White Coat, Black Art

How bringing room service to hospitals can help patients heal

Hospital chefs and medical students make a hands-on connection to put food at the heart of preventative care.
Basile Matabaro-Byamasu, 16, has sickle cell anemia and has been at Ottawa's CHEO for months after a serious infection. For lunch, he was able to select all beef, low-sodium hot dogs from the hospital's room-service menu. (Brian Goldman/CBC)

Originally published on January 26, 2019

It's not uncommon for people to complain about bland, unappetizing hospital food. But a growing number of hospitals in Canada are pushing back against this stereotype, overhauling menus to be locally sourced and delicious.

Patients in hospital need to eat nutritious food to heal. Yet research suggests that 51 per cent of young children admitted to hospital in one study lost weight, as did nearly 45 per cent of adult patients.

Some are too sick to eat. Many others leave the food tray untouched, leading to about 1.3 kilograms of food per bed to be thrown out each day. By one Canadian estimate, about half of the food placed at patients' bedsides went to waste.

Joshna Maharaj is a chef and food activist with Take Back The Tray. She helped to transform the patient menu at Scarborough Hospital, as well as café offerings for parents and visitors at Sick Kids in Toronto.

The meals went from what she called the "miserable monochrome" of processed foods, to scratch-made, local meals prepared in house.

When Joshna Maharaj sourced whole, fresh apples instead of bagged slices for the meal trays at a Toronto hospital, patients were delighted. (Supplied)

One of her first changes was to toss toast.

"It cannot escape the sweaty dome," Maharaj told CBC Radio's White Coat, Black Art. "Infection control means everything has to be covered when it leaves the kitchen and goes into the germy space of the hospital. No piece of toast will survive."

That dome, usually plastic, traps in steam from warm food, taking toast from crispy to soggy in a matter of minutes. Maharaj's solution was to serve a frittata instead.

"You pull the eggs out just before they're done and that extra bit of steam should let it arrive to the patient in reasonably good shape. We did the frittata the next morning to everybody's delight."

Maharaj solicited recipe ideas from food service staff at the hospital, resulting in more diverse dishes, such as congee, a popular Asian porridge, and rice and daal, a staple in India.

"This is what convalescing food is in these cultures, so we rebuilt the menu with no end to painstaking detail," she said.

An apple a day

Maharaj also has one simple tip for hospital officials who wish to improve the food they serve: Put an apple on the tray.

It's an encouraging visual for patients, emotionally and physically, as well as offers a touch of hospitality she said is often missing from hospitals.

Patients may complain about how difficult it is to heal from surgery when they're often served unappetizing and salty fare. But at one hospital in Ottawa, the menus and a 20-minute delivery guarantee are garnering positive reviews.

At the Children's Hospital of Eastern Ontario (CHEO), fresh food from a sauté station is now incorporated into the menus for patients, said Bernice Wolf, a registered dietitian and the facility's director of food and marketed services.

"We promote healthier choices," Wolf said. "We encourage once a day for chocolate milk or higher fat foods. But we have them on the menu because kids are picky eaters. We want them to have some nourishment while they are here."

To keep children satisfied with their meal trays, Wolf said she updates the menu based on rising food trends, such as butter chicken, stir-fries and hoisin beef.

Cultivating culinary medicine

Hospitals aren't the only institutions making the link between food and health.

The University of Toronto's medical school renewed its curriculum in 2016 to promote "lifestyle medicine," which includes healthy habits such as eating nutritious food, engaging in physical activity, quitting smoking and reducing stress.

Culinary medicine applies the healthy living approach in the kitchen for both patients and physicians, who are encouraged to act as role models.

One of the first assignments under the new U of T lesson plan included a cooking class at a grocery store, where first-year medical students learned to prepare meals like lentil burgers and a brussels sprouts salad.

'We've got to find a spot in the curriculum'

"We launched the curriculum and the second-year students who … weren't in the new foundations curriculum, they heard about it," recalled Dr. John Sievenpiper, a physician in the division of endocrinology and metabolism at St. Michael's Hospital.

"They were so excited by what they heard, they demanded that they get the same things. The leadership came and said 'Well, we've got to find a spot in the curriculum. You guys have to do this for the second years now.'"

Sievenpiper, who is also an associate professor of nutritional sciences at U of T, said that lifestyle medicine was previously just given "lip service." Medical learners were told of its importance without actually seeing how physicians could guide patients to put it into practice.

He's quick to acknowledge the university isn't the first to introduce the idea. In the U.S., Harvard's School of Public Health, Tulane University and the Culinary Institute of America all have similar programs.

As for Chef Maharaj, she is inviting doctors and dietitians to join her in championing better food both in and outside of hospitals.

"I've seen some doctors who do lovely things and start prescribing family meals at the table, or two weeks of not eating anything that came in package, which is a beautiful place to start," she said.

"Food lies in the heart of a preventative approach."


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