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Food Fight

Newly installed chief executive Toby Cosgrove, MD, says that the presence of fast food is inconsistent with the medical center's mission: People can get their coronary arteries cleared out upstairs, then stop for a fat-laden Big Mac on the way out of the hospital.

Others contend that patients, visitors, and hospital staff can make healthful choices and are entitled to familiar, affordable food. So we asked attendees at the recent American Diabetes Association 52nd Annual Advanced Postgraduate Course:

Does fast food belong in a medical center?

I would prefer not to see McDonald's in those types of settings in light of rising obesity levels, particularly in our children. When kids see fast-food restaurants, it perpetuates the notion that these are the only places to eat.

If you have fast-food restaurants present, at least offer additional menu items. However, I'm afraid that the fast-food industry is so tarnished that we need to look at other types of restaurants that can be present at places such as The Cleveland Clinic.

Karen Stidd, MA, RD, CDE
Diabetes Educator
Port St. Lucie, Fla.

I don't think there's an intrinsic problem. I don't think we should try to oppose popular culture, but I think fast-food restaurants could use that in a constructive way. They should design a menu that's compatible with a good diet, advertise the fact that they have a healthy McDonald's, and allow people to choose McDonald's if that's what they like to eat. It would probably be good for McDonald's and would probably be good for the institution, rather than trying to come up with some off-brand restaurant.

I don't think they should take the high-fat, high-carbohydrate diet wholesale and say this is all you get—there should be some kind of combination.

Kort Knudson, MD
Endocrinology
Middletown, Conn.

Usually, I would say no—especially it there's other food available.

On the other hand, people are going to be out in the public with these types of restaurants anyway. If you have them in the clinic setting, try and have the nutrition facts available for patrons when they come in. Maybe it would be a good place for the hospital to do some education. It could be more of a partnership.

Brigitte Sullivan, RD, CDE
Clinic Certified Diabetes Educator, Dietitian
LaCrosse, Wis.

[Fast-food restaurants] do have a place if they control the quality of food that they sell to the public, emphasizing low-fat, low-salt food—which some of them do. If they comply with these types of regulations and requirements, I would have no objection to having McDonald's in The Cleveland Clinic or in the hospital where I practice.

Gabriel Martinez, MD
Endocrinology
San Juan, Puerto Rico

I don't want to see McDonald's there, but this is a free society. If people want to kill themselves, they can enter at their own risk.

You can go into McDonald's and get a salad. Larger hospitals can do better, though, with their own food.

Jeffry Shiff, MD, CDE
Endocrinology
Massapequa, N.Y.

I don't believe fast-food restaurants belong there. We're trying to decrease obesity in this country. Fast-food restaurants encourage people to eat large portions. People tend to select items that are higher in saturated fat. We need to encourage people to eat in a more healthy fashion.

Darlene Paduano, RN, MSN, ANP, CDE
Nurse Practitioner, Primary Care
Port Jeff Station, N.Y.

I don't think it's appropriate. It's sort of like seeing doctors outside the hospital smoking. It sets a bad example. How can people possibly believe what you say about diet and nutrition when you have a fast-food joint in the lobby?

Esther Smith
Medical Student
Tucson, Ariz.

TALK BACK: PHARMACY CARE

Retail pharmacists are positioning themselves to take a more prominent role in the management of illness, including anticoagulant therapy, diabetes management, hypertension care, and anticholesterol therapy. Many pharmacies have remodeled to include a place for consultation, and some are testing the waters with various health-screening activities.

Pharmacists want to have some prescribing authority, and have been working to get compensated for the delivery of health services beyond the dispensing of drugs.

What do you think? Should pharmacists be more involved in the care of patients with chronic diseases such as type 2 diabetes?

Send your comments to docnews{at}diabetes.org.

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