Eve is here. The controversial nature of this flimsy HHS measure says a lot about the United States. Fast food is common in hospitals and nursing homes. jelly. Turkey on a white roll with mayonnaise. Spaghetti with red sauce. Too often they put orange dressing on iceberg lettuce (not the delicious Japanese kind). The abysmal level of hospital food is a great incentive to become healthy again.
It doesn’t have to be that way. The Hospital for Special Surgery had amazingly good food (and offered patients lots of options), and my friend who spent a month at the hospital here had amazing food.
In my experience, U.S. hospitals are actively promoting the “nutrition shake” Ensure. Original Ensure ingredient label:
And on that particular line about sugary drinks…what about fruit juices? They’re actually quite high in sugar, but at least they contain some real nutrients.
Written by Stephanie Armor. The original article was published in KFF Health News.
Complaints about hospital food are nothing new, and jellies and fruit juices are often the butt of related jokes. But the Trump administration recently raised that deposit.
The United States is asking people to report hospitals and nursing homes that serve sugary drinks, nutritional shakes and meals for not meeting dietary guidelines set by the U.S. Department of Agriculture last year, and officials have vowed to withhold millions of dollars in federal funds for violations.
The initiative, by Health and Human Services Secretary Robert F. Kennedy Jr., has drawn pushback from some doctors and health care workers who say it does not take into account patients’ unique dietary needs and is anathema to Republicans, who have long taken an anti-regulatory stance.
It’s also unclear whether HHS has the regulatory authority to enforce its threats without going through a formal rulemaking process, lawyers and nutritionists said.
“Most of it is political theater. HHS doesn’t have the power to do much,” said Kevin Klatt, a nutritionist and research scientist who is an assistant professor at the University of Toronto. “And if you’re trying to control people’s choices, you look a little bit like a fascist.”
Kennedy said in a March 30 press conference that the agency has sent a notice to hospitals requiring them to align their food purchases with the administration’s 2025-30 dietary guidelines to ensure continued eligibility for Medicaid and Medicare payments.
“We’re going to provide good food to every hospital in the country,” he said, describing the directive as “essentially a federal mandate.”
“If a hospital is serving sugary drinks to patients, it is not adhering to government standards and its reimbursement is at risk,” Carrie Means, an adviser to President Kennedy, wrote in a post on X. “If you see patients being served sugary drinks, please post the information below or let CMS know.”
The comment included a link to an HHS webpage with a toll-free number to report complaints typically used for medical billing. Withholding federal funds from hospitals is one of the most extreme enforcement tools available to regulators, and the Centers for Medicare and Medicaid Services has rarely implemented them.
Even offering liquid nutritional products like Ensure to patients can put hospitals at risk, Means warned. “They need to change the refund or lose it. If you see it, please report it,” he told X users.
Together, Medicare and Medicaid are the largest payers of hospital spending.
HHS spokesperson Andrew Nixon said the notification came in the form of an update to the “Conditions of Participation” issued by CMS to ensure that inpatient meals comply with dietary guidelines. “We applaud the many hospitals that are working to improve the food they serve, and we expect all hospital systems to do so,” he said.
Means did not directly respond to a request for comment from KFF Health News, but wrote on X shortly after being contacted: “‘Trump Derangement Syndrome’ has led Democrats to defend the medical importance of giving American patients lots of soda and junk food.” In a text message with KFF Health News, he said, “Just quote if necessary. No comment.”
Still, some administration officials have vowed they would not hesitate to cut off federal funding, a rare step that could hurt hospitals’ ability to stay open.
carrot and stick
HHS could withhold or threaten federal funding if a hospital violates mandatory minimum health and safety standards set by the agency. The standards stipulate that hospitals must protect patient privacy and comply with infection prevention measures.
Although the standard mentions hospital food, it does not explicitly refer to the USDA’s 2025-30 dietary guidelines.
Rather, the standards require that “the nutritional needs of individual patients must be met in accordance with accepted dietary practices,” and also list other requirements for hospitals, such as having access to a qualified dietitian.
“CMS has never previously interpreted this requirement as mandating compliance with the dietary guidelines,” according to an April 13 briefing from the law firm Akin Gump Strauss Hauer & Feld.
The CMS memo indicates the agency is taking a “notable step” to incorporate the dietary guidelines “into the hospital regulatory framework without enacting new rules,” according to the briefing.
Some lawyers say hospitals are likely to comply because they don’t want to go beyond the federal government and want to avoid legal battles or enforcement by President Kennedy.
“He has no legal basis to do this, but hospitals and nursing homes can’t ignore this completely because it signals potential enforcement,” said Nicholas Bagley, a law professor at the University of Michigan.
If federal funding is withheld, hospitals can always sue to challenge the health service’s authority.
“If the agency goes to the hospital and says, ‘We’re going to take your money away from this,’ the hospital might file a lawsuit and say, ‘Look, there’s no need to fry your french fries in beef tallow or anything,'” Bagley said.
The agency’s memo provides examples of what should and should not be provided to patients for hospitals seeking compliance.
food as medicine
What the guidance says “don’t do” is sugary drinks and juices. and “recommendations”: water, unsweetened tea, milk, or coffee. Meals suggested in the memo include grilled salmon with quinoa and bean-based entrees with leafy greens.
Some dietitians welcomed the focus on hospital food for patients. Public health advocate and molecular biologist Marion Nestle praised the initiative: “This is amazing!” In an April 8 post on her blog, Food Politics, she said:
Other health leaders and doctors objected, noting that hospitalized patients often have more individualized nutritional needs and may not adhere to federal dietary recommendations.
“Salmon and quinoa are the worst for patients who have just had a stroke and have difficulty swallowing. There is a risk of aspiration,” said Klatt, a nutritionist at the University of Toronto.
Hospitals that fail to provide certain standard treatments, such as protein shakes to treat malnutrition and unhealthy weight loss, could face legal liability. Results from a clinical trial published in the peer-reviewed scientific journal Hospital Nutrition found that 80% of malnourished elderly patients gained weight and improved muscle mass with nutritional supplements such as Ensure.
Abbott, which makes Ensure, makes a variety of products, including shakes, for people who “may be malnourished due to treatments such as chemotherapy, and are unable to consume the calories they need because they have a poor appetite,” company spokesman John Koval said in a statement.
“It’s always difficult to get people to eat, and losing weight in the hospital increases the risk of death,” says sleep medicine specialist Mary Talley Borden. Although he is often a supporter of the “Bring America Back to Health” movement, he criticized the government’s call to report violations on X, posting, “Give me a break, Curry. A hospital soda line?”
“It’s a little overbearing,” she said in an interview.
The focus on hospital food was announced in late March as part of President Kennedy’s MAHA initiative, in which he touted changes to federal dietary guidelines that emphasize protein and healthy fats when eating processed foods.
Kennedy is leaning heavily into a dietary change initiative that fits MAHA’s gestalt and has support from both Democratic and Republican voters. A Navigator Research poll released in September found that 86% of registered voters surveyed said every American household should have easy access to fresh fruits and vegetables.
