Strategic menu swaps for hospital food could prompt patients to choose healthier options
New research has shown hospital patients could reduce the carbon footprint and saturated fat content of their selected meals by up to almost a third through strategic reorganisation of weekly menus without removing any dishes, according to a University of Bristol study published in Philosophical Transactions of the Royal Society B.
A novel approach to reducing healthcare’s environmental impact has emerged from research showing that simply rearranging when dishes are offered on hospital menus could deliver substantial reductions in carbon emissions and improve nutritional outcomes for patients.
The study, led by Dr Annika Flynn from the University of Bristol and published in the September 2024 special issue of Philosophical Transactions of the Royal Society B, demonstrates that strategic menu optimisation could reduce carbon emissions and saturated fat consumption by reorganising existing weekly menus across NHS hospitals.
Method targets ‘healthy competition’ between dishes
The research builds on the concept that when multiple meal options compete against each other daily, the selection probability of any dish depends not only on its individual appeal but also on the relative attractiveness of alternatives served the same day. Rather than penalising healthy options, like lentil curry, by putting them alongside really popular choices, like meaty lasagne, we simply switched around their place on a weekly menu to give them a better chance of being selected, explained Dr Flynn.
The team analysed weekly inpatient menus from 12 NHS hospitals across the UK, though one was excluded due to insufficient menu variety. For each hospital, 50 residents from the local catchment area completed online preference assessments for 15 dishes offered across five weekdays. Using mathematical optimisation, researchers then calculated the carbon footprint and saturated fat reductions achievable through strategic menu reorganisation.
Significant reductions achieved without recipe changes
When minimising carbon footprint as a sole target variable, we achieved a predicted reduction of 12.7–29.3%. When minimising only SFA intake, the corresponding reductions were between 6.5% and 31.5%, the authors report in their published findings.
When both variables were optimised simultaneously, the study predicted carbon footprint reductions ranging from 9.1% to 29.3% and saturated fat reductions between 5.0% and 26.5% across the 11 hospitals analysed.
Creating healthier competition between dishes resulted in great benefits both in terms of significantly reducing patients’ carbon footprint and their saturated fat intake, Dr Flynn noted.
Real-world validation demonstrates effectiveness
The approach was previously validated in a university canteen setting where actual reductions of approximately 31% in carbon footprint and 6% in saturated fat intake were observed. Study co-author Professor Jeff Brunstrom from the University of Bristol explained: People don’t like change, so implementing successful behavioural change interventions can be challenging and costly. This modelling study shows our low-cost ‘sneaky’ technique presents an enticing opportunity to make people’s diets greener and healthier without them even realising it.
The research was conducted as part of the SNEAK (Sustainable Nutrition, Environment, and Agriculture, without Consumer Knowledge) project, supported by UK Research and Innovation’s Transforming UK Food Systems programme.
Hospital food improvement addresses urgent need
The healthcare sector represents a significant opportunity for sustainable food interventions, with hospitals being the second largest public-sector provider of catered meals in the UK. Hospital food often gets criticised and of course, especially when you’re unwell it’s important to have a range of options. If in that process patients can be steered towards making healthier choices, which are also more sustainable from an environmental perspective, without even noticing it’s a huge win-win, Dr Flynn observed.
Broader applications across public sector
The methodology could extend beyond healthcare settings. With 42% of UK workers reporting canteen use and millions of children served meals daily in educational institutions, the potential for population-level impact is substantial.
Professor Guy Poppy, Pro Vice-Chancellor for Research and Innovation at the University of Bristol and Director of TUKFS, noted: These different settings form a big proportion of all the food we eat, so effective changes like the dish swap formula could make a tangible, affordable difference at population-level, fuelling better, greener diets for all.
Implementation challenges and next steps
Despite promising results, the researchers acknowledge several implementation challenges. To realise the real-world application of our approach in hospitals or another public procurement setting, further investment and research are needed, the authors state.
Key requirements include developing user-friendly interfaces for catering providers, engaging stakeholders to understand feasibility and acceptability, and conducting cost-benefit analyses. The team plans to trial their approach in NHS hospitals to validate predictions and characterise implementation barriers.
The research was funded by UKRI TUKFS and supported by the National Institute for Health and Care Research Bristol Biomedical Research Centre.
Reference
Flynn, A. N., Takahashi, T., & Brunstrom, J. M. (2024). Strategic menu optimisation could reduce carbon emissions and saturated fat consumption: A simulation modelling study of UK hospital inpatient meals. Philosophical Transactions of the Royal Society B, 379(1911). https://doi.org/10.1098/rstb.2024.0152
