Preventive Medicine Column

Dr. David L. Katz

This week, Walmart announced the release of its home-grown, front-of-pack nutrition guidance system.

To be fair to Walmart, the criteria they are using to tell us which foods are ‘Great for You’ and which foods are…otherwise…are, for the most part, pretty reasonable.  The Great for You system represents a vast improvement over other such industry efforts as ‘Smart Choices’ which told us Froot Loops were exactly that (Walmart was at the table when Smart Choices was developed).  It is also superior to ‘Facts up Front,’ another food industry initiative which simply takes some nutrition facts from the back of pack and puts them on the front.  This would be a terrific idea if the rate-limiting problem in the average shopper’s ability to discern better nutrition were their inability to rotate a bag or box through 180°.

But imagine a world in which Toyota announces its new rating system for car of the year, and everybody’s ok with it.  No more need for Motor Trend, or Car & Driver. 

And then, if it just happened that Toyota, using its own criteria, won ‘Car of the Year’ every year- and if Honda always finished somewhere near the bottom- we would accept this as good information on which to base our car selections.  We asked for it, we got it: Toyota!  Car of the year, every year. 

And why stop there?  Instead of using any objective or valid measure, the makers of appliances and air conditioners and light bulbs could all invent their own measures of energy efficiency, and then tell us which of their products met the criteria they made up.   No need to use miles-per-gallon to rate fuel efficiency; auto makers could design their own criteria, and then give us the enormously useful information that their cars did, or didn’t, meet their ‘yes, fuel efficient!’ measure.

And let’s go all the way!  Why have a FDA, when we could just let pharmaceutical companies devise their own criteria for drug safety and efficacy, and put on their vials: “safe and effective” or…”not so much.”

We’ve all heard “caveat emptor,” and know that the buyer must take into account the motives of the seller.   And we’ve all also heard: the fox shouldn’t be left to guard the henhouse.

Back to Walmart, there are some pretty serious limitations to a system that says a minority of foods are a ‘yes’ and the majority of foods are a ‘no.’ Apple juice, canned chicken, walnuts, popcorn, iceberg lettuce and spinach all get the same ‘yes’ score.  Roughly 4 out of 5 foods- ranging from lightly sweetened green tea, to partially hydrogenated vegetable shortening- all get the same ‘no.’

With this in mind, I guess intelligence in the population could be usefully divided into ‘smart’ and ‘not so smart.’  Albert Einstein, Isaac Newton, Stephen Hawking, and everyone who ever graduated college would be together in the top group.  Is this even vaguely useful or reasonable information? 

We physicians could divide the world into ‘healthy’ and ‘not so healthy.’  Healthy would require, among other things, normal blood pressure, normal blood sugar, normal blood lipids.  Failing that, into the ‘not so healthy’ category you would go.  So the ‘not so healthy’ group would commingle those with LDL a bit too high but otherwise fine, with those suffering from metastatic cancer or life-threatening trauma.  Again, it’s hard to see that this would be terribly useful to anybody.

This is the information we get from ‘Great for You.’  Some food makes the cut, most food doesn’t.  A food is in the top 20%, or the bottom 80%.  And, of course, there is a reason why companies selling food may not want to provide much more information than that.  I’ll leave you to guess what it might be.

What I can’t guess is why we tolerate for nutrition – which is, without question, one of the most profoundly important and universally relevant determinants of health outcomes there is- for us, and our children- what we would tolerate in no other industry.

We generally don’t let foxes guard henhouses.  Not hen houses we care about- like cars and vacuums and washing machines.

Nutrition, it seems, isn’t in such a quality hen house.  So, when you walk by the farm we all seem willing to sell, you’ll recognize it:  It’s in the 2nd rate hen house, with the fox out front.

You can wave at the fox if you want, but he won’t wave back.  Ostensibly, it’s because he’s on guard duty.  In reality, it’s because he’s too busy eating.




Dr. David L. Katz;