In April 2016, the World Health Organisation’s Commission on Ending Childhood Obesity published their consensus report, which provides recommendations to tackle the major global public health problem of child obesity.1
In 2013, 42 million children under the age of 5 were overweight or obese, and this number may continue to rise.2 In addition, obese children are likely to remain obese in adulthood and are at risk of chronic illnesses, but obesity is preventable by following a balanced healthy diet and exercising regularly, amongst other practices.
The WHO report mentions three critical time periods to address obesity in the life-course of children:
- Preconception and pregnancy (i.e. the risk of obesity can be hereditary)1
- Infancy and early childhood
- Older childhood and adolescence
In the report, the role of the healthcare sector in tackling childhood obesity is only mentioned during the first period of life i.e. when parents are educated about the importance of healthy behaviours. Some schools in Europe are already taking measures to meet (healthy) dietary guidelines, such as including nutrition and health education within the core curriculum (promoted by British TV chef Jamie Oliver) and incorporating physical activity into children’s daily routine. But, what happens when children live some of their childhood years/months in hospital? Who takes care of ensuring that they are served healthy, tasty, and high quality food?
Hospital food contributes to patient wellbeing and recovery, supporting them physically and emotionally.3 Patient satisfaction is a great reason for hospital kitchens to improve the nutrient quality of their menus by making food more appetising, particularly in paediatric departments showing that hospital food can be tasty.
Some hospitals, including children’s hospitals, are starting to ask patients what has been the worst experience during their stay at the hospital, and often food is mentioned. To address this some hospitals have improved the quality of their food and the design of their menus.
Childrens' food served in Hospital de León
For example, the University Hospital Complex in León (Spain) is producing a weekly menu, from where children can directly pick what they want to eat between three starters and three main dishes. 4 5 For each menu item, an image of the dish with a list of the ingredients is included. The success of the project has changed the eating habits of the child patients and, consequently, cut down food waste.
In 2010 The Guardian published an article, denouncing the poor nutritional standards of the dishes served to child patients in hospitals, referring mostly to the high level of salt, saturated fats, and sugars found in a vegetable crumble, lasagne, or sticky toffee sponge pudding.6 Fortunately, the Royal Cornwall Hospitals Trust in UK proves not all English hospitals are the same.
Since 2001, the Cornwall Food Programme, working in partnership with the Soil Association, has transformed hospital menus by serving increasing amounts of fresh, locally produced, nutritious, and organic food to patients, visitors, and staff. This programme is run at the Royal Cornwall, St Michael's, and West of Cornwall hospitals and is in line with government guidelines of both the Department of Health and the Department for the Environment, Food, and Rural Affairs (Defra). These guidelines promote better food in hospitals and more environmentally sustainable procurement in the public sector. The most popular dishes in the children’s wards are burgers and sausages freshly made with locally produced organic beef, the recipe of which has been approved by NHS dieticians.7
Healthy food should be seen as a necessary medicine for patients to avoid illnesses, such as obesity or strokes.
Another example can be found at the Evalina’s Children’s Hospital, which is part of Guy’s Hospital in London. This hospital does not sell confectionery in the vending machines, where usually unhealthy food and drinks can be found, often located just outside the children’s ward. At Guy’s, vending machines include a range of healthy drinks such as fresh fruit juices, and now primarily promote Malvern bottled water.8
Lastly, the New Meyer Hospital in Florence (Italy), the country’s first ‘bio-climatic’ hospital, is continuing to support children’s well-being by ensuring all patients are offered high-quality, nutritionally balanced meals. These meals are individually tailored to patients’ unique medical conditions, including those undergoing cancer treatment. The hospital helps children and their families to gain a better understanding of nutritional needs in order to make better food choices. 70% of food served to children is organically produced, and local products with protected designation of origin (PDO) or protected geographical indication (PGI) status are served. Activities in the hospital vegetable garden, where children can plant and collect vegetables and fruits, are regularly organised.9
Healthy food should be seen as a necessary medicine for patients to avoid illnesses, such as obesity or strokes. This is why hospitals should set the example by creating healthy food environments for staff, patients, and visitors – with a particular focus on children and young people.
In the healthcare setting particular attention should be paid to enforcement and monitoring of hospital food standards, like NHS Scotland and Wales have done in 2008 and 2007 respectively.10 11 12 These standards focus in particular on reducing the sale of all unhealthy food and drink products in the vending machines, hospital onsite shops, and food outlets. Healthcare professional should also have the responsibility to provide appropriate advice and support to parents and children on healthy behaviour, taking into consideration patients’ individual cultural, social, and economic backgrounds.
- Paola Hernández, Sustainable and Healthy Food Programme Assistant
Preview image: Miia Sample via Flickr cc
(1) World Health Organization (2016) Report of the Commission on Ending Childhood Obesity. http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf?ua=1
(2) World Health Organization (2015). Commission on Ending Childhood Obesity: Facts and figures on childhood obesity. http://www.who.int/end-childhood-obesity/facts/en/
(3) Navarro, D. A. et al. (2015). Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients. Clinical Nutrition (Edinburgh, Scotland). http://doi.org/10.1016/j.clnu.2015.09.012
(4) Restauración colectiva (2016). Caso de éxito en el Hospital de León: adaptación de la dieta al paciente pediátrico. http://www.restauracioncolectiva.com/es/index.php?pag=nota&id=1040&cid=10
(5) Cuervo, M. (2013) Los niños del Hospital se comen la luna a mordiscos. Información de León. http://www.ileon.com/actualidad/leon_y_alfoz/027226/los-ninos-del-hospital-se-comen-la-luna-a-mordiscos
(6) Campbell, D. (2010). Hospital food for children is 'shockingly unhealthy'. The Guardian. http://www.theguardian.com/society/2010/oct/09/hospital-food-for-children-unhealthy
(7) Russell, C et al. (2006). A fresh approach to hospital food: The Cornwall Food Programme, pioneering tasty, healthier and environmentally friendly hospital meals. The Soil Association. https://www.soilassociationscotland.org/media/4910/policy_report_2006_fresh_appraoch_hospital_food.pdf
(8) Kidd, M. and Noble, E. (2007). Not what the doctor ordered: How junk food in hospitals and sports centres is undermining the drive for healthier living. The Soil Association in collaboration with Organix. https://www.organix.com/sites/default/files/activity_sheets/not-what-the-doctor-ordered.pdf
(9) Cottingham, M. (2007). Fresh, local and organic A successful recipe for improving Europe’s hospital food. HCWH Europe. https://noharm-europe.org/sites/default/files/documents-files/2634/Fresh%2C%20local%20and%20organic.pdf
(10) The Scottish Government (2008). Food in Hospitals: National Catering and Nutrition Specification for Food and Fluid Provision in Hospitals in Scotland. http://www.gov.scot/resource/doc/229423/0062185.pdf
(11) Taylor, M. (2015). Hospital food standards. The Scottish Government News. http://news.scotland.gov.uk/News/Hospital-food-standards-199c.aspx
(12) NHS England (2007). Better Hospital Food: Catering services for children and young adults. http://www.wales.nhs.uk/sites3/Documents/254/Better%20hospital%20food.pdf
In the following link:
The Action for Sick Kids Hospital Food Survey survey was conducted during 2014/2015, about parent/carer experiences of mealtimes and children’s food in hospital in Scotland. These findings were so remarkable that a new section was developed to cover food in children’s hospitals and wards, including nutrition standards for specific age groups, guidance on portion sizes, and the use of appropriate kitchenware.