This fact—a plant-based diet is healthier than a meat-heavy one—isn’t exactly new knowledge. But even as medical researchers discover more about the foods that keep our bodies well, many hospitals continue to serve foods that promote disease. Last year, the Physician’s Committee for Responsible Medicine (PCRM), a nonprofit group composed of 12,000 doctors, issued a damning report about the healthfulness of hospital food in the U.S. Of the 208 hospitals surveyed, 20 percent housed fast-food restaurants like McDonald’s, Chick-fil-A, and Wendy’s on their campuses. And in a study led by Lenard Lesser, a family-medicine physician at the University of California, San Francisco, and an advisor on hospital food environments for the Centers for Disease Control and Prevention, 98 out of 233 university-affiliated teaching hospitals (around 42 percent) had at least one fast-food franchise on campus. Lesser’s findings were similar to another report published in JAMA in 2002, which found that six of the top 16 hospitals in the U.S. housed fast-food establishments.

The food served in regular hospital cafeterias often isn’t much better; in the same 2015 report, PCRM analyzed cafeteria menus and patient meal plans, and found that they often included processed meats and items high in sugar, salt, and cholesterol. Another study from 2012, published in the journal Academic Pediatrics, assessed the food offerings in 14 California children’s hospitals, rating each hospital on a scale from 0 (unhealthy) to 37 (healthy). The average score was 19, and only 7 percent of the 384 entrees served were classified as healthy.

At one point during my gastroenterology fellowship, I cared for a patient who was suffering from Crohn’s disease, which causes inflammation of the gut. He was having bloody diarrhea several times a day; a colonoscopy revealed damaged intestinal membranes, with patchy redness and scattered ulcers. He was still well enough to eat, though, and his appetite didn’t appear to be affected. One day, I came into his room to find him starting on the hospital lunch of the day: chicken wings with hot sauce, creamy mashed potatoes, chocolate cake, and a soda—more or less the opposite of what a patient with gastrointestinal issues should be ingesting.

But remaking hospital menus isn’t easy. Hospitals have to remain fiscally solvent, and many contract with companies that specialize in high volumes of food at a low cost. Often, this means packaged and processed foods are favored over fresh produce. Yet the cost of hospital food is a fraction of the costs hospitals incur when caring for patients, and many of these patients have chronic conditions that can be prevented or treated with diet. Hospitals have incentives to keep patients well and, more broadly, to promote public health as well as the health of their employees.