Hospitals battle “deep-fried hypocrisy”- Is change in our future?

Photo credit:
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I read an article yesterday from the Ottawa Citizen, titled Hospitals battle ‘deep-fried hypocrisy’, push junk food out the door. The gist of the article describes the changes that are (slowly) being made to reduce the presence of fast food restaurants (Tim Hortons®, Burger King® etc) in hospitals, or at least change the offerings of these restaurants to healthier options. While this is a great idea (in theory), there are a few points to consider:

The Tim Hortons® near my hospital really makes my job challenging. Many of my clients are hooked on caffeine and sugar, therefore they frequent Tim Hortons® daily, or multiple times per day. The article in the Ottawa Citizen states “Hospitals in central Nova Scotia introduced a similar program about five years ago and Tim Hortons® now serve muffins, tea biscuits and trail mix cookies, instead of doughnuts, at hospitals there”. Ok.. but look at the nutritionals for a Tim Horton’s chocolate-dipped doughnut compared to a chocolate chip muffin (found on Tim Hortons® website):

  • Doughnut: 190 calories, 6g fat, 10g sugar
  • Muffin: 420 calories, 16g fat, 35g sugar

Yes, the doughnut is deep-fried, but you tell me what the better choice is. I would down a 190 calorie doughnut over a 420 calorie fat bomb muffin any day! I commend the hospitals for trying to encourage healthier choices at a fast food outlet, but they are missing the point between foods that are actually healthy, versus foods that are “health washed” (aka muffins, cookies with healthy-sounding names etc).

Are they even good for hospital business? Maybe not. A 2012 article published in the Windsor Star reports the Tim Hortons® kiosk in the Windsor Regional Hospital sets the hospital back about $265,000 per year. How? Labour costs. The Tim Hortons® franchise workers at this particular hospital are unionized (CAW) and they are paid DOUBLE what franchise workers in the community are paid. This is not the case for every hospital (many hospitals actually make quite a profit from these franchises), however it all depends on the collective agreement the hospital has with their union(s) in relation to contracting out work. So if the franchise is causing the hospital to bleed money, why not get rid of it? Well, the Windsor Star article reports there would be an “uproar from patients, staff and families” who purchase from the kiosk every day. Clearly a Tim Hortons® in and/or near a hospital is good business regardless.

So it looks like these types of establishments aren’t going anywhere. But how can we actually make it work out in the best interests of 1) customers and 2) healthcare workers who want these franchises to have their products align with healthy eating messages? Here are my ideas:

  • Make the healthy choice the default choice. Marion Nestle said it best: “Plenty of research shows that although customers can request other options, most take the default. So the default is what counts”. So make some small changes here and there so customers almost always pick the healthier option (by default). For example: a “double double” is 2 creams, 2 sugars. By making the default “double double” 2 MILKS, 2 sugars, you automatically save 54 calories and 6g of fat with a medium coffee. For combo meals, make the default side a piece of fruit (instead of a cookie/doughnut), and the beverage a small.
  • Portions are more important than “healthy-sounding” alternatives. As evidenced by my doughnut to muffin comparison, customers are often duped into purchasing health-washed foods, thinking they are making a better choice. So instead of continuing to promote these foods as “healthy”, what about reducing the portion size of gigantic muffins and bagels (both which have the carbohydrate equivalent to 4 slices of bread)? What about eliminating the largest sizes of the sugar-sweetened Iced Cappuccinos, fruit smoothies and frozen lemonades? All of these ideas sound great to a health professional, however it probably would spark customer outrage, who often look at “value for money”. A girl can dream though 🙂

Happy Friday!!

Taking on the Food Environment (Part 2): Personal Responsibility


The traditional views on weight loss tend to place a lot of blame on the individual. “Just change already”, “stop being lazy”, “put the cheeseburger down”. If losing weight were simple, why are one-third of U.S. adults obese? Why do one in four Canadians have Type 2 Diabetes/Prediabetes, the majority related to excess weight?

The reason being is that weight loss is not as simple as “calories-in, calories-out” or “eat less, move more”. The hundreds of choices we make every day related to our lifestyle are influenced by much more than our own personal willpower. Last week I wrote about a client I work with, who like many of us have a desire to lose weight (and keep it off). But as you saw in my example, despite the intentions to make changes, implementing these changes can be difficult when the food environment is factored in.

One of my biggest girl-crushes has to be Marion Nestle. Seriously, this woman is my hero. I follow her blog Food Politics and she speaks about the intricate relationships between government policy, farm subsidies, historical events (e.g. women joining the workforce), industry influence etc. and how these relate to the food we eventually consume. It’s complicated, it’s messy but I LOVE learning about it.

I wanted to showcase a food environment topic that Marion Nestle posted back in August 2011. It was her response to McDonalds offering “healthier” Happy Meals to children. You can read the full post here. Her views pinpointed that making healthier Happy Meals is basically a health-washed marketing tactic put on by McDonalds, secondary to recent declining sales. Are the new re-designed Happy Meals actually better for children? Hell no! Here is why:

  •  There were no changes to the default Happy Meal menu. Basically if you want a “healthier” meal, you would have to specify so, otherwise the default was given. And as Ms. Nestle points out, the majority of consumers will choose the default (because it’s the easiest).
  • The names “McDonalds” and “health food” rarely appear in the same sentence. Wouldn’t children be better off eating something healthy (e.g. a homemade meal) versus something that is “slightly healthier than before?” Overall, McDonalds should still be considered an occasional treat, not as an equal substitute to a healthy meal.
  • Consumers need to remember that McDonalds is a BUSINESS. “This means selling more food to more people more often, viewing food choice exclusively as a matter of personal responsibility and pretending that the company’s $1.3 billion annual marketing expenditure has no effect on consumer choice”.

So you can now see how easy it is for our food environment to place a perceived “concern” about our health, and how industry spews a desire to “help us” make healthier choices. But in reality, it always falls back onto our personal willpower and responsibility. We will offer you items that are “less bad”, but YOU need to make the choice. YOU need to pick items that are not the default. If you see our advertising promoting a $1.99 burger, it is YOUR fault you went and purchased it.

In summary, my take-home message is simple: be less judgemental. This is especially true for those who work in healthcare. If a person is overweight/obese and trying to lose weight, do not assume that they took the wrong turn because they lack the willpower to “say no to cake” or they are “too lazy to exercise”. Our food environment clearly shows that personal responsibility is one miniscule factor playing a role in our choices, DESPITE what the food industry says 🙂 Stay tuned for Part 3! xo

New Series: Taking on the Food Environment

Weight management. Eating healthy. Preventing disease. Choosing local. Saving money. Etc etc etc.

We all have goals when it comes to nutrition. Some of us want to lose a little bit of weight, some want to prevent diabetes (especially if we have a family history of it), some of us want to eat healthy yet do it on a budget. Whatever your goal may be, one of the most important things to consider before you embark in a big lifestyle change is our food environment. This is a huge topic, so big I thought I would cover it over a couple of posts.

First off, what does the food environment even mean? The Harvard School of Public Health defines it as “the physical and social surroundings that influence what we eat”. Seems simple right? Not so much. The fact is, our food environment plays a HUGE role in whether or not we can make lifestyle changes AND stick with them.

Let me provide you with an example. A client of mine indicated he would like to lose weight. He identifed with me his ideal body weight, and some of the goals he wanted to set to reach this. One of his goals was reducing snacking in between meals. Seems pretty simple right? However come 10am, a snack cart visits the unit he is staying on. On the snack cart there are king-size chocolate bars, bags of chips and gigantic cans of Arizona Iced Tea, all for $1 each. These snacks are hard to resist because this gentleman is bored, and everyone around him is purchasing a snack too.

Around 2 PM, this gentleman decides to go outside for a coffee with a friend. Outside the hospital grounds, the only (affordable) places for him to visit are Tim Hortons, Pizza Pizza and a greasy-spoon diner. Him and his friend go to Tim Hortons. When he approaches the cashier to order a coffee, the Tim’s employee states “would you like to try our new frosted cinnamon bun, only $1.49”? It’s hard for the gentleman to say no, as his friend says “of course” and it’s only $1.49!

Around 8pm, this gentleman and some co-clients decide to watch the big hockey game on TV in the lounge. Someone on the unit orders a large pepperoni pizza, and offers to share with everyone. The gentleman tells himself, “well everyone else is having pizza, and I haven’t had pizza in a while! What’s the harm in a few slices”? He digs in, and goes for the soda too.

Not really what my recommendations looked like...
Not really what my recommendations looked like…

Can you identify where the food environment played a role in this client’s choices? Here is a quick list:

– Lack of activities while in hospital/boredom

-Cheap snack foods readily available and no healthy options offered as alternatives (snack cart)

– Cheap restaurants in the neighbourhood and no healthy options offered as alternatives (well, healthy options ARE available in the area but not in the price range most of my clients can afford)

– Foodservice workers asked to upsell cheap, nutrient-poor foods 

– Social situations where it is acceptable to indulge in treats (e.g. visiting with friends, watching a sports game)

This example is not uncommon for me to see in the area I work in. Dietitians (and other health care providers) often have the deck stacked against us with the food environment. You can work with clients on setting goals and helping to motivate change, however after you leave we are unfortunately at the mercy of our environment. And as you can see (from the example above), it can be HARD to resist the temptations and the offerings our food environment provides.

So what can we do about it? Well, I will talk more about that in my future posts 🙂