MMenus are considered the most critical tool in food and beverage services that determine the complete food operation i.e., the process, food labor, equipment, and costs. It is an integral part of nutritional care that allows patients to have a lot of choices enhancing their satisfaction with an adequate intake of nutrients required for a patient's speedy recovery. This study aims to identify obstacles and challenges facing nutritional care providers to ensure adequate application of therapeutic menus at Fayoum Public hospital Egypt. A descriptive qualitative case study was conducted on health care workers and food and nutritional care providers at Fayoum Public hospital using semi-structured interviews. Seven themes are reflecting the challenges of therapeutic menu application at Fayoum Public hospital. They are as follows: lack of clear policy and definite responsibilities, absence of patient involvement in the nutritional plan, limited food resources, neglecting the importance of nutrition care, insufficient competence of nutritional care providers, rigid menus within the solid hospital system, and deficient quality and inappropriateness meal. The results imply that the food and nutritional care system have their limits within hospital structure, resources, and organizations. Also, the importance of food and nutritional care plays a critical role in the application of the therapeutic menu. As quality food and nutrition care can improve patient outcomes and reduce costs leading to patient satisfaction.