[Planetary Health Diet in a hospital cafeteria: Increasing employee satisfaction and reducing greenhouse gas emissions and costs].

Abstract

Introduction: In order to ensure a healthy diet for the world's population within planetary boundaries, the EAT-Lancet Commission has made recommendations for a "Planetary Health Diet" (PHD). Due to the special responsibility of the health sector for healthy living conditions, offering food provision in line with the Planetary Health Diet is a sensible thing to do for health facilities. With this in mind, we evaluated the acceptance, costs and reduction of greenhouse gas (GHG) emissions through a correspondingly modified food offer in the cafeteria of a large university hospital.

Methods: For three months, a lunch menu adapted to the recommendations of the PHD and information material on sustainable nutrition were offered in the hospital cafeteria. Customers in this cafeteria (intervention group) and in all other hospital cafeterias (control group) completed a questionnaire before (from 12/2022 to 01/2023) and after (from 03/2023 to 04/2023) the intervention period. In this questionnaire, customers were asked how satisfied they were with the sustainable food offer using German school grades (from 1 to 6). We calculated the difference-in-differences (DID), 95% confidence intervals (CIs) and p-values for the school grades. Open-ended questions were used to learn about customers' perception of health and sustainability aspects of the food supply and written feedback analysed qualitatively. We conducted a bottom-up analysis of the greenhouse gas emissions of the different lunch menu lines based on the main ingredients of the dishes and calculated cost differences between the vegan menu line and the conventional menu lines based on food costs.

Results: In the intervention group, the ratings for the sustainability, health, diversity, and flavour of the food on offer improved significantly compared to the control group. The composition of the food (e. g., proportion of meat or vegetables), the product selection (regional, seasonal, organic) and the amount of waste produced were important to the employees when rating the sustainability and healthiness of the food. In the intervention cafeteria, GHG emissions fell by 27 % from 26.2 tonnes to 20.5 tonnes of GHG emissions (saving 5.6 tonnes of GHG emissions) in the second half of the intervention period compared to the previous year, despite a higher number of orders. During the entire intervention period, the intervention group saved about € 4,000 on ingredients.

Discussion: Due to the robust quasi-experimental study design and in combination with the qualitative results, this study provides initial evidence that a PHD-oriented food offer can increase food-related employee satisfaction.

Conclusion: Switching to sustainable food supply at hospitals is to be recommended due to its cost-effectiveness, positive feedback from employees and the reduction of GHG emissions.