Can You Judge a Processed Food by Its Name?

Can You Judge a Processed Food by Its Name?

David Katz 21/02/2019 7

No, you really cannot. Not any better than that proverbial book by its cover.

I raise the question, and proffer the answer, because the contention reached me via social media feed yesterday that the NuVal nutrient guidance shelf tag system was “fatally flawed.” Actually, as I shared with the colleagues who wrote the commentary in question, that’s a food-industry-born falsehood repeated often enough to pass for truth.

The only fatal flaw in NuVal, a propriety, nationwide, 1-to-100-the-higher-the-number-the-more-nutritious-the-food system that ran on the overall nutritional quality index(ONQI) algorithm I engineered* with input from a dozen renowned nutrition experts, was that it worked exactly as intended. It pretty much unfailingly, across an expanse of some 125,000 food products scored, indicated which were better, which worse overall; which were good, which were bad, and which- whatever the lipstick on a pig legerdemain of food industry cosmeticians- were downright ugly.

This truth is important in all the same ways it is important to defend the reality that beans are better for the health of people and planet alike than beef. This truth, like the truth about NuVal, is opposed by food industry elements for the most obvious of reasons: money. The beef industry is not keen to see wholesale substitution of beans for beef, no matter the good it would do public and planetary health. Enter the merchants of doubt, and the propensity to assert, imply, or insinuate: fatal flaw.

Such allegations about NuVal, and thus the ONQI algorithm on which it ran, emanated principally from food industry sources, or those same sources by proxy, i.e., commentary by individuals with food industry ties (and funds). The ONQI is a potent truth-telling machine, effectively slapping a skull and crossbones (in the form of a very low score) on every junk food product this country contrives. Sadly, America does, indeed, run substantially on junk foods, so low scores were many- as, presumably, were the toes on which they trod.

Still, even if “fatal flaw” was objectively wrong as the many studies of the ONQI robustly indicate (see references below), there must have been some basis for making a claim of “fatal flaw” in the first place for it to seem more substantial than a simplistic insult. There was, and it leads us back to that which we call a food- which it turns out matters even rather less than it did for Shakespeare’s roses.

Imagine, for instance, this assertion: “NuVal is fatally flawed because…it scores a burger higher than a salad!” Now imagine I tell you: yes, guilty as charged! I leave you a moment to enjoy your righteous indignation…

OK, moving on: let’s address the particulars. The burger in question is lean ground turkey, or lean ground bison, blended with mushrooms; or maybe even one of these vegan wonders- with lettuce, tomato, avocado on a whole-grain bun. The salad in question is the dubiously designated “chef’s salad,”** comprised principally of miscellaneous highly processed meats, bacon bits, copious croutons, and only at best some wayward leaf of lettuce. In other words, the ONQI was entirely correct, and that which we call a burger or salad- entirely misleading.

Another example, and one I know was put to mischievous use in the service of ulterior motives, was this: NuVal has scored cake mix higher than canned fruit! Oh, the outrage.

But again, the ONQI accurately exorcised the devilry in the details. Whenever any such anomaly was brought to the attention of the team of dietitians working on NuVal, and then to mine, we examined it carefully to see if, indeed, the algorithm needed a tweak (algorithms can almost always be improved, and should be whenever they can be; and, indeed, the ONQI did evolve over time). In this infamous case, however, the algorithm was not the problem; the problem once again was the looming gulf between what we call a food, and what actually comprises it.

The “canned fruit” in question was actually a bit of misbegotten fruit stripped of major portions of itself, afloat in a sea of heavy syrup. Nutritionally, this was actually a can of dissolved sugar in which fruit was little more than a rounding error. 

Even so, it took rarefied cake mix to score better- but in an inventory of well over 100,000 foods, there is a place for rarefied cake mix. The mix in question was made of whole grain flour; cocoa; whole walnuts; and only a rather modest addition of sugar and anything else. To be clear, it scored rather low on the 100-point-scale; the ONQI never declared it a health food! It just rightly adjudicated that overall, it offered more nutritional quality than a can of heavy syrup sporting floating flecks of badly abused peaches.

So, no- the ONQI is not, was not, never was fatally flawed. When tested in diverse and demanding ways (see references below), it worked as intended. When apparent “anomalous results” were scrutinized, it turned out- it worked as intended. When people around the country used it to guide their shopping- it worked as intended, with some reporting weight loss of 100 pounds or more just by using this guidance to trade up their groceries for a year or so. That rivals bariatric surgery, and may seem incredible- but there is a plausible mechanism. Trading up selections using the numerical NuVal scale effectively distanced people from the food industry manipulations intended to make processed food all but addictive, as brilliantly described by Michael Moss. NuVal, in essence, reverse-engineered what we may presume to call “the Moss effect.”

No, the ONQI was not fatally flawed. Rather, when it produced counter-intuitive results, the ONQI was right, and that-which-we-call-a-food based intuition was wrong. Well, that was the point from the start. If common intuition were enough to see past food industry deceptions and distortions, what point would there have been in a dozen world leading scientists working for two years to build an algorithm? The value in the ONQI is that it works just as reliably when intuition is wrong, as when it is right.

The commentary authors were quite right, so far as I know, to declare the NuVal system “defunct” as a business. It is gone from the nearly 2,000 supermarkets, coast to coast, in which it was once on display. But that is testimony to failure of the business model, not the science- and it’s the science of it that matters to public (and planetary) health. Neither the expert panel, nor I, had any influence on the business model, and no role in it. I would go a step further in my case, since as the principal inventor of the algorithm I once had an interest in it*: my increasingly adamant concerns about the business model were systematically ignored for a decade. Oh, well.

Sadly, to the best of my knowledge, NuVal and the guidance it was offering millions of shoppers is, as the commentators say, defunct. So perhaps the business model was fatally flawed. Whether or not so, the proposition of speaking truth about nutritional quality to the power of the food industry was fraught with peril from the outset. There were food manufacturers- the very ones who offered us their own version of nutrition guidance that labeled Froot Loops and Cocoa Krispies “smart choices”- who fiercely opposed the ONQI from the start. Maybe they simply won in the end.

But consumers lost. NuVal’s one truly “fatal” flaw was that it worked just as intended; it told a truth some did not want on public display. The very value in the ONQI was that it processed all of the necessary details to be right, when intuition was wrong.

Dr. David L. Katz

Author, The Truth about Food. All book proceeds go to support the True Health Initiative, a federally authorized 501c3 non-profit.

*as principal inventor, and director of the team that developed the ONQI algorithm, Dr. Katz had a financial interest in NuVal when the business was viable - and was compensated as a science advisor. That role/relationship was terminated several years ago, and this column does not address matters of any current financial interest or conflict for the author.  

**I humbly propose an alternative moniker for chef's salad: "assorted dead animal bits with a bracing food science chemistry experiment thrown in for good measure, and limited allowance for accidental lettuce." I am anticipating stiff headwinds, and not really counting on it catching on. 

ONQI References
(peer reviewed publications addressing the ONQI/NuVal):

1)   Andrews JC, Jordan Lin CTJ, Levy AS, and Lo S (2014). Consumer Research Needs from the Food and Drug Administration on Front-of-Package Nutritional Labeling. Journal of Public Policy & Marketing: Spring 2014, Vol. 33, No. 1, pp. 10-16

2)   Bryan AD, Ginsburg ZA, Rubinstein EB, Frankel HJ, Maroko AR, Schechter CB, Cooksey Stowers K, Lucan SC. Foods and Drinks Available from Urban Food Pantries: Nutritional Quality by Item Type, Sourcing, and Distribution Method. J Community Health. 2018 Nov 17. doi: 10.1007/s10900-018-0592-z. [Epub ahead of print] 

3)   Carter KA, González-Vallejo C. Nutrient-specific system versus full fact panel: Testing the benefits of nutrient-specific front-of-package labels in a student sample. Appetite. 2018 Jun 1;125:512-526

4)   Chiuve SE, Sampson L, Willett WC. The association between a nutritional quality index and risk of chronic disease. Am J Prev Med. 2011 May;40(5):505-13

5)   Epstein LH, Finkelstein EA, Katz DL, Jankowiak N, Pudlewski C, Paluch RA. Effects of nutrient profiling and price changes based on NuVal® scores on food purchasing in an online experimental supermarket. Public Health Nutr. 2016 Aug;19(12):2157-64

6)   Finkelstein EA, Li W, Melo G, Strombotne K, Zhen C. Identifying the effect of shelf nutrition labels on consumer purchases: results of a natural experiment and consumer survey. Am J Clin Nutr. 2018 Apr 1;107(4):647-651

7)   González-Vallejo C, Lavins BD, Carter KA. Analysis of nutrition judgments using the Nutrition Facts Panel. Appetite. 2016 Oct 1;105:71-84

8)   González-Vallejo C, Lavins BD. Evaluation of breakfast cereals with the current nutrition facts panel (NFP) and the Food and Drug Administration's NFP proposal. Public Health Nutr. 2016 Apr;19(6):1047-58

9)   Gorski Findling MT, Werth PM, Musicus AA, Bragg MA, Graham DJ, Elbel B, Roberto CA. Comparing five front-of-pack nutrition labels' influence on consumers' perceptions and purchase intentions. Prev Med. 2018 Jan;106:114-121

10) Grant JD, Jenkins DJA. Resisting influence from agri-food industries on Canada's new food guide. CMAJ. 2018 Apr 16;190(15):E451-E452

11) Hawley KL, Roberto CA, Bragg MA, Liu PJ, Schwartz MB, Brownell KD. The science on front-of-package food labels. Public Health Nutr. 2013 Mar;16(3):430-9

12) Helfer P, Shultz TR. The effects of nutrition labeling on consumer food choice: a psychological experiment and computational model. Ann N Y Acad Sci. 2014 Dec;1331:174-185

13) Jacobson MF. An important new way to rate the nutritional quality of foods. Am J Health Promot. 2009 Nov-Dec;24(2):144-5

14)   Katz DL, Ayoob KT, Decker EA, Frank GC, Jenkins DA, Reeves RS, Charmel P. The ONQI is not a black box. Am J Prev Med. 2011 Sep;41(3):e15-6

15)   Katz DL, Njike VY, Faridi Z, Rhee LQ, Reeves RS, Jenkins DJ, Ayoob KT. The stratification of foods on the basis of overall nutritional quality: the overall nutritional quality index. Am J Health Promot. 2009 Nov-Dec;24(2):133-43

16)   Katz DL, Njike VY, Rhee LQ, Reingold A, Ayoob KT. Performance characteristics of NuVal and the Overall Nutritional Quality Index (ONQI). Am J Clin Nutr. 2010 Apr;91(4):1102S-1108S

17)   Nikolova HD, Inman JJ (2015). Healthy Choice: The Effect of Simplified Point-of-Sale Nutritional Information on Consumer Food Choice Behavior. Journal of Marketing Research: December 2015, Vol. 52, No. 6, pp. 817-835

18) Raynolds JS, , Treu JA, Njike V, Walker J, Smith E, Katz CS, Katz DL. The validation of a food label literacy questionnaire for elementary school children. J Nutr Educ Behav. 2012 May-Jun;44(3):262-6

19) Woodbury NJ, George VA. A comparison of the nutritional quality of organic and conventional ready-to-eat breakfast cereals based on NuVal scores. Public Health Nutr. 2014 Jul;17(7):1454-8

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  • Irene Gordon

    Just go for the everything in moderation approach and stop constantly worrying about what's healthy and unhealthy.

  • Sam Pitman

    It ultimately doesn't matter what you eat so long as you don't have too much of it.

  • Ryan Broadbent

    I agree 100%.

  • Nigel Welch

    My Dad (64) just got Chronic Kidney Disorder after eating process food from his childhood. Now, he cannot eat anything with salt,high phosphate and potassium and he can only drink a litre of water per day.

  • Timothy Dunn

    Not gonna lie, I quit processed foods and candies for a week and have never felt as amazing as I did when I eliminated these foods. I even read a book and did chores I didn’t know I had.

  • Chris Baker

    Plant based is the way forward

  • Liam Fagan

    It's so cringy to see adults scared of processed food.

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David Katz

Healthcare Expert

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and former President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.

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