Raquel Frazier: Healthy's Hero

Hospital foodservice directors often say offering healthy choices in their cafeterias is a key department mission. But many operators are quick to add that they still offer the so-called unhealthy options to prevent a drop in participation and revenue. Raquel Frazier, foodservice manager at 49-bed La Rabida Children’s Hospital in Chicago, doesn’t have that luxury. In 2007 she was mandated by the hospital’s administration to make the cafeteria 100% healthy.

“The administration wanted the employees to be healthy and to be good role models,” Frazier says. “So we made the change to healthy all at once in the cafeteria. It was like getting a shot over and done with.” In May 2007, the cafeteria made the switch to offering only healthy food options.

To meet the new nutritional guidelines, food items cannot exceed 450 calories, 10 grams of fat or three grams of saturated fat and have to contain at least three grams of fiber. In addition, portion sizes were decreased; vegetables are now offered in one-half-cup sizes; starches are one-half cup; meat is three to four ounces; gravies are two fluid ounces; and soup is eight fluid ounces.

Nutritional information for all menu items is posted on the menu and at the point of service. Calories and fat are listed for every item, and many items have their fiber and cholesterol content posted as well.

All items are available for à la carte sale. “We do have a combo option if people want to have an entrée and a side,” Frazier says. “Our thoughts for selling everything à la carte were that we didn’t want to tie folks into have an entrée, a starch and a vegetable by comboing everything. This way, if someone wants to purchase two vegetables they can do that.”

Daily cafeteria lunch options include a soup of the day, deli sandwiches, vegetarian fare and options from the Cooking Leaner menu, which has the meat and potatoes offerings—all healthy, of course. Choices on the Cooking Leaner menu include spicy fish kabobs, ginger chili fish cutlets with cilantro rice and Cuban steaks with a Creole sauce.

In the first year of the program, most hospital employees reported losing weight and keeping it off, according to an informal hospital survey. Some employees reported losing as many as 70 pounds by pairing the hospital’s healthy food initiative with exercise. Frazier says the employees have been so successful in their weight loss and overall health in part because “the no-temptation option the hospital provides has kept a healthier lifestyle in the forefront of our staff’s minds, which has added to the weight loss of those who are actively trying to do so.”

Raquel Frazier, FSD of the Month, August 2009, La Rabida Children's Hospital, Beef and Shiitake Mushroom Stir FryFrazier says there are still some customers who aren’t completely satisfied with the new cafeteria program. She says some people don’t like having the option to select unhealthy foods removed and that some still crave the old cafeteria fare. To accommodate these concerns, Frazier has taken some of the old comfort foods and re-engineered them to fit the new nutritional guidelines. “We [lured] people back to the cafeteria with healthy, new, in-house made desserts,” Frazier says. For example, the department made a healthier version of banana pudding by using non-fat yogurt. “We’ve been pretty creative by adapting some of the unhealthy items that we used to carry,” Frazier adds. “It was hard to swallow at first, but the overall response has been positive.”

In the first year of the healthy program, cafeteria sales dropped 3%, but since then sales have increased and are now up 15% since the program began.

Frazier says the biggest thing she learned during the transition to healthy was that you have to know your customer base. “You have to serve things that are appealing to your customers and you have to be creative. There are so many avenues of healthy, so you have to be able to come up with a clear definition of what healthy is. If you are too restrictive, you are going to have a hard time finding something to serve.”

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