Meals Served at Medical Meetings–Sweetened Soda, Potato Chips and Really, Really Big Cookies

Topics: Vitamins and Supplements, Wellness and Health

Read the first U.S. study of the Meals Served at Medical Meetings published in the peer reviewed medical journal Disease Management. The AMA’s American Medical News reports the research study’s findings. Full text of the research below, free.

Last week, Dr. La Puma spoke on “Healthy Eating: Food for Thought” at the American Society of Nuclear Cardiology to a scheduled luncheon audience of 350 radiologists and cardiologists in Seattle. GE HealthCare sponsored the event—and the special lunch menu.

Sodas, roast beef and Huge Cookies out…and chicken salad with tarragon, barley with red pepper and scallion, and crisp Washington apples in…gourmet food with healthy style. The lunch and the talk were a big success!

DISEASE MANAGEMENT
Volume 6, Number 4, 2003
� Mary Ann Liebert, Inc.
Point of View
Meals at Medical Specialty Society Annual Meetings:
A Preliminary Assessment
JOHN LA PUMA, M.D., F.A.C.P.,1 DAVID SCHIEDERMAYER, M.D., F.A.C.P.,2
and JENNIFER BECKER, R.D., L.D.3
ABSTRACT
Little is known about how meals are chosen for medical meetings. We surveyed the annual
meeting planners for 20 major specialty societies. Thirteen (65%) responded; all were currently
planning their next meeting. Attendance in 2000 was reported at 113,477 physicians,
with 2 million planned meals and snacks. No physician was named as responsible for food
choices; the meeting planner and staff were primarily responsible for deciding what food to
serve, excluding exhibit halls. Twelve (92%) respondents rated �available budget� as the most
important factor. �Nutritional guidelines� were rated �very important� by eight of 13 (63%).
However, no specific nutritional guidelines could be identified by any planner. All respondents
indicated that members would attend a meeting if �healthy� food were the only option.
For 2000, 100% of respondents indicated that for each lunch and for each dinner, a dessert
had been included. No annual meeting and no planned 2001 meeting excluded potato chips,
snack mixes, or candies at breaks; soda pop was offered with each break. Most respondents
(89%) relied on a concluding questionnaire about the meeting facilities to evaluate the food.
Respondents reported no difference in charges for �special meals,� including vegetarian and
kosher meals. Physicians may be unaware that some food served at medical meetings may
impair learning, with excessive calorie, fat, and carbohydrate consumption. Small changes
can improve the quality of food and beverages selected, without increased cost, and provide
choices that conform to national nutritional guidelines. Medical meetings should serve flavorful,
healthful food. (Disease Management 2003;6:xxx�xxx.)
191
INTRODUCTION
MOST PHYSICIANS REPORT that they observe
dietary restriction.1 Recent national survey
data, however, bring these data into question.
Obesity and obesity-related diseases have
increased in every sociodemographic and economic
class, including the most well-educated
and affluent.2
One of the few venues in which physicians
1Medical Director, The Santa Barbara Institute for Medical Nutrition and Healthy Weight, Santa Barbara, California.
2Waukesha Memorial Hospital, Waukesha, Wisconsin.
3Clinical Oncology Nutritionist, Midwestern Regional Medical Center, Cancer Treatment Centers of America, Zion,
Illinois.
can actually be observed while eating is during
their annual medical society meetings. Little is
known about how the meals are chosen for
medical meetings.3 Robb-Smith4 notes �we
must turn from physiologists to the doctors
who actually wrote cookery books, though
we cannot be sure that these physicians all fulfilled
Andrew Boorde�s requirements that they
should be �very experte in cokeing.�� Irrespective
of their expertise in the kitchen, physicians
do expect food and drink at medical meetings,5
and attend more often if meals are provided.6
We wondered how those responsible identify
the parameters used for choosing meals,
snacks, and beverages for annual national medical
meetings. We also wondered whether
physicians had input into the process of meal
selection, and were curious about whether nutritional
guidelines played a role in the food
and beverage selection. Finally, we wondered
whether physicians were observed to follow
nutritional guidelines. Physicians who practice
a health habit themselves are significantly more
likely to counsel patients about that health
habit.7
METHODS
A structured, pretested questionnaire was
developed by J.L.P. and then presented, reviewed,
and analyzed at the Medical College
of Wisconsin Internal Medicine Research Methods
Seminar by D.S. The questionnaire instrument
was submitted and initially reviewed by
the Institutional Review Board, and was returned
to the investigators after being exempted
from further review. The questionnaire
was administered in July 2001 by J.B.
To determine the process involved in meal
selection, we identified the 20 professional organizations
that make up the membership of
the Council on Medical Specialty Societies
(CMSS) (Table 1). The CMSS is a non-profit association
whose members are national medical
and surgical specialty organizations representing
more than 365,000 doctors nationwide. We
then contacted the annual national meeting
planners at each Society by telephone.
We asked respondents for information about
themselves and their meeting planning efforts.
We asked how they planned for, selected, and
monitored the meals and snacks at their annual
meetings. We asked respondents to rank 10 decisional
factors on a 3-point scale of importance
in selecting the food, snacks, and beverages for
the previous year�s annual national Specialty
Society meeting. We also asked for respondents�
methods of evaluation of the food
served, and for the feedback they received from
meeting attendees about the food, including
what they said they liked and disliked, and
LA PUMA ET AL. 192
TABLE 1. MEMBER SOCIETIES OF THE CMSS
American Academy of Allergy, Asthma & Immunology (AAAAI)
American Academy of Dermatology (AAD)
American Academy of Family Physicians (AAFP)
American Academy of Ophthalmology (AAO)
American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS)
American Academy of Pediatrics (AAP)
American Academy of Physical Medicine & Rehabilitationn (AAPMR)
American College of Medical Genetics (ACMG)
American College of Obstetricians & Gynecologists (ACOG)
American College of Physicians-American Society of Internal Medicine (ACP-ASIM)
American College of Radiology (ACR)
American College of Surgeons (ACS)
American Psychiatric Association (APA)
American Society of Anesthesiologists (ASA)
American Society of Clinical Pathologists (ASCP)
American Society of Colon and Rectal Surgeons (ASCRS)
American Society of Plastic Surgeons (ASPS)
Society of Neurological Surgeons (SNS)
Society of Nuclear Medicine (SNM)
Society of Thoracic Surgeons (STS)
T1 .
which, if any, special meals were made available
to attendees. We also requested menus for
the most recent meetings.
Specifically, our questions were:
1. Who was primarily responsible for deciding
what food to serve during the Annual Meeting,
excluding the exhibit halls?
2. How important were each of 10 factors in
actually deciding what to order, including
nutritional principles and dietary guidelines?
3. Were �healthy alternatives� offered and selected
and, if so, how often?
4. Was dessert offered at lunch and dinner, and
was soda pop offered at snacks?
5. Was the food at the annual meeting evaluated
and, if so, how?
6. How important would each of the 10 named
factors be next year in deciding what to order?
7. What foods do physicians as a group tend
to like and to dislike?
8. Is the meeting planner certified, and has she
taken continuing education classes for food
selection?
RESULTS
Thirteen of the 20 meeting planners (65%)
agreed to be interviewed; nine respondents
completed the standardized interview questionnaire
orally with the interviewer, and four
respondents self-administered the questionnaire.
Nine had planned the last annual meeting;
all 13 were currently planning the next
meeting. Twelve were female; their mean age
was 39.7 years (range 28�50 years). Respondents
had been planning meetings for 12 years
(median 12 years, range 0.25�25 years); five respondents
were Certified Meeting Planners, for
a mean of 4.6 years.
Respondents represented a combined membership
of over 250,000 physicians. Attendance
for their 13 meetings in the year 2000 was reported
to be 113,477 physicians (mean 8,729
physicians, median 9,311, range 300�25,000)
over a mean of 4.6 days per meeting. These
physicians consumed more than 2 million
planned meals and snacks. Respondents identified
the meeting planner and the meeting
planning staff as primarily responsible for deciding
what food to serve during the annual
meeting, excluding the exhibit halls, in 11 of the
13 meetings. The Continuing Medical Education
Director was responsible in one case, and
the meeting sponsor in another. No physician
was named as responsible for meal or snack
choices.
Twelve of 13 respondents rated �available
budget� as the most important factor in deciding
what food to serve attendees (Table 2). Only
two respondents offered average per person
costs for meals: $9�$20 for breakfast, $15�$30
for lunch, and $40�$60 for dinner. One respondent
reported that her total budget for the
meeting�s food was $150,000 for more than
10,000 attendees.
Nutritional guidelines were rated �very important�
by eight respondents. However, no
specific nutritional guidelines could be identi-
MEALS AT SPECIALTY SOCIETY ANNUAL MEETINGS 193
TABLE 2. IMPORTANCE OF DECISIONAL FACTORS IN MEETING PLANNERS� MEAL CHOICES (N . 13 PLANNERS)
Very Somewhat Not at all
Decisional factor important important important
Available budget 12 1 0
Nutritional guidelines 8 3 2
Avoiding complaints 6 5 2
Successful items from previous years 5 6 2
Creating a feeling of luxury 4 6 3
Conformance with a culinary, entertainment, 4 6 3
or other theme
Hotel�s suggestions/menu 3 9 1
Requests from members 3 4 6
Gathering compliments 2 9 2
Popular diet books 0 1 12
T2 .
fied by any planner. �Avoiding foods people
may feel that are bad for you� . . . �varies� . . .
�heart healthy� . . . �vegetarian� . . . �low fat
options� . . . �kosher� were the guidelines
which seven of the eight respondents considered.
All respondents (nine of nine) indicated
that their attendees would attend a meeting if
�healthy� food were the only option. Most
(seven of 10) respondents reported that catered
functions offered them the choice of a �healthy
alternative.� All (nine of nine) reported choosing
this �healthy alternative� for their attendees
each time it was proffered. No planner utilized
any �fad diet� in making food and
beverage selections. The same 10 decisional factors
were ranked by anticipated importance for
the coming annual meeting, without change in
factor ranking. �Overall healthy� were the nutritional
guidelines most commonly anticipated.
For the year 2000, all (11 of 11) respondents
indicated that for each lunch, a dessert had
been included; all (11 of 11) indicated that for
each dinner, dessert had been included. The respondents
identified many foods that physicians
as a group tend to like and only a few
they tend to dislike. In order of ranking, fish
and chicken were the top foods identified as
liked, followed by beef, baked goods, turkey,
vegetables, salads, and fruits. Foods identified
as disliked included, in order of ranking, pork
and ham, beef, and heavy sauces. Desserts
served at lunch or dinner included angel food
cake, brownies, cake, cheesecake, chocolate/
sweets, cookies, dessert display, key lime pie,
plated desserts, and upscale dessert.
Most (nine of 12) respondents asked attendees
to evaluate whether the food at the annual
meeting was successful. Most (eight of
nine) relied on a general written questionnaire
about the meeting facilities, including
the promptness of the food service, at or near
the meeting conclusion. One respondent
specifically evaluated the quality of the food,
on a descriptive scale of very good to poor.
Five of eight respondents reported receiving
written compliments on the food, one commenting
favorably on the ample supply. Two
respondents reported receiving written complaints
about the food: �not enough,� and
�the food was terrible.� One respondent reported
neither compliments nor complaints.
Special meals, most commonly vegetarian or
kosher, were reported to have been requested
by an estimated 2�20% of the attendees. Respondents
reported no difference in charges to
their medical society for these meals. No meeting,
according to the respondents (11 of 11),
provided �extras� such as green tea, soy milk,
or substituted olive oil for butter on the tables.
No annual national meeting was planned to include
a vegetarian meal, according to respondents
(13 of 13); no meeting excluded potato
chips, snack mixes, or candies at breaks (13 of
13).
One-third (three of nine) of respondents reported
serving wine or beer to attendees at
lunch; over half (58%) at dinners, and nearly all
(92%) at receptions. Only one planner reported
accompanying a snack break between meals
with alcoholic beverages. All planners reported
offering soda pop with each snack break.
Printed menus from past meetings were unavailable.
DISCUSSION
Our exploratory analysis of the process of
choosing over 2 million meals and snacks for
the annual medical meetings of 13 major medical
specialty organizations reveals that physicians
have little input into the process and provide
almost no feedback to meeting planners
about the food they eat. No physicians were involved
in food selection, in identifying useful
nutritional guidelines, or in menu development
or supervision. While it is possible that physicians
pursued largely healthful choices outside
of their medical meeting meals, and indulged
in these meals as special ones, physician eating
habits have not been carefully studied.
The �nutritional guidelines� respondents
named were vague and unassociated with any
governmental, culinary or professional organization.
Indeed, no specific guidelines were
cited by any respondent for any national medical
meeting. Responding planners appeared to
use their own, personal impressions of what
was �healthy� and what was not in ordering
LA PUMA ET AL. 194
the food for their medical meetings. Evaluations
of food quality were cursory, and respondents
were concerned about the potential
for negative comments of any kind. It appeared
that meals were a value-added item, with more
planner concern about quantity than quality.
One planner noted, �the worst thing that can
happen is to run out of food.�
Physicians were perceived as an easy-toplease
group by the respondents, as they appeared
to dislike only a few foods. Yet physicians
were also perceived as health conscious.
For example, though red meats, heavy sauces,
and pastries were reported to be enjoyed by
physicians, those same foods were identified as
disliked foods more often than were other
foods.
It is well known that Americans consume too
few fruits and vegetables, too much saturated
and trans fat, and too many empty calories.
Only 3% of people consume at least three daily
servings of vegetables.8 Potatoes (primarily
frozen) are the most widely consumed vegetable
in America.9 Nutrient-dense foods, such
as fish, fruits, and vegetables, which were not
disliked at all by physicians, might be served
more often as physicians learn more about their
nutritional qualities and banquet and catering
chefs prepare them in flavorful and healthful
ways.
Physician attendees appeared to have
prominent �sweet tooths� to the respondents,
who planned desserts accordingly. Dessert was
reportedly served at every meal in every annual
meeting, as was soda pop. The served
desserts described are generally rich in calories
and high in saturated and trans fats, and especially
high in sugar.
Planners appeared to order rich celebratory
foods for annual medical meeting meals. Foods
served on special occasions in contemporary society
tend to be high in calories, large in portion
size, and low in nutrients. While food at medical
meetings should be delicious and special,
special can mean something other than highly
caloric and sedating. Special occasion food
served regularly may make the special occasion
somewhat more common and less special.
Input from meeting attendees played a very
small role in responding meeting planners�
choices. For example, �special meals� (i.e., alternative
to the main served entr�e) appear to
be much more often requested than actually
served. It is unclear whether requests for special
meals were not honored or if the requesting
physicians simply made do with the portions
of the meal that suited their dietary
preferences. Better physician feedback to planners,
and innovative thinking �outside the box
lunch� among sponsors and meeting staff, may
advance physicians� roles in these choices.
Although wine was sometimes served as a
beverage at meals, especially at dinner, it was
most commonly served at receptions with food.
Although the cardiovascular benefits of limited
alcohol intake have been reasonably well demonstrated,
wine appeared to be offered by
meeting planners in large part for its social
rather than medical benefits. For both social
and nutritional reasons, wine is best served
with food at meetings: Food in the stomach
slows the absorption of the alcohol, slowing
any toxicity. It has been previously observed
that if alcohol was a drug under FDA scrutiny
for approval, it would fail quickly: Its potential
detriments (including addiction, cirrhosis, and
dementia) when abused are familiar to nearly
all clinicians.
It is not surprising that medical meeting
planners (instead of physicians themselves) select
the meals for the meeting�indeed, meeting
planners specialize in just this arena. Nor
is it surprising that these meals have a celebratory
quality. Physicians typically enjoy such
foods at their annual national meeting. It is also
not surprising that the composition of the
meals appears heavy (both rich in fats and simple
sugars), as physicians eat out four or five
times weekly (J. La Puma, P. Szapary, and K.
Maki, unpublished data) and often eat commercially
prepared meals provided in the medical
office and hospital. Meals prepared outside
the home have been shown to have higher calorie
and lower nutrient profiles than meals
cooked at home.
We know little of physician dietary behavior
outside of these examined meals. From 30% to
58% of physicians self-report their body
weights as overweight,10,11 and a smaller number
(8�18%) categorize themselves as obese.12
MEALS AT SPECIALTY SOCIETY ANNUAL MEETINGS 195
As in the general public, diabetes11 and allcause
mortality12 are much higher in overweight
physicians than those who are of
healthy weight. Investigators in the Women
Physician�s Health Study (2000)13 identified
self-reported cooking, shopping, and meal
preparation habits of female physicians, finding
them to possess �relatively healthy diet-related
habits.�
This small, exploratory study has several
limitations. We could estimate neither actual
composition of individual meals nor entr�e
serving size. Standard fine dining restaurant
entrees are 8 ounces for fish and chicken, and
10�12 ounces for beef and pork; paradoxically,
serving sizes in �casual dining� restaurants can
be much larger, though of lesser quality. Respondents
were understandably reluctant to
share their balance sheets and menus, and so
organizations� actual food, beverage and hospitality
costs were unavailable. Menus, however,
do not reveal calories, portion size, or
culinary preparation, and thus would be difficult
to analyze for nutritional content. Exhibit
hall food, especially continental breakfasts,
snacks, and boxed lunches, were not included;
they should be assessed in a future study. Finally,
although respondents� observations of
physician behaviors are qualitative, the large
number of meals for which respondents are responsible
and the respondents� years of experience
make their observations a valuable starting
point for improving medical meals.
We believe that physicians may wish to
model personal nutritional choices for their patients,
as physicians and medical students are
now modeling anti-smoking behavior. Fewer
than 10% of physicians14 and just 2% of medical
students15 choose to smoke, compared with
24% of the adult population overall.16 This
medical student achievement is especially significant,
almost 40 years after the U.S. Surgeon
General�s Report focused attention on tobaccorelated
diseases; over 42% of American adults
smoked in the early 1960s.17
CONCLUSION
We found that meeting planners are well-intended,
experienced individuals who work
within their budgets as a first priority and who
may be unaware that the food at national medical
meetings does not conform to nutritional
guidelines. They receive some compliments and
very few complaints about the meals they order.
In planning meals, they try to please attendees�
tastes, and emphasize celebratory, special occasion
foods despite their own stated interests in
more healthful choices. Physicians are uninvolved
in any of these decisions, and may be unaware
that the food at national medical meetings
does not conform to medical guidelines. Many
of the meals served and consumed contain ingredients,
entrees, beverages, and desserts for
which there are healthier, tasty alternatives.
Physicians are also, at the moment, unaware
that the food at national medical meetings does
not conform to nutritional guidelines. It is possible
that this food may actually impair physician
learning, increase fatigue, and cause postprandial
sedation because of excessive calorie and unhealthful
fat intake. Several simple changes in
food and beverages would measurably improve
the meeting�s attendees� performance, alertness,
and health. Basic recommendations follow.
RECOMMENDATIONS
Areas for future study include the effect that
this food has on physician learning, conference
performance, and ability to contribute within
the medical meeting: Excessive calorie intake
has been associated with impairment in each of
these areas, and with overweight and obesity.
In addition, the following 12 basic suggestions
for medical meals and coffee breaks and snacks
will improve the nutritional profile of the meals
and be acceptable to physicians based on the
data presented above. The recommendations reflect
the now common medical knowledge that
saturated and trans fats contribute to arterial
disease, and that monounsaturated and polyunsaturated
fats may work against it, and thus the
latter are favored. Similarly, large quantities of
highly sweetened foods carry few nutrients and
may carry a high glycemic load, minimizing
satiety, and promoting weight gain; foods that
are naturally sweet and are of smaller size are
generally eaten more judiciously and contribute
to satiety.
LA PUMA ET AL. 196
Coffee breaks and snacks: basic suggestions for
medical meetings
1. Eliminate sugared soda and �energy
drinks.�
2. Add bottled water, including carbonated
water, to the beverages.
3. Provide whole fresh fruit, preferably ripe
and in season (e.g., apples, oranges, pears,
bananas, plums, peaches, apricots).
4. Eliminate tortilla and potato chips that are
deep-fried, especially those that are fried in
hydrogenated or partially hydrogenated
oils. Eliminate the mayonnaise- and sour
cream-based white dips and dressings that
accompany them.
5. Substitute chips and crackers that are baked
or fried in olive or canola oil for the chips,
and substitute tomato-based salsa and guacamole
for the white dips.
6. Offer toasted tree nuts (e.g., almonds, walnuts,
hazelnuts, pecans, macadamias) on the
snack table.
Main meals
1. Substitute fish for red meat as an entr�e.
2. Reduce the size of the fish entr�e from 8
ounces to 6 ounces.
3. Increase�nearly double�the portions of
vegetables, fruits, whole grains and legumes
on an entr�e plate.
4. Offer olive oil on the table instead of butter
for bread.
5. Serve no dessert or baked good that contains
hydrogenated fats or trans fats.
6. Serve desserts that are small but intensely
flavored and of high quality.
ACKNOWLEDGMENTS
Dr. La Puma has been compensated for consulting
with four medical conference sponsors
over the past 4 years to create and supervise
healthful conference meals. Project support
comes from the Division of General Internal
Medicine, Medical College of Wisconsin, Milwaukee,
WI; and from CHEF Clinic, a nutritional
medical corporation, Santa Barbara, CA.
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Address reprint requests to:
John La Puma, M.D.
CHEF Clinic
P.O. Box 24039
Santa Barbara, CA 93121
E-mail: www.drjohnlapuma.com