Yves here. It is telling about the state of the U.S. healthcare system that a recent initiative from the Department of Health and Human Services (HHS) is creating controversy. Hospital and nursing home meals often leave much to be desired—think Jell-O, turkey sandwiches with mayo, spaghetti drenched in red sauce, and iceberg lettuce topped with uninspired orange dressing (certainly not the delightful Japanese version). The poor quality of food served in hospitals is a significant factor that discourages patients from recovering fully.
However, it doesn’t have to be this way. For example, the Hospital for Special Surgery provides surprisingly good food and numerous options for its patients. A friend of mine who spent a month in a local hospital enjoyed excellent meals.
From my perspective, U.S. hospitals emphasize the “nutrition shake” Ensure far too much. Here’s a look at the ingredients in Original Ensure:
When it comes to the discussion around sugary drinks, let’s not overlook fruit juices. While they can be high in sugars, they do offer some legitimate nutrients.
By Stephanie Armour. Originally published at KFF Health News
Complaints about hospital food are certainly not new, and Jell-O, as well as fruit juice, often finds itself the punchline of many jokes. Recently, however, the Trump administration has taken this issue up a notch.
The administration is calling on the public to report hospitals and nursing homes that serve sugary drinks, nutrition shakes, or meals that fall short of dietary guidelines established by the U.S. Department of Agriculture last year. Officials have warned that violations could jeopardize millions of dollars in federal funding.
This initiative, led by Health and Human Services Secretary Robert F. Kennedy Jr., is generating pushback from some medical professionals who argue that it overlooks the specific dietary needs of patients. It is also met with resistance from Republicans, who are traditionally opposed to regulatory measures.
Legal experts and dietitians express uncertainty regarding whether HHS actually has the authority to impose such threats without undergoing a formal rulemaking process. “Much of this is political theater. HHS lacks the power to effectuate substantial changes,” noted Kevin Klatt, a dietitian and research scientist from the University of Toronto. “Attempting to control individuals’ choices does come across as authoritarian.”
Recently, the agency issued notices to hospitals mandating that their food purchases comply with the administration’s 2025-30 dietary guidelines to maintain eligibility for Medicaid and Medicare reimbursements, as stated by Kennedy during a March 30 press event.
“We will ensure that hospitals nationwide adhere to quality food standards,” he declared, referring to the instructions as essentially a federal mandate.
“If a hospital serves sugary drinks, it is out of compliance with government standards and risks its reimbursements,” tweeted Calley Means, a senior advisor to Kennedy. “If you notice patients being given sugary drinks, please share this information or report it to CMS.”
This comment also included a link to an HHS webpage featuring a hotline number for reporting complaints, which is typically utilized for addressing medical bills. Withholding federal funding from hospitals is an extreme regulatory measure that the Centers for Medicare & Medicaid Services seldom employs.
Means even cautioned that offering liquid nutritional products like Ensure could place hospitals at risk. “They must adapt or face lost reimbursements. Do report them if observed,” he advised an X user.
Combined, Medicare and Medicaid represent the largest contributors to hospital funding.
The notice was framed as a “Conditions of Participation” update released by CMS to ensure that the food served to hospital patients meets the dietary guidelines, according to HHS spokesperson Andrew Nixon. “We applaud hospitals that are committed to improving their food offerings and expect all healthcare systems to provide quality options,” he added.
However, Means did not respond directly to KFF Health News for comment but later posted on X: “‘Trump Derangement Syndrome’ has led Democrats to defend the medical importance of offering soda and junk food to American patients.” In a subsequent text to KFF Health News, he stated, “That’s all I have to say; I won’t provide further comments.”
Some officials within the administration, however, have made it clear they are willing to halt federal funding—a rarely used tactic that could threaten a hospital’s viability.
A Carrot and a Stick
HHS can withhold federal funding or threaten to do so if hospitals do not meet mandatory health and safety standards specified by the agency. These standards require that hospitals safeguard patient privacy and ensure infection control, among other requirements.
While the standards mention food in hospitals, they do not specifically reference the USDA’s 2025-30 dietary guidelines.
Instead, the regulations stipulate that “individual patient nutritional needs must be met in line with recognized dietary practices” and outline additional requirements such as the availability of a qualified dietitian.
According to an April 13 briefing by the law firm Akin Gump Strauss Hauer & Feld, CMS has never interpreted this stipulation to require adherence to any specific dietary guidelines.
The CMS memo indicates that the agency is taking a “notable step” to incorporate the dietary guidelines “into the hospital regulatory framework without new rulemaking,” as noted in the brief.
Some attorneys believe that hospitals may feel compelled to comply to avoid conflict with the federal government, fearing legal challenges or enforcement actions initiated by Kennedy. “Although he may lack a legal foundation for these measures, hospitals and nursing homes can’t afford to disregard them entirely due to the implications of potential enforcement,” stated Nicholas Bagley, a law professor at the University of Michigan.
If federal funds were withheld, hospitals could seek legal recourse to contest HHS’s authority. “When an agency threatens to withdraw funding, hospitals can respond legally by arguing that they are not obligated to comply with every specific dietary requirement,” Bagley clarified.
For hospitals wanting to comply, the agency’s memo outlines examples of acceptable foods to serve patients.
Food as Medicine
The guidance outlines “don’ts”: such as sugary drinks and juice, and “do’s”: including water, unsweetened tea, milk, or coffee. Suggested meal options consist of grilled salmon with quinoa or bean-based dishes served with leafy greens.
Some nutrition experts have applauded the renewed focus on hospital food for patients. Public health advocate and molecular biologist Marion Nestle praised the initiative, stating, “These sound fantastic!” in an April 8 blog post on her site, Food Politics.
In contrast, other health professionals and medical leaders express concern. They highlight that patients in hospitals often have unique nutritional needs that may not align with federal dietary recommendations. “For a patient recovering from a stroke who has trouble swallowing, salmon and quinoa could pose a risk of aspiration,” remarked Klatt, the dietitian from the University of Toronto.
Hospitals that fail to meet essential care standards—such as providing protein shakes for malnutrition or unhealthy weight loss—could find themselves facing legal ramifications. Data from a clinical trial published in Nutrición Hospitalaria indicated that 80% of malnourished elderly patients who received nutritional supplements like Ensure saw increased weight and improved muscle mass.
Abbott, the manufacturer of Ensure, provides a variety of products including shakes designed for individuals who may be malnourished due to medical treatments, such as chemotherapy, which can diminish appetite. Company spokesperson John Koval stated that “it is always challenging to encourage patients to eat, as weight loss during hospital stays can significantly increase mortality risks.” Mary Talley Bowden, a sleep medicine specialist who has often supported healthy initiatives, criticized the administration’s approach, saying: “A hospital snitch line for soda? Give me a break.”
“It feels a bit tyrannical,” she shared in an interview.
The focus on hospital food emerged as part of Kennedy’s MAHA initiative, promoting a shift in federal dietary guidelines that favor protein and healthy fats while avoiding processed foods.
In his efforts to encourage healthier eating habits, Kennedy has gained favor among both Democratic and Republican voters. A recent poll by Navigator Research revealed that 86% of registered voters believe it should be easier for American families to access fresh fruits and vegetables, reflecting a shift in public sentiment.
