Why nutrition guidance fails by succeeding

There are two reasons the nutrient profiling system known as NuVal, which assigned a score from 1 to 100, the higher the number the more nutritious the food, has disappeared from the shelves of the nearly 2,000 U.S. supermarkets it populated at its peak. The first reason is that the business model didn’t work; and the second is that the science of the system worked a bit too well.

The NuVal business model failed by failing. The approach relied exclusively, for a decade during which health guidance of every variety was populating websites and apps, on supermarket shelf tags. The scores were routinely placed next to price tags on supermarket shelves.

There is a lot of information in supermarkets, however, and we rightly tune most of it out. Without any reason to look for such scores, or even know they were there — most people never even noticed them. I once gave a talk at SUNY Buffalo as a visiting professor, and during a break in the day walked to a neighboring TOPS supermarket with the chairperson of their Preventive Medicine program. The supermarket had been using the NuVal system for several years, and my colleague — who was devoted to the promotion of good nutrition, and shopped there routinely — had never even noticed it before. A guidance system you don’t know is there can’t offer much guidance.

That problem is much compounded by a number of other factors. Retailers have slim profit margins compared to manufacturers, and need to make their money where they can. They make quite a bit by accepting fees from big food manufacturers for prime, prominent shelf space. They are often less than entirely enthusiastic about unflattering scores on prominent display in such locations. They are also distracted by the need to display weekly specials, and seasonal and holiday décor. A dedicated focus on nutrition labels is extra work without much reward. The result, often, is that NuVal scores were tiny, missing, or even covered over.

As for the science of NuVal, it has mostly failed because it works too well. The algorithm underlying the program was developed by a dozen diverse luminaries in nutrition, including past and current chairpersons of nutrition at the Harvard School of Public Health; the inventor of the glycemic index; the inventor of the volumetrics concept; and so on. I was privileged to lead the group, but every decision ran the gauntlet of consensus.

The algorithm went on to be the most robustly validated nutrient profiling system yet devised, not all that surprising given that was the intent at the start. It was run through initial and advanced validation testing, and went on to be tested directly against both total chronic disease risk and all-cause mortality. In a study of more than 100,000 people, higher average NuVal scores meant lower rates of chronic disease and premature death. Studies have also examined its user friendliness, utility to shoppers, effects on food choices, and effects on food sales. NuVal has also been used as a “gold standard” by unaffiliated nutrition researchers in diverse studies.

But the system has always had the liability of very blunt truth. From 1 to 100, scores indicate overall nutritional quality based on more than 30 nutrient entries, from fatty acids to fiber, antioxidants to amino acids, added sugar to artificial sweeteners, each weighted for its specific health effects. There are many individuals and entities that do not want the truth about food on at-aglance display, some peddling baked goods, others bacon, still others purveyors of baloney of the more figurative variety.

Over the years, I met numerous people around the country, and heard from many more via email who reported losing 30, 50, over 100, and in one case over 200 pounds just by trading up every item in their grocery cart with use of NuVal for a year or more. Unlike any “diet,” this was an approach to losing weight and finding health that benefited whole families, and cost nothing extra. Why would it work? Among many virtues of the more nutritious versions of every kind of food is that they are less subject to processing that underlies intentional addictiveness, and they tend to fill us up on fewer calories. A headline of “goodbye and good riddance” may be good click bait, but does not reflect the reality. The loss of blunt honesty about nutrition is something to lament, not celebrate. The enemies of better nutrition are profitably powerful and rather ruthless, to say the least. Their interests are served when the truth about overall nutritional quality is elusive or misrepresented. The interests of those eating the many varieties of baloney they sell most certainly are not.

There is a lot of information in supermarkets, however, and we rightly tune most of it out. Without any reason to look for such scores, or even know they were there — most people never even noticed them.

Contributed photo Dr. David Katz