Nutrition in correctional facilities has come a long way in the past two decades.  While in the 1980s the recommended dietary allowances published by the Food and Nutrition Board sought to meet the needs of healthy people, they now endeavor to help people stay healthy by preventing nutritional deficiency diseases and chronic disease.  According to Barbara Wakeen, a registered licensed dietitian, correctional systems are beginning to successfully incorporate these nationally recognized standards into correctional menus.

Wakeen, who plans correctional menus and researches the standards upon which they are based, believes that correctional systems are generally in compliance with both national standards and the often more stringent statewide standards.  Yet Wakeen also said that if more states and jails instituted a "heart healthy" menu, it could lead to fewer specialized diets and healthier inmates overall.

"It's important to take the proactive approach to prevention instead of just maintaining health," Wakeen said.  By providing more nutrition education and serving heart healthy meals, Wakeen believes prisons will "prevent disease down the road instead of just treating it later."

A heart healthy diet as promoted by the American Heart Association consists of foods high in fiber and low in saturated fat, sodium, and cholesterol.  While many states already serve healthy heart meals to inmates, Wakeen advocates the use of these kinds of diets in all correctional facilities.

"By streamlining the process using these nationally recognized standards and offering a healthy heart menu to all inmates, we can optimize nutritional care to ensure that all inmates get adequate nutrients," Wakeen said.

Although Wakeen expresses satisfaction with the overall nationwide compliance with dietary regulations, she also said that the accuracy of medical meals is an ongoing concern.  "If medical diets for inmates with health conditions such as diabetes, hypertension, or cardiovascular disease are not followed, serious consequences can result," she said.  Wakeen indicated that varying monitoring systems are used nationwide to ensure that those who need special diets receive them consistently.
 
Universal Diet Cards

A new program in Washington State addresses this concern with the Universal Diet Card, a system that ensures consistency in the diets of offenders.  According to Cheryl Johnson, Registered Dietitian and Food Program Manager for the Washington State Department of Corrections, the program "successfully reduces costs while also ensuring the dietary health of offenders."

The program requires that a medical provider or religious chaplain screen new inmates for special nutritional requirements when they first enter the prison system.  As usual, inmates with special dietary needs receive a card listing their dietary requirements.  Yet, by laminating this card to the back of the offender's identification badge and marking the front of the badge with a red stripe to indicate the presence of a dietary requirement, prison officials ensure that the inmate's diet remains consistent no matter how often he is transferred from prison to prison.

"Before we had to repeat the screening process at every institution, reissuing dietary cards every time," said Johnson.  This allowed inmates to change their dietary requests frequently, often without cause.  "Even then," Johnson said, "inmates could take their dietary requirement badge off or put it on depending on the meal, [leading to a lack of dietary consistency and effectiveness]."

By issuing permanent cards that are consistent throughout the prison system, Washington State increased offender accountability and compliance.  According to Johnson, inmates now receive the right meal every time they come through the chow line, which helps to maintain the inmates' health.

It has also decreased the number of confrontations between inmates and food service staff, which is good news for Johnson.  Inmates can no longer claim false dietary needs because staff can confidently determine an offender's dietary status with a glance at his identification badge. 

"There are much fewer arguments over meals because the dietary cards are always right there on the inmate's badge," she said. 

Another benefit of the Universal Dietary Card is lowered operating costs in Washington prisons, according to Johnson.  Although prisons continue to screen inmates at regular intervals to reevaluate dietary needs, administrative costs have declined because prisons no longer conduct a new screening every time an offender transfers.  The program also saves money in the kitchen, reducing waste by ensuring that all special meals are eaten.  "If we make 10 vegetarian meals because there are 10 inmates registered as vegetarians, all 10 will be eaten," said Johnson.  "This way, we make only as many meals as we need."

Johnson recommends the program to prison systems across the nation.  "It has real medical implications, especially with the cost of healthcare on the rise," she said.

Wakeen and Johnson will present their work in a joint presentation at the NCCHC Conference in November.