Objective: To quantify the consumption of chocolates in a hospital ward environment.
Design: [protocol] Multicentre, prospective, covert observational study.
Setting: 4 wards at 3 hospitals (where the authors worked) within the United Kingdom.
Participants: Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates.
Intervention: Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten.
Main Outcome Measure: Median survival time of a chocolate.
Results: 191⁄258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39–63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R2=0.844, p < 0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% CI: 0–24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% CI 0.53–0.93, p = 0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%).
Conclusions: From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed.
…Conclusions: The median survival time of a chocolate in this study was just 51 minutes. In keeping with many biological processes, the way a box of chocolates is consumed seems to follow an exponential decay process, with an initial rapid “grab” phase. Further appropriately powered studies investigating the preference for specific chocolate flavours over a wider variety of specialty wards may prove interesting. Given the short half life of a box of chocolates, to ensure that all healthcare staff get benefits from consistent chocolate consumption it is the authors’ opinion that the frequency of chocolates delivered to wards needs to be increased and a concerted lobbying response instigated against recent manufacturers’ trends in shrinking the size of chocolate boxes.
…Notes: We thank the participating staff on the wards. The observers would like to apologise to anyone who received a less than truthful answer to the question: “What are you doing here?”
…Funding: This study received no external funding. The costs of the study were borne equally by the authors. No sponsorship was obtained.
…Conflict of interest statement: Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years. Other non-financial relevant interests: PRG is particularly sentimental about, and incredibly fond of, Lindt Lindor white chocolate truffles; DJM advocates abstinence as the only effective way to avoid chocolate over-consumption; PLRN is influenced by the intoxicating smells emanating from the Cadbury’s chocolate factory at Bournville near his home; FDA supports her native Ghana’s cocoa exports by eating a single Heroes chocolate (Cadbury) every night; HEC declares an interest in polishing off leftover Bounty chocolates (Mars); RDM’s Germanic background means that he is hard-wired, like his brethren, to love all milk chocolate; and CAM reports a preference for Milkybar buttons (Nestlé).