Prognosis Grim for McDonald's Restaurants in Hospitals

Hamburger giant McDonald's USA says that only 26 of its more than 14,000 fast-food restaurants in the United States are located on hospital campuses.

But in the view of one consumer advocacy group, that's 26 restaurants too many.

"We are calling on the administrators of the nation's leading hospitals and health institutions to bag the burger joints and create a healthier eating environment for children," says Sriram Madhusoodanan, national campaign organizer for Boston-based Corporate Accountability International.

CAI this month sent a letter to 22 hospitals with a McDonald's on their campuses, including Cleveland Clinic and Children's Memorial Hospital of Chicago, urging them to sever ties with the Golden Arches.

"The main reason we are launching this effort is because in hospitals, clinics, and doctors' offices kids are being treated for diet-related conditions like diabetes on one floor and being offered the world's most-recognized junk food brand on the next," Madhusoodanan says. "The practice earns McDonald's a very undeserved association with healthfulness among parents and children. It needs to stop."

Madhusoodanan says McDonald's marketers have taken a page from "the tobacco industry before it and worked to co-opt the voice of the health community."

"These hospitals where McDonald's is siting are essentially used as part of McDonald's comprehensive marketing strategy, and it's a strategy that is at its core inconsistent with the goals of the health institution. It's important that when people come to these hospitals that they have food environments that reflect the advice that their doctors and health providers are giving them and doesn't totally contradict it."

Not surprisingly, McDonald's has a different perspective.

"McDonald's promotes the idea that it's not about where you eat; rather, it's about what and how much a person chooses to consume during every eating occasion," Danya Proud, spokesperson McDonald's USA, said in an email to HealthLeaders Media.  "We are proud of our menu and the actions we have taken to evolve the variety of choices we offer our customers, which have led our industry."

Proud said some meal combinations provide less than one-third of the USDA's daily recommendation for fat, sodium, and calories. The hamburger giant also provides easy access to nutritional and ingredient information in each restaurant and on the Internet. For example, the signature Big Mac, large fries and large coke carry about 1,350 calories.

"As always, we continue to assess our menu and actively engage in dialogue with experts to determine opportunities to offer expanded menu choices and additional information and education that enable our customers to make the choices that are right for them," Proud says.

Comparing McDonald's to the tobacco industry is a stretch. Nonetheless, CAI has resuscitated longstanding and legitimate concerns about the appropriateness of fast-food restaurants situated on hospital campuses at a time when more than 60% of Americans are overweight or obese.

In fact, many hospital administrators probably have already reached that conclusion. That's why we shouldn't be surprised if these 26 hospitals quietly look for other food vendors when it's time to renew franchise leases. It's likely that within 10 years McDonald's will have no hospital-based restaurants.

Vanderbilt University Medical Center was one of the first hospitals in the nation to have an on-site McDonald's. The Nashville, TN-based health system let its long-term lease with McDonald's lapse in January 2011 after a 20-year relationship and signed Au Bon Pain as a new tenant. John Howser, VUMC director of media relations, says pressure from CAI or other outside groups was not a factor in the decision to part with McDonald's.

"Ultimately what this came down to was a desire to offer a segment of our workforce and our visitors who would use this particular venue a broader array of food options," Howser says. "We already have a grill in our cafeteria in our clinic where hamburgers are available."

Cleveland Clinic spokeswoman Eileen Sheil says the blue chip health system will not renew its soon-to-expire lease with McDonald's. The decision is consistent with the comments and actions of Cleveland Clinic CEO Toby Cosgrove, MD, who created a stir in 2009 when he said in an interview that he would not hire obese people if it were legal.

Sheil tells HealthLeaders Media that "Cleveland Clinic as a healthcare institution tries hard to walk the talk in healthcare."

"So, we banned smoking on the campus. We no longer hire smokers. We supported the efforts for Ohio to go smoke free in public places. We've taken trans fats out of all of our cafeterias. We've posted calories. We took out our fryers. We made 40 to 50 changes in our cafeteria alone and in our patients' food. We provided in the community a couple years ago free access to the YMCA. We partnered with the YMCA, Curves, and Weight Watchers to offer free gym memberships and access to Weight Watchers for community members for six months," Sheil says.

"It was to focus on wellness and generate awareness over the premature causes of death which are caused because of smoking, obesity and lack of exercise."

"This issue with McDonald's is old news to us. It's not going to change anything we do," she says. "We are well on our way to creating the healthiest environment we can and to be a role model for healthy behaviors in the hospital industry and we have done a pretty good job. This lease is up soon and it's an old issue for us."

What we are hearing now from Howser and Sheil is what we can expect to hear in the coming months and years from officials in the 26 hospitals that still house McDonald's franchises. Hospital leaders are already weary of defending their association with McDonald's in those predictable interviews with the local TV news station that occur every time a group like CAI issues a press release. You've seen those spots. They invariably show shoulders-down and backside video of obese McDonald's customers waiting in line for a Big Mac fix.

No hospital wants to have the distinction of being the last in the United States to house a McDonald's. There won't be a grand announcement so much as a quiet parting of the ways. Hospital officials will deny or play down the idea that McDonald's fat-infused diet was a factor. After all, there is no need to bad-mouth a former business partner. It's just time to move on.

This has to happen. We know about the causes, effects, and costs of overweight and obesity. So it is indefensible for hospitals to continue to provide space for a restaurant chain that serves food linked to the health problems clinicians are treating just a few steps away. It's not just a mixed message. It's the wrong message.