What actually makes food 'healthy'?
At a public hearing, the FDA heard many of the complexities behind an outdated definition. Here's what stakeholders had to say.
When it comes to food, what, exactly, does the word “healthy” mean?
Many people agree that fruits and vegetables are healthy. But what about meat? Pasta? A loaf of white bread? A low-fat ice cream bar? Vegetable snack chips? Walnuts?
The Food and Drug Administration defined “healthy” for use on food labels in 1994. But as Kind Snacks found out when it got a warning notice from the FDA two years ago over the amount of saturated fat in several of its bars, that definition is a bit outdated. One of the major tenets of the definition has to do with a product’s fat content — and while Kind bars have a higher fat content than other “healthy” products, that's because one of their major ingredients is nuts, which are naturally higher in fat.
A chart displayed by Justin Mervis, Kind's senior vice president and general counsel, at an FDA hearing in Maryland on Thursday showed “healthy” food items — at least according to the existing FDA definition — next to ones that are not. Under “healthy”? A bowl of brightly colored children’s fruit cereal, a low-fat chocolate pudding cup and frosted toaster pastries. The non-"healthy" items included almonds, avocados and salmon.
The FDA reversed its decision on Kind’s “healthy” claim in May 2016 and vowed to take another look at the word’s definition following a petition put forward by Kind. In September, the FDA officially started reconsidering the definition of “healthy"; comments about how best to define the term are being accepted through April 26.
The agency's public hearing this week was held to get input from manufacturers, nutritionists and the general public about how to redefine the term and better align it with modern science and diets.
Speaking on a panel of stakeholders, Kind's Mervis said it is important to have the term defined and regulated to best serve consumers.
“It’s simply just a signal. It’s a signal that this food meets a set of criteria,” he said. “They are foods generally recognized as good for you. It doesn’t have much of the bad stuff.”
That may sound simple. But coming up with a new, appropriate definition for the term is much harder than it seems at first glance.
“Healthy” isn’t a universally defined term, according to Douglas Balentine, the director of the FDA’s Office of Nutrition and Food Labeling’s Center for Food Safety and Applied Nutrition. Every consumer now has their own definition of what is — and is not — healthy food. Most consumers trust government food regulators to provide accurate information, and if a food product claims to be healthy, it should meet an agreed-upon definition.
“‘Healthy’ is a term that will hopefully be used by consumers in defining their food choices,” Balentine said. “We need to put consumers first and help them establish dietary patterns along healthy guidelines.”
Balentine said the original definition was targeted at reducing fat intake and pushing consumers to get important nutrients like vitamin C, vitamin A, protein, calcium and fiber in their diets. Nowadays, most consumers are more interested in the total nutritional package of the foods they are eating. Fat intake isn’t necessarily a big deal, but things like added sugars are. And the foods and nutrients that consumers should be nudged toward eating have changed, Balentine said, including more fruits and vegetables, vitamin D and potassium.
What consumers think
Labels and health claims speak loudly to consumers.
According to the FDA's 2014 Health and Diet survey, 77% of adults use food labels to help make a purchase, said Linda Verrill, a member of the consumer studies team in the agency's Center for Food Safety and Applied Nutrition’s Office of Analytics and Outreach. The same study found 79% of consumers pay attention to the label at least sometimes when they buy a food product for the first time.
While those numbers are impressive, health and nutritional claims outshine them. Almost 9 in 10 consumers use health claims in making decisions about which foods to buy. Many consumers will stop reading a product label if they see a health claim that catches their eye and satisfies what they’re looking for. If a product says it's low in sodium, for example, consumers are less likely to keep reading and see exactly how much sodium is in the product. They are also more likely to assume other positive health aspects, such as thinking the product may be low in added sugars, too.
Claims can make consumers believe in them, even if they are unlikely. The FDA's Verrill shared the results of a couple of studies she had done: One of them showed bags of snack chips, but one of the bags had a claim that it was a source of vitamins on the front. Consumers chose the chips with the claim as healthier — and spent less time looking into whether the product actually was healthier.
“Claims work. They influence what consumers think about the product and contribute to the decision to buy it.”
FDA Center for Food Safety and Applied Nutrition’s Office of Analytics and Outreach
Another study showed consumers bags and boxes of junk food — candy, chocolates, and other snacks. Some had health-related claims on them and consumers were likely to rank those as healthier.
“Claims work,” Verrill said. “They influence what consumers think about the product, and contribute to the decision to buy it.”
David Portalatin, vice president of food analyst at The NPD Group, sees similar consumer reliance on information in studies he performs. Consumers can easily find information about everything and they pay close attention to what is on product labels. A definition of “healthy” should align with what they can understand. Nowadays, consumers are most interested in seeing how much sugar is in a product — not how many calories. They aren’t looking to avoid things like fat or cholesterol.
Instead, consumers want the whole package, he said. Most consumers who follow a particular diet today use an eating regimen of their own design because they do their research and have an idea of what is best for them.
“More information is better,” he said. “It can be on the front of the package, on the back, a QR code to scan. I think the consumer desire today is for more information available.”
When the International Food Information Council Foundation asks open-ended questions to consumers about what “healthy” means, they think it should mean things like low sugar, low fat, low sodium, and overall better for them, according to Liz Sanders, the groups' associate director of nutrition and food safety. Since consumers place so much trust in the terminology on food labels, the FDA should carefully write the definition to encourage better health habits, she said.
“There are a lot of expectations around ‘healthy,’" she said. “It can create a health halo around the product as a whole.”
The perspectives of manufacturers and nutritionists
Those who make food and study nutrition have their own goals when trying to redefine “healthy.” Manufacturers want to be able to make the claim on their products, while nutritionists want to be able to ensure products with the claim are actually good for consumers.
After outlining his company’s involvement in redefining “healthy,” Kind's Mervis presented nutritional goals that he thinks should be reflected in the new definition. Healthy food should have a meaningful amount of foods and nutrients that make up a healthy diet, including fruits and vegetables, legumes or nuts. There should be no threshold of how much of a nutrient would need to be in a product, he said, meaning that it would not need to contain a certain percentage of the recommended daily amount of vitamin C or calcium.
Mervis suggested some things that “healthy” foods should not have a lot of added sugar, sodium, added fats, no-calorie or low-calorie sweeteners, or artificial colors.
“Let’s focus on the right foods, the right diets,” Mervis said. “Overwhelmingly, people are going to focus on eating the right things.”
Kind wasn’t the only brand with a representative speaking at the forum. Conagra was involved in the first definition of “healthy,” which was key to its popular brand Healthy Choice, according to Kristin Reimers, the manufacturer’s director of nutrition. Conagra launched Healthy Choice in the 1980s after its then-CEO had a heart attack and couldn’t find the kind of food he needed to promote heart health. In order to call the brand “healthy,” Conagra worked to make sure the FDA would agree with the claim.
But through the years, Reimers said, science and consumer perceptions have changed — and “healthy” doesn’t mean what it used to. “A definition of ‘healthy’ can bring excitement and consumer appeal back to foods bearing the healthy claim,” she said.
She presented a somewhat complex matrix that ranked different kinds of food based on the beneficial and less healthy components that make up their nutritional profile. Through this matrix, foods like natural peanut butter could be defined as healthy; french fries would not.
“A healthy label should not be a marketing tool that helps marginally better processed food compete with truly healthy foods like fruits and vegetables."
senior nutritionist, Center for Science in the Public Interest
Lindsay Moyer, senior nutritionist at the Center for Science in the Public Interest, suggested the most stringent guidelines of all. She said that labels need to be able to guide consumers to eat the right foods. She showed pictures of several packages of less-than-healthy items — dry pasta, fruit snacks and children’s canned tomato pasta — that all boasted label claims that made them appear to be good for the consumer.
“A healthy label should not be a marketing tool that helps marginally better processed food compete with truly healthy foods like fruits and vegetables,” Moyer said.
But is “healthy” worth defining at all? Pepin Tuma, senior director of government and regulatory affairs for the Academy of Nutrition and Dietetics, said he spoke to his members about what “healthy” should mean. He got consensus on several things: Dietitians overwhelmingly agree that the definition is outdated, and they feel a definition should reflect actual nutrition science.
The word “healthy,” however, means something different to everyone, Tuma acknowledged. The things that everyone agrees are healthy — fruits and vegetables — aren’t subject to labeling. Anything put in place should nudge consumers toward better eating habits.
Tuma said the Academy of Nutrition and Dietetics ultimately found itself in the “frustrating” position of not being able to come to consensus over how “healthy” should be defined.
“Where does that leave us? We don’t have an answer,” Tuma said. “I know that’s unnerving. We have not been able to come up with a legal definition to apply the principles.”
Follow Megan Poinski on Twitter