Tuesday, August 31, 2010

Is obesity genetic?

While lifestyle contributes substantially more to risk of cancer (and other chronic diseases) than genetics alone, the interplay between genetics and lifestyle is a subject of increasing interest. That's what makes a new study out of the UK, published in PLoS Medicine so exciting.

The researchers took 12 genetic mutations that had previously been found to be associated with obesity risk and examined how they combined to be associated with risk of weight gain. The presence of each additional mutation increased risk of weight gain -- the more mutations, the greater the risk. The mutations significantly increased the risk of obesity by 16%. The researchers then did something quite novel, using the data the participants reported about how physically active (or not) they were, the researchers re-examined the associations. In the inactive men and women, the association was stronger than in the inactive people. What this means is that the effect of genes were stronger in the people who were inactive - or - that physical activity "erased" some of the genetic predisposition - about 40% of it.

What does this mean for those of us who have no idea how "genetically predisposed" we might be to obesity? Physical activity has benefits for everyone, but for individuals who are genetically predisposed to obesity, physical activity is especially important. It also means that a genetic predisposition to obesity isn't cause for "doom and gloom" - there ARE things you can do to counter it - notably, being physically active!

Monday, August 30, 2010

Medicare: putting their money where the evidence is

On Friday, the federal government announced that effective immediately Medicare would cover the cost of smoking cessation counseling. Anyone covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them quit. (All people with Medicare will continue to have access to tobacco cessation prescription medication through the Medicare Prescription Drug Program.)

This is great news on several fronts:
- there is great evidence for the value of this kind of coverage so it is nice to see the goverment implementing evidence-based medicine
- other insurers typically follow what Medicare does
- it keeps tobacco in the news - an issue we've discussed before

Friday, August 27, 2010

The price we pay for obesity: diabetes drives hospital costs

The Agency for Healthcare Research and Quality reported yesterday (see full report) that 1 in 5 hospitalizations in 2008 involved a person with diabetes. This amounted to 7.7 million hospital stays at a cost of $83 billion in just the hospital costs. Diabetics had hospital stays that were longer, on average, and more likely to originate in the emergency department than stays for patients without diabetes. While diabetes was the indication for hospitalization, many of these patients were admitted with circulatory disorders or complications due to their diabetes.

Why this matters
Medicare covered almost 60% of the total hospital costs for these diabetic patients. So we all paid our share.
Second, diabetes is driven by obesity and lack of physical activity, with poor diet adding further risk. We have previously shown that the vast majority of diabetes in adults is preventable. This is supported by randomized trial evidence that weight loss reduces incidence of diabetes.
Importantly, we have discussed the role of diabetes and obesity as causes of cancer, yet another cost to society.  These disease and their costs are avoidable through prevention.

So while the pattern of hospitalization for diabetes tracks the CDC maps of obesity – higher rates of hospital sat in the South, the cost to society of not acting to prevent adult weight gain and the ensuing health consequences is adding enormously to the costs of our health care system. We have the strongest evidence that weight control can avoid many of the complications of overweight and obesity, not just diabetes but also cancer and heart disease.

Following the steps we outline can prevent cancer now. We need to increase our focus on weight control at the clinical level of primary cancer; at the policy level through strategies that can make activity a part of our everyday lives (and reinforce these behaviors once we all adopt them); and through our communities and schools so that we all move to a healthier lifestyle before our hospitals buckle and collapse under the weight of obese diabetic patients.

Thursday, August 26, 2010

State policies drive cancer burden

Recent media reports highlight how a lack of state policy on cigarette taxes can drive a state to have high cancer rates. Missouri is a fine US example which now has the lowest tax on cigarettes in the nation (17 cents per pack).

State level policy impacting cancer is not limited to just cigarettes and increased burden from smoking-related cancers, however. With reductions in resources available to the state, Missouri cut back funding for the Breast and Cervical Cancer Screening Program (in Missouri called Show Me Healthy Women). This added t to the existing language in qualifying for treatment after diagnosis among women without health insurance leads poor rural areas to have low breast cancer incidence (lack of screening) and high mortality. This morality is driven by late stage at diagnosis and limited access to current standard quality of care for breast cancer.  Maps at the county level show rural Missouri dominates the state with high cancer mortality.

If we are to overcome disparities in access to detection and care for cancer patients, then state policies must foster access for all. Access has to be not only for detection methods (breast, cervix, and colon cancer screening) but also to effective programs to aid cessation from smoking.  Programs must also seamlessly link those diagnosed with cancer to effective care.

Wednesday, August 18, 2010

Superbad? The Problem with "Superfood" Lists

Today I hopped over to Forbes.com to review their "most stressful cities" list (and was relieved that St Louis wasn't topping another "bad" place to live list -- I think topping the syphilis list is enough). While I was there, a link to a list of "10 foods you should be eating" caught my eye. I'm always wary of such lists, and this one provided a nice reminder of why:

The list starts out with three great foods - cherries, blueberries and kiwi. All three are great choices because they are fruit and eating a lot of fruits and vegetables have been shown to decrease risk of several diseases, including cancer. The problem, to me, is that most Americans don't come anywhere near to eating enough fruit, regardless of the type. Also, the three fruits are in season for a pretty short period of time, making their cost pretty high the rest of the year. Add to that, the fact that berries tend to top lists of fruits that absorb the most pesticides, so other lists are telling you to only buy organic and you've got a major cost issue on your hands. For most people, just starting to eat 2-3 servings of fruit a day, of ANY fruit, is going to be a big step.

The list then moves on to proteins -- grass-fed beef, wild salmon, flax seed and whey protein powder. While I certainly see the merit of choosing grass-fed beef over industrial beef for the reasons listed (omega-3 content being a big one, environmental impact being another), the context is missing here. Grass-fed beef is expensive and most Americans eat too much red meat of all kinds and certainly don't need beef appearing on a list of things they need more of. If you want to up your omega-3 intake, replace your meat intake with other sources of protein rich in omega-3, like fish and flax seed and aim to reduce your meat intake in general.

The list ends with dark chocolate. With overweight and obesity rates topping 60% in the US, I don't think anyone needs encouragement to eat more chocolate. Granted, the fine print suggests looking for chocolate with at least 60% cocoa content (ruling out most candy bars in the checkout aisle), but portion size and frequency of intake are big issues here and neither is mentioned.

Also overlooked in the discussion is that much of the data supporting the "superfood" concept don't come from studies of people eating those foods. The data come from studies of human cell lines or of extracts of a single component/nutrient that the food is high in. The problem with these studies is 1) that flesh and blood humans are very different from a collection of cells in a petri dish and 2) that the volume of intake needed to reach the dose given to the cells or extracted and given to humans is difficult to achieve through consumption of the food itself.

So, the cold reality is that there are no real "superfoods," just like there are no magic bullets.  It's simply a title dreamed up by magazine editors or folks who don't have a good understanding of the science linking diet and human health.

Of course, overall diet can have a large impact on chronic disease, and making simple, largely inexpensive, changes to what we eat can have big benefits.  Eating a diet rich in fruits, vegetables, whole grains, and healthy fats (like poly and monounsaturated fats); and low in red meat and unhealthy fats (like saturated and trans) will trump any collection of "superfoods" when it comes to health benefits, and it'll likely save you a lot of money along the way.

I wonder if by suggesting that people need to go spend $30 on organic blueberries and eat chocolate to be healthy we actually encourage the status quo as so few people have the ability to spend at this level and so few read the fine print of the message? What do you think? Do these lists help you make healthy choices or confirm that you are/aren't healthy already?

Monday, August 16, 2010

Carrots, Sticks, and the Potential Benefits of Health Incentives

It's a common theme here at Cancer News in Context - the important role our social and physical surroundings play in our health choices (previous posts).  The current issue of CDC's journal, Preventing Chronic Disease, is devoted almost solely to one aspect of this: creating incentives for individuals or communities to make positive health choices.  Because as we all know, sometimes it takes a little push - a view of that carrot on the stick - to actually take the steps we know we should.  

Discussed in the articles, which were penned by researchers and scientists involved in Robert Wood Johnson's MATCH (Mobilizing Action Toward Community Health) program, are incentives that range from financial (like, pay-for-performance) to reputational (like, community health rankings) to legal.  

By developing such incentives and studying them closely to determine which ones work and which ones are best left on the shelf, the ultimate hope is to not only effect a broad, positive change in populations but also ultimately shift the balance of the health care focus in the US much more towards prevention than it is right now.  

It's a tall order, but the benefits (apart from the carrots) could be huge.

Thursday, August 12, 2010

Preventing Cancer: It's this easy...and this tasty.

In previous posts, we’ve talked about implementing the weekday vegetarian plan or moving from your farm share box to a meal plan. For those who don’t have a big pile of recipes in the kitchen (or who are at work trying to figure out what to make for dinner that night), the internet is a GREAT resource for just this type of meal planning.

Last week I realized I had a bunch of eggplant from my farm share that I needed to use up. I was at the office, so on my lunch break (of course), I went to a few of my favorite websites for recipes using eggplant. On Smitten Kitchen, I found a recipe for an eggplant and barley salad. I looked through the ingredient list to see how it aligned with my recipe goals:

- Whole grains? Yes – the recipe base is barley, a tasty whole grain. I think you could also substitute brown rice if that’s what you have, but we always have barley in the freezer (which helps keep it from going rancid in the sweltering swampy summer heat of St. Louis).

- Vegetables? YES! In addition to eggplant, the recipe calls for zucchini and tomatoes. Both are in season and were looking fantastic at the Washington University School of Medicine Farmer’s Market last Thursday so I grabbed both.

- Color? Lots of it! Nothing makes a healthy dish less appetizing than a sea of drab brown colors. But Deb’s recipe is full of color – green (zucchini and lots of fresh herbs), red (tomato), purple (red onion, eggplant and olives)

And of course, the ultimate test was the taste – which was delicious. I scaled back the oil, salt and sugar by about half and skipped the cheese and thought the result was fantastic.

Knowing that I was going to make this on the weekend and that my husband would appreciate some meat after a week of delicious meatless meals, I headed over to another favorite website, One Hungry Mama, for some ideas. I’ve found that one of the keys to keeping my sanity when cooking family dinners is to focus on one dish and keep everything else simple. Since the barley salad had a good amount of chopping involved, I was looking for a main course dish that involved little to no effort. As usually happens, Stacie had the perfect option – slow cooker ribs. While ribs aren’t appearing on any “healthy living” list anytime soon, they are a fine “occasional” food, particularly if that is your only red meat for the week! I’d never thought to do ribs in the slow cooker before but the ability to drop them in and forget them was hugely appealing. And, as Stacie notes, the slow cooker is a great resource for hot summer days when you don't want to turn on the oven (see above). My family’s favorite barbeque sauce isn’t sold in stores around here (hint hint Dinosaur guys), but thankfully, they have a cookbook that includes the recipe for their Mutha sauce. I like to cook up a batch at the beginning of summer and freeze it in 2 cup portions. Since I still have a bit left, I decided to use that instead of Stacie’s Asian BBQ sauce recipe (that I’m hoping to try another day). I knew I’d want to throw the ribs on the grill at the end as Stacie suggests to get that nice crisp edge so I scaled back the sauce I put in the slow cooker to about one cup (the sugars in barbeque sauce will burn on the grill and you’ll get too much char). When the ribs were done in the slow cooker (perfectly cooked, falling off the bone), I slathered a tad more sauce on them (about ¼ cup) and put them on the grill for about 3 minutes. When I took them off, I slathered on another 1/3 cup of sauce and served the rest on the side.

Last, I took some gorgeous sweet corn I picked up at the farmer’s market and cooked that. It was a great summer meal – full of flavor, whole grains and vegetables.

Wednesday, August 11, 2010

Obesity Epidemic: Let's move from media attention to action

We have covered numerous aspect of the obesity epidemic over the past 3 months. The report last week on rising obesity in America continues to point to the growing burden now and into the future that our lifestyle and social structures are  facilitating. Time (see article) covered a new research study showing weight gain during pregnancy increases risk of heavy weight babies – and previous studies show birth weight and childhood obesity lead to adult obesity. Are we programming the next generation for obesity and poor health?

Recent studies now suggest that diet around the time of conception can impact the genetic function of cells in the newborn – programming them to become overweight and obese adolescents.

Given the mounting evidence when will we move beyond simply reporting more studies and translate our enormous knowledge base to an action plan that is supported, implemented, and finally successful to turn the epidemic around and successfully prevent cancer and other chronic diseases like diabetes and heart disease that are driven by the excess weight gain we are seeing al around us?

Australia has launched a major campaign with strategies (see reports) that range from reshaping the food supply towards lower risk products and encouraging physical activity to protecting children and others from inappropriate marketing of unhealthy food s and beverages, to reshaping the urban environments towards healthy options (active commuting and the like) to strengthening the skills of primary cancer providers and the public health workforce to support people making healthier choices. All these changes must of course be implemented across all sectors of society to shift us to a healthier population with lower risk of cancer diabetes and heart disease.

Action steps:
We need to focus on steps we can take with our families, friends and workplaces; strategies that will change our environment to be healthier; and changes in the health care system place more skills and appropriate resources into bringing weigh control into the center of many interactions between patients and health care providers.

Tips for individuals

The basics
To achieve and maintain a healthy weight, you must find a balance between the calories you take in from food and the calories you burn during physical activity.  Eating more calories than you burn leads to weight gain; eating fewer calories or exercising more leads to weight loss.

To lose a pound of weight, you must burn 3,500 calories more than you take in.  This is possible by combining healthy eating with increased activity.   For example, eating 350 fewer calories and doing 30 minutes of moderate activity (burning 150 calories) leads to a 500 calorie reduction per day.  Over seven days, this results in a 3,500 calorie reduction and the loss of one pound.   Even small changes can make a big difference: cutting out one soda (about 150 calories) or taking a 30 minute brisk walk (also about 150 calories) on most days can lead to more than a 10-pound weight loss over a year.

Tips on diet and weight
The best way to lose weight is to make small changes in diet and exercise that can be maintained over time. 
  • Set reasonable goals.  First, avoid additional weight gain.  If you are overweight or obese, aim to lose 10% of your body weight, which can bring significant health benefits.
  • If you need to lose weight, do it gradually.  Work to lose 1/2 to 2 pounds per week, and keep it off permanently.
  • Motivation is key.  You are more likely to succeed when you believe you can and are willing to take steps to control your weight.
  • Avoid large, rapid changes in your diet.  Your body may react by slowing its basal metabolic rate, making it harder to shed extra pounds. It is better to make small changes that can be maintained over time.  Gradual weight loss can lead to decreased body fat, not just the temporary loss of water weight that can come with rapid weight change.
  • Avoid fad diets, which do not include a variety of nutritious foods or promise quick and easy weight loss.  Weight that is lost quickly is often regained quickly.
  • Make healthy food choices.  Focus on fruits, vegetables, and whole-grain foods.  Many high fiber foods provide nutrients and help you feel full.
  • Know your eating patterns.
  • Find ways to deal with stress other than eating.  Try exercise, support groups, meditation, or talking to friends
  • Eat a healthy breakfast, and don't skip meals.  Try to eat small meals throughout the day to keep from feeling too hungry.
  • Plan healthy snacks, and make them readily available.  For example, have carrots and celery sticks, or pretzels and popcorn around the house.  Leave a bowl of fruit on the table.  Bring healthy snacks to work.
  • Drink water to keep yourself well hydrated, and avoid high calorie sodas.
  • Avoid alcohol, which can add a lot of calories without any nutritional benefit.
  • Avoid snacking or eating meals in front of the television.
  • Eat smaller portions, and use a smaller plate if you like seeing a plate full of food.
  • Identify the barriers to healthy food choices and look for ways to overcome them.

When you shop 
  •  Don’t go food shopping when you are hungry.  Make a grocery list, and stick to it. 
  • Always read labels to learn how many calories and what types of nutrients are in different foods.
  • Go to the produce section of the store first to make sure you get enough fruits and vegetables.
  • Don’t buy “junk food” or drinks high in added sugar, like soda, fruit drinks and sports drinks.
  • Buy more chicken or fish instead of red meat.
  • If you like red meat, choose the leanest cuts (such as cuts called "loin" or "round").
  • Instead of whole-milk or 2%, choose low-fat dairy products, like 1% or fat free milk, cheese and yogurt to get the nutrients you need with less fat and fewer calories.
  • Choose lower calorie options if they are available.  Remember that low-fat options may be high in calories, and even low-calorie foods can lead to weight gain if eaten in large amounts.
  • Choose a squeeze margarine without any hydrogenated oils instead of butter or stick margarine.
When you prepare food
  •          Make fruits, vegetables, and whole grain foods the center of your meals.
  •  Always take the skin off chicken, trim the fat from meat, and drain the grease
  •  Bake or broil foods instead of frying them.
  •  If you cook or bake with oil, use it sparingly and choose the more healthy oils, like peanut, canola, or olive oil, rather than butter or shortening.
  • Avoid drenching salads in dressing. Use a smaller amount of dressing, and spread it evenly over your salad.  Use lemon juice or spices to add extra flavor.
  • Avoid adding large amounts of butter or margarine to foods, like bread, corn, potatoes, or vegetables.
When you eat out
  •   Choose salad instead of creamy soups, high-calorie appetizers, or dinner rolls.
  •  Select from the light menu if one is available.
  •  Choose chicken or fish instead of red meat.
  •  Ask for baked or broiled foods instead of fried foods.
  •  Order a half portion, or take extra food home in a doggy bag.
  • Order items without mayonnaise or cheese.
  • Don’t add extra butter, margarine, sour cream, or dressing to your food.
  • Skip dessert or share with a friend.
  • Drink water instead of high calorie soft drinks.
  • Limit alcohol.

Tips on exercise and weight
Physical activity does not need to be strenuous to be healthy.  Exercise not only burns calories, it also raises the body's metabolic rate (how fast the body burns calories even when you're not exercising). Exercise also decreases appetite, helps reduce stress, and lowers the risk of many chronic diseases.
  • Start slowly and build up the amount of physical activity that you do each day.
  • Even if your time is very limited, you can reach the recommended 30 minutes per day by  doing just a few minutes of exercise several times per day.
  • Decrease time spent doing sedentary activities like watching TV.
  • Plan family activities centered around fun and exercise.
  • Pick activities you enjoy.
  • Establish an exercise routine.
  • Make exercise a priority.
  • Find a friend to exercise with.
  • If you start getting bored, make an exercise log to check to progress, or consider adding other types of physical activity to keep up your interest.

Important reminders
Weight control is a lifelong effort, so don't get discouraged by temporary setbacks.  Losing weight can be very challenging; work to keep yourself motivated. 

  • Make healthy food choices and stay active.
  • Set short-term, realistic goals, and reward yourself for achieving them with non-food items, like a movie, a visit with a friend, or a new piece of clothing.
  • Keep a food diary and an exercise log to monitor your progress, identify barriers and improve your efforts.
  • Avoid weight gain over the holidays. If you do gain weight, take steps to lose it as soon as possible.  Even a few pounds gained each year can add up to a large weight gain over time.
  • Weight-loss diets should be lower in calories without compromising nutrition.
  • Always think about healthy substitutions, like having a baked potato instead of French fries, a bagel instead of a doughnut, fish instead of beef, pretzels instead of potato chips, fruit instead of cookies.
  • Don't deprive yourself.  Instead look for lower-fat or lower-calorie substitutes.  If there is no acceptable substitution available, have a smaller portion, or have it less frequently.
  • Ask for help if you need it: talk to family, friends, or your health care provider.  Also consider a weight loss support group in your neighborhood or at a health club.

Wednesday, August 4, 2010

Obesity: Disturbing Rates Even if Trends Show a Glimmer of Hope

The health making headline this morning is the latest data out of the CDC indicating that obesity rates are continuing to rise across the country – topping 30% of the population in nine US states. Yet, just a few months ago, weren’t we celebrating the headline that obesity rates had plateaued and stopped rising based on data from the CDC?

In a word, yes.

How is this possible? Does it mean the CDC doesn’t know what is going on? Not at all! The data are based on two different sources of information under the purview of the CDC – the Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey. The two studies, unfortunately, do provide different estimates of the prevalence of health behaviors (including physical activity) and health outcomes in the US. In part this is due to different sampling strategies. Simply put, they are both trying to sample a group of people representative of the entire US, but each go about it in different ways.

But the headlines surrounding the NHANES data that came out earlier this year masked the important data that the BRFSS data highlights today – that 30% of the US is obese. Whether or not the trends are going up or leveling off, that is an alarmingly high figure. And remember, that doesn’t include the percentage of the population who are overweight – which correspond to another 30-35% of the population.

For tips on making some of the healthy choices than can help with weight management, check out our tips on healthy cooking, eating fruits and veggies, being sedentary, being active, the context of weight loss and perhaps most important – making time for those healthy choices.

Tuesday, August 3, 2010

Improving America's Health

In the August issue of Health Affairs (vol 29, no8 pages 1481-88), David Williams and colleagues summarized the report of the Robert Wood Johnson Foundation Commission to Build a Healthier America. Much of the focus of this report is on the need for actions at all levels of society to promote the development and maintenance of health rather than depending on the health care system to treat Americans after the onset of major diseases. Acknowledging that medical care prevents only 10 to 15% of premature deaths the commission advocates a range of policy and behavior changes that will promote health. The major emphasis is on early childhood and healthy growth. Initiatives could focus on children through prevention of childhood obesity, emphasis on physical activity, and healthy nutrition. Such child development clearly needs a supportive healthy community to sustain active lifestyles, avoid the uptake of cigarette smoking, and maintain healthy growth and development among children and adolescents. The commission clearly makes the case for improvement in health through documenting substantial gaps between the United States and other developed countries. These gaps in measures of health persist, but are reduced, with increases in income and education. Even the best off Americans are behind citizens of other countries in many key health measures.

In a manner similar to this commission, Australia has developed a framework for preventive health and established goals to position the country as the healthiest nation in the world by 2020 (see report and detailed strategy). In both countries, it is clear prevention and sustaining healthy lifestyles requires action both through the healthcare system and in the broader community including workplaces, schools, and neighborhoods. Only when we address prevention across individual behaviors, social determinants of behavior, and broader social supports for healthy lifestyles, will the US begin to approach the levels of health and wellness that many of the other countries in that the leading economies of the world have already achieved.

Education is a key variable that drives much of ones lifetime trajectory for health and wellness. The Robert Wood Johnson report clearly articulates the importance of bringing many areas, including education, to the table to better inform strategies to achieve improved population health. We have much potential to build on examples of local initiatives that have successfully improved nutrition and physical activity and development of children (Gortmaker, Cheung et al. 1999). Workplace interventions have also improved diet (Sorensen, Stoddard et al. 1999), reduced smoking(Sorensen, Rigotti et al. 1991), and reduced risk of cancer and other chronic diseases (Colditz 2002; Sorensen, Stoddard et al. 2002). Applying these lessons more broadly throughout the country court substantially improve the health of all Americans (Colditz 2002). The challenge we face as a nation is bringing these advances to the whole of our society. The Affordable Health Care act is but one tiny and necessary step to improving the health of our nation.


Colditz, G. (2002). "Disseminating research findings into public health practice." Cancer Causes Control 13(6): 503-504.
Gortmaker, S. L., L. W. Cheung, et al. (1999). "Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving." Arch Pediatr Adolesc Med 153(9): 975-983.
Sorensen, G., N. Rigotti, et al. (1991). "Effects of a Worksite Non-Smoking Policy: Evidence for Increased Cessation." Am J Public Health 81: 202-204.
Sorensen, G., A. Stoddard, et al. (1999). "Increasing fruit and vegetable consumption through worksites and families in the treatwell 5-a-day study." Am J Public Health 89(1): 54-60.
Sorensen, G., A. M. Stoddard, et al. (2002). "A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States)." Cancer Causes Control 13(6): 493-502.

Monday, August 2, 2010

Keeping Score: Help at the Grocery

This week, the Wall Street Journal reported on the launch of a new scoring system in grocery stores developed by the company, NuVal, which worked with a panel of (reputable) nutrition and health experts to create a scoring system that can be used to evaluate the nutritional value of products. While creating a perfect scoring system isn’t going to happen, NuVal does a pretty good job. Here are a few of the reasons why we think so:

1) “Healthy” is a pretty ambiguous word these days and some food items or nutrients may be more or less beneficial depending on your goal. For example, lycopene may reduce risk of prostate cancer, but for the 50% of us (i.e. women) without a prostate, that may not be a real priority when making food choices. Despite the limitations inherent in any scoring or valuation system, NuVal is pretty good at highlighting items that would fall under the “healthy” category for just about any “health” outcome. Unlike, say, the manufacturer produced labels trying to entice me to buy sugar-laden cereals because they threw in a scoop of whole grains. For example, even though Kashi brand cereals all contain whole grains, the Strawberry Fields cereal gets a score of 11 as compared to the 7 Whole Grain Flakes that gets a 29.
2) It provides a sense of magnitude of “healthiness” (I’m starting to feel a bit like I’m diving into Colbert’s “truthiness” here, but stick with me). I think most people would accurately guess that shredded wheat (unfrosted) is “better” than cocoa whatevers, but I think seeing the difference between shredded wheat and a cereal plenty of people I know think of as being “okay” (certainly not the healthiest cereal in the aisle but not a demon either) like Life (91 vs 25) might push folks to reconsider the Life and look for a cereal with a bit more fiber. My guess is that it will also help many parents look a little closer at the items marketed to kids. There are plenty of kids yogurt products in my local grocery store with as much added sugar as a candy bar. For someone rushing through the store with a tired, hungry (and thus, cranky) kid, the single number in front of the shelf might push a healthier choice when full label reading isn’t feasible.
3) That said, I’m still intrigued by the system and curious how iceberg lettuce gets the same score as canned spinach. I think other shoppers will be too and hopefully their curiosity will get them to read the labels (does that canned spinach have added salt perhaps?)

I’m sure the NuVal system will continue to evolve and alternates are surely on the way. I can easily see someone combining the UPC reader app on my iPhone with an eating guide app. What do you think? Anyone have NuVal in their local grocery? Is a system like this helpful or do the “huh?” moments make you wonder about the whole thing? Would you rather have a topic specific rating system? Perhaps that eating guide app would let you pick your goal – cancer prevention, weight management, cardiac rehab or general health?