Preventive Medicine Column
Dr. David L. Katz
At a press conference this week featuring none other than First Lady Michelle Obama, Walmart made pledges that should, in principle, put more nutritious food within easier reach, literally and figuratively.
Literally, because the nation’s largest grocer promised to reduce sugar and sodium in its own product line, and eliminate added trans fats over the next 5 years. They also plan to develop a logo to signify foods that meet their internal standard for better nutrition.
These promises sound good, and along with my public health colleagues, I commend Walmart for making them- and in anticipation of Walmart keeping them. But I must append some precautionary caveats.
Perhaps ironically, even as Walmart was promising both to provide more nutritious foods, and tell us which ones they are, the national non-profit Prevention Institute issued a report indicating that entities selling us food are not reliable judges of nutritional quality. The report, based on an examination of various front-of-pack claims indicating “more nutritious” children’s foods, found that nearly 85% of the products with specific shout-outs about their nutritional virtues were unhealthy by the evaluators’ objective standards (http://www.preventioninstitute.org/component/jlibrary/article/id-293/127.html).
I can validate this worry with a personal view from altitude. NuVal (www.nuval.com) scores for overall nutritional quality have been generated for over 90,000 food products thus far. These scores require a database of ingredient lists, nutrition facts, and scanned images of packaging for every product. In fact, to our knowledge, this is by far the largest and most detailed nutrient database on the planet.
It provides a disquieting view of how marketing claims and nutritional reality part company. The NuVal database includes examples of sugar-reduced kids’ cereals that are less nutritious than the original- because of added sodium, reduced fiber, and other changes. The average score for regular peanut butter is a respectable 20; the average score for seemingly more nutritious fat-reduced peanut butter is a far-less-respectable 7, because of copious additions of sugar and salt in place of the removed fat.
In fact, the consistency with which front-of-pack nutrient claims and an objective measure of overall nutrition go in opposite directions is so compelling that we are currently pursuing a formal analysis.
Will Walmart offer us truly more nutritious products, or products tweaked to allow for claims of better nutrition belied by an objective measure of overall nutritional quality? Time will tell.
As for putting nutritious foods figuratively within easier reach, Walmart also pledged to reduce prices of healthful foods, produce in particular. Here, too, the commitment sounds good. But here, too, some caveats attach.
First, with the possible exception of the produce aisle, more nutritious food does not necessarily cost more right now, despite the urban legend that it does. In a research paper currently in press, my colleagues and I report what happened when we sent a volunteer grocery shopping with nutrition standards and instructions to buy equal numbers of foods from a variety of categories meeting, and failing the standards (freely available to you, by the way: http://www.davidkatzmd.com/nutritiondetectives.aspx). We compared price, and found…no difference.
Why the urban legend in the first place? Because health conscious shoppers are willing to pay a premium for more nutritious foods, so there is an incentive to make foods that call out their nutritional virtues on the package, whether or not they are in fact nutritious overall, and charge extra for them. That practice prevails. But by and large, such foods are not more nutritious- just more expensive! Often, a less expensive, more humbly packaged alternative offers better nutrition as well.
Walmart may simply be engaging in good corporate citizenship (I know some of the good people in high places there, and this is by no means implausible); they may be propping up their argument for real estate in New York City; or they may be making some promises they will have a hard time keeping.
But come what may, we all know that the business of business is business, and no publicly traded company will go very far in a direction that makes share holders unhappy. What Walmart does must ultimately be good for their bottom line, whether or not it’s good for yours.
Logically, there is only so much a company that sells food can benefit from lowering the price of food. If we want real action in the area of making more nutritious foods more affordable, we need it from those directly involved in paying the health care costs that relate in no small measure to the bad food choices that currently prevail. The development and course of obesity, diabetes and cardiovascular disease are powerfully and directly associated with food choices. For cancer, osteoporosis, arthritis and a number of other conditions, the causal chains are a bit longer and more twisted, but diet is still quite clearly among the key links.
Thus, policies that meaningfully shift food selection and diet pattern in a healthful direction with financial incentives could also meaningfully reduce the population burden of these conditions, which in turn could slash health care costs. The SNAP program would be a great place to prove the principle. Large employers, private insurers, and the federal government could all win big.
And so could we. But only when the promise of truly better food truly within easier reach of all is truly kept.
Dr. David L. Katz; www.davidkatzmd.com