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A GPS for Better Nutrition? Looking Under the Hood at Hy-Vee’s NuVal System PDF Print E-mail
News/Features - Health
Written by Jeff Ignatius   
Thursday, 21 July 2011 05:51

Since the NuVal food-scoring system was introduced at all Hy-Vee stores in January 2009, my family – both consciously and subconsciously – has changed the way it buys and eats.

There are times when we’ve discussed whether to buy this yogurt or that yogurt, and the decision was based on nothing more than the higher NuVal score. (Sometimes, we look at the nutrition panel to try to figure out why a certain score was higher. Sometimes, we succeed.) And I’m certain there have been times when, without thinking about it, we’ve grabbed one food item instead of the lower-scoring version right next to it.

The funny thing is that until I began researching this article, we took it on faith that NuVal scores meaningfully and accurately reflected the nutritional content of the food we were buying.

Conceptually, the system is intuitively understood. It’s a number from 1 to 100 (on top of NuVal’s joined-hexagon logo) on the shelf tags of a vast majority of edible items in Hy-Vee. The higher the score, the better the food is nutritionally. Fresh blueberries get a 100, and nearly all fresh fruits and vegetables score in the 90s. Scores for hot dogs generally range from 6 to 16, while sugared sodas get a 1.

Of course, you already know that fresh fruits and vegetables are good for you, and hot dogs and sugared sodas aren’t. Where NuVal is most instructive – and fascinating – is within a given food group. In its simplest form, NuVal is about deciding between two or three or 10 products jostling for your attention on the same supermarket shelf. As Dr. David L. Katz – the chief architect of NuVal and director of the Yale-Griffin Prevention Research Center – said in an interview last month: “Any aisle of the supermarket where you were already going to buy something, go ahead, but try to buy the most nutritious version that satisfies your wallet and your palate.”

Hy-Vee still has work to do in terms of educating consumers about NuVal. Ruth Comer, an assistant vice president for media relations at Hy-Vee, said that in the company’s most recent customer survey, a little more than half of those questioned knew about the system. That’s a long way from universal.

And being aware that NuVal exists is different from using it, and using it is different from understanding it. Blindly trusting NuVal can be satisfying on a gut level, but the scoring system is most powerful if you take a look under the hood and get a sense of its origins, goals, and methods; what it is and isn’t; and its strengths and weaknesses. While it was developed by a panel of scientists without the input of the food industry and takes into account roughly 30 nutritional factors, NuVal has its quirks, it’s still being refined, and its reductive nature means that it can’t replace careful consideration of a food’s nutrition-fact panel.

So while the tool is easily grasped, its nuances are many and worth exploring. “It only takes one minute to explain NuVal to a customer who has never heard about it,” wrote Hy-Vee dietitian Chrissy Mitzel in an e-mail. “Of course, I can also spend a one-hour presentation explaining the details of NuVal to a group. It is very versatile in the amount a customer can learn about it.”

The Need for NuVal

The reference manual for ONQI – the engine that powers NuVal – sketches out the case for NuVal: “There are two ways to close the gap between how we eat at present and how we should eat for optimal health. One involves a fundamental shift in the pattern of the diet, as reflected in such advice as ‘eat more fruits and vegetables.’ Such advice is valid, and important, but subject to considerable resistance. ...

“There is another way to improve dietary patterns, and that is one food choice at a time. The range in nutritional quality for every food category represented on supermarket shelves – from greens to granola bars, sandwich meat to salad dressing, cookies to cooking oils, and even the proverbial soup to nuts – is vast. Choosing the most nutritious offerings in each category offers a powerful means to reduce intake of calories, sodium, added sugar, and harmful fats, while increasing intake of fiber, beneficial nutrients, vitamins, and minerals.”

In other words, we know we need to eat more fruits and vegetables, but most of us don’t heed that advice. NuVal, Katz summarized, offers as an alternative a “simple, elegant power. Improve your diet, improve your health – one easy, well-informed choice at a time. You want bread, buy a bread; just buy a better bread.”

Or snacks. Look at the dried-fruit section of Hy-Vee, and you’ll see a massive gulf between products that score in the 90s (raisins, dried peaches, dried apricots) and those coming in below 10 (dried cranberries and blueberries) – a function of whether they have added sugar.

Comer said that she used to buy reduced-fat peanut butter. And when saw the NuVal scores – with some reduced-fat products scoring significantly lower than their full-fat equivalents – she thought: “This doesn’t make sense to me.” But after she investigated and understood the scores, she changed what she bought. “I buy the regular peanut butter again,” she said. “I’m not sacrificing nutritionally.”

In this way, NuVal helps consumers understand that certain foods aren’t by definition healthy – dried fruit, for instance – and claims by manufacturers are often not meaningful in terms of nutrition. Lower-fat foods often compensate for the lost fat with sugar, typically more than negating any nutritional gain. A vast majority of breakfast cereals are almost depressingly low-scoring, regardless of whether they’re aimed at kids (Cap’n Crunch, which scores a 10) or pitched as wholesome (Wheaties, a 28).

“It’s easy in a world where nobody knew what better nutrition actually meant for manufacturers to just make it up,” Katz said. “With NuVal you can tell at a glance.”

And NuVal helps overturn some long-held beliefs. “I scratched my head when iceberg lettuce received a score of 82, as did some of my customers,” wrote Hy-Vee dietitian Janet Macon. “Iceberg has a reputation as a leaf with little to offer; 82 seemed like an unlikely high score. When looking into the score, I realized that the nutrients it provides, including potassium, folate, and carotenoids, come at a very low caloric cost (less than 10 calories per cup), which explains the high NuVal score.”

The scoring system offers other benefits, too, as Hy-Vee dietitian Dawn Blocklinger listed in an e-mail:

“NuVal is very helpful for those individuals with language barriers or who are illiterate.

“NuVal is definitely kid-friendly. What kid doesn’t want to score a 100?

“NuVal is available free and on most items in the store.”

And it’s even helpful to people who know their nutrition. Hy-Vee dietitian Kristen Decker wrote: “It has reinforced facts I know about nutrition but makes it easier to assess on a glance when comparing options.”

It Needed to Be Fixed; We Fixed It”

Katz says a 2003 event represents the obvious genesis of NuVal. But “the origins in my head go back much longer than that. As a preventive-medicine specialist who focuses on lifestyle in particular – food as medicine, if you will – I’ve really been wrestling with my patients’ challenges in this area for many, many years, and recognizing that patients can get perfectly good advice about eating better and yet find it almost impossible to implement when the rubber hits the road – when they get out there and have to make food choices. ... They trip over all of the confusing marketing messages that stand between them and better health. ... The public at large – patients – needed better guidance in this area. ...

“It would be bad enough to miss out on the power of nutrition as medicine ... if it was because people didn’t care,” Katz added. “But you know what? People do care. ... They just don’t feel empowered to do anything about it. And even the people who are really trying are getting lost on the way. And that’s just wrong. It needed to be fixed; we fixed it.”

Eight years ago, Katz said, he was among 15 researchers invited to speak to the Working Group on Obesity, under the federal Food & Drug Administration (FDA). He and his fellow scientists were given three minutes apiece to offer one idea that the FDA could implement.

Katz said he told a story about bread and his wife, who has Ph.D. in neuroscience from Princeton and shops for the family. (They’ve been married more than 20 years and have five kids.) “Even my wife ... – extremely intelligent, highly educated, lives with somebody whose nutrition bona fides are good enough to get him a seat at this table, takes care of all seven of us on a daily basis – even she comes home from the supermarket with smoke coming out of her ears at times.

“She’s shopping for a loaf of bread, and one bread has the most fiber, but that’s the one with the most sodium. And one, the fiber’s good and the sodium’s better, but that’s the one with added sugar in the form of high-fructose corn syrup. And another one, the fiber’s good, the sodium’s not bad, it doesn’t have added sugar, and it says zero grams trans fat on the front of the pack, but that’s the one with partially hydrogenated oil in the ingredient list. And another one says ‘multigrain’ and looks like it’s the most wholesome choice but actually has the least fiber of all and as far as she can tell doesn’t contain any whole grain. And so she brings home all four, looks at me, and says, ‘If you want the most nutritious one of these, you figure out which one it is.’”

He concluded his presentation by addressing Health & Human Services Secretary Tommy Thompson: “And I said, ‘Mr. Secretary, with all due respect, if a Ph.D. in neuroscience from Princeton is not good enough to pick out a loaf of bread, I think we set the bar a little high.’”

He suggested that the FDA convene a panel to create “a tool that everybody can use, so that at a glance everybody can tell what’s the most nutritious choice. ... Essentially like a GPS for the food supply: ‘You want better nutrition, turn here now.’ And let’s make it completely simple.”

Katz said the idea was dismissed. (The working group in 2004 made recommendations on changes to foods’ nutrition labels that could charitably called minor: “increasing the font size for calories, including a percent-daily-value column for total calories, and eliminating the listing for calories from fat,” and “encourag[ing]” manufacturers to stop the practice of dividing packages of food that most people consume in one sitting into unrealistically small serving sizes for nutrition-panel purposes – 20-ounce sodas, for example, claiming 2.5 servings per bottle.)

But in late 2005, Katz said, Griffin Hospital said it would financially support the development of the system he proposed. Katz and a team of scientists crafted the Overall Nutritional Quality Index (ONQI) algorithm. Katz then took that back to the FDA, but one official there advised him to pursue the project through the private sector rather than the federal government: “If you turn it over to our bureaucracy, I’m not sure you’ll live long enough to see this in the hands of consumers ... .”

So Griffin Hospital partnered with grocery-chain co-op Topco Associates (of which Hy-Vee is a member/owner) to form the for-profit NuVal LLC. That company licenses the NuVal system, and Griffin and Topco share in the profits. NuVal is now in more than 1,100 stores nationwide.

While NuVal LLC is a for-profit venture, Katz said there’s a clear separation between the algorithm and the marketing of its application. Griffin Hospital retains sole ownership of ONQI, “and the business side has nothing to say about it,” Katz said. “We’re at liberty to just keep this all about pure public-health science and then rely on NuVal LLC to get it out there where it can do some good.”

Hy-Vee’s Comer said NuVal was attractive to the chain for several reasons. It’s “completely independent” and developed by scientists rather than the food industry, she said. “And it’s also very simple to use and easy to understand.”

Comer said Hy-Vee explored other nutrition-rating systems – such as those that break foods down into broader groupings – but thought they were “somewhat subjective.” She gave the example of a stoplight system – with green, yellow, and red – and said there wasn’t enough nuance; one product might be a high yellow and another a low green, and there was no way for consumers to know that they were more similar than different nutritionally.