If the phrase "Eat More chickpeas" sounds familiar, that's exactly what the Physicians Committee for Responsible Medicine was hoping for. The play on the Chick-fil-A slogan "Eat More Chicken" is part of an ad campaign they're running in cities across the country against fast-food franchises setting up shop in hospitals.
"We're not trying to attack anyone. Our goal is to promote good health for patients. One of the ways you can do that is by eating a more healthful diet," said Stephen Neabore, MD, a physician with the Committee who practices internal medicine in Washington D.C.
The Committee, a nonprofit made up of 12,000 physicians, has placed most of the ads within a mile or two of all hospitals that host Chick-fil-A franchises. They include billboards above major roadways leading to hospitals as well as signage in nearby bus shelters to catch the attention of staff taking public transportation. In some cities, ads were placed in entire fleets of city buses, like in Charleston, South Carolina, where all 66 coaches flew the "Eat More Chickpeas" branding.
While they aren't meant to be hostile, PCRM does want their anti-fast-food message to have bite. Neabore says the high calorie, high-cholesterol items common on fast-food menus like Chick-fil-A contribute to disease and serious long-term health complications like heart disease, diabetes and high blood pressure. He believes hospitals have the opportunity for teachable moments when it comes to nutrition for patients and staff that can have a ripple effect in the community.
"We want the hospitals to set an example for people and say, 'you're coming here and this is the food that we're giving you because it's been shown to be the healthiest food you can eat.' So then when people leave the hospital and go home they're like 'oh I ate great in the hospital. I felt so much better. Let me try and eat that same way at home,'" Neabore said.
"Many of the hospitals that host Chick-fil-A are in states with high rates of diet-related diseases, making hospitals part of the overall toxic food environment," said Angie Eakin, MD, one of the doctors who appears in the advertisements. "Hospitals should be fast-food-free, and patients should eat more chickpeas, vegetables, fruits, and other foods that can promote healing and prevent disease."
Greenville Memorial Hospital in Greenville, South Carolina is home to a Chick-fil-A franchise, and PCRM placed their ads in a bus shelter right across the street. While the hospital offered no comment on the ads themselves or whether they consider Chick-fil-A food to be healthy, Chief Medical Officer Angelo Sinopoli, MD, elaborated on the system's commitment to health and wellness, listing some steps Greenville Health has taken to that end.
He said they offer "ChooseWell meals" that contain no more than 500 calories or 15 grams of fat in their cafeterias, and have made healthy food options more visible and less expensive. Last year, Sinopoli said they removed sugary drinks like sweet tea and full-calorie soda from their cafeterias and vending machines, and this year bid farewell to deep fryers, removing them from cafeterias in lieu of "combi ovens" that mimic the taste and texture of fried foods but with fewer fat and calories.
"We also added signage in our cafeterias and franchises educating people on how to make healthy food choices, and we recently launched a meal rewards program for those who buy ChooseWell meals in our cafeterias. Our goal is to make the healthy choice an easy choice, no matter where someone chooses to eat," Sinopoli said.
They also stressed that Chick-fil-A items are not offered on the patient menu. But Neabore said that doesn't mean patients aren't getting their hands on it.
"Sometimes family members buy food and give it to patient they are visiting. I see that a lot. So take it out of hospitals so no one can get it there," Neabore said.
Chick-fil-A did not respond to emails or calls for comment.
Taking a stand
Michael West, food and retail services director at Stony Brook Hospital in Stony Brook, New York, called the PCRM ads thought-provoking and eye-opening, echoing the sentiment that hospitals should be free of fast food. He said the only franchise they offer right now is Starbucks, and they've never been home to Chick-fil-A, McDonalds, Burger King or any of the conventional fast-food outfits. He said knowing that staff don't often have the time to leave the campus to eat, he wanted to make sure the food choices in front of them were good ones.
"We have a captive audience here and we realize that. So we thought it was an obligation on our part to make sure that we were still providing them with options that were healthy, that were not going to be damaging to their diet, their health, trying to help them be a little more health conscious, even if they didn't think or want to do that. We're giving them the opportunity to do that by keeping the fast food out and keeping the healthy food in."
Upon the completion of a new hospital pavilion, however, Stony Brook will host a new Au Bon Pain. The purportedly healthy fast-food outlet has come under fire in the past, with at least one report claiming that some of it's menu items had as much if not more fat, calories and sodium as some of its fast-food competitors like McDonalds and Burger King.
But West defended the choice, saying Au Bon Pain offered a healthy and appropriate healthcare model for their facility.
"Our contract calls for Au Bon Pain to be required to meet the same standards and requirements in all other healthcare locations they maintain. But it also goes as far as to say that any and all menu changes must first be discussed with and approved by me before they go into effect. This would include added or deleting items from their menus. It was their healthcare model that drove to this decision, and their willingness to work with us and allow us to have say in the menu was just another example that we made the right choice."
Furthermore, West predicted that the lack of control many hospitals actually have over the fast-food franchises they host, and what they serve, will eventually spell the demise of many of those contracts.
"Self-operation is going to start becoming more prevalent across the country as hospitals want more of that control and say in 'what are these menus going to be, how are we going to offer this to our patients and what are we going to offer to our faculty and staff that is of a healthy nature and I think that's going to to start to show a little bit more," West said.
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Indeed, a number of fast-food franchises have disappeared from hospitals. The Committee said in their 2016 Hospital Food Report that The Cleveland Clinic, Children's Hospital Los Angeles, and Driscoll Children's Hospital in Texas have recently ended contracts with McDonald's. Additionally, the report stated that Abbott Northwestern Hospital in Minneapolis will end their lease with McDonald's by the end of May, and Kosair Children's Hospital in Louisville, Kentucky has predicted it's Mcdonald's will close sometime this year.
Still, dozens of fast food franchises exist in hospitals across the country and Neabore worries about the message their presence sends, not just to patients and staff, but to the community in general. He said he has made it his mission to educate his patients that their health, and even their lives, hinge a great deal what they choose to put in their bodies.
"I tell my patients with every bite you take you're making a choice: am I contributing to my health or am I taking away from it? So if we can start that from the ground up with people before they even get sick, my hope is that they will make healthier choices and not wait till they become that patient who just had a heart attack."