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New signs highlight an array of fresh produce at the Los Compadres Market and Restaurant. HEAC staff built a relationship with the owner over three years.

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Oakland Hospitals

Oakland Hospitals See Nutritious Food as Integral to Health Of Patients and Their Families

As Chief of Pediatrics at Highland General Hospital, Alameda County's public hospital in the heart of Oakland, Dr. Robert Savio sees hundreds of young patients who are obese and face a high risk for diabetes, hypertension, and cardiovascular disease. Hospitals are supposed to promote health, he says, "but sitting in the waiting room, kids would see these snack carts come through loaded with candy and Cheetos. My colleagues and I call them 'diabetes carts'!"

Recognizing that eating healthier, more nutritious food is critical to children's health, Dr. Savio has helped spearhead a year-long campaign to transform the hospital's food environment.

"If we don't change the food available in hospital settings, it's like we're creating our own patients," he says.

Dr. Savio and his wife have two young children of their own and have been longtime members of a local CSA—a Community Supported Agriculture cooperative—which delivers a weekly box of fresh produce to participating families. So when his colleague Michele Bunker-Alberts, a family nurse practitioner and lactation consultant, suggested making farm-fresh produce available right there at Highland, he immediately teamed up to help her. With a modest $5,000 grant from the hospital's Physician Foundation, along with technical and moral support from The California Endowment-funded Healthy Eating, Active Communities (HEAC) initiative, Highland Hospital partnered with West Oakland's Peoples Grocery to have a truckload of fruits and vegetables delivered to the hospital every week. Staff members sign up in advance, paying $24 per box, in turn subsidizing free or reduced-price produce boxes for low-income patients' families.

"In an area with dozens of liquor stores and no grocery stores, even one box of fresh produce makes a real difference," says Dr. Savio, who now uses the weekly drop-off at Highland to feed his own family. "We also want to get more staff on board, so we walk around and distribute free samples to different departments. We go to every nook and cranny to share with them."

To build awareness for their efforts among CHO executive staff, nurse Bunker-Alberts had the idea of cooking an entire dinner for the management team out of a box of produce. "They loved it!" says Dr. Savio, recalling the healthy and delicious multi-course meal. "And they have put their unanimous support behind us."

Together the duo also convinced the people in charge of snack carts—the organization of hospital volunteers—to offer healthier choices such as nuts, fresh fruit, and baked rather than fried potato chips; and they got the gift shop to agree not to sell candy anymore.

Meanwhile, across town at Children's Hospital Oakland, Dr. Lydia Tinajero-Deck has also been working on positive changes to the food environment.

"As the co-director of Healthy Hearts, our overweight management clinic, I think it's important that we practice what we preach," says Dr. Tinajero-Deck. "We'd tell patients to go home and work on eating healthy, but if they were grabbing lunch here, it would be hamburgers and hot dogs. We needed to create a food environment offering healthy choices every place they touch, and helpful guides like a little heart insignia next to the healthier options. It's important for our patients and also for our staff, to help them eat healthy wherever they are."

With strong support from upper management, the hospital began by taking a close look at its cafeteria menu, eliminating trans fats (for example, replacing French fries with baked fries) and introducing nutrition labeling so that diners could see at a glance the sodium, carbohydrate and calorie content of each menu item. There's now a salad bar and build-your-own-sandwich station, and throughout the cafeteria the most healthful food selections are now identified by a "Healthy Choice" logo.

"Most hospitals get their food like airlines do," says Brenda Rueda-Yamashita, HEAC Health Sector Coordinator and Chronic Disease Manager for Alameda County Public Health. "They don't cook it themselves." But, she adds, with some pushback on the suppliers of cafeterias and vending machines, healthier options can usually be found. "We worked with suppliers to make sure that 50 percent of what's in Childrens Hospital's vending machines meets Oakland Unified School District's Wellness Policy nutrition guidelines in terms of sugar and fat percentages. Our next project is to work on the in-patient menu with the hospital's Clinical Nutrition Director who, like the cafeteria manager, has been very supportive."

Of all the institutions in a community, Yamashita believes, hospitals in particular "need to walk the talk."

Oakland's health sector initiative is part of the statewide collaborative Healthy Eating, Active Communities, which aims to fight the growing childhood obesity epidemic in California and to develop state policy changes that will reduce the risk factors for diabetes and obesity.

For more information:

Robert (Bob) Savio, M.D., Chief of Pediatrics, Highland General Hospital (Alameda County Hospital),

Lydia Tinajero-Deck, M.D., Co-director, Healthy Hearts Program, Division of Cardiology, Children's Hospital Oakland, and Member of the HEAC Health Sector Committee, (510) 428-3885 ext. 4624,

Brenda Yamashita, HEAC Health Sector Coordinator and Chronic Disease Manager for Alameda County Public Health, (510) 577-7081,

Tamiko Johnson, HEAC Oakland Site Coordinator, Alameda Public Health Department: (510) 595-6439,