Hospital and nursing home food undermines both patient and planetary health, new study shows

In the world’s first comprehensive study to evaluate both the nutritional quality and environmental footprint of food served in health care institutions using detailed, food-level data, researchers assessed menus and food procurement data from two hospitals and three nursing homes of average size in Germany. These institutions’ foodservice likely reflects that of many health care institutions in high-income countries.

“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,” says Lisa Pörtner, lead author from PIK and Charité. “This leads to an inadequate provision of nutrients and low dietary quality.”

At all the institutions analyzed, meals fell critically short of the recommended daily intake of key nutrients such as folate, potassium and vitamin B6, with nursing homes also falling short in protein provision.

“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 adds.

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.

Health care foodservice contributes to environmental degradation and climate change

“Our results indicate that food served in health care settings poses a health risk if consumed over the long term, as unhealthy diets are a major cause of chronic illness,” explains Nathalie Lambrecht 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.” The authors conclude that substantial changes to health care foodservice are essential to protect both human and planetary health.

Fortunately, both can be achieved through similar actions: reducing the overconsumption of animal-source foods while increasing the intake of healthy, plant-based options. The researchers recommend mandatory nutrition and sustainability standards for health care institutions—along with regular assessments of food quality and environmental impact—as important levers for improving health and protecting the planet.

Germany published a nutritional strategy last year that explicitly mentions improving foodservice in health care settings, but political actions have so far been lacking. The authors of the study stress that institutions are not solely to blame for the shortcomings, with financial pressures and other demands having risen over recent years.

“Policymakers and health care 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,” says PIK researcher Pörtner.