Food for people who can’t eat

Her patients were living on three balls of beige a day. There had to be something better. So Sue Adams created gourmet puree

Start with hospital food: soft, tasteless, institutional. Now mash it to paste. And eat nothing else for the rest of your life.

It’s a dismal prospect, and one that’s faced by millions of people each year who for one reason or another can no longer swallow normal foods and liquids. When Sue Adams was a speech pathologist in San Francisco, her patients were some of the ones most affected. “We started seeing a lot of repeat offenders who would come in malnourished,” she says. “And the three balls of beige got really old. It didn’t look like real food, no one ever really tasted it—no one wanted to taste it.”

Sue Adams in blue shirt standing in front of kitchen with produce.

Sue Adams in the Blossom Kitchen

Adams figured she could do better and in 2006 resigned from her position at Sutter Summit Medical Center in Oakland, California to start Blossom Foods. Her goal: better-tasting food for people with dysphagia. (Dysphagia is not a disease per se, but an umbrella term for swallowing problems with a variety of causes, including stroke, neurological problems, and some cancers.) She was thinking about her customers, not so much the scale and structure of her market, but intentionally or not, she found her way into exactly the kind of business environment food entrepreneurs should be looking for—one that by its very nature made it easier for her to succeed.

How so? There are four big reasons:

The dysphagia market is huge.

Exact numbers are hard to come by, but here are some useful data points:

  • Approximately 15 million Americans suffer from the condition, with a million new cases diagnosed every year
  • Almost three-quarters of nursing home patients have dysphagia, and it is estimated that half of people over age 60 will experience problems with it at some point
  • Claus Hipp, CEO of Germany’s largest producer of pureed baby foods, estimates that 25 percent of his product is now consumed by adults with swallowing problems

There’s not much competition for a high-quality alternative.

Food for dysphagics is dominated by a handful of huge, organized, and well-established contract suppliers of industrial nutrition products akin to military rations: shelf-stable meals and beverage thickeners. (Dysphagia patients also struggle to swallow liquid consistencies.) Hospitals that want better have generally had to turn to their own kitchens. There aren’t many companies like Adams’s, certainly not at the national level. That simplifies her selling. Once she’s nudged a hospital toward better food for dysphagics — and for that matter, its general patient population, too — Adams doesn’t have to beat a half dozen other companies for the business. The taste, quality and texture of Blossom’s food means she’s usually on her own.

Blossom meals are real food, simply made softer. They are the antidote to institutional molded purees / Blossom FoodsBlossom Foods

Blossom meals are real food, simply made softer. They are the antidote to institutional molded purees

Barriers to entry are low. A lot of the food produced for dysphagic patients is highly processed. For example, one supplier to hospitals that Adams didn’t want to name, produces pureed foods molded to look like the real thing. “It’s cute,” says Adams. “A carrot looks like a carrot. But it’s starch. Nutrition-wise it’s not that good. And it doesn’t particularly taste great.” Other manufacturers are looking into the idea of using 3D printing to create an even greater range of shapes.

Not exactly three balls of beige, but pretty close: traditional hospital meal, including molded, shaped peas

But the industrial approach isn’t necessary. Blossom doesn’t so much manufacture as it cooks. Her first employee was a chef. “We make everything pretty much from scratch, it’s our own recipes,” says Adams. That means roast turkey is really roast turkey, albeit pureed and then frozen, as are all of Blossom’s offerings. The menu includes familiar foods like French toast, barbecue beef brisket, and peach pie. And puree isn’t the only texture Blossom produces; food also comes ground and chopped, for people who are able to do a little chewing on their own. Proteins, which are the hardest to get right in a home kitchen, are the biggest sellers. She freezes food, rather than creating a shelf-stable product—another way to keep things simple.

It’s a wholesale business that feeds a retail business. Adams landed her first institutional client in 2006: Sutter Summit, the hospital where she had worked as a speech therapist. Fueled by word of mouth, Blossom Foods has expanded into the largest high-profile hospitals in the San Francisco bay area, Los Angeles and the Pacific Northwest, and is moving into the East Coast in 2016.

Not many customers for a larger manufacturer, but they account for lots of meals. Adams says her largest institutional customers buy 2,500 to 3,000 meals a week; smaller ones purchase around 200. Bolstered largely by that business, Blossom has become a full-service supplier. “We’re a manufacturer now,” Adams says, with a staff of eleven (and growing), and producing, packaging and shipping its own product. “We grew eighteen percent last year. We’ve grown every year in double digits.”

Blossom’s mission – restoring dignity to dining on a special diet—is about freedom to choose how and what we eat, whether or not we’re feeling well.

Adams doesn’t reveal her institutional prices, but her consumer meals run a bit over $6. Even if hospitals pay half the retail rate, a hospital buying 3,000 meals a week would translate into $450,000 a year—a rounding error in the larger world of institutional food, but a significant amount for a smaller company.

And many of those patients will need to continue on a pureed diet even after they leave the hospital. Adams is attempting to serve that population by selling directly to them online.

Getting a taste of success

Food was one thing. Business was something else. “It took me a couple years to get it going, to figure out how to do it,” Adams says. She and her husband funded the company, never taking outside funds, and like many food start-ups, Blossom initially shared a kitchen to save money. Pricing for institutions proved immediately perplexing. “How do you price and what’s it worth?” she wondered. “And if a hospital’s plate cost is $2 a meal per patient, what do we charge? It’s a business, we did it for the right reasons, but we have to make money to keep it going. Shifting into distribution costing, you know, every day, it’s a learning curve all the time.”

Lately, Adams has been thinking more about retail. Where once she offered only individual dishes, now she offers three-item complete meal packs. There’s some precedent for retail pureed food—but mostly in pharmacies. Grocery stores, despite the size of the potential market, haven’t shown much interest. “They’ll put frozen dog food in, but they won’t put pureed or soft food in there.”

Blossom’s mission – restoring dignity to dining on a special diet—is about freedom to choose how and what we eat, whether or not we’re feeling well. For patients, enjoying renewed dominion over their palates can make eating a special diet feel a little less…special…and a little more like simply eating.

Also tagged

Kate Cox is The Counter's editor. She oversees partnerships and edits investigative, feature, and senior staff reporting. Prior to joining The Counter in 2015, Kate was a freelance reporter for radio and text, focused on health policy and the American age boom. She has written for The Guardian, The Nation, Huffington Post, and others. She holds a master's degree from Columbia University's Graduate School of Journalism, where she produced and reported a three-part radio documentary on the nation's first emergency shelter for victims of elder abuse.