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Dialogue: Sharon Collier and Jenna Davis on healthy eating for patients
What role do dietitians play in getting inpatients to eat healthy foods?
SC: I have to preface my answer by saying it's very difficult for us. When patients are admitted to the hospital, they're here for a very short period of time and are often very sick. Our main goal is often just to get them to eat anything at all.
Our dietitians in the Clinical Nutrition Service do not meet with every patient that is admitted to the hospital. In fact, we only meet with about 25 to 50 percent of them. We are brought into the plan of care in a few different ways—through a direct request from the physician, nurse or parent; through a diet or formula order or a particular diagnosis like an eating disorder; or through a screening process performed by a diet technician after the patient has been in the hospital for 72 hours.
The time we spend with inpatients is not always conducive to working in the message of healthy eating, and many times there may be more important things to consider.
Can you provide an example?
SC: I've been struggling with a patient who has to undergo supplemental tube feedings at night because she isn't eating enough during the day. She just recently started to eat more on her own, but two of her favorite foods are chicken fingers and onion rings. She asks for them repeatedly—sometimes twice a day. While chicken fingers and onion rings aren't the healthiest foods she could be eating, at this point, any foods she eats are good because they will allow her to get off the feeding tube.
We don't want patients to be dependent on tube feeding or intravenous nutrition, as they are abnormal ways to be nutritionally supported. If patients can eat on their own and tolerate the food, then we tell them to eat what they like. It's not the answer everyone wants to hear, but in terms of what we're dealing with here in the hospital, it's often the best we can do.
How do Food Services and the Clinical Nutrition Service work together to care for patients?
JD: We collaborate on Room Service, an in-room food service that allows patients to order meals through a restaurant-style menu that includes appetizers, main dishes, side dishes, desserts, etc. The meals are served within 45 minutes of the order. The Clinical Nutrition Service diet technicians oversee certain meal plans and specialized diets, which are then processed and prepared by the Food Services staff.
SC: Room Service has been very well-received. In the past, kids had a hard time deciding a whole day in advance what they wanted to eat the following day. This allows them to decide right before they are ready to eat.
What foods do patients request the most?
JD: Typical kid-friendly items like macaroni and cheese, chicken tenders, hamburgers, French fries, etc., are requested the most.
SC: It's interesting to hear what foods are requested most by patients. You'll see they're the ones that tend to be higher in fat that we wouldn't necessarily consider healthy, but they are, as Jenna said, "kid-friendly." When you think about it, these foods could be considered "comfort foods." To a child, they could be associated with feeling better. So if chicken fingers are going to make a child feel better, even if they are higher in fat and higher in sodium, then we shouldn't deny them to the child, especially if he is very sick.
How does healthy eating affect foods offered by Food Services?
JD: We're currently working on an initiative to provide healthy food options for patients and employees. We look for healthy alternatives for our most popular selling items, such as fried foods, which are now cooked in oil that doesn't contain trans fats. Trans fat, which is used in many foods, including fried foods, cookies and pastries, increases "bad" cholesterol and lowers "good" cholesterol. It clogs arteries, increases the risk of heart disease and can cause Type II diabetes and other health problems. We also ensure that we have fresh fruit and a rotating salad bar.
How have fad diets—Atkins, South Beach, the Zone, etc.’Äîaffected what is offered by Food Services?
JD: We have initiated some low-carb options and changed some of the vegetable sides and the salad bar to help accommodate our dieting customers. But the majority of our customers don't take part in these diets, so we still offer our regular menu items. Surprisingly enough, our most popular cafeteria items are the fried fisherman's platter, chicken bar, the complete turkey dinner and the spicy buffalo chicken wrap—none of which really adhere to the fad diets.
What other healthy eating projects are you working on?
SC: There's an initiative in the Office of Child Advocacy called "Nutrition and Fitness" that is working on how best to reach out to the Boston community about healthy eating. I think the most impact can be made at the school and community levels, where you can work with parents and children, starting at an early age. The goal is to try to help families learn to eat well so those habits can last a lifetime.
