Food for Thought

El Mercado Juarez by Hal Marcus installed at El Paso Children's Hospital

El Mercado Juarez by Hal Marcus installed at El Paso Children's Hospital

How is design being used in the healthcare industry to nudge individuals to perpetuate healthier eating habits?

Many popular media outlets have likened newly constructed and renovated hospitals to that of hotels, sparking a debate about whether amenities are merely frivolous luxuries or linked to specific health outcomes.  While it is often difficult to tease out how a single feature of the environment impacts health, one amenity seems to stand beyond the debate: improving the quality of hospital food.  Our country has a weight problem and recent studies project escalating obesity rates and associated healthcare costs over the next fifteen years.  How can hospitals become agents of change?

Choice Architecture: Design Influences Behavior

Choice architects understand that people rarely make decisions on their own.  The organization of an interior sends messages in subtle but powerful ways that can help support a healthy food initiative.  Each section below provides a series of design recommendations aimed at nudging patients, visitors, and staff to make more nutritious food choices. 

Nutritious and Delicious

Nudge Healthier Habits

In the wake of troubling national health statistics, the fried food and calorie-laden sides and snacks typically found in hospital cafeterias have come under scrutiny by nutrition advocacy groups.  Many hospitals have terminated contracts with fast food vendors and have revamped menus in an effort to provide more heart-healthy alternatives.  Other institutions have completely transformed their food offerings recognizing their instrumental role in promoting healthier eating habits and improving overall community wellness.  A number of hospitals have joined the Hospital Healthy Food Initiative sponsored by The Partnership for a Healthier America (PHA).  Facilities commit to implementing changes over three years that include: the addition of wellness meals to the menu, improvement to overall cafeteria offerings, healthier checkouts, nutritional labeling and marketing, removal of fryers and deep-fried products, an increase in the purchase of fruit and vegetables, and a reduction in the availability of sugary beverages. 

Choice Architecture: Wellness meals priced less than or equal to other available meal options / Product placement – display only health-related food options within five feet of cash register stations, place healthy options at eye level and easily within reach / Provide feedback – label items with calories per serving and market only healthy food options / Smart receipts and calorie counting apps

Farm Fresh

Source Sustainable Local Ingredients

Hospitals across the country have recognized that fostering farm to hospital relationships increase access to healthy, fresh food for patients and staff and offers new markets for local farmers.  Over 400 hospitals have committed to adopting more sustainable food practices by taking Health Care Without Harm’s (HCWH), Healthy Food Pledge. 

Choice Architecture: Increase offerings of fruit, vegetables and minimally processed unrefined foods / On-site vegetable and herb gardens / Work with local farmers, community-based organizations and food suppliers to increase the availability of fresh, locally produced food / Sustainably harvested seafood / Antibiotic and hormone-free meat / Promote vegetarian options / Milk free of growth hormones / Food management company, outside vendors, and/or head chef cook from scratch using fresh ingredients.

Population Health

Inspire Community Wellness

Instituting change can be difficult, especially in large organizations entrenched in old ways, but many hospitals are taking both small and large steps to address obesity and obesity-related diseases.  This section recognizes industry best practices with Kaiser Permanente leading the way with their healthy, sustainable hospital food and for their many innovative partnerships and health initiatives that reach deep into the communities they serve. 

Choice Architecture: Onsite farmer’s markets / Fruit and vegetable prescription programs / Community supported agriculture (CSA) programs for staff / Teaching kitchens / Senior suppers

Gourmet Cuisine

Taste Trumps Everything

Gourmet food is showing up everywhere.  Twenty years ago, hip ingredients and savory dishes gracing the best restaurants more than likely never penetrated far beyond the city.  With the advent of smart phones, however, the progression from five-star restaurant to grocery store shelf happens faster than ever before, as evidenced by the average grocery store offerings of locally grown produce, artisanal cheeses, gourmet coffees, and authentic international foods.  Most even sell freshly made sushi, even in Texas.  From college dining halls, to airports, and even food trucks interesting and inventive food options are showing up on the menus.  Hospitals are also recognizing the demand for such variety and many are seeking out food vendors that offer tasty meals that align with healthy food initiatives. 

Choice Architecture: A variety of menu options including vegetarian and international cuisines / Display cooking that allows for customization / Increased variety of grab ‘n go options / Healthy fast casual vendors / Improved dining experiences – consider single, pair, and group settings / Healthier dessert options such as frozen yogurt or better portion control

Chefs Feed

Agents of Change

The influence of chefs on consumer attitudes continues to grow especially as more people turn to them not just at times of celebration but also for everyday meals.  Taste alone is no longer good enough; meals must also demonstrate a commitment to sustainable and healthy food practices. But for even the most progressive chefs, delving deeper into these topics often leads to confusion and indecisiveness due to the sheer number of studies across a variety of disciplines and the conflicting claims that emerge.  In an attempt to provide clarity, The Culinary Institute of America and Harvard School of Public Health has developed the initiative Menus of Change as a means of arming foodservice and culinary professionals with clear, accurate information to encourage a decision-making process aligned with people, the planet, and profits.  Unsurprisingly, chefs are increasingly becoming agents of change, assuming leadership roles in this food revolution. 

Choice Architecture: Trained chefs able to cook from scratch with seasonal ingredients / Chefs to implement menu changes / In-house cook training programs / Special dining events such as guest chefs and competitions / Display cooking


Life Indoors is an ongoing series of papers exploring how the built environment impacts health and wellbeing. Contact for more information.