Assessment of Food Offerings and Marketing Strategies in the Food-Service Venues at California Children’s Hospitals

Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Academic pediatrics (Impact Factor: 2.01). 11/2011; 12(1):62-7. DOI: 10.1016/j.acap.2011.09.004
Source: PubMed


Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children's hospitals.
We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them.
Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13-30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria.
Most children's hospitals' food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register.

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    ABSTRACT: OBJECTIVE: The present study evaluated the restaurant and dining venues on and near post-secondary campuses varying in institution size. DESIGN: The Nutrition Environment Measures Survey for Restaurants (NEMS-R) was modified to evaluate restaurants as fast food, sit down and fast casual; and campus dining venues as dining halls, student unions and snack bar/cafés. ANOVA with post hoc Tukey's B and T tests were used to distinguish differences between dining venues and associated institutions by size. SETTING: The study was conducted at fifteen US post-secondary institutions, 2009-2011. SUBJECTS: Data presented are from a sample of 175 restaurants and sixty-eight on-campus dining venues. RESULTS: There were minimal differences in dining halls by institution size, although medium-sized institutions as compared with small-sized institutions offered significantly more healthful side dish/salad bar items. Dining halls scored significantly higher than student unions or snack bar/cafés on healthful entrées, side dish/salad bar and beverages offerings, but they also had the most barriers to healthful dietary habits (i.e. all-you-can-eat). No differences were found by restaurant type for NEMS-R scores for total restaurant dining environment or healthful entrées and barriers. Snack bars had more healthful side dishes (P = 0·002) and fast-food restaurants had the highest level of facilitators (i.e. nutrition information; P = 0·002). CONCLUSIONS: Based on this evaluation in fifteen institutions, the full campus dining environment provides limited support for healthy eating and obesity prevention. The quality of campus dining environments can be improved via healthful offerings, providing nutrition information and other supports to facilitate healthy eating and prevent unwanted weight gain.
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