some muffins will meet their guidelines.

Of course their guidelines will be based on Canada's Food Guide, and therein lies the rub.

According to a CTV article on this story, Capital Health hospital Tim Horton's will still be selling their low-fat berry muffin. Low-fat of course, is pretty much the focus of Canada's entire Food Guide.

Problem is, evidence-based nutrition would suggest that with rare exceptions, single nutrients are difficult to truly link to disease and that rather patterns of eating are more important. Using a guideline that falsely elevates the reduction of fat to the pinnacle of dietary discretion means that so long as a food's fat levels are low, the rest doesn't matter.

So let's look at Tim Horton's low-fat berry muffin.

Compared with a soon-to-be-banned chocolate donut it's made with the same highly refined carbohydrates, packs nearly 30% more calories, 150% more sodium, equivalent amounts of trans-fat, and a whopping 5 teaspoons more added sugar.

So at the end of the day, while this is a real, formative and praise-worthy step forward for Nova Scotia's Capital Health and hospital food reform, until we see our government step up with actual evidence-based dietary guidelines, these forward thinking efforts, may still ultimately end up being nutritionally backwards.

Ottawa Hospital finally follows through with cafeteria reform!

Yesterday, nearly 3 years after they first told the Ottawa Citizen they'd be initiating a nutrition labeling plan in their cafeterias, the Ottawa Hospital announced that point of service electronic calorie, sodium and fat content will be made available to customers.

They'll also be implementing their own version of Health Check whereby a little green apple will signify meals they deem healthy.....er...sort of......well not really. Let me explain.

Only two criteria will determine whether or not a meal will get a little green apple. Those criteria? Sodium content and total fat.

Sodium content? That seems like a reasonable determinant to include, but unfortunately it would appear that the levels they adopted were those put forth by the Heart and Stroke Foundation's Health Check program. That means a large entree can have up to 960mg of sodium and a small 720mg. Given sodium's total recommended daily maximum is 1,500mg, that's an awfully generous "healthy" amount.

Total fat? Again, probably a consequence of not building criteria from scratch but rather from existing, underpowered programs like Health Check and EatRight Ontario, the hospital's adopted total fat as an important nutritional determinant. Problem there is that it's not. The notion that total fat in one's diet is in and of itself responsible for the development of chronic disease or obesity has been soundly refuted over the course of the past decade or so of nutritional research.

There's probably also risk in clinging to it.

Dr. Frank Hu, one of the world's leading obesity and diabetes researchers and professor of nutrition at Harvard was recently quoted as saying,

"The country’s big low-fat message backfired. The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today."

So while I recognize the safety of working within the context of established programs, unfortunately if the established programs aren't in fact evidence-based, up to date, or nutritionally sound, the outcomes, while perhaps politically safe, may not be particularly stellar.

I'm also confused by the notion of a check based on just two nutritional determinants of health. I'd argue that such a check is potentially worse than no check as it will undoubtedly confer a health halo to foods that may well be chalk full of calories, refined carbohydrates, sugar, and trans-fat.

Interestingly the hospital has already distanced itself from the suggestion that their apple check'ed choices are in fact "healthy". In an article published yesterday in the Ottawa Citizen, Frances Furmankiewicz, the hospital's Director of Nutrition and Food Services was quoted as stating,

"So we're not saying they're healthy, they're healthier"

And while that may be the glass-half full version of looking at things, my glass-half empty version still maintains that "less bad" is not the same as "good", especially given the lack of any real criteria to reflect even "healthier", and the inherent risks associated with outdated, blindly low fat messaging.

All that said, I'm thrilled there will be point of sale nutritional information provided, and that apparently there will be healthier options available.

Here's hoping that given their will to launch the program, they'll also have the will to improve upon it.

Stay tuned for a video tour over the coming few weeks, but for now, congratulations to the Ottawa Hospital for starting what I hope over time will prove to be a much more substantial initiative.

Food still junk at Ottawa Hospitals

Today's one of those rare days when something comes up that knocks Funny Friday to the backseat.

Early morning readers of the Citizen may already know this (click here to read the article in the Citizen) but we've revisited Ottawa hospital cafeterias 14 months after we first showed up with my trusty little video camera to see what if anything has changed.

If you recall (and if you don't just click here) 14 months ago I visited Ottawa's hospital cafeterias and I was appalled by the lack of healthy hospital food and so too was the Citizen and later the Canadian Medical Association Journal.

In anycase, a few weeks ago I was speaking with Don Butler from the Citizen and invited him to join me on another cafeteria tour. This past Tuesday we visited cafeterias at CHEO, the Heart Institute, the Civic and the General and sadly, nothing has changed.

I've written a letter to the CEOs of the hospitals (which I'll post below) asking if they would be willing to personally commit to improving the nutrition in their hospitals and I've extended a standing invitation to Don Butler to join me annually to revisit Ottawa's hospital fare to see how things are going.

Bottom line - hospital cafeterias shouldn't simply be no-name junk food restaurants. If anything hospital cafeterias should serve as examples of healthy eating and extend their role as leaders in the provision of health care to their dietary offerings.

[BTW - below the letter are a few videos we shot while walking around and you can hear Don and I discussing some of the available cafeteria fare]

Dear Drs. Kitts, Roberts and Bilodeau,

My name is Yoni Freedhoff and I'm a physician located in Ottawa with special interests in nutrition and in public health advocacy. A little over a year ago I spent some time touring the cafeterias of Ottawa’s various hospitals and was appalled by what I found. Rather than catering to good health and chronic disease prevention by offering nutritious foods I found that Ottawa's hospital cafeterias functioned more as no-name junk food providers and served foods that we as health professionals strongly advise our patients to avoid. Menus generally consisted of a slew of deep-fried fare, trans-fat containing soups, over-sized sandwiches, greasy pizza, walls of chips and soda pop, ice-cream bins, and giant muffins. I published my findings on my blog Weighty Matters and the Ottawa Citizen quickly picked up on the story and wrote a front page piece detailing the situation and followed it up with an editorial that rightly called for the hospitals to clean house in their cafeterias. The CMAJ then got in the mix and invited me to pen an editorial on the matter wherein we called on hospitals to put an end to this deep-fried hypocrisy.

So has there been change? On Tuesday of this week the Citizen's Don Butler and I visited the cafeterias of your hospitals to see what, if anything, had changed. I was disheartened by what we found.

In Mr. Butler's original article an Ottawa Hospital physician reported to him that detailed nutritional information would soon be posted to help patients and staff make more informed and hopefully healthier choices. 14 months later no such posting was visible. 14 month ago Mr. Butler was told that there was already program in place that steered people to healthy choices - "Healthwise". Apparently these reportedly healthy and wise choices are meant to identify meals containing fewer than 500 calories and 800mg of sodium and according to the Heart Institute's VP of communications, "if you see the symbol, you'll know you're eating the right stuff.". The "right stuff"? Since when are meals containing 800mg of sodium, "the right stuff" at a Heart Institute or anywhere else for that matter? Frankly I also doubt the validity of the Healthwise claims regarding calories as one of the "Healthwise" choices 14 months later was fish and chips whereby there's simply no way the calories of deep fried fish and chips come up shy of 500; and regarding sodium every soup on the menu received a "Healthwise" award, yet at the Greenery (the Civic cafeteria) where the only available nutritional information is for soup, only 3 of the 43 listed soups contain less than 800mg of sodium per serving with the average being 957mg.

And about those soups. Did you know that of the Civic and General's 43 listed soups almost 50% of them contain trans-fat (with some having as much as 3g) and almost 50% have more than 1,000mg of sodium per serving?

How is the provision of lowest common denominator nutrition good medicine?

The arguments against reforming hospital cafeterias are both predictable and hollow and usually go as follows:

1. Selling healthy food won't be profitable.

Firstly since when did the hospital as profit centre become the hospital's mission? I thought that hospitals were public institutions geared to provide patients with excellence in health care. Given the incredibly important role of nutrition as a determinant of health and the incredibly important role of the hospital as role model and community leader, serving junk food does not fit either bill. But putting idealism aside, since when does serving healthy foods preclude profit? The Compass Group, the world's largest institutional provider of retail food service delivery, in 2007 attributed part of its rising profits on it's increased focus on healthy foods, and Capital Health in Alberta has in fact demonstrated that not only is serving healthy fare in a hospital feasible but that it's dramatically more successful than their traditional cafeterias. Their Healthy Trendz concept implemented in 19 different hospital based cafeteria and snack bar venues resulted in an overall 67% growth in revenue totalling $12.1 million and a 33% increase in the number of transactions.

2. We're not the food police, (or grown adults should be allowed to choose for themselves).

No we aren't the food police and grown ups are responsible for their own choices. While frankly I am not averse to hospitals selling exclusively healthy foods, to request that hospitals provide healthy, reasonably priced, flavourful options alongside less healthy fare surely does not constitute policing. Regarding choice - absolutely adults are free to make their own choices, however it is surely the hospital's duty to allow patients to make informed decisions as to their care. Given the role of good nutrition in health care, I would argue it is the hospital's responsibility to ensure patients make informed choices therein by at the very least posting nutritional information for each and every item sold. This is not in and of itself a difficult endeavour and certainly menu board calorie posting is slowly becoming law across the globe; was called for by the OMA on April 7th in a press conference; and is currently being debated in the Ontario legislature in the form of Bill 156. Given that Dana Hospitality, the food service provider for the Heart Institute (and perhaps the other hospitals as well), reports directly on their website that, "We provide Nutrient and Ingredient Content Information About the Food We Serve", I can't understand what might be stopping our hospitals from sharing that information with their staff and patients.

3. Healthy food doesn't taste good (or we already sell salads).

Believe it or not this was an argument put forth by an Ottawa Hospital spokesman when Mr. Butler wrote his article last year. I'm saddened to have to include a discussion of this argument here given how nonsensical it is, but nonetheless it will likely come up again. While it may be true that the creation of healthy, flavourful foods that will sell in a cafeteria takes a modicum more creativity than deep frying a potato, that certainly doesn't mean it isn't a doable endeavour. And yes, the hospitals do sell salads. Of course there is far more to healthy eating than simply salads and certainly there needs to be healthy, non-salad bar based options available for main dishes and snacks as well. And about those salads - while the hospitals do indeed sell them, their cost is astronomical. At $1.25 per 100grams the average cost of a plated salad the day we were observing seemed to fall in the $7-8 range - far more expensive then the less healthy, fried, value-meal styled servings at the hospitals various fry counters and sandwich bars and certainly not a price conducive to encouraging their purchase or consumption.

Hospitals should not be in the business of making business for themselves by serving foods known to be contributors to the development of a myriad of chronic diseases, especially not in the absence of healthy choices and readily available nutritional information. Frankly I think it's downright shameful that the very institutions built to protect our health feel comfortable serving junk food not only to their patients but also to the thousands of hardworking and dedicated allied health professionals who have committed their lives to protecting and promoting health, and then when challenged seem to myopically talk of profits rather than focusing on opportunity - the opportunity to become community leaders in what healthy cafeterias can constitute.

Drs. Kitts, Roberts, and Bilodeau, I'd like to ask each of you, are you willing to personally commit to making nutrition a priority in your hospitals?

Sincerely,Yoni Freedhoff, MD
Medical Director, Bariatric Medical Institute

Ottawa Civic Hospital


Ottawa General Hospital


Children's Hospital of Eastern Ontario

Update on Hospital Cafeteria Food

Just thought I'd bring you an update on what's gone on with the hospital food issue.

Following Don Butler's excellent piece on my hospital food adventures in the Citizen the Canadian Medical Association Journal invited me and that doc I've blogged about from the East coast Rob Stevenson, to co-author an editorial about our experiences.

That editorial, available online was posted last week and in turn that led to a flurry of activity and potentially even some change.

The day after the editorial was published the Quebec Minister of Health Dr. Yves Bolduc announced (link is in French) that he would see to it to ensure that healthy foods would in fact be served in Quebec hospitals. There were also a myriad of articles across the country covering what to most allied health professionals is a no-brainer issue and I was thrilled to see in the comment sections for these articles, it's a no-brainer for most Canadians too who see improving hospital cafeteria options as an obvious, necessary and medically responsible thing to do.

A few days ago I was invited onto Steve Madely's show (hosted by Mark Sutcliffe) to talk a bit further and I was pleasantly surprised that the interview was pretty lengthy and really allowed me to flesh out the issue for the listeners. If you're curious, you can click the player below to hear it (if you're an email subscriber and the player doesn't work, just head over to the blog):

Lastly this coming weekend Dr. Barry Dworkin has invited me onto his now nationally syndicated show Sunday Housecall to discuss this an other issues (you can listen online by clicking here at 3:30pm Sunday August 10th or tune into CFRA in Ottawa).

Who says a few loud voices can't affect change?

Food at the Ottawa General Hospital

Today's installment in my ongoing Ottawa Hospital Food Series is the Ottawa General Hospital.

The fare was more of the same - no-name junk food, although at least on the surface there were a few healthier sounding options: Wraps, whole-grain sandwiches and Carribean crusted snapper.

Of course as evidenced at the Ottawa Civic, simply sounding healthy doesn't mean the nutritional breakdown's good - I mean who ever would have thought hospital soups (soups that are by the way sold at the General as well) would contain up to 3grams of trans fats and a day's worth of sodium? Therefore without a nutritional breakdown, it's hard to say how healthy the options really were.

Prices were interesting. You could have chosen the snapper for $6.99 or the cheesy bistro burger for $3.99.

And $1.25 for an apple?

Royal Gala Apples are $0.99/lb this week at Food Basics. That means my non-wholesale price on apples is roughly $0.33 per medium sized apple. So the General's cafeteria is selling them with an almost 400% markup?

That's a helluva profit margin!

Oh, and I finally got to see with my own two eyes the mind-boggling display of Health Check'ed Slush Puppies (made with sugar from juice which somehow magically is better for you than other sugars and which allows the Heart and Stroke Foundation to formally endorse them with their ridiculous Health Check).

And what was right next to the Slush Puppies?

A fridge dedicated to the energy drinks Rock Star and Full Throttle.

Interesting choices to sell in hospitals given that energy drinks have been implicated in hospital admissions for individuals with mental illness, supra-ventricular tachycardia (super-fast heart rhythms leading to emergency room visits), caffeine poisoning in adolescents and a constellation of risky and aggressive behaviors including unprotected sex, substance abuse and violence in College students.

All this really makes me wonder if there's any dietetic oversight in these institutions or whether it's simply the almighty dollar that's king?

Are there ANY healthy hospital cafeterias?

That's the question Dr. Rob Stevenson is trying to answer and to do it, he and his colleagues have launched the Canadian Healthy Hospital Cafeteria Project Survey (CHHCPS - pronounced 'chips').

They announced the project last week at the Canadian Lipid Nurses Network Conference in Halifax and it consists of ten simple questions based on principles of the Nova Scotia School Food and Nutrition policy (I can't speak to the principles of this policy as I haven't seen them).

If you work at a hospital, please take a few moments and fill out their questionnaire by simply clicking here.

Who knows, maybe there is a shining beacon on nutritional light somewhere on the North American hospital horizon.

But don't hold your breath.

(As an added bonus for today, here's a video of the situation out in Halifax that Rob pointed out and I blogged about before - it's hospital staff heading to a local high school for a healhty lunch while the students ironically head to the hospital for a deep fried one)

Food at the Children's Hospital of Eastern Ontario (CHEO)

Continuing in my Ottawa Hospital Food Series I bring you the Children's Hospital of Eastern Ontario's (CHEO's) offerings.

What's remarkable about CHEO's offerings is that they can be broken down by time. If you're there between 6:30AM and 2:00PM Monday to Friday you can enjoy CHEO's Rainbow Cafe which according to CHEO's website offers hot and cold meals along with offerings from Pizza Pizza and Timothy's coffee.

If however you're at CHEO after 2:00pm or on weekends, well now you're stuck with the Oasis coffee shop open from 7:30AM to 11:00PM seven days a week. Don't worry though, you'll find much more than just coffee at this junk food Oasis. You'll find Mr. Sub, Pizza Pizza, Starbucks and plenty of potato chips, ice cream, sugary cereals, huge bottles of pop, supersized chocolate milks (they don't offer a 250ml only the 500ml, more calories than 2 cans of Coca Cola carton) and if you look carefully you'll see the People's Pantry line of "Perfect Portion" nuts that I complained to the Canadian Food Inspection Agency about their misleading and likely erroneous labeling.

Here's a quick tour:



But let's get back to the Rainbow Cafe. The Cafe's interesting because it was recently designated a "Centre of Excellence" by the EatSmart! program.

[UPDATE: The junk-food Oasis is also an EatSmart! location as evidenced by this picture a kind reader just sent me from their cell phone:


What's EatSmart!?

Well if it helps, in a prior post I renamed it EatStupid! and in a nutshell if within your cafeteria's kitchen you've got ingredients the program deems healthful, and if your cafeteria is clean, then you can brag about how healthy you are. Here's a quote from EatSmart!'s website,

"Through its "Award of Excellence" program, Eat Smart! Ontario’s Healthy Restaurant Program offers recognition to Ontario restaurants that meet exceptional standards in nutrition, food safety and smoke-free dining."

The reason the program's so stupid is because it doesn't actually steer people to healthy dishes and frankly doesn't even care if there are any - all it cares about is whether or not the ingredients in your kitchen could be combined together to make a healthy meal.

(By way of example, Denny's is an EatSmart! restaurant)

Want to know what the EatSmart! Centre of Excellence Rainbow Cafe offered patients and staff on May 29th?

Breakfast

CHEO's version of the McMuffin

CHEO's version of Tim Horton's Bagel BELT

One or two eggs with sausages, homefries and toast

Two egg omelets with home fries

Western omelet sandwich with homefries.

Lunch

Roasted Red Pepper and Cream of Chicken Soup (and if it's anything like the soups served at the Civic this one's not going to be a healthy choice)

Fish and Chips with Coleslaw

Sundried Tomato and Chicken Ravioli with Vodka Rose Sauce

Pesto Grilled Chicken on Garlic Ciabatta with Fries or Salad

Hamburger

Hot Hamburger (I believe that's a hamburger smothered in gravy)

Cheeseburger

Swiss Mushroom Burger

Bacon Cheeseburger

Chicken Fingers

And while it's certainly not a regular custom I'm aware of, there's the option of dessert with lunch:

Blackberry Crisp

Apple Crisp

Banana Cream Pie

Those are sure some "Centre of Excellence" choices huh?



But of course even if the Rainbow Cafe were to change their menu today and actually include healthy and nutritious choices (and before you start telling me there's nothing wrong with grilled chicken or ravioli with rose sauce I'd want to see a nutritional breakdown), you're right out of luck if you happen to go or work at CHEO after 2:00PM or on weekends.

Oh, and let's get real here - even if there were multiple nutritious options available at CHEO, the hospital administrators sold their souls to Pizza Pizza, Mr. Sub, Starbucks and Timothy's for a reason - junk sells. Really, when faced with the option of a slice of pizza, bag of chips and a sugared soda special, are there many parents out there that would force their sick child to opt for a healthier choice even if by some miracle something other than simply a salad were available?

Gee thanks CHEO for looking out for my children's best interests.

(Oh, and did you notice whose logo is on the EatSmart! certificate? Good ole Heart and Stroke Foundation. Thanks Heart and Stroke Foundation - great work once again)

[Real thanks to my undercover videographer, my wonderful wife, who also reports that at Pizza Pizza you are not allowed to substitute bottled water in place of the 591ml pop in the meal deal or purchase their salads individually and that with the exception of the plain garden salad, the cost of a Mr. Sub salad (which you are allowed to purchase individually) is greater than or equal to the cost of the pizza, pop and chips deal offered right beside it.]

"Bad Food on Campus"

So my series on Ottawa Hospital Food sure has sparked some talk.

Happily I received many a call from dietitians and doctors at the Heart Institute who strongly supported my contention that Heart Institutes' shouldn't be serving unhealthy foods.

I also received a bunch of emails and for today's post, I'm going to include one in it's entirety (with the author's permission). It's about food in Canadian Universities and I think it does a great job highlighting shortcomings therein and in the end those in our atrocious Food Guide.

Oh, and that picture up above. That's from the cafeteria at the University of Guelph (click it to get a better view of all the healthy goodness).

Here's the letter,

"Hello,

I think you are doing great work by exposing the poor nutrition in hospital food. You may also want to expose the poor nutrition offered on University campuses.

The thing about hospital food is that when you leave the hospital, you can go home and cook nutritious meals for yourself. Thousands of Canadian university students do not have this option. This past school year, I lived in a university residence for the first time. I cannot describe adequately how shocked I was about the poor quality of food offered. We had pizza at least three times per week, mashed potatoes that were stretched with a paste of flour and water and most meats were processed deep fried cutlets. The food had so much sodium that it burned my tongue. Although there was a salad bar, most of the contents were mayonnaise salads and leftovers. Fresh vegetables were scarce and often wilted.

Although I am considered obese with a BMI of 38, I have always been conscientious of consuming healthy food. Never before was I in a position where I had no choice but to eat deep fried, high sodium, high calorie food every day. As you would expect, I quickly gained 25 lbs within 3 months of living in residence. Thankfully, I have lost those 25 lbs since returning home.

Not everyone is prone to weight gain as I am. Many of the students were able to maintain their weight or only gain a few pounds extra, but their health was deteriorating. Others had BMIs of over 40. I met many young students who were suffering from high cholesterol and high blood pressure. People in their early 20s should not be suffering from high blood pressure and high cholesterol and I am positive that their health problems are associated with the type of food they are forced to eat while living on campus. I must insist the proper word to use is ‘forced’ because there are rarely kitchens available for student use and depending upon the university, a zero vacancy rate off campus.

Perhaps the most striking thing about my experience with campus food is how these cafeterias proudly conform to the Canada Food Guide. When the cafeteria worker dishes out a dinner platter that consists of a cup of white rice, a cup of white pasta, a cup of mashed potatoes, 2 oz of deep-fried, breaded meat, a scoop of frozen peas and carrots, a bowl of something called pizza soup, and a bowl of ice cream all while pointing to the Canada Food Guide for justification—then something is very wrong."

Are you a University student or have similar campus stories? Do you want to send me some pics of the "healthy" food at your cafeteria? Feel free!

[Thanks very much to the reader who sent me such a thoughtful and interesting letter]

Food at the Ottawa Civic Hospital

Continuing with my Ottawa Hospital Food Series, today I bring you The Greenery, otherwise known as the Ottawa Civic's cafteria.

Not surprisingly, much of it was junk.

Poutine.

Bacon Cheeseburgers.

Chicken fingers.

Chicken wings.

Pizza.

Sugared soda.

Giant muffins.

Potato chips.

And that's just the obviously unhealthy stuff.

While I was recording my brief video some folks alerted the cafeteria manager who cut my taping rather short.

She was extremely pleasant and helpful and clearly was very sincere in her desire to provide a good dining experience for the cafeteria's patrons.

She was excited to tell me that the cafeteria offered smaller poutine/french fry portions in 4oz containers - but was unable to tell me why it was important for a hospital of all places to serve poutine.

[conservatively 4oz of poutine (for my international readers poutine is french fries, smothered in gravy, smothered in cheese curds) would have a minimum of 1,000mg of sodium and likely a fair amount of trans fats.]

She was also excited to tell me that they've recently posted nutritional information on their soups. While I don't have a picture, the information was located on a laminated card that was actually not visible as it was tucked between items and was on its side.

I took a look at the nutritional breakdown when I got home and my jaw still hurts from hitting my counter. Here's a smattering (or you can click here to see them all):

Cheddar Cheese and Bacon Soup - 170 calories (that's fine), 10grams of fat (45% of it saturated and 30% (3g) of it trans) and 1,150mg of sodium.

Hearty Chili Style Mix with Beef - 230 calories, 1,540mg of sodium, 2 teaspoons of sugar.

or how about one that sounds like you couldn't go wrong:

Garden Vegetable Soup with 70 calories but 970mg of sodium!

Breaking out my calculator I found that the average amount of sodium in a soup choice at the Ottawa Civic cafteria is a brain swelling 957mg. That's 42% of your total daily Health Canada recommended daily maximum and 64% of your total daily Blood Pressure Canada recommended daily maximum in a tiny bowl of soup that you just bought at a hospital of all places and in many cases it came with an artery clogging amount of trans fats for added bad measure!

Is there really a good reason why a hospital would serve soups with 3 grams of trans fats and a day's worth of sodium?

Boy oh boy, after seeing the nutritional breakdown for soups I'd sure hate to see the breakdown for the burgers, fries, pizzas, liver steaks with onions, giant gobs of mashed potatoes and other cafeteria fare - good news I suppose that I'm told they don't have those numbers.

Ignorance surely is bliss.

Oh, and of course there's a Second Cup at the Civic serving gigantic as-many-calories-as-a-Big-Mac muffins and other wonderful sugar laden foods.

I've got to ask again, why are our hospitals serving such unhealthy foods?

I can only think of two arguments. The first is the, "we need them to make money" argument.

I have a tough time with that argument. Frankly folks in hospitals are fairly captive. There simply isn't anywhere within walking distance (aside from the chip truck that parks by the Heart Institute) to buy food and therefore if the hospital decided to eliminate unhealthy foods from its premises, people would still need to eat and with some effort, thought and creativity I'm quite confident that the cafeteria could manage to serve up exclusively nutritious fare.

The second argument is the, "patients and their families need comfort foods".

I don't buy that argument either. Really the hospital is divided into 4 categories of folks:

1. The non-urgent emergency room folks who certainly don't need comfort because their problems aren't urgent.
2. The urgent emergency folks whose problems are too overwhelming to worry about food at the moment.
3. Admitted inpatient folks - who may well need comforting but their families and friends can certainly bring in any foods from the outside that they want including comforting junk.
4. Allied health professionals and hospital staff where again, comfort's not an issue.

At the end of the day it's pretty simply math for me.

A hospital should not be serving foods its doctors and dietitans wouldn't recommend to their patients.

Or at the very least they should post nutritional information such as calories, trans fats and sodium smack dab on the menu boards so that patients have a fighting chance of navigating through the far less than ideal options.

Sure is a shame you've got to fight to eat healthy in a hospital.

The Food at the Ottawa Heart Institute

My regular readers will remember a ways back I blogged about the QEII hospital in Halifax where a cardiology resident wrote an opinion piece about the state of the cafeteria's food there.

Well, I've decided to take a tour of our local hospitals and last week I took advantage of being at the Ottawa Heart Institute (OHI) giving a talk and I brought my new toy - it's a Flip video camera that's roughly the size of a cell phone that dead easy to use and at least a little bit inconspicuous.

My goal was to record the dietary fare at the OHI. The picture of the frying bacon on the grill above in the Heart Institute's Cafeteria (named Tickers) sums things up fairly well, but I'll run it down for you a bit further.

One of the first things you see when you walk through the Heart Institute's main doors is a Tim Horton's replete with its many varieties of deep fried donuts. More interesting are their non-donut options - here's a smattering along with some of their nutritional information:

Sausage, Egg and Cheese Breakfast Sandwich - 500 calories, 34grams of fat and 920mg of sodium.

Turkey Bacon Club - 440 calories, only 8 grams of fat and a blood pressure bursting 1730mg of sodium (that's more than Blood Pressure Canada recommends in an entire day for a healthy individual let alone a patient at the Heart Institute)

Hearty Vegetable Soup - 70 calories, 0.4 grams of fat and, wait for it, 1,060mg of sodium

In fact if you were a patient or a visitor at the OHI and you didn't particularly like the cafeteria or the hospital's food and instead decided to eat at Tim Horton's for breakfast, lunch and dinner and you chose the options with the lowest amount of sodium, you'd still almost certainly consume over 3,000mg of sodium. If you weren't being careful it'd be no trouble at all to clear 4,000mg.

Ok, so maybe an argument could be made that Tim Horton's is just there for snacking rather than meals and that instead OHI's Tickers has the healthy fare.

If only that were true.

Eat at Tickers too often and heaven help your tickers. While there may be a healthy option here or there, the bulk of the food served at Tickers is junk food. Burgers, fries, pop, ice cream, pastries etc., and I could not find a nutritional breakdown anywhere. That's really a shame given that many of the folks eating at Tickers will be patients and their relatives, all of whom clearly have risk factors for heart disease and therefore don't need to incur any additional dietary peril - I wonder if they'd appreciate a means with which to evaluate their choices?

Hey Heart Institute MDs - isn't sodium something you recommend we reduce?

Certainly the hour long lecture entitled "Salt and Hypertension" available on your website suggests you do.

Funny, I didn't see a slide that suggesting folks reduce their dietary salt intake by avoiding the food sold at the Heart Institute!

Below's a choppy video tape I took at the OHI. Hopefully I'll get more skilled with the equipment as this series progresses.

(Future editions of this series will cover the Ottawa Civic, the Ottawa General, the Queensway Carleton, the Royal Ottawa and the Children's Hospital of Eastern Ontario.)