Does a Spoonful of Sugar Help the Medicine Go Down?

Food NHS Hospitals Public Health

Why fill our hospitals with vending machines and Costa coffee shops when we are fighting a massive obesity epidemic?

Sally Norton is a NHS consultant, specialising in weight loss and upper gastrointestinal surgery, on a crusade to put herself out of work by promoting healthier behaviour.

At last, with health secretary Jeremy Hunt’s announcement of new measures being introduced to improve the standard of food in English hospitals, we may finally see better quality food in our hospitals.

These changes will see hospitals ranked according to the quality and choice of the food they serve. They will hopefully provide some sanity, and not before time, because I was beginning to think I was going mad.

We read every week, in The BMJ and other leading medical journals, of research detailing the perils of sugar and fizzy drinks. We frequently hear laments about the cost to the NHS of the epidemic of obesity and type 2 diabetes, which is threatening to engulf us. And yet, the NHS, which I understood to be an organisation that promotes and supports health (rather than just treating disease), is actually contributing to the problem.

As a weight loss surgeon, I find it frustrating and, frankly, embarrassing to spend time in clinic, explaining to my patients how sugary drinks and snacks are one of the biggest drivers of obesity, when I know that just outside in our hospital foyer are not one, but two Costa coffee shops, as well as vending machines stocked full of coke and chocolate.

Coffee with whipped cream

When I try to grab a quick coffee from Costa, an obedient employee always tries to tempt me into buying one of their huge, sugar-laden and calorific cakes to go with it . . . hard to resist after a stressful morning in theatre or a busy night on-call. If I did need a snack, I would be hard pushed to find much that you could describe as healthy—there is very little fresh, nutrient-rich food and next to nothing that doesn’t involve a load of refined carbs.

I no longer shake the hands of patients as they come in through the clinic door—more often than not, they are clutching their Costa take-outs, which they have been tempted into buying while waiting for their consultation.

I know I can’t be the only one who thinks that a hospital should be setting a good example for its patients, visitors . . . and its staff.

As we recently heard from Simon Stevens, NHS England’s chief executive, many of our NHS staff are hardly role models for our patients. And, from my own experience, I frequently hear the amazed reactions from patients when they see morbidly obese staff members providing advice on healthcare.

Of course, NHS staff are human too and subject to the usual lack of willpower that makes these sugar-laden temptations difficult to resist . . . although we do have the education to know that we should be trying to do better. However, the stressful environment in which we work, coupled with the unsociable hours, means that we need to have access at all times to good, nutritious food—not a vending machine promising us a sugary quick fix.

However, the old chestnut that it is all down to the individual, and that people should be able to control their cravings, just doesn’t wash. With two thirds of the English population classed as being overweight, we would be tarring a lot of people with the same “weak willed” brush. The problem is as much the food environment that we are constantly subjected to, as it is an individual issue.

The food we eat is now much more densely packed with fat and sugar than it used to be, so we are passively consuming far more calories than we may realise. The cheapness of the food, and the increasingly huge portions, available wherever we turn, mean that we are actively consuming far more too. In addition, more and more evidence is accruing that sugar is addictive, and that we are in a downward spiral of poor eating owing to the excess of highly processed carbs that make up the vast bulk of our diets.

The government seems unable to take a significant stand against the insidious pervasiveness of the food industry, but the NHS can and should make a stand. If we can’t be the leading light in promoting healthy eating, then who can? Shame on us, for allowing most of our hospitals to play willing hosts to the fast food outlets that are contributing to our health crisis.

How can we have allowed hospitals to get tied up in contracts with these providers—who give away some of our control of good nutrition, a fundamental tenet of health? We are giving tacit agreement that it is OK to drink a coffee that contains nine teaspoons of sugar, or a muffin that contains a quarter of our day’s recommended calories.
Why do we allow these vending machines to spew out coke and chocolate at the very patients and staff who we may well be treating for diabetes, heart disease, and knee arthritis before long—and at increasingly crippling expense too.

Let’s just go the whole hog and open a pub in the foyer too—why not? Surely our patients are sensible enough to know that we aren’t actually encouraging alcohol, just because we host outlets on the premises?

More seriously though, the NHS has made it clear to our patients and visitors that hospitals don’t condone smoking on or around our premises. When I was a trainee, I remember patients smoking on the vascular ward. Why is that different to my bariatric patients being offered chocolate and crisps from the hospital trolley while waiting for their weight loss surgery?

We can set a similar example to our anti-smoking policy with a focus on healthy eating. Why don’t we adopt an NHS policy to only commission fresh, locally sourced food to sell on our premises? What a message to give our patients: that we support the “real food” producers in our local community, not multi-million pound chains profiting at the expense of our health. Why can’t we show them that it is possible to eat delicious, fresh food, rather than the sugar-laden, heavily processed offerings that are their current choices?

Enough is enough—let’s face up to our responsibilities as a health promotion service and a role model, and actually practice what we preach. We must ensure that these new recommendations are actioned quickly and properly.

Article first published by BMJ