In March 2010, Fairview Hospital, a 25-bed critical access facility that’s part of the Berkshire Health Systems in Massachusetts, discontinued the sale of sugar-sweetened beverages (SSBs) in its cafeteria and vending machines and eliminated them from its patient menus.
Fairview was the U.S.’s first healthcare facility to take this action, prompted, hospital management says, by its desire to combat obesity.
Since then hospitals across the country have revamped their beverage programs, either limiting or eliminating SSBs altogether. St. Elizabeth Medical System, a member of the Steward Health Care System in Boston, introduced a successful reduction program in March 2011. This past April, Vanguard Health Chicago, which operates four hospitals in Cook County, phased out SSBs, implementing the county’s “Rethink Your Drink” program.
“This is the direction [eliminating SSBs) that hospital management is moving toward,” says Stacia Clinton, R.D., New England co-coordinator of Health Care Without Harm’s Healthy Food in Health Care (Health Care Without Harm), a national initiative that is leading the charge in this arena. “Hospitals are understanding that they need to model healthy behaviors to combat the obesity epidemic. Foodservice directors need to innovate their beverage programs.”
Bolstering the moral imperative, institutions that adopt SSB reduction measures are eligible for federal Communities Putting Prevention to Work grants from the Centers for Disease Control and Prevention(CDC).
Definition of a SSB: Sugar-sweetened beverages are defined by the CDC as soft drinks, fruit drinks, sports drinks, tea and coffee drinks, energy drinks, sweetened milk or milk alternatives and any other beverages to which sugar (typically high fructose corn syrup or sucrose) has been added. Consider this: One 12-ounce soft drink contains approximately eight teaspoons of added sugar; the American Heart Association recommends that most women should ingest no more than six teaspoons of added sugar a day, men no more than nine.
How does this affect the general public? Each year, approximately $45 billion is spent on treating the diseases associated with obesity. “Initial interest in limiting sugar-sweetened beverages came through overwhelming research that points to their contribution to obesity,” says Clinton.
At Fairview Hospital, employees, patients and visitors now choose from naturally flavored seltzers—the top seller—unsweetened iced teas, iced coffees, milk, 100% juices (reduced portion sizes), diet sodas and sugar-free alternative beverages.
The hospital’s 2010 SSB ban has had little impact on the beverage program’s bottom line. “We remained budget neutral,” says Roger Knysh, director, nutrition and foodservices department at Fairview. “People are either going to purchase a beverage or they’re not. If they went in with the idea of buying a beverage, they’re going to look at your selection and choose from it.”
Fairview Hospital’s roll out plan followed these steps:
· A year prior to rollout, the idea was introduced at a management meeting
· Good education was provided to staff about SSBs throughout the process
· SSBs were phased out in vending and not reordered
· Getting support on the initiative from the CEO, which assisted in conveying the importance of the ban
· Setting up a contract with a vendor that didn’t specify a percentage of SSBs sold
· Turning to Health Care Without Harm for best practices.
St. Elizabeth follows suit: In 2011, St. Elizabeth Medical Center removed SSBs from patient menus (impacting an average of 170 patients per day), eliminated more than 40 SSBs overall, and saw an almost 40% increase in sales of beverages with no added sugars or artificial sweeteners.
“We wanted to be the choice architecture, focusing on education to get people on board with it,” says James Corbett, Steward’s vice president of community health & ethics.
Today, the hospital allows SSBs in no more than 15% of its beverage selections in vending and retail outlets. No signage or marketing materials are used to promote SSBs and no SSBs are served at catered events.
Price strategies are at work here, too: St. Elizabeth’s reduced the price of bottled water from $1.25 to $1; it initially increased SSBs from $1.25 to $1.50, then six months later priced them at $2.
St. Elizabeth based its program on the Boston Public Health Commission’s Healthy Beverage Toolkit (Healthy Beverage Tool Kit), a call to action for institutions “to implement policies and practices that encourage healthy lifestyles for their employees, clients, students and visitors.”
St. Elizabeth’s beverage program includes:
•Designation of beverages into three categories:
o Red—high in sugar, sodium or fat
o Yellow—moderate amounts of sugar or sodium
o Green—no added sugars or artificial sweeteners
· The replacement of vending machines with clear glass faces to reduce SSB advertising
· A free water machine in the cafeteria
· The implementation of an educational campaign with weekly emails, monthly newsletter, signage and presentations.
“Sales [for beverage] are steady, and where they dropped a little bit, we made up for it with a higher profit margin,” says Corbett. “The only thing that dropped significantly was the volume of sales of sugar-sweetened beverages. And we wanted that.”