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

Photo credit: www.foodcourtlunch.com
Photo credit: http://www.foodcourtlunch.com

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!!

Nutrition and Mental Health: The Times They Are a-Changin’

You said it Bobby D... Photo: © Sony
You said it Bobby D… Photo: © Sony

So for those of you who aren’t aware of my day job, my long-winded title is “Clinical Inpatient Dietitian in Complex Mental Illness at the Centre for Addiction and Mental Health (CAMH)”. I’ve been working at CAMH just shy of 3 years now. When I first started working at the hospital, my background in mental health was extremely limited. Working in downtown Toronto in community health gave me a bit of exposure, but I was far from an expert. And I will remind you all that I am STILL by no means an expert. Working in mental health is a continuing learning experience, and I learn something new every day on the job.

Recently I was extremely lucky to speak at a conference in Ottawa for the Family Health Team (FHT) Dietitian network. It was such a fantastic learning experience for me, and a great opportunity to share my knowledge with others and increase exposure to the exciting world of nutrition and mental health.

Photo credit: my wonderful friend Katie Hortobagyi
Photo credit: my wonderful friend Katie Hortobagyi

I explained during my presentation that when I was in school for Applied Human Nutrition (back in the day kids), I don’t recall learning ANYTHING about mental health. The only thing I can really think of is learning about the management of dementia/Alzheimer’s. But working in the field, it honestly shocks me how much there is to know, and how the role that nutrition plays is always changing. For example, nutrition-related interventions can pop up in many of the following scenarios (and this list is not exhaustive!):

-Managing metabolic side-effects with antipsychotic medications (weight gain, increased appetite, insulin resistance)

-Helping clients cope with food-related delusions, hallucinations and phobias

-Managing macro/micronutrient deficiencies after abstaining from substances or recovering from an acute psychotic episode (many of my clients come into hospital really malnourished because they do not eat or take care of themselves)

-Teaching basic life skills around shopping, storing and cooking food

-Helping clients on a budget make healthier choices within their budgets

-Helping clients manage other chronic diseases (diabetes, heart disease, high blood pressure, cancer, kidney disease) that they may have ON TOP OF their mental illness

-Education and research on how food affects mood, depression (such as the mind-gut connection)

-Keeping updated on current research and what is emerging around nutraceuticals (e.g. there is research going on right now looking at nutritional supplements as adjunct therapy to medications used to treat schizophrenia)

-Debunking myths around food fads and the evidence on what works/doesn’t (e.g. I have educated patients and families on the relationships between gluten and schizophrenia symptoms)

As you can see, there is a lot coming down the pipe! It makes me very excited to be involved in this area of healthcare. Recently I’ve been having some feelings of doubt related to my position at CAMH. Mostly these feelings are in my own head, after a particularly bad day where I wonder “am I really making a difference, am I actually helping anyone?” The answer I have to keep telling myself is YES, YES a million times YES. As you can see above, a Dietitian can play a HUGE part in mental health, and the part is just going to get better as more knowledge emerges. So rather than feeling bad and wondering whether my job makes any impact, I’m going to embrace my unique role and do as much as I can to learn, grow and help those with a mental illness thrive 🙂

Feature Friday: Re-think your drink

soda pop

Lolz…. my work colleague shared this article with me, about a guy who decided to drink 10 cans of Coca Cola® every day for a month. You can see the results of his “experiment” here. Even though you can’t possibly extrapolate the results of one guy’s experience to the general public, it paints an interesting picture around the effects of sugar on our bodies.

Happy Friday everyone! xo