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A Healthy Misperception

Most consumers are confused or misled — or outright wrong — about the healthfulness of food and where healthy food can be found.

By David H. Freedman

Every other week I spend three days in Baltimore for work. There’s no kitchenette in the hotel I stay at, so almost every day I’m there I get prepared take-out meals from two places: a Whole Foods and a 7-Eleven.

I like the Whole Foods because the salad bar and prepared food section provide a wide selection of tasty foods, but I actually feel better about the meals I buy at the 7-Eleven. Never mind that the meals at the 7-Eleven are a lot cheaper than at Whole Foods — about half the price for roughly equally filling meals. I prefer the 7-Eleven meals because they’re much healthier.

In fact, I have a lot of trouble picking out the healthy fare at Whole Foods. Whole Foods doesn’t post calories, fat content and other basic nutritional information above their prepared foods bar, which would be extremely helpful to those of us who would prefer to eat healthfully. But they do post ingredients lists, which reveal that some type of fat is usually in the top two or three ingredients, helping to send the calorie count shooting up. And there are lots of simple or starchy carbs in virtually all their prepared foods, including sugar. Yes, it’s all pretty tasty — but food that’s tasty by virtue of being fatty, floury or sweet isn’t a very good deal if you’d like to live beyond 70, and be walking when you get there.

That’s why I appreciate my usual 7-Eleven meal: A chef’s salad and a ham and cheese sandwich on a whole wheat bun. Both are reasonably delicious and fresh-tasting. More important to me is that both items provide lots of good protein, whole grain and fiber, modest amounts of fat and calories, and almost no sugar or refined flour. I skip the salad dressing and throw out half the bun (healthy eater that I am). I only wish it were that easy to trim the fat and carbs in the Whole Foods meals — even most of their vegetable dishes glisten with oily, sugary coatings.

And one more bonus to getting food at the 7-Eleven: I can be  in and out of there in two minutes, compared to the 20 minutes it can take to make it out of the Whole Foods.

No one would be surprised to hear that a convenience store’s packaged meal is faster and less expensive than a prepared meal from a high-end supermarket catering to foodies obsessed with eating natural foods. But the claim that the convenience store meal is a lot healthier would strike most people as unlikely. There’s a simple reason why: Most people are confused, misled or outright wrong when it comes to judging the healthfulness of food and to figuring out where healthy food is or isn’t easily found.

But that’s likely to change, and therein lies a great opportunity for the convenience store industry.

We hear over and over again in all media that processed food is making us sick and convenience stores, along with fast-food restaurants, are among the biggest culprits in slinging these toxic fake foods at the public. The New York Times alone has provided a string of prominent articles hitting on this theme, from popular journalists such as Michael Moss, Mark Bittman and — most famously — Michael Pollan. Their messages are similar: Processed food is making us sick. We have to switch away from these “food-like substances,” as Pollan calls them, to natural, fresh, “real” foods.

But what really makes a food healthy? Before we can answer that question, let’s first decide what health problems we want to address through food choices. After all, the answer can be very different depending on whether we’re worried about malnutrition, heart disease, cancer or infection.

The Focus: Obesity
I’d argue there’s really only one food-related health problem worth focusing on: obesity. About one-third of all Americans are obese, including children. A study published in the journal Obesity found that obese young adults and middle-agers in the United States are likely to lose an entire decade of life on average, which means those who are alive today in the United States can collectively expect to lose a billion years of life to obesity. For the first time in modern history, the human race is getting less healthy, mostly because of excess weight. Obesity degrades people’s quality of life, and according to a George Washington University study an obese person costs society more than $7,000 per year in lost productivity and added medical treatment.

We don’t know how to hugely lower the rates of most types of disease, but we know exactly how to do it with obesity: Getting exercise is important, but mostly we need to get people to eat differently.

So let’s say that by “healthy food” we mean food that will help people manage excess weight. What sort of food is that? Science is absolutely clear on that question: It’s food that’s lower in calories and that tends to go easy on fat, sugar, simple carbohydrates (like white flour), and starches (like potato), while pumping up the lean protein and whole grains and other complex carbs. Fat carries twice as many calories as carbohydrates and protein do per gram, which means it drives up the calorie count. Sugar and many other carbs provide a fast energy rush, commonly followed by an energy crash that can lead to a surge in appetite. Fat and simple carbs also push the many pleasure meters that evolution placed in our brains and digestive systems over the millions of years during which starvation was an ever-present threat.

That’s why experts recommend that anyone who wants to lose weight transition to a diet high in lean protein, complex carbs such as whole grains and legumes, and the sort of fiber with which vegetables are loaded. That’s what healthy food is. Does it matter if that food is processed or completely natural? Absolutely not. There is no hard evidence to back any health-risk claims about processed food. Nor is there any clear evidence that any food that has been recently plucked from a nearby farm has any special health properties. In fact, that wonderful natural food is often brimming with fat, sugar and calories, which can make it a health nightmare.

Want to see some great health food? Forget Whole Foods. Go to the nearest Burger King and check out the “Satisfries” — the lower-fat, lower-calorie version of their French fries — or the turkey burger. At McDonald’s, try the Egg White McMuffin or  the  Premium  Chicken Wrap. These sorts of products typically reduce calorie counts in a dish by about 50 calories. That places an eater exactly on track for a full-day reduction of a few hundred calories, exactly the amount needed for long-term weight loss. Any  bigger  reduction would risk leaving someone too hungry to stick to their program. It’s just the sort of small step in the right direction we should be aiming for, because the obese are much  more  likely  to  take the small step than they are to make a big leap to very low-calorie foods.

It’s true, much of the food in convenience stores and fast-food restaurants is pretty unhealthy from the point of view of someone trying to lose weight, because of the large amounts of fat, sugar, simple carbs  and  high  calorie  counts in most dishes. But the fact is, fancy restaurants and upscale markets that feature natural foods are often no better — and sometimes worse — when it comes to these critical health measures. A 2012 British Medical Journal study by the U.K.’s National Health Service and Newcastle University found that the recipes in the books of top TV chefs called for “significantly more” fat per portion than what’s contained in ready-to-eat supermarket meals.

My point isn’t to say that processed foods are healthier than natural foods. It’s that either one can be healthy or unhealthy and we tend to see a full spectrum of each at most food outlets. Unfortunately, the public by and large doesn’t understand this crucial point.

The Miseducation of Healthy
Much of the public currently doesn’t give much thought to the healthfulness of food at all; they simply eat what they want — one good reason why a third of us are obese. Of those who do care about food health, many have been brainwashed to believe, in defiance of science, that whatever natural, unprocessed food they eat is healthy, and that everything processed is unhealthy.

But that picture is an evolving one. Over time, more and more people are coming to understand that they need to lower calories, fat, sugar, simple carbs and starches, and they’re starting to look for foods that are healthier in this way. As clear nutritional labeling becomes more common and prominent, consumers   will   gradually switch to healthier foods and many of them will be processed. That evolution seems to be gaining speed and it may only be five or so years before a large percentage of the population is focusing on healthier food options. If people know they can quickly grab reasonably priced versions of those healthier foods at convenience stores, they’ll do it.

Or at least that’s what they’ll do if they like the taste of the food they find there. Because while people care about healthfulness, cost and convenience, what they really care about is the sensual experience of eating. Most consumers just don’t want a lunch that consists of a big bowl of plain vegetables or a pile of beans, as healthy as they may be.

Here’s where processing offers a huge advantage: It makes healthier food taste much better. Food companies know how to deliver the eating experience that fat and simple carbs provide in foods and with less of those ingredients. There is no way to do that with farm-fresh produce and meat. Today, researchers are figuring out not only how to make healthy foods taste better, but how to make them feel more fi and generally satisfying too.

Everyone is going to jump on the healthy food bandwagon in the coming years, but those outlets that do it sooner rather than later will have a huge leg up in winning over that health-conscious market. Subway has done a good job in carving out a name for itself in this regard and other outlets are already moving in that direction.

Yes, pushing healthy options is a tricky business right now, because most of America is actually turned off by foods billed as lower-calorie, lower-fat and lower-sugar, under the assumption that they’re also lower-taste, less filling and altogether less satisfying. Most people don’t yet realize how delicious and rewarding this food can be. That’s why McDonald’s — whose healthy McLean Deluxe was scorned by the public in the 1990s — doesn’t brag much about the reduced calories and fat in some of its newer products, and has practically kept secret the fact that it has begun substituting whole grains for some of the less-healthy refined flour in some of its buns. Making things worse, the health-conscious crowd right now is largely dominated by the confused anti-processed-food movement, which will hate the food industry no matter how healthy it makes its products.

That confused movement will fade out over time. For now the trick may be simply to increase healthy food options and market them in relatively low-key ways. Some of these options can be versions of currently popular food products — be it candy, snacks or prepared meals — that take advantage of food processing technology to reduce calories, fat and sugar without much changing the taste profile. These substitutions can be carried out quietly for the time being. Eventually, as the public comes to embrace these options, stores can gradually get louder and more explicit about them in their marketing.

It’s not just that there are likely to be significant business rewards for becoming associated with healthier food. It’s that there may well be significant negative consequences for food outlets that aren’t responding to health trends. Food and health activists blindly point the finger at all of the food industry, but over time they are going to start singling out those companies that are behind in improving the health profiles of their offerings. In addition, the government is considering various forms of regulation that would penalize companies that aren’t moving toward healthier products. Companies that are slower than competitors to make the transition may never fully recover from the blows to their reputation.

Those companies that take the lead in offering convenient, affordable, tasty food products that are also healthy, on the other hand, are certain to get a boost from it. Why wait to be dragged into this profitable new trend?

David H. Freedman is a contributing editor for The Atlantic, a consulting editor at Johns Hopkins Medicine International, and the author of Wrong: Why Experts Mislead Us. He has not been paid to write this article, and does not accept any fees or expense reimbursement from the food industry.