Improving the food environment in Colorado hospitals: a case study

Implementation of Food Service Guidelines (FSG) can improve nutritious offerings and individual health behaviors. This case study demonstrates how a state health department supported hospitals to improve their nutrition environments. The Colorado Healthy Hospital Compact (the Compact) is a statewide initiative designed to implement FSG to improve hospital nutrition environments by increasing the availability of healthier foods and beverages and reducing or eliminating unhealthy items. Developed and implemented by the Colorado Department of Public Health and Environment (CDPHE), hospitals voluntarily participated and completed assessments to monitor changes in the cafeteria nutrition and marketing environments. Of the n = 10 participating hospitals that submitted quantitative data in 2021 and 2023, one staff member (eg, food service directors, registered dietitians, wellness coordinators) from 8 of these hospitals completed interviews with CDPHE staff in March 2023 on facilitators and barriers, attitudes and feedback on changes by implementers and clients, maintenance, and experiences with implementation of the Compact. From 2021 to 2023, hospitals showed improvements in meeting standards for healthy sides, entrees, snacks, desserts, and beverages. Hospitals also showed improvements in their pricing strategies and healthy product offerings. The primary barrier to implementation was customer desire for specific foods; facilitators included existing priorities around healthy food environments and buy-in from staff. Common themes of intervention maintenance included having a nutrition policy or contracts, good communication/culture about the Compact, leadership support, and using food service vendor healthy food program(s). The Compact appears to be a feasible approach for implementing healthier nutrition standards in the hospital setting and spreading implementation across hospital settings.