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The New Health Dialogue

A Blog from New America's Health Policy Program

HEALTH CARE: Watching Waistlines in the Lunch Line

Published:  June 29, 2010
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Michele Obama and her “Let’s Move” campaign has helped focus attention on childhood obesity and school cafeterias.  But who is paying attention to hospital cafeterias?

Apparently, some of the people who eat in them.

Paul Levy of Beth Israel Deaconess Medical Center in Boston turns his famed "radical transparency" (see here and here) on his own hospital lunch offerings (think beef quesadilla), sharing a recent email exchange with some of his employees.

You can read the full exchange on his Running A Hospital blog but in brief: a worker faced a dilemma around the “Angus Quesadilla Burger” on special. She wanted one. To get the special though, she had to order two.  She caved, but then followed up with a complaint to the food service manager (as well as Levy) in an email calling for different menu options and better menu labeling to make it easier to find the healthy low-fat, low-sodium and vegetarian options that the cafeteria does offer. The saga ended in the adoption of a single quesadilla special option, priced to encourage wallet-motivated portion control. (Not a new idea, but growing in popularity.) There was also quite a bit of discussion about how fattening that two-quesadilla special was -- 1480 calories and 210 percent of the daily fat allowance. "For a health institution, I find that absurd" the email writer said, adding that she could only get the nutritional information by going back to her desk and looking it up online.

Her story is a microcosm of incentivized personal health decisions, and the rest of the country might be wise to take note, because, as many of you know, the new health reform law requires menu labeling in chain restaurants -- visible, not just online. The Beth Israel cafeteria isn't bound by that law, but its decision to post at least some nutritional information (via a "wellness logo") shows how a health-conscious community can demand, and respond to, such information. Growing consumer hunger (pun intended) for nutritional information is one reason the National Restaurant Association stopped fighting the legislation, as our blog editor Joanne Kenen noted in this article.

The Beth Israel cafeteria story interested us because it brings together many of the issues we'll need to tackle in addressing our national obesity problem, with direct benefits for the parallel costly chronic disease problem. We must strive for heightened awareness of what we eat and recognize that we can't reliably guess whether or not something is healthy by sight.  We must understand the interplay between price and portion. There is some early data that menu labeling can influence consumer choice and dissuade us from the fatty and frequently cheaper foods. 

We must understand that sometimes, two quesadillas aren't better than one.

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