Why Patients Discard Their Food? A Qualitative Study in Iranian Hospitals

Razieh Anari, Maryam Amini, Bahareh Nikooyeh, Delaram Ghodsi, Tirang R. Neyestani


Introduction: Food waste reflects inadequate food intake and is of economic and environmental importance. Therefore, understanding the underlying factors is a must to combat food waste. Methods: A qualitative study was conducted using semi‑structured interviews with managers, nurses, nutritionists, food providers, kitchen staff, and inpatients at three hospitals in Tehran. Responses were recorded, coded, and analyzed thematically. Results: Forty‑eight face‑to‑face interviews led to three core categories: 1. opinions/performance; 2. causes, related factors, and characteristics; and 3. rooting and suggestions. We found that the majority of the hospitalized patients did not consume their entire food. In spite of overall satisfaction with the quantity and quality of food, anorexia, personal taste, and poor quality of raw materials prohibited patients from eating. Also, rice was the most discarded food. Economic barriers were the most important hindrance to elevate the quality, and some strategies, like the supply of high‑quality materials and recruiting skillful cooking team, were proposed to improve it. Conclusions: Our findings delineated a limited budget as the main barrier to improve the quality. Nevertheless, the low quality of hospital foods may actually impose a heavier economic burden due to food waste.


Food service; food waste; hospital; patients; plate food waste; qualitative study

Full Text:



Schindler K, Themessl‑Huber M, Hiesmayr M, Kosak S,

Lainscak M, Laviano A, et al. To eat or not to eat? Indicators for

reduced food intake in 91,245 patients hospitalized on nutrition

days 2006‑2014 in 56 countries worldwide: A descriptive

analysis. Am J Clin Nutr 2016;104:1393‑402.

Williams P, Walton K. Plate waste in hospitals and strategies for

change. E SPEN Eur E J Clin Nutr Metab 2011;6:e235‑41.

Barton A, Beigg C, Macdonald I, Allison S. High food wastage

and low nutritional intakes in hospital patients. Clin Nutr


Simzari K, Vahabzadeh D, Nouri Saeidlou S, Khoshbin S,

Bektas Y. Food intake, plate waste and its association with

malnutrition in hospitalized patients. Nutr Hosp 2017;34:1376‑81.

Hiesmayr M, Schindler K, Pernicka E, Schuh C,

Schoeniger‑Hekele A, Bauer P, et al. Decreased food intake

is a risk factor for mortality in hospitalised patients: The

NutritionDay survey 2006. Clin Nutr 2009;28:484‑91.

Iff S, Leuenberger M, Rösch S, Knecht G, Tanner B, Stanga Z.

Meeting the nutritional requirements of hospitalized patients:

An interdisciplinary approach to hospital catering. Clin Nutr


Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting

qualitative research (COREQ): A 32‑item checklist for interviews

and focus groups. Int J Qual Health Care 2007;19:349‑57.

Anari R, Amini‎ M, Nikooyeh B, Ghodsi D, Torabi P,

Neyestani TR. Evaluation of nutritional status, food intake

and costs of food waste in hospitalized patients, considering

relevant causes and finding possible solutions: Protocol of a

mixed‑method study. Nutr Food Sci Res 2021;8:1‑10.

Long T, Johnson M. Rigour, reliability and validity in qualitative

research. Clin Eff Nurs 2000;4:30‑7.

Noble, H., & Smith, J. Issues of validity and reliability in

qualitative research. Evidence-Based Nursing, 2015;18:34-5.

Trochim WMK. Research Methods Knowledge Base: Qualitative

Validity 2021. Available from: https://conjointly.com/kb

/qualitative‑validity/. [Last accessed on 2022 May 20].

Hammersley M. What’s Wrong with Ethnography?:

Methodological Explorations. London: Psychology Press; 1992.

Holsti OR. Content Analysis for the Social Sciences and

Humanities. Reading MA: Addison‑Wesley (content analysis);

Vaismoradi M, Turunen H, Bondas T. Content analysis and

thematic analysis: Implications for conducting a qualitative

descriptive study. Nurs Health Sci 2013;15:398‑405.

Jessri M, Mirmiran P, Jessri M, Johns N, Rashidkhani B, Amiri P,

et al. A qualitative difference. Patients’ views of hospital food

service in Iran. Appetite 2011;57:530‑3.

Dias‑Ferreira C, Santos T, Oliveira V. Hospital food waste and

environmental and economic indicators–A Portuguese case study.

Waste Manag 2015;46:146‑54.

Walton K, Williams P, Tapsell L. What do stakeholders consider

the key issues affecting the quality of foodservice provision for

long‐stay patients? J Foodserv 2006;17:212‑25.

McLymont V, Cox S, Stell F. Improving patient meal

satisfaction with room service meal delivery. J Nurs Care Qual


Stanga Z, Zurflüh Y, Roselli M, Sterchi A, Tanner B, Knecht G.

Hospital food: A survey of patients’ perceptions. Clin Nutr


Hong W, Kirk D. The analysis of edible plate waste results in 11

hospitals in the UK. Foodserv Res Int 1995;8:115‑23.

Thibault R, Chikhi M, Clerc A, Darmon P, Chopard P, Genton L,

et al. Assessment of food intake in hospitalised patients:

A 10‑year comparative study of a prospective hospital survey.

Clin Nutr 2011;30:289‑96.

Goonan S, Mirosa M, Spence H. Getting a taste for food waste:

A mixed methods ethnographic study into hospital food waste

before patient consumption conducted at three New Zealand

foodservice facilities. J Acad Nutr Diet 2014;114:63‑71.

Naithani S, Whelan K, Thomas J, Gulliford MC, Morgan M.

Hospital inpatients’ experiences of access to food:

A qualitative interview and observational study. Health Expect


Freedman MR, Brochado C. Reducing portion size reduces food

intake and plate waste. Obesity 2010;18:1864‑6.

Sumarto, Saragih M. Does the taste and appearance of

food affect food waste in low‑salt diet patients? J Nutr Sci

Vitaminol (Tokyo) 2020;66(Suppl):S56‑62.

Kowanko I. The role of the nurse in food service: A literature

review and recommendations. Int J Nurs Pract 1997;3:73‑8.

Chang E, Chenoweth L, Hancock K. Nursing needs of

hospitalized older adults Consumer and nurse perceptions.

J Gerontol Nurs 2003;29:32‑41.