--- title: "An assessment of food offerings and marketing strategies in the food-service venues at California children's hospitals | Sutter Health" description: "The purpose of this study was to assess the food environment available to patients, staff, and visitors in all 14 California children's hospitals." url: "https://www.sutterhealth.org/research/publications/food-offerings-and-marketing-in-ca-hospitals-1055312567" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. An assessment of food offerings and marketing strategies in the food-service venues at California children's hospitals # An assessment of food offerings and marketing strategies in the food-service venues at California children's hospitals Lesser LI, Hunnes DE, Reyes P, Arab L, Ryan GW, Brook RH, & Cohen DA. _Acad Pediatr. 12(1):62-7. doi: 10.1016/j.acap.2011.09.004. Epub 2011 Nov 30._ 2011-11-30 ## Abstract OBJECTIVE: Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children's hospitals. METHODS: We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them. RESULTS: Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13-30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria. CONCLUSIONS: Most children's hospitals' food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/?term=An+Assessment+of+Food+Offerings+and+Marketing+Strategies) ## Research topics - [Food and Nutrition](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Food+and+Nutrition%5C%22%22) - [Health Policy](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Policy%5C%22%22) - [Obesity](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Obesity%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Obesity prevention at the point of purchase.](https://www.sutterhealth.org/research/publications/obesity-prevention-at-point-of-purchase-1055312473) Cohen DA, Lesser LI. Obes Rev. doi: 10.1111/obr.12387. \[Epub ahead of print\] 2016 Feb 22 - Publication ### [Outdoor advertising, obesity, and soda consumption: a cross-sectional study](https://www.sutterhealth.org/research/publications/outdoor-advertising-obesity-and-soda-consumption-1055312547) Lesser LI, Zimmerman FJ, Cohen DA BMC Public Health 13:20. doi: 10.1186/1471-2458-13-20. 2013 Jan 10 - Publication ### [Knowledge and perceptions of overweight employees about lifestyle-related health benefit changes.](https://www.sutterhealth.org/research/publications/overwt-employees-knowledge-lifestyle-changes-1055312427) Li J, Linnan L, Finkelstein EA, Tate D, Carolyn Naseer, M.A., c and Kelly R. Evenson N C Med J. 72(3):183–190. 2011 May 01 - Publication ### [Differing views regarding diet and physical activity: adolescents versus parents' perspectives.](https://www.sutterhealth.org/research/publications/diet-and-exercise-obese-teens-and-parent-views-1055312773) Azar KMJ, Halley M, Lv N, Wulfovich S, Gillespie K, Liang L, Goldman Rosas L. BMC Pediatr. 20(1):137. doi: 10.1186/s12887-020-02038-4. 2020 Mar 27 - Publication ### [Dietary associations of household food insecurity among children of Mexican descent: results of a binational study.](https://www.sutterhealth.org/research/publications/diet-and-food-insecurity-in-mexican-children-1055312904) Rosas LG, Harley K, Fernald LC, Guendelman S, Mejia F, Neufeld LM, Eskenazi B. J Am Diet Assoc. 109(12):2001-9. doi: 10.1016/j.jada.2009.09.004. 2009 Dec 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/food-offerings-and-marketing-in-ca-hospitals-1055312567#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"An assessment of food offerings and marketing strategies in the food-service venues at California children's hospitals"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/food-offerings-and-marketing-in-ca-hospitals-1055312567#medicalscholarlyarticle","name":"An assessment of food offerings and marketing strategies in the food-service venues at California children's hospitals","headline":"An assessment of food offerings and marketing strategies in the food-service venues at California children's hospitals","abstract":"OBJECTIVE: Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children's hospitals. METHODS: We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them. RESULTS: Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13-30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria. CONCLUSIONS: Most children's hospitals' food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register.","description":"The purpose of this study was to assess the food environment available to patients, staff, and visitors in all 14 California children's hospitals.","keywords":["Food and Nutrition","Health Policy","Obesity"],"datePublished":"2011-11-30","url":"https://www.sutterhealth.org/research/publications/food-offerings-and-marketing-in-ca-hospitals-1055312567","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"DOI","value":"10.1016/j.acap.2011.09.004"}],"sameAs":["https://doi.org/10.1016/j.acap.2011.09.004"],"isPartOf":{"@type":"Periodical","name":"Acad Pediatr"},"author":[{"@type":"Person","name":"Lesser LI"},{"@type":"Person","name":"Hunnes DE"},{"@type":"Person","name":"Reyes P"},{"@type":"Person","name":"Arab L"},{"@type":"Person","name":"Ryan GW"},{"@type":"Person","name":"Brook RH"},{"@type":"Person","name":"Cohen DA"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Food and Nutrition","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Food+and+Nutrition%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Policy","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Policy%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Obesity","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Obesity%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/food-offerings-and-marketing-in-ca-hospitals-1055312567","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/food-offerings-and-marketing-in-ca-hospitals-1055312567#breadcrumblist"}}} ```