Reducing Sodium in Hospital Food Service Operations Across Southern California

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The Los Angeles County Department of Public Health (DPH) and the County of San Diego Health and Human Services Agency (HHSA) have partnered with nine public and private hospitals to implement comprehensive nutrition standards (e.g., calorie and sodium limits for meals and snacks served and sold) and other practices to buy and promote healthy foods. These unique regional partnerships have led to healthier choices for hospital patrons.

Public Health Challenge

Diet-related chronic diseases such as heart disease are a major public health issue in Southern California. For example, almost a third of Los Angeles County adults have been diagnosed with high blood pressure, according to the 2017 California Health Interview Survey. Eating foods high in sodium can lead to high blood pressure, which is a major risk factor for heart disease and stroke.

Improving the availability of lower sodium food offerings in settings such as hospital cafeterias, snack shops, and patient meals can improve dietary behaviors among diverse populations at risk for high blood pressure and other chronic conditions. Yet many hospital food service operations struggle to offer these healthier foods because of limited staff or infrastructure to alter menu items and concerns about patrons not being receptive to changes.

Approach

Since 2016, the Los Angeles County DPH and County of San Diego HHSA have worked together to improve the nutritional quality of foods served and sold in Southern California hospitals. Los Angeles County DPH partnered with Children’s Hospital Los Angeles to implement a hospital nutrition policy that includes sodium limits for patient meals and foods served/sold in cafeterias. Los Angeles and San Diego Counties have similar partnerships with City of Hope National Medical Center and Rady Children’s Hospital, respectively. In addition to helping these hospitals change their nutrition policies, the public health partners trained staff in food preparation.

Results

These partnerships have improved the procurement of lower sodium ingredients, increased the development of new low sodium menu items, and promoted lower sodium foods to patrons.

For example, at Children’s Hospital Los Angeles, four new grain-based salads averaging less than 50 mg of sodium and four new grab-and-go wraps averaging less than 600 mg were added. From November 2018 to April 2019, consumption of fresh whole fruit increased by more than 15% and water consumption increased by 62%.

At City of Hope, achievements included replacement of six high sodium ingredients, resulting in an average sodium reduction of 58% for affected ingredients.

At Rady Children’s, 20% of menu ingredients exceeded the sodium limits outlined by Good Choice food purchasing criteria standards, and lower sodium substitutions were recommended for 46 of these higher sodium items.