Fast Food, Obesity, and Hospitals

Howard Markel, MD, PhD


July 15, 2003


Every day, as I walk through the main corridor of the university hospital where I work, I am confronted by a disturbing, incongruous, and decidedly unhealthy sight: armies of people carrying bags filled with french fries, bacon cheeseburgers, milk shakes, and extra-large soft drinks. But most distressing is the fact that these high-caloric, fat-rich meals can be easily purchased at the Wendy's burger joint that is located right on the premises.

Alas, my hospital is hardly a trendsetter in this regard. More than a third of our nation's top-rated hospitals have a fast-food outlet on the premises, and 4 of these temples of health have more than 1. And for those who seek your healthcare at a medical center not yet listed in the annual rankings of U.S. News & World Report, do not despair. At many hospitals across the United States, you are likely to find that the venerable cafeteria (never themselves bastions of good nutrition) has been replaced with (or supplemented by) a McDonald's, Burger King, Wendy's, or similar fast-food emporia.

Even more troubling, according to the Centers for Disease Control and Prevention (CDC), students can purchase name-brand fast foods, soda pop, candy bars, potato chips, and other high-fat, sugary snacks in 98.2% of American high schools without ever leaving the campus. It does not take too much imagination to figure out the menu chosen by of most of these kids for breakfast and lunch.

By now, most pediatricians are aware of the epidemic of obesity that seems to be expanding almost as rapidly as our collective waistlines. Today, more than 20% of all preschool children are overweight -- almost double the number in 1970 -- and 1 in 10 are considered to be clinically obese. Because eating habits are established early in life -- an obese 10-year-old has a 70% to 80% chance of being an obese adult -- a growing number of physicians are concerned about a broad increase in heart disease in the years to come, including atherosclerosis and hypertension, diabetes, strokes and other maladies related to excess weight.

Although fast-food consumption is hardly the only cause of obesity, it certainly plays a role. As a service to their consumers, most of the fast-food chains have developed elaborate Web sites regaling their products. They also include detailed nutritional analyses of the meals they serve. While I doubt that most of the people lining up for these products have taken the time to review these data, the analyses are hardly encouraging. For example, a Wendy's "Classic Single" (without cheese) delivers 410 calories and 19 grams of fat (7 of which are the artery-clogging, saturated form). Would you like fries with that order? Add 390 calories and 17 more grams of fat (fortunately only 3 are saturated).

Lest you think I am picking on Wendy's, take a look at the Web site for McDonald's (a Quarter Pounder with cheese contains 530 calories and 30 grams of fat, of which 13 are saturated fat). Or Pizza Hut -- 1 slice of sausage pizza contains 280 calories and 18 grams of fat (8 are the saturated variety). Indeed, almost every fast-food product is loaded with calories, fat, and cholesterol. Contrast this to our medical recommendations that the average adult consume about 2000 calories per day, including < 67 grams of fat and < 22 grams of saturated fat. You don't really need a calculator to figure out that one "super-sized" meal quickly approaches one's daily nutritional allotment.

Recently, one of my colleagues, a cardiologist, confessed to me over a low-fat salad that it would be more intellectually honest if our hospital named its new Cardiovascular Center after Wendy's, as opposed to the donor who merely contributed 50 million bucks to its construction. "After all," he quipped, "the monetary gift is quickly spent, but with all these burgers and fries, the patients keep coming and coming as far as the eye can see."

Matters only become more confusing when we take into account the millions of dollars these companies raise for children's causes and pediatric research. Almost every children's hospital in the United States boasts a Ronald McDonald House that provides lodging for the parents of hospitalized children. But how many parents (or hospital administrators, for that matter) would accept lodgings from a "Marlboro Man House"?

Obesity is a difficult entity to treat, and most of us are woefully inadequate at it. Physicians in general, and pediatricians in particular, need to focus on this public health problem with all the intensity that we are capable of giving. As the World Health Organization recently declared, obesity is one of the most serious health threats facing the world today. One place to start is getting fast-food restaurants out of our hospitals and schools. I know that people, adults and children alike, will still want to go grab a burger anyway, but at least the walk down the block will do them some good.


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