Should plant-based hospital meals be the law? An American experience

ABSTRACT

Hospitalization is an unparalleled opportunity for physicians to educate patients about the interconnection between poor dietary choices and the occurrence of many chronic diseases. For those patients who are ready to embrace nutrition as an essential part of the healing process, however, it is oftentimes difficult to find healthy menus at hospitals. Meat-based entrées, sugar-sweetened beverages and candy appear to be omnipresent in cafeterias and restaurants at U.S. hospitals. On the other hand, healthy plant-based menus are still the exception rather than the rule.

Some states undertook considerable efforts to change this and made plant-based meals the law. Upon request by a patient, hospitals in New York are now required by law to provide plant-based options at every meal. This recent development triggered a controversial discussion within the medical community whether other states should follow this example and make plant-based hospital menus the law as well.

This editorial illuminates why mandatory plant-based hospital menus could be a win-win situation for many involved stakeholders, including patients, hospitals and food services. This step is not a loss-marking venture for hospitals but rather a chance to save money and to improve corporate brand marketing at the same time.

The introduction of mandatory plant-based menus in hospitals at a large scale represents a unique opportunity at the nexus of health, innovative corporate strategies and economics. Adequate framework conditions are necessary to ensure that all individuals can make healthy and affordable dietary choices while being hospitalized.

KEYWORDS:

• Hospital Menu
• law
• mandatory
• meal
• plant-based Menu
• vegan

Prevention-based lifestyle medicine, including whole-food plant-based diets, has significantly increased in popularity in the medical community[1].

There is now continuously growing recognition and acknowledgment of the health benefits of plant-based diets for both disease prevention and treatment [2,3]. Therefore, several renowned American societies gradually incorporated plant-based nutrition on the front lines with their dietary recommendations[4].

In their ‘Healthy Food Options in Hospitals’ resolution, the American Medical Association called on United States health care facilities to improve the health of its patients by providing more plant-based meals[5]. Above all, they asked hospitals to eliminate processed meats and other foods that are high in saturated- and trans-fats from daily menus[5]. The American College of Cardiology made comparable recommendations and emphasized the importance of plant-based main dishes and a minimum of 3 fruit and/or vegetable options offered at each meal[6].

While these pleas sound promising, a key question arises: How do we get these nutrient-dense plant-based menus to hospital patients and health care facility residents?

According to the American College of Cardiology, hospitalization can be a ‘teachable moment’ for those who are ready to embrace nutrition as part of their healing process[6]. Ironically, it might oftentimes be a challenging task for those patients to find healthy food options during their hospital stay [4,7]. Sugar-sweetened soda and sweets appear to be omnipresent in canteens and restaurants at U.S. hospitals[7]. In this context, the Physicians Committee for Responsible Medicine emphasized that many hospitals across the United States still host fast-food restaurants offering processed meats and cheeseburgers[8]. A review by Aggarwal and colleagues revealed that hospital food offerings, especially in cafeterias, may be largely driven by financial considerations rather than by health guidelines[4].

A recently signed landmark bill could contribute to a significant change here[9]. Senate bill S1471A, introduced by Senator Brad Hoylman, now requires hospitals in New York that provide inpatient or residential care to offer plant-based meals[10]. More specifically, these facilities are now required to make available upon request by a patient a plant-based food option containing no animal products or by-products which is nutritionally equivalent to other menu items. Moreover, this service shall be offered at no additional costs to the patient beyond the price for a comparable non-plant-based food option. Comparable legislation was enacted in California in 2018 (SB-1138, Food options: plant-based meals)[11].

Senate bill S1471A recently triggered a controversial discussion within the medical community whether other states should follow this example and make plant-based hospital menus the law as well. While many proponents of this bill argue that this step is long overdue, its detractors oppose that the new law interferes with hospital food services’ freedom of decision of what menus to offer.

What many critics seem to neglect is the fact that the wider introduction of mandatory plant-based meals could be a classical win-win situation for patients and hospitals alike. Plant-based diets were shown to exert beneficial health effects with regard to many chronic conditions, such as diabetes, cardiovascular disease and obesity[12]. Healthful foods are also important for hospital staff and employees who are frequently exposed to a stressful environment which oftentimes includes shift work and extra hours. These individuals are particularly vulnerable to an unhealthy lifestyle and would certainly appreciate any efforts by their hospital food service to increase the availability of non-processed fresh whole foods. Such efforts would reinforce the ‘culture of health’ that is recognized as vital in the today’s workplace[6]. In this context, results from the GEICO studies, which introduced a plant-based nutrition program in a multicenter, corporate setting, were most promising [13,14]. A low-fat plant-based diet intervention program effectively reduced body weight and waist circumference and also improved depression, anxiety, and productivity in a corporate setting. These outcomes might be of paramount importance for healthcare organizations and hospital managers because poor wellbeing and mental health in healthcare staff are both associated with poor patient safety outcomes[15].

Moreover, endeavors to offer plant-based menus on a regular basis could also boost the credibility and authenticity of a hospital that advertises for holistic care approaches. The latter is of uttermost importance because lifestyle medicine approaches receive more and more public attention and an increasing number of patients seeks information on lifestyle-related issues[1]. In a competitive and consumer-driven industry, it is essential to respond to these current trends and the individual needs of patients. By actively promoting healthful plant-based menus, hospitals can take credit for innovations that were not offered in the past[6].

More and more studies emphasize the overwhelming effects of plant-based nutrition – incorporating these latest finding in the strategic decisions and direction of a hospital might be a huge asset when it comes to marketing issues and media coverage.

Offering plant-based menus is also a good strategy for hospitals and healthcare facilities to engage in corporate social responsibility (CSR). CSR refers to business operations that involve initiatives benefiting society[16]. In regard to the alignment of health and environmental outcomes for plant-based diets [17], offering greener plant-based menus might be a potent tool in a hospital management’s CSR strategy. According to Albert Schweitzer Foundation, hardly any other CSR measure appears to have a more positive impact than expanding the range of vegan menus offered[18]. A hospital that engages in environmental and social issues by promoting plant-based menus might experience a significantly better corporate reputation. The latter is of paramount importance in terms of marketing and public relations, given the already large quantities of greenhouse gas emissions generated by hospital-based healthcare.

In the end, expanding the range of plant-based menus can also lead to significant direct savings. Meat prices are steadily rising and it must be noted that plant-based options are usually cheaper compared to their meat-containing counterparts. St. Joseph Health System in Sonoma County, California, reported projected savings of approximately 5,000 USD a year by serving more meat-free menus [9,19]. The reason behind this is simple: ‘Vegetarian entrées cost about 50% less than meat entrées.’ [9,19]

In conclusion, mandatory plant-based hospital menus could be a win-win situation for many involved stakeholders. Introducing mandatory plant-based menus in hospitals at a large scale therefore represents a unique opportunity at the nexus of health, innovative corporate strategies and economic aspects (Figure 1). Most importantly, the regular introduction of plant-based menus is not a loss-marking venture for hospitals but rather a chance to save money while attracting more patients and improving corporate brand marketing at the same time.

Figure 1. Considerations for plant-based hospital meals. Menu modifications at the nexus of health, social responsibility and economics

An in-hospital stay is an often unparalleled opportunity for physicians to emphasize the interconnection between an unhealthy lifestyle, poor diet and most chronic diseases. This is of particular importance in COVID-19 times, since recent research indicated that COVID-19 mortality is strongly associated with uncontrolled type-2-diabetes, which is usually responsive to a plant-based diet[20]. The reservation must be made, however, that not every individual wishes to change his dietary habits, particularly if the potential benefits have not been described by the treating physician. For those who are ready to embrace nutrition as part of their healing process, everything possible should be done to create adequate framework conditions. Above all, this includes the guaranteed availability of healthy plant-based meals during hospitalization. Thus, there are several conclusive arguments for making plant-based menus in hospitals and healthcare facilities the law.

Legislation should guarantee that all individuals can make good and sustainable dietary choices while being hospitalized. Moreover, it is of paramount importance to make these better dietary choices affordable for all patients. Only when these prerequisites are fulfilled, a transition from processed and meat-based hospital menus toward whole-food plant-based hospital menus will be achievable.

Declaration of interest

The author declares that there is no conflict of interest. The author reports no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Reviewer disclosure

A reviewer on this manuscript has disclosed that they are an Adjunct Professor of Medicine at the George Washington University School of Medicine. They also serve without compensation as president of the Physicians Committee for Responsible Medicine and Barnard Medical Center in Washington, DC, both nonprofit organizations providing educational, research, and medical services related to nutrition. They write books and articles and give lectures related to nutrition and health which they receive royalties and honoraria for. The other peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

Maximilian Andreas Storz, MD, did the literature research, analyzed the data, designed and drafted the manuscript and submitted the final version. MA Storz is the sole author of the submitted manuscript.

Author disclosures

The author received no funding for this work. I hereby confirm, that the manuscript has not been accepted elsewhere for publication. The author declares that there is no conflict of interest. The author reports no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Additional information

Funding

The author received no funding for this work.