Ensure, Hospital Food, and Cancer Nutrition: What Research Shows About Nutrition Drinks and Better Alternatives

A widely shared story featured a hospice patient with cancer who held up a bottle of Ensure, the nutrition drink commonly given to patients who are not eating enough, and said she would not feed it to a dying animal. She objected to its ingredients, which include sugar, corn-derived carbohydrates, and vegetable oils. Photos of processed nutrition drinks and unappetizing hospital meals regularly go viral, and they strike a nerve because most people expect hospitals, of all places, to serve food that supports healing.

The frustration reflects real problems. Malnutrition is common among hospitalized patients, particularly people with cancer, and hospital food often fails to meet their needs, either because of its quality or because patients cannot eat enough of it. At the same time, research shows that well-designed nutrition support in hospitals can improve outcomes. This article examines what is in nutrition drinks like Ensure, what research shows about oral nutritional supplements and hospital food in cancer care, what guidelines recommend, and how patients and families can advocate for better nutrition.

Why Hospital Food Matters More Than It Seems

Hospital meals are often treated as a hotel service rather than part of medical care, but for many patients, food is treatment. Illness, surgery, chemotherapy, and radiation increase the body’s needs for energy and protein while often reducing appetite. Patients who do not eat enough lose muscle and strength, heal more slowly, develop more complications such as infections and pressure ulcers, and may stay in the hospital longer. In cancer care, weight loss and muscle wasting are associated with worse tolerance of treatment and poorer survival.

A one-day survey of 1,903 cancer patients in French hospitals, published in 2014 by Xavier Hébuterne and colleagues, found that 39 percent were malnourished, with higher rates in some cancer types, and that more than half said they were eating less than before their cancer. Many malnourished patients were not receiving nutrition support.

What the Evidence Says About Nutrition Support

For years, it was unclear whether nutrition interventions in hospitals improved outcomes beyond weight. The EFFORT trial helped answer that question. Published in The Lancet in 2019 by Philipp Schuetz and colleagues, the trial randomly assigned 2,088 medical inpatients at nutritional risk in Swiss hospitals to individualized nutrition support, designed by dietitians to meet protein and energy goals, or to standard hospital food. Individualized support reduced the combined risk of adverse outcomes, including death, admission to intensive care, readmission, major complications, and functional decline at 30 days, and reduced 30-day mortality.

A 2021 secondary analysis in the Annals of Oncology by Laura Bargetzi and colleagues focused on patients with cancer in the EFFORT trial. It found that nutritional risk independently predicted mortality over 180 days and that individualized nutrition support during the hospital stay reduced mortality compared with standard hospital food, supporting nutrition screening and support as part of cancer care.

What’s in Nutrition Drinks Like Ensure

Ensure, made by Abbott, and similar products are oral nutritional supplements: ready-to-drink liquids designed to provide concentrated calories, protein, vitamins, and minerals in a small volume that is easy to consume when appetite is poor. Typical formulations combine milk or soy proteins, carbohydrates from maltodextrin and sugar, vegetable oils, and a vitamin and mineral blend. Critics, including the patient in the viral story, object to added sugar, processed ingredients, and the contrast with the whole-food diets many cancer patients try to follow.

These criticisms have some merit: standard formulas are not designed as health foods for the general population, and a person who can eat a balanced diet does not need them. But for patients who are losing weight because they cannot eat enough, the priority is getting adequate energy and protein, and sugar and easily digested carbohydrates help achieve that in small volumes. Manufacturers also offer versions with less sugar, higher protein, plant-based proteins, or ingredients from whole foods, and some hospitals use blended whole-food formulas.

Do Oral Nutritional Supplements Help?

Evidence suggests they can, for the right patients. A 2023 systematic review and meta-analysis in Ageing Research Reviews by Anne Cawood and colleagues analyzed 44 randomized trials of oral nutritional supplements used in community settings by surgical and medical patients and found that supplement use reduced complications, including infections, pressure ulcers, and problems with wound and fracture healing. The NOURISH trial, published in Clinical Nutrition in 2016 by Nicolaas Deutz and colleagues and funded by Abbott, tested a high-protein supplement containing beta-hydroxy-beta-methylbutyrate in malnourished older adults after hospital discharge; it did not reduce the combined primary outcome of readmission or death, but 90-day mortality was lower in the supplement group. Industry funding is common in this field and is a reason to look for independent confirmation.

For patients who dislike commercial drinks, dietitians can suggest alternatives such as homemade smoothies with milk or yogurt, nut butters, and fruit; fortified soups; or enriched foods. The goal is to meet protein and energy needs in whatever form the patient will actually consume.

What Guidelines Recommend

The European Society for Clinical Nutrition and Metabolism (ESPEN) has published detailed guidance. Its 2017 guidelines on nutrition in cancer patients by Jann Arends and colleagues, and a 2021 practical guideline by Maurizio Muscaritoli and colleagues, recommend screening all cancer patients regularly for nutritional risk from the time of diagnosis; assessing intake, weight change, muscle mass, physical performance, and inflammation in those at risk; and providing individualized interventions, starting with nutritional counseling and food fortification and progressing to oral supplements or tube or intravenous feeding when needed. The guidelines emphasize adequate protein and energy intake, physical activity to maintain muscle, and attention to symptoms that interfere with eating, such as nausea, mouth sores, taste changes, and constipation.

For patients at the end of life, guidelines shift the focus toward comfort and quality of life, with food offered for pleasure and according to the patient’s wishes rather than to meet nutritional targets.

Step	What it involves
Screening	Quick check for weight loss, reduced intake, and illness severity at admission and regularly
Assessment	Detailed evaluation by a dietitian of intake, body composition, and symptoms
Individualized plan	Protein and energy goals, meal modifications, snacks, fortified foods
Supplements	Oral nutritional supplements when food alone is insufficient
Artificial nutrition	Tube or intravenous feeding when needed and consistent with goals of care
Monitoring	Regular review of intake and adjustment of the plan

Why Hospital Meals Fall Short

Several factors contribute to disappointing hospital food. Budgets for patient meals are often tight, and food services may rely on processed, shelf-stable items that are easy to store and serve. Large-scale cooking and holding food for delivery can reduce quality and appeal. Meals may arrive when patients are asleep, away for tests, or feeling nauseated, and may be removed before they can eat. Patients may need help opening packages or feeding themselves but may not receive it. Menus designed for general populations may not suit cancer patients with taste changes, mouth sores, or early fullness. Studies in many countries have documented substantial food waste on hospital wards, meaning that even well-planned meals often go uneaten.

Concerns about the healthiness of food served in hospitals extend beyond patients to staff and visitors, with criticism of sugary drinks, fast-food outlets, and processed snacks in hospital settings. Some health systems have adopted healthier food standards for cafeterias, vending machines, and patient meals.

Improving Hospital Food: What Works

Hospitals that have improved patient nutrition have used several approaches. Room-service or on-demand ordering lets patients choose what and when they eat, which some hospitals report has increased satisfaction and intake while reducing waste. Protected mealtimes limit nonurgent clinical activities during meals so patients can eat without interruption. Mealtime assistance from staff or volunteers helps patients who need help. Fortified foods and snacks increase protein and calories in small portions for patients with poor appetites. Fresh, locally sourced ingredients, sometimes from hospital gardens or regional farms, improve flavor and appeal. Dietitian involvement in menu planning and individual care ensures that nutrition needs, not just budgets, shape meals.

These changes require investment and organizational commitment, but nutrition support has been shown in trials to improve outcomes, and malnutrition increases costs through complications and longer stays.

How Patients and Families Can Advocate

Ask for a nutrition screening and a dietitian. If you or a loved one is losing weight or not eating well, ask the care team for a dietitian consultation.

Request modifications. Many hospitals can provide softer foods, smaller frequent meals, snacks, cultural or religious meals, and alternatives for taste changes.

Ask about supplements. Oral nutritional supplements can help when meals are not enough.

Bring food when allowed. Familiar foods from home can improve intake; check with staff about dietary restrictions and food safety.

Ask for help at mealtimes. If a patient needs assistance opening containers or eating, request it.

Give feedback. Patient experience surveys and patient advocates can relay concerns about food quality to hospital leadership.

Cancer Cachexia: Why Eating More Isn’t Always Enough

Many people with advanced cancer develop cachexia, a complex syndrome of weight loss, muscle wasting, and loss of appetite driven partly by inflammation and metabolic changes caused by the tumor. Unlike simple starvation, cachexia cannot be fully reversed by eating more, because the body breaks down muscle even when food intake is adequate. This is one reason patients and families can feel frustrated when nutrition drinks or larger meals do not restore weight. Current approaches combine nutritional support, physical activity to preserve muscle, management of symptoms that interfere with eating, and in some cases medications to stimulate appetite. Research into treatments for cachexia is ongoing. Understanding cachexia can help families set realistic expectations and focus on comfort and quality of life when appropriate.

Managing Symptoms That Interfere With Eating

Cancer and its treatments can cause nausea, vomiting, mouth sores, dry mouth, taste and smell changes, difficulty swallowing, early fullness, constipation, and diarrhea, all of which make eating harder. Practical strategies include eating small, frequent meals; choosing cold or room-temperature foods when smells are bothersome; using plastic utensils if foods taste metallic; trying tart or seasoned foods if taste is dulled; choosing soft, moist foods for mouth sores; and sipping fluids between rather than with meals. Anti-nausea medications, mouth care, and treatment of constipation can make a substantial difference. Dietitians and oncology nurses can tailor suggestions to each patient’s symptoms.

Protein and Energy Needs

ESPEN guidelines suggest that most patients with cancer need more protein than healthy adults, generally above 1 gram per kilogram of body weight per day and up to 1.5 grams if possible, along with enough energy to maintain weight. Meeting these targets can be difficult when appetite is poor, which is why energy-dense and protein-rich foods, fortified dishes, and supplements are often recommended. Individual needs vary with the type of cancer, treatment, and overall health, so a dietitian’s assessment is valuable.

Food in Hospice and Palliative Care

In hospice and palliative care, the role of food changes. As illness progresses, appetite naturally declines, and forcing food may cause discomfort. Care focuses on offering favorite foods for comfort and pleasure, managing symptoms such as nausea and dry mouth, and respecting patients’ wishes. Families often find it distressing when a loved one eats little; hospice teams can explain what to expect and help families find other ways to provide care and connection. Even so, the food that is offered should be appealing and respectful, which is why criticism of poor-quality meals in end-of-life settings resonates so strongly.

Hospital Food Policy and Quality Measures

Malnutrition in hospitals has gained attention from regulators and quality organizations. In the United States, the Centers for Medicare & Medicaid Services has adopted a measure assessing how well hospitals screen, assess, diagnose, and plan care for malnutrition in older adults, encouraging hospitals to treat nutrition as part of clinical quality. In the United Kingdom, a government-commissioned independent review of hospital food published in 2020 called for improvements in food quality, nutrition standards, and the role of catering staff. Professional organizations such as the American Society for Parenteral and Enteral Nutrition promote malnutrition awareness and screening. These efforts aim to ensure that hospital food is treated as part of patient care, not merely a hotel service.

Family Members as Advocates

Family members often notice when a loved one is not eating, because hospital staff may be busy and meal trays may be collected without anyone recording how much was eaten. Families can help by keeping track of intake, telling nurses when meals are missed or uneaten, asking whether a dietitian has seen the patient, bringing preferred foods when allowed, and asking about supplements or alternatives. Asking specific questions, such as whether the patient’s weight is being monitored and what the nutrition plan is, can prompt action. At discharge, families can ask for nutrition guidance and referrals to outpatient dietitians.

Whole-Food Alternatives to Commercial Drinks

Option	Advantages	Considerations
Commercial oral supplements	Standardized nutrition, convenient, shelf-stable, evidence from trials	Added sugars, processed ingredients, taste fatigue
Homemade smoothies	Whole foods such as milk, yogurt, fruit, nut butters; customizable	Preparation time; food safety for immunocompromised patients
Fortified soups and puddings	Familiar foods with added protein and calories	May require recipes and planning
Whole-food-based formulas	Blended real-food ingredients in ready-to-use form	Cost; availability
Energy-dense snacks	Nuts, cheese, eggs, avocado, hummus in small portions	Chewing and swallowing difficulties for some patients

Food Safety During Cancer Treatment

Patients receiving treatments that weaken the immune system may be advised to follow food safety precautions, such as avoiding unpasteurized products, undercooked meat and eggs, and unwashed produce, and handling homemade drinks carefully. Commercial supplements are produced under controlled conditions, which can be an advantage for patients at high risk of infection. Oncology teams can advise on which precautions apply.

Key Terms

Malnutrition: A state resulting from inadequate intake or uptake of nutrients, leading to changes in body composition and function.

Oral nutritional supplement: A drink or powder providing concentrated energy, protein, and micronutrients.

Cachexia: A syndrome of weight and muscle loss associated with illness that cannot be fully reversed by nutrition alone.

Nutritional risk screening: A brief assessment to identify patients who need nutrition evaluation.

Palliative care: Care focused on relieving symptoms and improving quality of life in serious illness.

The Bottom Line

The viral criticism of Ensure reflects real frustration with processed nutrition products and hospital food, and a real problem: malnutrition is common in cancer patients and often undertreated. Commercial nutrition drinks contain sugar and processed ingredients, but trials show that oral supplements can reduce complications in malnourished patients, and individualized nutrition support in hospitals reduced mortality in the EFFORT trial. The best approach combines screening, dietitian-led plans, appealing food, symptom management, and supplements or whole-food alternatives that patients will actually consume, with comfort taking priority at the end of life.

Questions to Ask the Care Team

Has my loved one been screened for malnutrition? Has a dietitian seen them, and what is the nutrition plan? How much are they eating, and is anyone tracking intake? Can meals be adjusted for symptoms such as nausea or mouth sores? Are there supplement options other than the standard drink, or flavors and formats they might prefer? Can we bring food from home? What should nutrition look like after discharge? These questions help families participate in care and ensure nutrition is treated as part of treatment.

A Balanced View of Nutrition Drinks

Nutrition drinks occupy an uncomfortable middle ground. To critics, they symbolize processed, industrial food served to vulnerable people, and their sugar content seems at odds with healthy eating advice. To clinicians treating malnutrition, they are a practical tool that can deliver hundreds of calories and substantial protein to a patient who cannot face a full meal. Both perspectives have merit. The best outcome for patients is a choice of options, including whole-food alternatives and better-tasting, lower-sugar products where appropriate, chosen with a dietitian’s guidance and the patient’s preferences in mind. Respecting what a patient is willing and able to eat is central, especially near the end of life.

Key Facts at a Glance

A French survey of 1,903 cancer patients found 39 percent were malnourished, and many were not receiving nutrition support. The EFFORT trial of 2,088 medical inpatients at nutritional risk found that individualized nutrition support reduced adverse outcomes and 30-day mortality compared with standard hospital food, and a secondary analysis found benefits in patients with cancer. A 2023 meta-analysis of 44 randomized trials found that oral nutritional supplements reduced complications in community settings. ESPEN guidelines recommend regular nutrition screening for cancer patients, protein intakes generally above 1 gram per kilogram per day, and individualized support. Nutrition drinks contain sugar and processed ingredients, but they can help patients who cannot eat enough.

For families, the most practical takeaway is to ask early about nutrition screening and dietitian support rather than waiting for weight loss to become severe.

Further Reading

Patients and families can find guidance on nutrition during cancer treatment from cancer centers, national cancer organizations, and professional societies for clinical nutrition. The ESPEN guidelines cited here are written for clinicians but summarize the evidence behind current recommendations. Registered dietitians specializing in oncology can translate this guidance into practical plans tailored to each patient’s situation and preferences.

Above all, the patient’s own preferences matter. A meal or drink is only useful if the person is willing and able to consume it, and respecting those wishes is part of good care at every stage of illness.

Looking Ahead

Research on nutrition in cancer care continues to expand, including studies of immunonutrition, personalized nutrition based on body composition, and interventions to counter cachexia. Hospitals are experimenting with better food service models, and patient voices, including viral critiques like the one about Ensure, have pushed institutions to pay more attention to what they serve.

Readers who have had experiences with hospital food or nutrition drinks during a loved one’s illness can share feedback with hospitals and patient advocates; such feedback has helped drive improvements in many institutions and keeps attention on the importance of nutrition in care.

Summary for Families

If someone you love is in the hospital with cancer and not eating well, ask for a nutrition screening and a dietitian visit, request meal changes that suit their symptoms, explore supplement options or whole-food alternatives they will actually drink or eat, and bring familiar foods when allowed. Near the end of life, let comfort and the patient’s wishes guide what is offered.

Small changes, such as a favorite food from home, a different flavor of supplement, or a meal at a better time of day, can sometimes make a large difference in how much a patient eats and how they feel. Nurses and dietitians often welcome family input about what the patient likes and tolerates.

How Malnutrition Screening Works

Nutrition screening tools are short questionnaires that nurses or dietitians use at hospital admission to identify patients at risk. The Nutritional Risk Screening 2002 (NRS 2002), used in the EFFORT trial, combines recent weight loss, reduced food intake, body mass index, disease severity, and age into a score. The Malnutrition Universal Screening Tool (MUST), common in the United Kingdom, uses body mass index, unintentional weight loss, and the effect of acute illness on intake. The Malnutrition Screening Tool asks two simple questions about recent weight loss and appetite. Patients who screen positive should receive a full assessment by a dietitian and an individualized plan. Families can ask whether screening was done and what the result was.

Screening is quick, usually taking only a few minutes, and repeating it during longer hospital stays helps catch patients whose intake declines after admission, which is common during treatment for cancer and other serious illnesses.

Screening results also guide whether a patient is referred for detailed assessment, which typically includes a review of weight history, diet, and physical function.

Frequently Asked Questions

Is Ensure bad for cancer patients?

Ensure and similar drinks contain sugar and processed ingredients, but for patients who cannot eat enough they can provide needed calories and protein, and trials show oral supplements can reduce complications. Dietitians can suggest lower-sugar or whole-food alternatives.

Why is hospital food often unhealthy?

Budget limits, large-scale production, and reliance on processed foods contribute. Some hospitals have improved menus through room service, fresh ingredients, and dietitian-led planning.

How common is malnutrition in cancer patients?

Common. A French survey of 1,903 cancer patients found 39 percent were malnourished.

Does better hospital nutrition improve outcomes?

Yes. The EFFORT trial found that individualized nutrition support reduced adverse outcomes and 30-day mortality in medical inpatients at nutritional risk, including those with cancer.

What can I do if my family member is not eating in the hospital?

Ask for a dietitian, request meal modifications or supplements, ask about bringing food from home, and seek help at mealtimes.

Should hospice patients be encouraged to eat?

Food should be offered for comfort according to the patient’s wishes; appetite naturally declines near the end of life.

References

1. Hébuterne X, Lemarié E, Michallet M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN Journal of Parenteral and Enteral Nutrition. 2014;38(2):196–204. PMID 24748626
2. Schuetz P, Fehr R, Baechli V, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019;393(10188):2312–2321. PMID 31030981
3. Bargetzi L, Brack C, Herrmann J, et al. Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial. Annals of Oncology. 2021;32(8):1025–1033. PMID 34022376
4. Cawood AL, Burden ST, Smith T, et al. A systematic review and meta-analysis of the effects of community use of oral nutritional supplements on clinical outcomes. Ageing Research Reviews. 2023;88:101953. PMID 37182743
5. Deutz NE, Matheson EM, Matarese LE, et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clinical Nutrition. 2016;35(1):18–26. PMID 26797412
6. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36(1):11–48. PMID 27637832
7. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition. 2021;40(5):2898–2913. PMID 33946039

Last updated: October 6, 2026