Hospital meals have long been the butt of jokes, but new research shows they might actually pose a health risk, with low-quality diets failing to meet basic nutrition standards in hospitals and nursing homes.
Anyone who has been a hospital patient or has visited someone in the hospital during mealtimes can attest, hospital food can be abysmal. Often colorless and cooked beyond recognition, what’s served up in healthcare settings has, for a long time, earned itself a bad reputation.
New research by the Potsdam Institute for Climate Impact Research (PIK), Charité – Universitätsmedizin hospital in Berlin, and Stanford University has examined the quality of food served in German hospitals and nursing homes. As the first comprehensive study of its kind, the researchers also analyzed the environmental footprint of the food provided in these institutions.
“We found that meals contained too few healthy plant-based foods such as vegetables, fruits, whole grains and legumes, and too many refined grains, added sugars, salt and saturated fats,” said lead and corresponding author Lisa Pörtner, MD, a researcher at PIK and Charité. “This leads to an inadequate provision of nutrients and low dietary quality.”
The researchers gathered meal plans and recipes from two hospitals and three nursing homes across Germany. They measured food quality using the Healthy Eating Index-2020 (HEI-2020), which assessed how well the food met dietary guidelines, and the Planetary Health Diet Index (PHDI), which measured how well it aligned with a diet that supports both human and planetary health. The researchers also compared the provided nutrients to recommended dietary values. To measure environmental impact, they examined the impact of food procurement through factors such as land use, greenhouse gas emissions, and water use.
The HEI-2020 provides a score out of 100, based on 13 dietary components, categorized into “adequacy” (the consumption of foods like fruits, veggies, whole grains, dairy, protein, and healthy fats) and “moderation” (limiting intake of refined grains, salt, saturated fats and added sugars). The higher the score, the better aligned with dietary guidelines. The PHDI was introduced in 2019 to better align nutrition and sustainability targets. It’s scored out of a total of 150 points, based on 16 dietary components. Derived from the EAT-Lancet Commission on Food, Planet, Health’s recommendation, these components are categorized into adequacy, moderation, optimum, and ratio components. The framework is designed to nourish a global population while minimizing environmental harm.
In terms of dietary quality, the institutions analyzed by the researchers scored low on both HEI-2020 (39 to 57 out of 100) and PHDI (30 to 44 out of 150). Most calories came from animal-source foods like red meat and dairy, refined grains, added sugars and animal fats. Less than 20% of calories came from healthy plant-based foods such as legumes, nuts, and vegetables. The study also exposed nutritional deficiencies. Protein intake met less than 73% of recommended values in nursing homes, highlighting risks for muscle loss, frailty, and delayed recovery. Micronutrients (B vitamins, vitamin C, potassium, magnesium, calcium, iron, and zinc) were critically low, below 67% of recommended values. Whereas salt and saturated fats were far too high.
From an environmental standpoint, the animal-source foods served caused around 75% of the environmental impact, even though they made up only around 33% of food weight and calories and around 60% of protein. Meat alone was responsible for about 38% of greenhouse gas emissions and around 45% of land use impact. Dairy was the second largest contributor. Legumes and nuts, which are more sustainable proteins, made up less than 1% of total procurement by weight.
“Calories from wholesome plant-based foods made up less than one-fifth of energy provision in all institutions, which is far lower than the 80% recommended by the Planetary Health Diet,” Pörtner said. “At the same time, refined grains made up over 20% of calories, and red meat accounted for 10 to 17% – resulting in poor overall dietary quality. Animal-source foods, namely red meat and dairy products, were also major contributors to negative environmental impacts, including greenhouse gas emissions, land use change and water pollution.”
The study had limitations. Only five institutions were chosen, which is a small sample size, and they were not randomly selected. The researchers didn’t measure what people actually ate, only what was served to them. They also excluded important factors like cooking methods and simplified environmental estimates (composite foods were broken down by ingredients, but some processing impacts may have been underestimated).
Nonetheless, the study’s findings highlight a need for change.
“Our results indicate that food served in healthcare settings poses a health risk if consumed over the long term, as unhealthy diets are a major cause of chronic illness,” said the study’s senior author, Nathalie Lambrecht, PhD, a nutritional epidemiologist and food systems scholar from Stanford University. “This is particularly troubling as health care institutions should be role models for healthy diets. In addition, we find that their foodservice contributes to environmental degradation and climate change – which also threaten to undermine health.”
There have been initiatives aimed at resuscitating the reputation of hospital food. In January 2024, Germany’s Federal Government introduced the food and nutrition strategy, Good Food for Germany, to make it easier for people – at school, at home, and in healthcare settings – to eat well and sustainably. The New South Wales government announced in October 2024 that it would be rolling out the Co-Designing Healthy and Enjoyable Food (CHEF) program across 12 public hospitals in the Australian state. The program aims to deliver more delicious and nutritious meals alongside a 52% reduction in food waste.
It would be remiss to lump all hospital meals on the same tray, as it were. Not all hospital meals are created equal, and there are differences between not only healthcare facilities, but countries, as this Food & Wine article from 2022 makes very apparent. But with poor food quality in healthcare a worldwide problem and with up to 40% of hospitalized patients affected by disease-related malnutrition, it’s important that improvements are made when and where they’re needed.
“Policymakers and healthcare providers alike urgently need to prioritize food quality, set clear standards and close existing data gaps to ensure meals truly are health-promoting – without harming the planet,” Pörtner said.
The study was funded by the Deutsche Bundesstiftung Umwelt (DBU), also known as the German Federal Environmental Foundation, and was published in the journal The Lancet: Planetary Health.
Source: PIK
