Nutritional quality of food and drink in the outpatient setting of a UK tertiary children's hospital: full product-level dataset

Background: Childhood obesity is a major public health challenge in the UK, and hospitals are expected to model health-promoting environments. No previous study has examined the outpatient retail food environment of a UK tertiary children's hospital. This study analysed the nutritional quality of all food and drink available for purchase in this setting and evaluated alignment with NHS food standards commitments. Methods: A cross-sectional observational audit was conducted in May 2023 at Sheffield Children's Hospital, a UK tertiary paediatric referral centre. All food and drink products available for purchase (n = 550) across two retail shop outlets and six vending machines were recorded and assessed using the Australian Health Star Rating (HSR) system and UK dietary reference intakes (DRIs) for free sugars for children aged 7–10 years (24 g/day). The main outcomes were the proportion of items exceeding the daily free sugar reference intake, the distribution of HSR scores across product categories, and the overall nutritional profile relative to NHS food standards commitments. Results: A total of 550 items were identified: 395 from shops (290 food, 105 drinks) and 155 from vending machines (101 food, 54 drinks). Overall quality was poor: 55% of shop food and 72% of vending food scored ≤1.5 stars on the HSR. Sugar was the predominant nutrient of concern: 32% of all items exceeded the daily free sugar limit for a child aged 7–10 years in a single portion. Cakes, chocolate and sweets averaged 40.3 ± 35.6 g per portion (67% exceeding the limit). Milkshakes, frappés and fruit juices (73% each) were the most concerning shop drink categories; vending sweets (100%) and fruit juices (71%) exceeded the daily free sugar limit most frequently. Conclusions: The outpatient food environment at this UK paediatric hospital is dominated by energy-dense, nutrient-poor products that frequently exceed recommended daily sugar limits for children. Mandatory procurement standards, healthier choice architecture and transparent annual auditing are urgently required to align hospital retail environments with NHS health commitments.