Why Hong Kong hospitals should serve patients more vegetarian food instead of meat – and not just overboiled cabbage
Being provided with good plant-based food options can help a patient’s recovery, so why do we hear so many complaints about what local public hospitals offer? Perhaps they should take the lead from Adventist
Quiche with spinach and broccoli; zucchini and wild mushrooms with sweet and sour sauce; tofu puffs stuffed with glutinous rice – all might sound like dishes from a fine dining menu, but are actually served to patients at Hong Kong’s two Adventist hospitals. And they’re all vegetarian.
The two private hospitals – in Happy Valley and Tsuen Wan – are the only ones in Hong Kong that provide exclusively vegetarian meals for patients, visitors and staff. Their precept of not serving any meat products flows from the health principles of the Seventh-day Adventist Church.
“We believe that plant-based foods are good sources for healing the body, mind and soul,” says Wong Chi-wing, the registered dietitian at Adventist’s Happy Valley hospital. “A balanced vegetarian diet can provide good nutrients and at the same time provide some extra benefits such as phytochemicals and antioxidants, which can have a surprising positive effect on [recovering] patients.”
Wong is in charge of designing healthy, well-balanced and tasty meals and drinks for Adventist hospital patients. For someone undergoing treatment for cancer, for example, he ensures they receive a variety of foods high in protein and antioxidants. “Strawberry milkshakes are one of our favourite high-protein drinks,” he says.
Adventist Hospital’s long-held belief in serving quality vegetarian fare in hospitals seems to be catching on globally. In June, the American Medical Association (AMA) adopted a resolution calling on US hospitals to provide a variety of healthy food, including plant-based meals, to improve the health of patients, staff and visitors. It added that meals ought to be low in fat, salt and added sugars, processed meats should be taken off menus, and healthy drinks should be provided and promoted.
“The AMA came out with a resolution and the house of delegates of the AMA said that healthy foods should be in hospitals,” says Neal Barnard, president of the Physicians Committee for Responsible Medicine (PCRM), in a video news release. “Specifically, plant-based foods have to be offered to every patient, and get rid of the bacon, the sausage, the hot dogs, all the processed meats that have been shown to cause cancer.”
Dr James Loomis, medical director of the Barnard Medical Centre in the UK, is a PCRM member who also supported the AMA resolution. “Hospitals that provide and promote fruits, vegetables, whole grains and beans are likely to reduce readmissions, speed recovery times, and measurably improve the long-term health of visitors, patients and staff.”
The resolution followed a shocking 2015 report published by the World Health Organisation that classified processed meat such as hot dogs, ham, bacon and beef jerky as having the potential to cause cancer in humans. The WHO subsequently classified such foods in the same group as tobacco and asbestos, which it said highlighted the strength of scientific evidence that they are a cause of colorectal cancer.
Not all hospitals are prepared to embrace change, though. In Hong Kong’s public hospitals, the availability and quality of plant-based food options is underwhelming.
When Helen Norton, 37, was recently admitted to Prince of Wales Hospital in Sha Tin after complaining of severe abdominal pains, she was stopped from eating so doctors could determine the cause of her condition. Having arrived on a Sunday morning, she was relieved when a doctor finally allowed her to eat late on Tuesday night. But Norton, a vegan, was shocked and disappointed when her meal was served.
“They gave me a bowl of vegetables which was pale, overboiled and could not possibly have any nutritional value left. I had a couple of mouthfuls of rice, looked at the cabbage, and the third dish was meat – I just said no. My mother had brought some soup for me, so I had that, and got a bagel from a coffee shop there,” she says.
Norton says she had told the hospital of her diet restrictions, but they had not followed up. The following day’s lunch fixed that particular problem, but was not even remotely appealing.
“It was the same boiled cabbage, badly cooked rice and a block of tofu that was covered in some fluorescent yellow substance,” she says, adding that she received similar bland, overcooked meals throughout her five-day stay at the hospital.
She expresses concern about the lack of healthy, plant-based meal options available for patients in public hospitals, explaining that you do not feel like you are getting the best nourishment.
“I’m a great believer that food heals your body. We are told all this information that you need to eat a healthy, nutritious, balanced diet. I know public hospitals are overstretched and there are big issues with budget, but when you’re trying to get people healthy and well again, why aren’t [public hospitals] giving them something that’s going to help?”
A spokesman for the Hospital Authority (HA) – which manages 42 public hospitals in Hong Kong – says it offers vegetarian and Halal meals to patients that meet their preferences and therapeutic needs. This includes low-carb, low-fibre and low-potassium meals, and soft meals for toothless patients. A menu cycle ensures food options are rotated frequently in both canteens or cafes (for staff and visitors) and therapeutic diets (for patients). To promote healthy eating, a total of 20 staff canteens in public hospitals now display calories on menus, following advice from the government’s Committee on Reduction of Salt and Sugar in Food.
Asked whether processed meat would be removed from hospital menus, the authority said menus were already designed and developed by hospital catering and dietetic departments, taking patients’ nutritional needs and individual preferences into account.
“I’m so surprised to hear that,” says Norton, adding that she also tasted meals as an inpatient at Queen Elizabeth Hospital in Yau Ma Tei two years ago. “I would certainly suggest the HA looks into the type of food they’re feeding their patients, and that a one-size-fits-all meal isn’t suitable for everybody. The catering is definitely below standard.”
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Two types of food service are offered in public hospitals: one for patients, one for canteen or cafe services for visitors and staff. Both services are partially organised in-house, with the balance contracted out to catering companies. Catering companies are awarded contracts after a tendering exercise in accordance with the Hospital Authority Procurement & Materials Management Manual. Tender details are posted on its website.
While it is apparent every effort is made to maintain standards, health professionals say there is room for improvement.
Carmen Lo, a dietitian with Asia Medical Specialists, says she hears many people complain about the quality of food available when she goes to visit people in Hong Kong’s public hospitals. “They may say the food has no taste, or it is tasty but not healthy,” she says.
Many visiting family members bring food from home, she says, because they understand both the patient’s preferences and that plant-based or vegetarian options are few.
“The HA has vegetarian options, but not too many. There aren’t many vegetarian inpatients. I think they can work to develop more options,” she says.
While Lo supports the idea of more plant-based meals in hospitals, and removing processed meat, she says vegetarian food may not suit everyone. Ultimately, she explains, better local education on the benefits of eating more plant-based foods is a good place to start.
“We know a vegetarian diet can be healthy, but it may not be balanced – it really depends on the patient’s health issue, such as if the patient has a poor appetite or low energy,” Lo says.
“Education is important; it’s not enough to just say eating vegetarian is good, plant-based diets are good … I would say greater education comes when there’s a healthy selection.”
For staff and visitors, Lo suggests that dietitians rethink menus by dividing them into columns based on the food pyramid, such as appetisers, carbohydrates, protein and dessert. In the carbohydrates column, for example, brown rice could be offered at a lower price than white rice, pasta or bread, to encourage people to select whole grains. At the end of the meal, a dessert like a yogurt can be earned free of charge by playing an informational game like a crossword.
“Instead of having an ice cream or a cake, have the yogurt because it’s high in calcium. It could be a way to instil something healthy in their mind.”
Adventist’s Wong says that for more plant-based meals to be offered in both public and private hospitals, greater input from dietitians is key.
“They need to make sure vegetarian menus at hospitals are well-balanced and to initiate their promotion [to patients]. It is vital to educate the public about the nutritional value of vegetarian food. There are deep-rooted misconceptions in the public’s mind. They will be amazed at how a plant-based diet brings extra benefits to them.”