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Good Food that Tastes Good

Q&A - The Science Behind Better Menus




By Mark Couch


(November 2013) Janine Higgins, PhD, associate professor of pediatrics, runs the Nutrition Core for the Colorado Clinical Translational Sciences Institute (CCTSI) and has been a key partner in the effort to provide healthy, tasty and affordable food in the cafeteria of Children’s Hospital Colorado.

Higgins earned her PhD in biochemistry at the University of Sydney in 1995 and moved to Colorado to “broaden her horizons.” She joined the University of Colorado School of Medicine in 1999, conducting research on carbohydrates and metabolism rates.

As the nutrition director for CCTSI, Higgins oversees a team that pro-vides support for others conducting research in the School of Medicine. Her team helps implement protocols for research experiments, dispenses metabolic diets to patients, and assesses the dietary intake and physical activity of research subjects.

Higgins and her team donate their time to an effort called the Healthy Hospital Initiative.

Q: What is the Healthy Hospital Initiative?
A: The Healthy Hospital Initiative is a program at Children’s Hospital that aims to improve the health and wellness of patients, their families, visitors and staff. We’re looking at people in terms of their physical, emotional and mental health.

Q: Where do the guidelines come from?
A: The nutrition guidelines are from the Centers for Disease Control. Some of the guidelines, like reducing or eliminating sugar-sweetened beverages, come from the national Children’s Hospital Association.

Q: Eliminating sugar-sweetened beverages seems to be a big reach. Tell me about that process.
A: The initial step was the placement of water from the back of the cafeteria to the point of sale, right near the cash registers and placing water bottles in all the vending machines at eye level. That in-creased water sales. Over time, we’ve increased water sales and we’ve reduced sales of sugar-sweetened beverages by putting those bever-ages much lower down in all the machines and having more diet options available. A lot of vending machine operators didn’t want to put diet sodas in the machines because they said it wouldn’t sell. So we insisted. In terms of eliminating sugar-sweetened beverages, some children’s hospitals around the nation have already done that.

Q: You’re serving a broad population, not just the employees of the hospital. You’re serving the patients and their families and anybody else on campus. Does that make it harder to implement the Healthy Hospitals Initiative?
A: What we did from the CCTSI Nutrition Core was donate use of our time. We have the most advanced software for calculating calories and the macro and micronutrients in food—much more than would be available clinically. We had an intern for 11 weeks in 2012 and she spent all 11 weeks entering every food that’s offered in the cafeteria into our database and coming up with calories, fat, protein, fiber, sodium and saturated fat.

Q: What kind of food is served?
A: We used to have a pasta station in the cafeteria and it was renamed the Light Side Bistro, which is where you can get a meal every day that meets or exceeds the CDC guidelines. Before we got involved, it started off being all salads and rice and pasta dishes. It was basically a very iterative process that looks at what sells, making sure we get a big range of proteins, of cuisines from around the world. We’ve got Moroccan food; we’ve got Middle Eastern; we’ve got Asian; we’ve got American classics, turkey sloppy Joes; and we also added a soup to our soup bar each day that is a light and healthy soup.One of the items we have is a salmon po’boy, and getting Cajun season-ing on a piece of salmon with no sodium and having a lot of taste is hard, but you know what? One of my staff made it work. We want to give people the freedom to say I can eat all of the things that I like, modify them a little bit and have really healthy, tasty options. In fact one of the best comments I have gotten is an email from someone saying, “I had that Thai-mango chicken from the Light Side today and it was so good that I thought I was eating something naughty.” That’s what we want people to think.

Q: Obviously this initiative is to keep people who work here or who are here for other reasons healthy and happy, but you talked about being a service to the community. How?
A: We all go out at the end of the day and take with us what we learned and did during the day, so if you come and realize you can have fish and pork and beef as part of a healthy balanced diet and you can do it in a low-calorie, low-sodium way, this is an education mission in part. You can look and say it’s all things you could do at home if you wanted. It’s fajitas, it’s fish tacos, it’s a salmon po’boy. To give people that education empowerment and have them take that out with them into the community should really improve people’s lives.

Q: Can you explain the signs at the serving stations with the green and yellow dots on them?
A: It’s the stoplight system. We have signs around the cafeteria telling you what it means. Foods that meet all the CDC guidelines are labeled with a green dot, and green means go for it. Things that meet most of the guidelines, but might be higher in saturated fat or higher in sodium are labeled with a yellow dot, which means approach with caution. It’s not that you shouldn’t eat it, you just don’t want to go and eat only that all day every day. We haven’t really labeled red dots, but red dots are stop and think before you eat this.

Q: What if I don’t see any dots?
A: It’s probably red. The french fries and onion rings are red. They don’t have dots.

Q: Why not just eliminate the unhealthier options?
A: At the end of the day, we’re a hospital. We are not a regular work-place. There are people here who are sick. There are children who are critically ill who have families who may need comfort food at that time. We have children here who are in recovery after surgery, who have complications, who aren’t eating very much and don’t have good appetites, and that day, they might feel like french fries. The Healthy Hospital Initiative isn’t about telling you what food you have to eat. It’s about your physical, mental and spiritual well-being. And sometimes for your mental and spiritual well-being, when you’re in a very emotionally tough situation in a hospital, you might need some-thing that we wouldn’t consider a green-dot food. And that’s OK.

Q: You and your team volunteered for this effort. How does this all tie back to what you get paid to do for the university?
A: The CCTSI’s mission is to facilitate clinical research, and speed the translation from bench to bedside. We educate and train future scientists and physicians, but we also take these ideals of health and what we learn in our clinical research out in to the community. We are being good citizens to Children’s Hospital. We work here. We want this to be the healthiest, best place for everybody to work.