A New Year, A New Kitchen

As the sweeping changes in the healthcare industry influence everything from care delivery to organizational models, we assess the effect on the kitchen. Are food options for patients healthy? Is the healthcare industry contributing to our obesity epidemic? What changes could the industry implement to help improve Americans’ diets and help them make better choices?

Director of Nutrition Care at Bethesda Hospital, Bret Tupper offers a fresh perspective for hospitals to consider as we move into 2013. “New strategies in cafeterias are becoming popular to offer employees and patients healthier options and improve their choices when selecting food. It’s time our industry embraces new tools to create real change,” says Bret.

For example, we can benchmark from other countries, such as Britain and Australia, where they implemented a “traffic lights” program in cafeterias to educate patients nearly 10 years ago. Here in the United States, a report published in the American Journal of Public Health in 2011 described results of a 2-phased study conducted in a large hospital cafeteria.1 The phases of the study included color-coded labeling of food and beverage items—with red, yellow, and green reflecting a descending level of healthiness—and product placement to increase visibility of some green items. The study showed a decrease in sales of red items and an increase in sales of green items.

The traffic light strategy is simple and effective. Colored stickers are easier for consumers to understand than calories and fat grams. Translating this color-coded strategy into a labeling system and rearranging placement of food items for increased accessibility of green items simplifies the choice process and influences consumers’ decisions.  (Download a sample traffic light menu here:  Soriant Healthy Eating Menu)

However, this is just one approach hospital cafeterias can take to create healthy change. Simply offering more fresh fruit and vegetable options and fewer sugar-sweetened beverage choices are other alternatives to consider. Providing education about nutritional data and increasing the variety of healthy selections available are important to helping employees and patients make better decisions when choosing food options.

One of the methods currently utilized to promote healthy eating in the cafeteria at Bethesda Hospital is to more aggressively market the premium nutritious choices. “We do this for many of our fruit items. For example, we just started carrying a fresh (not from concentrate) orange juice product. Even though it is more expensive than the other orange juice, it is flying off the shelves,” says Bret.

Top 5 Healthy Kitchen Strategies for 2013 at Bethesda Hospital:

  1. Harness marketing strength of vendors. Increase the “buzz” generated for healthy products by utilizing the marketing potential of vendors that supply them. For example, in March (national nutrition month) Nestlé will be providing marketing tools to introduce a healthy choice entrée each day in the cafeteria, and there will be a drawing for a free mountain bike. There is no cost to Bethesda Hospital, no increase in the culinary staff’s workload, and Nestlé has the ability to promote its brand.
  2. Increase demand for high quality healthy options. Introduction of new healthy items happens slowly via the development and production of a high quality product that people are willing to pay for. Guiding the consumer’s perception of the product’s popularity influences its demand. A smaller amount of a product may be produced at one time to give the impression that it is in high demand.
  3. Focus on attractive food presentation. Food that is prepared with its presentation in mind is often perceived to be of higher quality. A higher price point can be commanded when paired with appealing options.
  4. Modernize the salad bar. Promotion of these particular items can be a challenge, as many employees often consider them an afterthought. Remove offerings like iceberg lettuce and deli lunchmeat, and instead use good quality products like baby spinach and low-fat versions of dressing packets.
  5. Adjust catering options to force inclusion of healthy items. Catering requests might be modified to ensure that healthy items must accompany every catering order. For example, if brownies are selected, a variety of fresh fruit choices are automatically included.

These tactics each help lead consumers to the healthier items. Whether a hospital chooses to implement a color-coded labeling program or offer more significant education about nutritional data, even small modifications can make a positive impact and contribute to an environment that promotes health and wellness.

This post was written with support from Bret Tupper.

Bret Tupper, RD, MBA, has 22 years of healthcare foodservice, clinical, and management experience. He earned his undergraduate and graduate degrees from the University of Minnesota, and has served as Director of Nutrition Care at Bethesda Hospital in St. Paul, Minnesota, for 2 years.


1. Thorndike AN, et al. A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices.  Am J Pub Health. 2012;102(3):527-533.

Download a sample traffic light menu here:  Soriant Healthy Eating Menu