Hospital Foods Made to Order

First appeared in the Wall Street Journal

Pnina Peled, executive chef at Memorial Sloan-Kettering Cancer Center, recently faced an unusual culinary challenge: A teenage cancer patient wanted pizza, but chemotherapy treatments had dulled the girl's taste buds and she could only taste lemon.

"This kid liked Italian food, and we couldn't think of a lemon-flavored pizza because we kept thinking of tomato sauce," says Ms. Peled. After some trial and error, the chef created a pizza with a lemon Alfredo sauce for the young patient. "We made it for her three or four times in a month because she kept requesting it," Ms. Peled says.

Getting patients in a cancer hospital to eat is a challenge. "They can't swallow or they can't taste it or they're nauseous," Ms. Peled says. "The adults force themselves, because they know they need the nutrition. But the children don't understand why food doesn't taste like it used to, or why they can't taste anything."

Most hospitals have been updating their food offerings to include more vegetarian and healthier fare. But some major institutions are going further, hiring trained chefs to revamp menu selections and expanding kitchen hours to cater to a variety of medical needs. Diabetic, gastric-bypass, cardiac, cancer and other types of patients all have different cravings and nutritional requirements, these hospitals say.

Chefs are experimenting with Nutella milkshakes, made from the sweet hazelnut spread, for patients needing extra calories. Cancer patients may dine on chicken with a side dish of Flamin' Hot Cheetos to tingle chemo-numbed tongues.

Rex Healthcare in Raleigh, N.C., maintains a small herb garden outside the cafeteria where patients can watch the chefs cut mint and tarragon for the day's dishes. Jim McGrody, Rex's director of culinary and food services, says each disease has its own issues: Cancer patients can't have fresh herbs and raw vegetables because of bacterial concerns, renal patients have to watch potassium (so, no bananas) and cardiac patients eat a low-fat diet.

"Gastric bypass patients are really a challenge because they have to eat very low-fat, low-sugar diets with high protein," says Mr. McGrody, a Culinary Institute of America graduate. "This summer I tried an outdoor menu, with some cedar-plank-grilled salmon. You have to show them that they can get flavor without the fat using citrus juices or roasted garlic."

It takes more work to provide specialized meals. And some healthier ingredients, like fish, can be more expensive. But hospital officials say the cost, which is incorporated into the daily room charge, works out about the same as traditional hospital fare.

"Although we reinvented the menu, the trade off is that we saw a significant reduction in food waste," says Veronica McLymont, director of food and nutrition services at Memorial Sloan-Kettering, in New York. "Patients now order what they want to eat, when they are ready to eat," she says.

Extra care in preparing meals also can give a boost to a hospital's reputation. A 2009 study published in the journal Nutrition & Dietetics found that the more personalized the food service, the more satisfied the patients.

Patients say it makes a difference. Carl William Cousins, 54 years old, had a triple bypass at Rex Hospital last summer. During his six-day stay, he remembers the grilled chicken and turkey sandwiches and well-spiced vegetables.

"Most of the time when you think heart healthy, you just think bland," says Mr. Cousins, a retiree in Raleigh. "I really looked forward to getting something to eat."

Rex Healthcare has two recipes for grilled chicken. "One is marinated in oil with onions, pickles, herbs and spices," Mr. McGrody says. The other, for the heart-healthy menu, "has no oil but is more of a rub of fresh herbs and spices," he says.

At MD Anderson Cancer Center, patients can have Froot Loops cereal and Louisiana Hot Sauce if that is what will get them to eat, says Carol Frankmann, director of clinical nutrition for the Houston hospital. The hospital got so many requests for Flamin' Hot Cheetos that the chefs added the selection to the menu, she says. Cancer patients' "taste can be blunted so they need something strong—sweet, spicy or acidic—just so they can taste it," she says.

Some hospitals have begun cooking to order for patients, similar to a restaurant, instead of requiring them to submit food requests the night before. Orders can be placed any time during the day, until 9 p.m. at MD Anderson, and even later at some hospitals. Memorial Sloan-Kettering blends custom-made smoothies for its patients; MD Anderson offers made-to-order pasta dishes. Some hospitals say they have added kitchen workers to deal with the changes, while others readjusted staff schedules.

"There's been a major shift in philosophy, not just about feeding patients but for the whole hospital," says Kathy McManus, director of nutrition at Brigham and Women's Hospital in Boston, which has 800 beds. The hospital recently began a pilot study with eight other medical centers, including Johns Hopkins in Baltimore and Ohio State University, to evaluate how to improve nutrition and what cancer patients think about food.

Memorial Sloan-Kettering, which serves about 900 meals a day, revamped its kitchen to offer more personalized patient service about two years ago. Ms. Peled, the executive chef, says that if a patient is having a particular dietary challenge, she will personally visit and see if there is something the kitchen can do. For patients who have trouble swallowing, she developed egg-based custards, like a French toast custard with blended croissants, topped with crème anglaise and cinnamon and nutmeg, served in a ramekin.

"All the kids have my card, and they email me constantly," says Ms. Peled. "Here's one I got today from a 13-year-old: 'I wanted to know if you could stop by my room to talk about what I can eat and what you can make me. I miss talking to you in person and I hope you get back to me. Your food friend, Courtney.' "