Research Letter

Methods

This study used medical students to report on fast food franchises at the teaching hospitals through which they rotate. Students from all allopathic medical schools in the United States (including Puerto Rico) were surveyed. Respondents were obtained from active members of the American Medical Student Association, and through contacting schools for student representatives (eg, class presidents). One student at each medical school was instructed to list up to 5 of their main teaching hospitals/medical centers using a Web-based survey. For each, they identified which, if any, BNFF was sold on the hospital campus. This included franchise fast food served at a chain restaurant or in other venues (ie, snack bars and cafeterias). Students were provided a list of popular chains taken from an industry database. (The industry defines “limited service chain restaurants” as eating places where customers order items and pay before eating and where food can be eaten on the premises or taken out.⁹) Students were also instructed to fill in other brand-name fast food not on the list. Data were collected from January through October of 2005.

Results

Survey responses were received from a student at 113 of 125 medical schools (90% response rate) and represented 233 affiliated hospitals/medical centers. Ninety-eight of the 233 hospitals (42%) had at least one BNFF served on campus. There were a total of 163 occurrences of BNFF served on hospital grounds, because many hospitals had more than one type. One hundred thirty five hospitals (58%) had no BNFF establishments on campus; 65 (28%) hospitals had one BNFF, whereas 15 (6%) had 2 on their campus, 10 (4%) had 3, 5 (2%) had 4, and 3 (1%) hospitals had >4 BNFF types on their grounds. When looking at the prevalence by medical school, 71/113 (63%) of medical schools had at least one affiliated teaching hospital/medical center that served BNFF. Table 1 shows the most common franchises represented at these hospitals/medical centers.

Conclusions

Among the 234 academic-affiliated hospitals surveyed, 42% had BNFF served on their campus. This percentage is similar to that reported by Cram et al,¹⁰ who found that 38% of the top 16 hospitals in the United States had fast food establishments. McDonald et al¹¹ reported that 9% of children’s hospitals (including academic and non-academic) in North America had BNFF franchises. However, in the present study we included food served in restaurants and also brand name products available in other venues on campus.

Others have studied the location of BNFF franchises. One study showed a positive association between the state level of obesity and the number of Burger Kings and McDonalds per person or per square mile.¹² Moreover, although 35% of Chicago schools had a fast food franchise within 400 meters,⁹ this study confirms that they are also prevalent in close proximity to (ie, on the grounds of) many hospitals/medical centers.

Our study also reports the most common types of BNFF in hospitals. As nutritional information on BNFF is available on most company Web sites, the readership can use this data to make its own judgments on the nutritional quality of some of the food offered by academic-affiliated hospitals. Some hospital administrators have attempted, with some success, to remove what they deemed as unhealthy fast food from their premises. For instance, at the Cleveland Clinic, the Pizza Hut was removed from the hospital, but McDonalds remained.¹³ Administrators at teaching hospitals should continue to consider whether the food they serve on their campuses is consistent with the mission of improving the health of their communities. Future studies should continue to characterize the types of food available in all venues on medical center campuses.