Self-Serve Meals or Hospital-Style Meals: Which Do Inpatients Prefer?

In British Columbia, one goal among hospital-based eating disorder treatment programs is to help patients normalize eating behaviors in a safe and nurturing environment. Researchers at BC Children’s Hospital’s Eating Disorders Program, Vancouver, are using a cafeteria-style (self-serve) meal program aimed at helping patients learn to manage meals before they are discharged home.

Kristina J. Sandy, PhD and colleagues have reported that using an approach that lets patients select their own foods helps patients to be gradually reintroduced into normal meal-management activities and may also enable them to work toward overcoming difficulties handling food and toward making appropriate food choices (JADA 2007; 107:376).

Patients serve themselves, under supervision

At BC General, the cafeteria-style meals are served in large bulk containers that arrive on kitchen trolleys outside the dining area about 30 minutes before the meals are served. The containers hold food prepared for each specific meal—meals for patients on level-one care are premeasured by meal support staff. Other patients are expected to serve themselves and are guided by color-coded serving utensils; the color indicates one serving or two, for example. After finishing the meal, the patients clear their dishes and place them in a dishwasher.

In contrast, hospital-style meals are served on a tray for each individual patient. All meals are preordered by the patients and the dietitian during the preceding week. After finishing their meals, patients with hospital-style meals clear their trays and place them back onto the kitchen trolleys.

How did patients like the approach?

The researchers recently conducted a small study to see how patients liked the transition to cafeteria-style presentation of foods from the previous use of hospital-style meals. There was no qualification as to how long the patients had been in the program, and most were between 13 and 18 years of age. Two were male and 10 were female.

All inpatients and day-treatment patients from the intensive treatment program at the hospital completed a series of four questionnaires during a 4-month period. The questionnaires explored general attitudes, including how patients felt about the way the food was presented and changes they would like to see implemented.

Four main themes emerged

When the researchers reviewed the questionnaires, they found four main themes: trust and safety; presentation of food preferences; feelings of fear and apprehension; and increasing responsibility.

Trust and safety issues. Meal support staff members were initially viewed with suspicion and not trusted to measure the food accurately because patients believed they wanted them to gain weight. While some distrusted the staff members at first, at the end of the transition period most patients acknowledged that the cafeteria-style meals represented a normal style of eating, and many expressed hope that they could gain positive results from learning the new skills.

Food preferences. In the hospital-style presentation of meals, one patient liked the fact that the foods were separated, while others complained that they didn’t like putting the trays away and that it took time to heat food, which left them feeling that hospital-style presentation felt less like home (where food is served hot).

Fear and apprehension. Even the thought of implementing a home-cooking, cafeteria-style eating arrangement left many patients feeling fearful at first. However, after a cafeteria-style breakfast had been served for several weeks, patients commented that the cafeteria-style meals felt more real and normal compared to the hospital-style meals.

Increasing responsibility. Patients seemed pleased with the increased responsibility that cafeteria-style meals offered. They reported that this felt more “home-like” and normal, and commented that even loading the dishwasher, getting their own food, and learning the appropriate sizes of portions were helpful. After a while, the cafeteria-style presentation was not so frightening, and many of the patients were happy about the possibility of learning transferable skills they could use when they were discharged from the hospital. The only consistent complaint from patients was the lack of personal space where they prepared their meals, which contributed to feelings of chaos and anxiety. Some felt suspicious about other patients’ abilities to take appropriate portions and “not to cheat.” Overall, they much preferred the cafeteria style.

The researchers found that despite some initial anxiety, most patients accepted the transition to cafeteria-style meals and to date no negative impact has been seen on the rate of weight gain among patients.