Dear North York General Hospital:
I work in a nutrition clinic at your facility. Many of my patients struggle with obesity. It is my job to help them and their families learn to make healthier lifestyle changes in the spirit of mitigating their risks of developing obesity-related disease: metabolic syndrome, diabetes, cardiovascular disease, social stigmatization, depression … the list goes on.
Today I came down to the cafeteria and noticed the following sign, flanked by rows and rows of potato chips, strategically placed prominently in a central, high-traffic area:
If I understand correctly, you are encouraging your patrons to buy unhealthy pizza (especially slices with pepperoni) so that they can get $10 off tickets for the most sedentary activity known to humankind: movie-watching. And the physical arrangement also suggests that your patrons should consider buying a bag of chips to go with their slice.
By the way, The amount of salt in the one slice of pizza and one bag of chips exceeds the total daily recommended sodium intake for an entire day.
This disturbs me. I was particularly saddened as I watched one of my patients, fresh out of my counselling session about healthy food choices, notice the sign and respond with excitement to ‘such a great deal’. He bought and ate two slices.
You state in your press releases that North York General Hospital “embraces health by providing innovative and compassionate care for the whole family at every stage of life.”
This marketing tactic is not an example of embracing health. Quite the opposite. It undermines the work that we do as health care providers helping our patients bring health and balance to their lives.
Why should we (patrons, patients and employees), day in and day out, have to incessantly fight our lunchtime/dinnertime/anytime impulses to buy pizza, chips and pop every time we walk past the cafeteria. Shouldn’t a hospital be a safer place that gives us respite and protection from subversive anti-health marketing tactics of this nature?
As an institution that aspires to bring health to its community, how have you allowed this to happen? Why make healthy choices ever-increasingly difficult for your patients, patrons, and employees?
We can do better.
Please take this sign down.
Yours sincerely,
Daniel Flanders, MD FRCPC
Pediatrician
Hi Dr. Flanders,
I agree completely with your post here, but one thing that struck me as odd was the sodium intake comment. From what I can see, two large slices of pepperoni pizza from Pizza Pizza + a bag of Lays chips would be ~1400mg of sodium MAX. This is not the daily recommendation of 2500mg. Could you elaborate on this?
Thanks, Theodore, for your interesting observation and question.
There are different ways to approach this. As you argue, one can simply say that the RDI for salt is up to 2300 mg/day in which case you would be right, the pizza slice and chips doesn’t quite get the pizza slice eater above the limit.
However, consider this more nuanced argument. In 2005, the Center for Disease Control (CDC) published updated guidelines: a reduction of daily sodium intake to <1500 mg for those at higher risk for sodium-intake-related illness. Those considered at risk are 1) anyone with hypertension, 2) anyone >50 years old, 3) African Americans, and 4) anyone with kidney disease. Amazingly, 69% of american adults meet at least one of these criteria and should therefore be consuming <1500 mg of sodium per day.
Among children, recommendations vary widely. That said, the Institute of Medicine sets the Adequate Intake for sodium at 1000 mg/day for children ages 2 to 3, 1200 mg/d for 4 to 8 and 1500 mg/day for boys and girls ages 9 to 18.
So, we can conclude that the Sodium RDI for the vast majority of people is <1500 mg/day.
Now back to your question. I took the pizza nutritional information from here. According to this information, a walk-in slice of pizza pizza pepperoni pizza has 1710 mg of sodium. Whether we add the 150 mg of salt in a bag of chips or not, this slice does exceed 1500 mg/d which is the upper acceptable recommended intake for more than three quarters of the US population – probably Canada too.
Thanks for the interesting observation…
DF
I was a physician at NYGH for about 10 years. When the cafeteria went corporate, I spearheaded a petition from staff about this very topic. We received over 200 signatures of NYGH employees about how the messaging coming from that cafeteria undermines everything we do as health care professionals. Clearly this fell on deaf ears. It disgusts and disappoints me that an otherwise phenomenal healthcare organization has put its bottom line so far in front (or so far behind!) of its mission statement and core values.