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Building a Healthier Hospital

Hospitals can be a key player in the fight against obesity By James M. Galloway, MD, MPH

The United States is experiencing unparalleled levels of obesity. Currently, nearly 36 percent of adults and 17 percent of children ages two through 19 years are obese. What is more concerning is that since 1980, obesity prevalence among children and adolescents has almost tripled. A recent report from Trust for America’s Health estimates that all 50 states are on track to have obesity rates greater than 44 percent by 2030. In Illinois, the report shows the rate of obesity may double, reaching almost 54 percent in 2020. Obesity has become one of the main contributors to medical problems such as heart disease, stroke, type 2 diabetes and certain types of cancer in the U.S. When quantified for Illinois, the numbers equal more than 1.5 million new cases of type 2 diabetes; more than three million new cases of coronary heart disease and stroke; more than three million new cases of hypertension; and nearly 500,000 new cases of obesity-related cancer.

Beyond the medical impact of obesity, there are considerable economic effects. The rising rates of obesity were associated with nearly $40 billion in increased medical spending through 2006, which includes $7 billion in Medicare prescription drug costs. These costs translate to an additional $1,152 per year in medical spending for obese men, which is largely attributable to hospitalizations and prescription drugs, and an extra $3,613 each year for obese women. When considered on a nationwide level, these expenditures total $190 billion per year in additional medical spending, which is more than 20 percent of all U.S. health care spending. If Illinois can decrease its obesity rates by just five percent, it has the potential to save more than $9 billion in 10 years and $28 billion in 20 years.

Many initiatives are currently underway to tackle rising obesity rates. They range from national policy, such as The Healthy Hunger Free Kids Act, to city-specific measures, such as those being undertaken by our own mayor in Chicago, to smaller scale programs such as workplace wellness initiatives. More recently, hospitals have been identified as a potential source of obesity prevention and health promotion for the role they play in nutrition for patients, visitors, and staff. As of 2010, there were 5,754 registered hospitals in the U.S. with a total of 36,915,331 admissions. Considering that an individual hospital serves anywhere between several hundred thousand to one million meals per year to employees, patients and visitors, most of whom are a captive audience dependent on the food options provided by the hospital, these institutions provide a significant vehicle by which to encourage healthy eating.

The CDC has also recognized the need to increase access to healthy food and beverages in hospitals through its Healthy Hospital Practice to Practice Series, which presents case studies of hospitals seeking to better support the health of employees. They have sought to increase healthy food and beverage options in hospitals by encouraging food procurement policies that are environmentally sound and socially responsible. The importance of using hospital food as a method of health promotion and obesity prevention is currently receiving a great deal of attention.

In synergy with these national efforts, Building a Healthier Chicago—a collaborative of more than 150 local and national stakeholders and steered by an executive committee consisting of Chicago Medical Society leadership, Institute of Medicine of Chicago, Chicago Department of Public Health, and U.S. Department of Health and Human Services-Region V—is developing a workgroup to coordinate efforts on the Building a Healthier Hospital initiative in Chicago, which is focused initially on healthy hospital cafeterias.

Since its creation in 2008, the goal of BHC has been to improve the health of Chicago’s residents and employees through the integration of new and existing public health, business, medical, and community efforts. Partnering with the Metropolitan Chicago Healthcare Council, BHC will develop and promote hospital food that is balanced, nutritious and tasty, providing a critical component of the healthy living model. The initiative will challenge Chicago-area hospitals to improve the health of patients, visitors, and staff with healthy meals emphasizing local produce, when possible. BHC will also examine broader processes such as cooking with healthier oils and eliminating trans fats, as well as promoting access to healthier beverages.

One Chicago-area provider, Vanguard Health Systems, which operates MacNeal Hospital in Berwyn and three other Chicago-area hospitals, has undertaken its own initiative to ban all sodas and sugary drinks at their sites. BHC’s goal is to encourage other Chicago-area hospitals to follow Vanguard’s lead and take their efforts even farther in promoting a hospital nutrition system that focuses on healthy foods as well. Considering the significant reach of a hospital system, an enormous potential exists for nutritious food promotion and distribution, which will ultimately help curb rising rates of obesity.

Dr. Galloway is Assistant U.S. Surgeon General and Acting Regional Director, Regional Health Administrator, Region V. For a list of references please contact

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