Meals in the hospital? From “Everything pale, colorless, tasteless”, says a surfer on Twitter, supporting a photo of a beige dish. “Inedible”, castigates another, when a third pours into black humor: “Friday is fish day on the hospital meal trays. To taste, it looks like they put an extra “s” … “
If the French hospital shines with its medical excellence, it is not famous for its gastronomy. “There is however a clear difference between the public hospital and private clinics”, raises Clémentine Hugol-Gential, co-responsible for the “food and gastronomy” axis in the information and communication sciences laboratory at the University of Burgundy (Cimeos). “Moreover, it is not the quality of the doctors that distinguishes the public and the private, but that of the reception in general and of what we eat there in particular”, underlines this specialist in eating practices.
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“Food is the primary fuel the body needs to function. The better patients eat, the faster they heal and the faster they get home. And yet, food is clearly not a priority for the hospital ”, deplores Jean-Rémy Dumont, head of catering at the Hospices Civils de Lyon and president of the Union of hospital engineers in catering. According to the National Food Council (CNA), French establishments only devote 1 to 2% of their budget to it. Or on average € 3.73 per day for the three daily meals. Difficult, at this price, to put the small dishes in the big ones.
The notion of care in question
The challenge is not only to satisfy the taste buds of patients, but not to hinder their healing. In a notice published in 2017, the CNA warns about the frequency of cases of malnutrition in hospitals, a consequence of“Massive under-consumption of meals” in more than half of the patients. “Despite a quantitatively sufficient supply, especially in energy and macronutrients, most patients do not meet their needs, without this deficit being able to be attributed to the disease”, notes this independent body. A shame in the eyes of Clémentine Hugol-Gential, who reminds us that “In official texts, food is a care in its own right”.
It is still necessary to agree on the concept of care. “If we reduce care to the mere fact of treating a pathology, then we miss the essential, especially well-being, estimates Jean-Pierre Corbeau, professor emeritus of sociology of food and consumption at the University of Tours. By over-medicalizing food, by reducing it too much to its sole micronutrient function, we end up forgetting its symbolic, social and emotional dimension ”, he analyzes, lamenting that meals are defined first and foremost by what they do not contain: no salt, no sugar, no fat … And never, oh never, alcohol – with the exception notable from Clermont-Ferrand University Hospital, whose palliative care service has had a wine bar since 2014. A space “Medically supervised”, placed under the sign of “Right to have fun”.
The benefits of selected menus
Better adapting the offer to patients’ expectations could, moreover, make it possible to limit food losses. Also according to the CNA, 40% of the food served in the hospital is thrown away, i.e. “The greatest amount of waste” in collective catering in the health and medico-social sector. For Clémentine Hugol-Gential, the best way to reduce these losses would be to let patients choose their menu.
A measure whose impact it assessed between 2014 and 2019, as part of a research project called Alims (Food and fight against inequalities in health). Result: if this à la carte restoration involves a “Human cost” for establishments – “Staff are needed to take orders from the sick bed”, specifies the researcher -, she “Leads to better food intake from meals as well as a 20% reduction in wastage”. And ultimately, savings for the hospital.
“What is lacking today is not the ideas, but the political will”, says Jean-Pierre Corbeau, for whom establishments outsourcing meal preparation – around 30% – are too often content to blame providers. “In reality, companies like Sodexo are capable of doing very good things… provided we pay the price! “, he points out.
The weight of constraints
Would more money be enough? “This would make it possible to stock up with better quality products, but hospital catering remains subject to many constraints that are detrimental to taste”, assures Jean-Rémy Dumont, at the Hospices Civils de Lyon. Starting with the need to cook food as much as possible, “To destroy germs”.“We may prefer tender pieces of meat and cooking at low temperature, the flavors are not the same. There is no such thing as rare steak in the hospital! “
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According to him, progress is nevertheless starting to take shape, in particular thanks to the agriculture and food law (Egalim), which sets the objective for the catering services of health establishments to offer 50% of quality and sustainable products, including at least 20% organic products. A transition to which the Hospices Civils de Lyon, financially balanced, plan to devote € 800,000 in 2022, in addition to the € 9 million devoted each year to the purchase of foodstuffs. “We plan to achieve 36% sustainable products by 2022, including 22% organic”, reports Jean-Rémy Dumont.
A progress that Jean-Pierre Corbeau regards with suspicion, fearing that health establishments will “Shelter behind labels”, to the detriment of a real reflection on the place of food. “An avocado as hard as a stone, even organic, it remains an inedible avocado that will end up in the garbage …”
The Food and Nutrition Liaison Committee (Clan)
Created in 2002 to improve the diet of hospitalized patients, the Food and Nutrition Liaison Committee (Clan) is made up, in each establishment, of the director and staff involved in food (doctors, dieticians, nurses, cooks , etc.).
Recommended but not mandatory, these advisory structures still play too limited a role, according to the National Food Council.