HHS urges hospitals to align patient menus with updated dietary guidance

Health and Human Services Secretary Robert F. Kennedy Jr.’s focus on healthy eating extended into the hospital Monday with a new notice for Medicare hospitals and a spotlight on “farm-to-hospital” food sourcing. 

In a Quality and Safety Special Alert Memo, the Centers for Medicare & Medicaid Services (CMS) reiterated to hospitals that existing Medicare Conditions of Participation (CoP) require in-house or contracted food delivery. The menus offered to patients must meet “individual patient nutritional needs … in accordance with recognized dietary practices” and with qualified dietitian oversight, according to the CoP.

In January, HHS and the Department of Agriculture unveiled updated dietary guidelines that flipped the traditional food pyramid with its heavy focus on proteins, healthy fats and, to a lesser extent, whole grains. The update also discourages foods with added sugars, refined carbohydrates and other highly processed foods (often referred to as “ultraprocessed” foods, a term that currently lacks a formal regulatory definition). 

Monday’s CMS memo reinforces the CoP while calling on hospitals to review their policies and menus to align with the updated dietary guidelines. 

“Aligning patient food services with these standards may support improved patient outcomes, reduced cardiometabolic risk, enhanced recovery and responsible stewardship of Medicare resources,” the memo (PDF) reads. 

The memo outlines a slew of examples on how hospitals should be reconsidering their existing food programs. Current inpatient menus, for instance, could swap out refined cereals with added sugar for steel-cut oats with berries and nuts, or nix processed deli meats with freshly prepared lean protein options. Sugar-sweetened drinks or juice should be avoided on a general level, and for post-surgical patients requiring a clear liquid diet, hospitals are “encouraged to evaluate whether lower-sugar or no-added-sugar alternatives are clinically feasible while maintaining patient safety, hydration, and electrolyte balance,” according to the memo.

The memo also describes hospital stays as potential patient education opportunities. Food served in the hospital gives patients initial exposure to dietary options, which clinicians can reinforce during discharge counseling. Doing so will not only aid short-term recovery but likely bring a long-term reduction in risk of cardiometabolic disease, CMS said.

“Food should not be an afterthought in healthcare,” CMS Administrator Mehmet Oz, M.D., said in an accompanying press release. “When hospitals align what’s on the tray with what’s in the chart, we give patients a better chance to faster recovery, avoided complications and healthier long-term outcomes." 

Kennedy and Oz announced the alert during a Monday afternoon event highlighting the pledge of Nicklaus Children’s Hospital, a Florida provider, to source its meals directly from local farmers. 

The commitment, facilitated by the Florida Department of Agriculture and Consumer Sciences, removes “longstanding procurement and contracting barriers that have historically limited farm-to-hospital sourcing,” HHS wrote in a Monday release. Alongside improved access to high-quality food, the department said the arrangement supports workforce and training programs tied to nutrition services and can help better provide medically tailored meal strategies for specific patient populations. 

HHS said the partnership pledge sets an example it hopes will be followed by hospitals across the country.  

“Quality health care starts with quality food,” Kennedy said in an announcement. “The actions announced today will help improve patient outcomes, prevent chronic disease and Make America Healthy Again.”

Nutrition and eating “real food” has been a cornerstone of the health secretary’s Make America Healthy Again (MAHA) strategy. Recently, the administration touted voluntary agreements from dozens of medical schools and leading healthcare professional organizations to increase nutrition’s prominence in medical education programs. 

Such efforts have enjoyed substantially broader support from the healthcare industry and the public than some of MAHA’s other tenets surrounding “overmedicalization” and routine vaccinations. Media reports have outlined pressure from the White House to rein in Kennedy’s policy upheaval on the controversial issues in the months leading up to midterms—to the frustration of his allies inside and out of the department.