During my experiences in hospitals, I’ve noticed a troubling contradiction. These places are meant to promote healing, yet they often serve unhealthy, ultra-processed foods that undermine that mission. Why should a McDonald’s exist in a facility treating obesity, diabetes, heart disease, hypertension, microbiome issues, and cancer?
Not only do hospitals typically serve ultra-processed, low-nutrient food to their patients, high in carbohydrates, sodium and saturated fats, and poor in fresh vegetables and fruit, but they also lease space to fast food chains. A 2024 survey by the Physicians Committee for Responsible Medicine found that “nearly 70% of hospitals affiliated with a medical school host at least one fast food restaurant, some of the most common of them being McDonald’s and Chick-fil-A.” It is now well documented that meals high in sugar and refined carbohydrates can contribute to and exacerbate chronic conditions like diabetes and heart disease. Excess sodium and unhealthy saturated fats can lead to blood pressure and cholesterol issues, and worsen conditions like heart disease and hypertension. Ultra-processed foods often lack fiber and contain additives that disrupt gut health. Patients recovering from antibiotics, infections, or gastrointestinal surgeries may experience worsened digestive symptoms.
So why do hospitals even offer foods that may worsen the health conditions they intend to treat? I initially embraced a cynical stance and assumed that hospitals benefit financially from repeat customers. By keeping patients unhealthy thanks to poor nutrition, hospitals are more likely to see them come back and generate more revenue. It turns out this assumption is partially false. Hospitals are actually fined for certain avoidable readmissions by the federal government’s Centers for Medicare & Medicaid Services (CMS). These penalties apply mainly to readmissions for specific conditions like heart failure, pneumonia, or chronic obstructive pulmonary disease rather than every case. In theory, these fines should incentivize hospitals to keep patients healthy. However, these fines are only one part of a still-evolving shift toward value-based reimbursement, which rewards providers for quality of care rather than quantity. Due to this system not yet being fully implemented, most hospitals continue to rely on fee-for-service revenue, where the number of procedures and short-term income drives financial decisions. As a result, hospitals have strong financial incentives to partner with fast food chains and large food-service corporations, which provide inexpensive, ultra-processed meals for patients.
Only 16% of hospitals are for-profit entities, but all face financial constraints and the pressure to remain fiscally solvent. Fast food leases provide steady, immediate revenue and partnerships with large food-service corporations allow to cut costs on patient food. Yet, in doing so, hospitals are prioritizing short-term revenue over long-term stability. In the long term, poor nutrition contributes to recurring illnesses like heart disease, diabetes, and hypertension, which can increase readmission rates and, for some hospitals, trigger federal fines. Therefore, the hospitals’ operation as a “business” goes against their core mission, healing people. The prioritization of short-term profit is also why Western medicine is reactive, often focused on treating illness rather than preventing it, and why the idea that food is medicine is undermined in our system. A 2019 analysis by the CDC found that “financial considerations explained the lack of emphasis on preventive services. These include lifestyle programs, early screenings, and chronic-disease management, all of which could keep people out of the hospital in the first place.”
What is problematic is that hospitals should be setting the standard for a healthy lifestyle. Initially, when researching this topic, I assumed that when people see unhealthy foods normalized in health institutions, they perceive them as not harmful. Given that hospitals are trusted institutions, the presence of certain foods can signal implicit approval. Research supports this: a study published in Pediatrics found that families visiting a hospital with a McDonald’s on site were about twice as likely to perceive McDonald’s as healthy compared with families visiting hospitals without one (Sahud et al., 2006). This information is especially concerning because many of the individuals influenced by this perception may be receiving treatment for illnesses that are exacerbated by such food.
In the past, hospitals have set healthy living standards. They were the first to ban smoking, paving the way for subsequent smoke bans by demonstrating the health benefits of removing harmful substances from patient environments. Previously, it had been completely normal to sell cigarettes to patients in their rooms or designated areas up until the 1990s. In this instance, these spaces of healing took a clear stance against an unhealthy practice. So why shouldn’t they do the same for the ultra-processed, nutrient-poor food that they offer to patients? Certainly, hospitals should remain fiscally solvent. But as the federal government enforces penalties for avoidable readmissions, hospitals need to stop prioritizing short-term profits that will ultimately lead to financial troubles in the long-term, and start thinking in a more proactive way. This will benefit their patients’ health and their finances. For example, UC Davis Health is committed to its “farm-to-fork” initiatives, expanding access to healthy and locally sourced food. If hospitals were able to take a stance against smoking decades ago, I believe they should now take one against the overprocessing and poor nutrition that silently undermine recovery.