This is how unhealthy the food in German hospitals is: “Too much fat, salt and sugar”

A team from the Charité and the Potsdam Institute examined the quality of meals in hospitals and nursing homes. The conclusions are drastic.

A study by the Charité hospital shows that hospital and nursing home food in Germany is often unhealthy. Westend61/imago

Hospital food has a rather shaky reputation among many patients. This experience is now scientifically substantiated: Led by a Berlin internist, a research team from the Charité , the Potsdam Institute for Climate Impact Research, and Stanford University analyzed menus from German hospitals and nursing homes. They also evaluated the nutritional composition and environmental impact of the meals.

The study was published a few days ago in the prestigious journal The Lancet Planetary Health . Study leader Lisa Pörtner explains why the food in these facilities is actually harmful to health.

Ms. Pörtner, you have investigated the quality of meals in hospitals and nursing homes – what was the result?

In the hospitals and nursing homes we examined, the food was predominantly unhealthy. It contained too much saturated fat, salt, and sugar, and too little fiber, vitamins, and minerals such as potassium and magnesium. Less than 20 percent of the calories came from wholesome, plant-based ingredients. The main energy sources were animal products and unhealthy plant-based foods such as white flour products and sugar. We also found that the facilities' food probably has a larger ecological footprint than previously thought. This is primarily determined by animal-based products, which require a lot of land to produce and have a poor climate impact. Overall, compliance with recommendations for a healthy and environmentally friendly diet, for example with the Planetary Health Diet [ a scientific model for a healthy and sustainable diet; editor's note ], was very low.

“Even relevant for short hospital stays”

The fact that the food in many establishments isn't particularly good is a common experience for many people. You write in your study: It's even harmful to our health—why?

In senior living facilities, it's clear that the food offered potentially has a long-term impact on people's quality of life and health. Poor diet, for example, can increase the risk of cardiovascular disease and be associated with greater mental decline. Studies show that even during a short hospital stay, the quality of food is relevant to health. Nutrition in hospitals, for example, can influence the risk of complications such as impaired wound healing and susceptibility to infection. The combination of too much salt and too little potassium can lead to blood pressure fluctuations.

You criticize that meals in nursing homes lack sufficient protein. What impact does this have?

Especially in old age, an adequate protein supply is important to maintain muscle strength and thus independence. A deficiency can promote muscle atrophy, which increases the risk of falls and impaired wound healing and leads to a higher complication rate during medical treatment.

In addition to health concerns, you emphasize ecological aspects. It's well known that our food system as a whole contributes significantly to climate change—but don't hospitals and nursing homes, with their ecological footprint, play a subordinate role?

In Germany, approximately six percent of greenhouse gas emissions are attributable to the healthcare sector. Hospitals contribute significantly to this, and in every individual facility, the food offered is certainly a lever for reducing the ecological footprint. But there are also indirect effects. Only if these facilities set an example can they encourage their patients to change their individual dietary habits. We know that communal catering has a particularly significant influence here. In the USA, some hospitals have McDonald's branches – and a study shows that patients perceive this food as healthier because it is offered in a healthcare context.

You identify the amount of animal products as a key factor in both the unhealthy and ecologically unsound offerings. In Germany, the diet is traditionally very meat-heavy. To what extent are hospitals and nursing homes, where sick people seek recovery and elderly people spend their final years, particularly suitable places to promote a change in eating habits?

If we don't take the lead in healthier and more environmentally friendly food provision in our healthcare facilities, where will we? Hospitals, in particular, have the opportunity to translate scientific evidence into practice and demonstrate that a more plant-based diet contributes to both individual and planetary health. They can thus play an important role in promoting a healthy lifestyle that counteracts the development of chronic diseases in the population. And climate change and species extinction are increasingly also a massive health crisis. To protect our patients, we therefore have a responsibility to limit the environmental impact of our diets. Fortunately, a healthy, highly plant-based diet is also particularly environmentally friendly. So we have a win-win situation.

“You can do better with an average budget”

For these facilities, food is primarily a cost factor. How can a better service be achieved?

We conducted many interviews with kitchen managers and management at these facilities. When asked what stands in the way of better food, finances were mentioned quite often. However, we see that there are facilities that are doing many things better with an average budget, for example, Havelhöhe Hospital and the Johannesstift-Diakonie clinics in Berlin. Essen University Hospital, a very large facility, is currently converting its catering to the Planetary Health Diet in a pilot project. This shows that more is already possible today. Knowledge is often lacking, which is why we urgently need advisory services for these facilities. But it is true that these facilities are under enormous financial pressure. Therefore, the most important thing is a political framework, such as binding quality standards for food that people can rely on, and better financial conditions. Without policy, we will not be able to achieve change across the board. There are senior citizens' facilities that operate on a budget of €3.40 per person per day for food – that simply cannot be enough.

Your study only includes two hospitals and three nursing homes – how representative is this data?

It's a small sample, which of course can't be statistically representative. However, these were facilities with their own kitchens, which usually also supply other homes, clinics, or schools. From my experience and that of those around me, I have the impression that the quality of food offered by these kitchens is very common in German healthcare facilities. Our study therefore probably reflects the situation in Germany well.