Some of the children at the Verner Center for Early Learning came up with a Brussels sprouts dance. Others have asked for second helpings of asparagus.
Food and nutrition manager Genie Gunn is behind the magic at the Asheville, N.C., day-care center. Like many of her culinary peers in the health care industry, Gunn works to maximize flavor while minimizing factors such as fat and sodium content. It’s a tough task when dealing with picky children, but she’s up for it.
“I think real food can be exciting,” Gunn said. “If you use real ingredients, you can bring out the flavors of those ingredients without adding a lot of extra sodium and sugar.”
Hospitals, day cares and other health care centers have long endeavored to serve patients healthy food, but there has been a greater push for creativity in recent years. Culinarians such as Gunn have strayed from the dreaded mashed potatoes and Jell-O cups of the past, opting instead for fresh and often locally grown produce. But breaking with the processed-food habit takes some work, so larger organizations are looking to help these chefs make the transition.
Premier, a health care improvement company, hosts a recipe competition at its national conference each year. Hospital chefs and food service workers across Premier’s networks submit themed recipes in the months leading up to the conference, at which four finalists compete for the top award.
This year’s theme was on-trend bowls, just broad enough to attract a variety of interpretations.
“We also have a little bit of a ‘better for you’ bent to it,” said Joan Ralph, who heads food and nutrition services at Premier. The bowls had to be less than 800 calories, no more than 10 percent of which could come from fat. Of that fat, less than 3 grams could be saturated. The dishes were limited to less than 800 milligrams of sodium and chefs were expected to enhance the flavor, taste and appearance of their dishes. Given the volume of hospital patients and employees, the recipes also had to be able to be served on an institutional level.
The finalists weren’t intimidated.
Maureen Brooker is used to limiting fats, sodium and sugar. She works as the executive chef at Adrian Dominican Sisters in Adrian, Mich., and generally cooks for those in independent or assisted living situations. Brooker’s official duty is to create menus and recipes, but she also engages with the people she serves and sometimes acts as a mentor. As such, it’s her goal to make sure her meals align with their needs.
“Flavor’s important,” Brooker said. “You don’t have to add fat to get good flavor. In place of salt, you can use fresh herbs or flavored oils.”
The wild blend rice of her sesame lime shrimp bowl was flavorful, with sesame oil dominating its taste. In addition to thinly sliced cabbage, carrots and kale, Brooker tossed pan-fried shrimp and roasted cashews into the dish. A light sesame-lime vinaigrette topped it off.
The 430 Premier members who attended this year’s Culinary Creations dinner, held Wednesday at the Marriott Marquis in Washington, largely work in health care or higher education. After testing the four bowls, served in mini portions, and voting electronically, they deemed Matthew Cervay, executive chef of Pennsylvania’s Geisinger Health System, the winner.
“I wanted to keep things fresh, flavorful and bright,” he said of his winning dish.
Cervay built upon his Santa Fe breakfast bowl’s farro base with black beans and fresh vegetables, with a fried egg on top. Cumin-seasoned pico de gallo and salsa verde gave the dish a zing, while avocado and sprinkled queso fresco added a creamy — and binding — touch. At roughly $1.68 a serving, Cervay’s recipe is also cost effective.
“I wanted to introduce it [with] a breakfast twist,” he said. “Breakfast is really important, and hospitals especially, we usually have large salad bars so we have a variety of leafy greens.”
The tricky part of serving healthier meals is in the logistics; hospitals’ efforts must be matched by food suppliers.
Stacia Clinton, director of the Healthy Food in Health Care program at the advocacy group Health Care Without Harm, used to be a dietitian and noticed that the food served at hospitals often conflicted with what she recommended to her patients. Many hospitals model their food service after fast-food restaurants, she said, and this “cookie cutter” approach leads to a dependency on highly processed foods.
“What we’re aiming to do is pull hospitals back into their mission-driven interest of serving the community where they’re situated,” Clinton said.
This could mean drawing up new contracts or switching suppliers, she said. Tricky, but possible.
“Some hospitals are prioritizing purchasing seasonally, and they’re getting products that are freshest or most nutritious at that time,” Clinton said. “The easiest way to control the nutritional composition is to prepare from scratch. Chef competitions like this one challenge chefs to pull out their culinary skills and apply it to hospitals with therapeutic diets.”
Hospitals need not give up established recipes altogether — a complete menu overhaul might take some time, given the scale of such institutions — because they can instead source better ingredients with similar flavors, Cervay added.
It’s about “really taking stuff that people already like, looking at it a little differently and figuring out how we can source better ingredients,” he said. “In doing so, it’ll reduce the fat, calories and sodium, overall. It takes a little bit of effort and focus.”
In choosing the base for her bibimbap bowl, Gunn was drawn to the sprouted red rice sold by InHarvest. Gunn noted that a bowl can be topped with practically anything available in a kitchen. She opted for a protein-heavy combination of edamame, egg and tofu, complemented by pickled vegetables and Asian-inspired sauces.
“The idea of using tofu and edamame . . . as the protein rather than meat in the center is something we’re certainly all aware of right now,” Gunn said. “Leaner proteins — a little less steak in the center of the plate, so to speak.”
These ingredients, particularly the edamame, aren’t always cheap.
“In hospitals, we’re not there to make money, but we need to cover our costs,” Cervay said. “It is hard.”
The passage of the Affordable Care Act might have played an indirect role in hospitals’ recent efforts. As part of the IRS regulation for nonprofit hospital community benefit, Clinton said, the ACA allows hospitals to use funding for preventive care, which could include dietary efforts. Before the ACA’s passage, funds were often restricted to charitable care only. The GOP’s health care bill would likely revert to this model, Clinton said, limiting the money hospitals could put toward innovative efforts.
“The Affordable Care Act expedited the uptake of looking at food as a way to improve patient health and therefore improve the financial stability of hospitals through their reimbursement rates,” Clinton said. “That was a transformative change, because essentially what the Affordable Care Act did was incentivize hospitals to keep people healthier in the community.”
Many of the people crafting menus have been to culinary school, giving them a foundation in crafting appealing meals. Jacques Wilson, who created a wakame salmon bowl for the competition, attended culinary school and worked at hotels and resorts for decades. He decided to switch to health care in 2002 because he wanted to make a difference and is now the executive chef at El Camino Hospital in Mountain View, Calif.
“I think health care led the charge,” Wilson said of the push for nutritious meals.
Recognizing that long-term dietary choices are ultimately up to the patient, Cervay added that it’s important to show them how appetizing simple meals can be.
“Food is medicine,” he said. “If you eat right and give your body what you need, you feel better.”