April, 2011

Research Perspective and Comments & Analysis

Connecting The Dots Between Produce & Health

By Bill Bishop,  Chairman, Willard Bishop LLC

 Who’s doing the best job of connecting the dots between produce and health? Based on recent field research, the answer may just be Whole Foods Markets. Under their Health Starts Here program, founder John Mackey sees as a key driver in repositioning the retailer from “whole paycheck” to a retailer-focused on shopper health Whole Foods is doing as good a job as we’ve seen in putting produce first in its health and wellness campaign.

At the core of its effort is a powerful but simple idea with a lot of appeal in today’s obesity-obsessed culture; i.e., a nutrient density index. Simply put, the nutrient density index scores products in terms of the amount of nutrition they deliver per calorie. Products are rated on their aggregate nutrient density including an extensive range of micro-nutrients that includes, but isn’t limited to, vitamins, minerals, vito chemicals and anti-oxidants capabilities. The index ranges from 1,000 on the high end to 1 on the low end.

All this sounds complicated until you see it through the eyes of a Whole Foods shopper. As shoppers enter the produce department, which is already very visually appealing, there are not only signs calling out the Health Starts Here Program, but also easy-to-read lists of the vegetables and fruit ranked tops in terms of nutrient density. Below left is a sample of what we found listed throughout the store, as well as on pocket guides available free at their Health Starts Here reading center.

And the information continues on through the store including meat, fish, cheese and other dairy products.

So how does a shopper use this information?  It’s simple to say, but it takes a little will power to do; i.e., eat more of the high indexing foods first at each meal so that you satisfy your nutritional needs while consuming a lower amount of calories. After trying it, I can tell you that it really isn’t that hard to do if you concentrate, and use some of the recipes made available through the program.

Not surprisingly, the program is the creation of a leading physician, Dr. Joel Fuhrman, M.D., Chief Medical Officer of Eat Right America, who has treated more than 10,000 patients over the past 15 years and recently written a peer-reviewed article in the journal Alternative Therapies, reporting an average weight loss of participants in his program of 53 lbs over a two-year period. So it appears you can manage your weight, get the nutrition you need and not have to be hungry all the time by eating a lot more fruits and vegetables.

The Whole Foods brochure invites shoppers to use the Eat Right America nutrition prescription — the nation’s only online personal nutritional assessment and eating plan by visiting the retailer’s Web site or the Eat Right America Web site.

Turns out that more than 25,000 customers have already taken the personal nutritional assessment. Based on an analysis of more than 7,000 of the assessments, there’s a clear difference between the diets of shoppers with a high risk for diabetes vs. those who follow a diet that includes more high nutrient density foods.

Unconfirmed reports are that Whole Foods has seen measurable increase in produce sales as a result. This was particularly true for green vegetables.

It’s common knowledge that it makes sense to eat more vegetables and fruit, and now at least one retailer is helping customers see the direct connection to better health and customers are apparently rewarding them for this.  Sounds like the way it should work.

 Will It Work Outside Of Whole Foods?

The produce industry has little to complain about regarding the Whole Foods “Health Starts Here” program — it probably has helped boost produce consumption, specifically, consumption of healthy greens. Alas, man does not live by mustard, turnip and collard greens alone, and so the Nutrient Density Index is not really all that useful.

An item can be chock full of particular nutrients and people will drop dead if that is all they eat. Nutritional diversity — getting needed fats, protein, various vitamins and minerals, etc. — is much more important than nutrient density.

Besides, there is a real question about the wisdom of a retailer hanging its hat on a program with so little evidence of effectiveness. Yes, there is a peer reviewed study that does show a loss of 53 lbs. over a two-year period. It is worth noting, however, that this statistic only applies to 19 — yes, 19, count ‘em — people! In fact the study started out with 56 people, and only 19 showed up for their two-year weigh in. We don’t know, but it seems reasonable to surmise that the other folks were not as proud of their weight loss accomplishments.

The truth is, the whole study is not really projectable to the general population. The 56 people who started in the study were people motivated enough about weight loss to go visit a doctor for the specific purpose of getting weight loss counseling. So the study is dealing with highly motivated people with the means to access medical care — and, even so, almost two-thirds of the people dropped out before the two-year mark.

This is one of the great dilemmas of public health. If we tell people they should eat only fruits, vegetables, whole grains and a little fish, we might be giving them good advice. But if nobody will follow that advice, how helpful are we really being?

The Whole Foods customer is very atypical — with higher incomes, higher educational levels, and greater interest in health and wellness — than the general population. Perhaps this program, with a need for highly motivated consumers, will be useful to those Whole Foods shoppers and thus to the chain and its suppliers. Yet it seems unlikely to appeal significantly to the Wal-Mart shopper.

Whatever its impact with specific shopper groups, the whole issue of marketing based on health and nutritional content begs the question of whether such pleas actually motivate consumers. There is a kind of Aristotelian certainty in thinking that if people know something is good for them, then they will do that thing. But the evidence that this is true is scanty.

Due to family illness, I’ve had a lot of time recently to interact with doctors. Many doctors are obese. If doctors working in direct contact with the effects of obesity and with access to information and education far beyond that of the general public are not motivated to change their own habits, it seems highly unlikely that signage in stores or produce industry marketing efforts are going to prompt such behavioral change.

We do have indications that as education and income increase, better dietary habits become more common. It is not 100 percent clear what to make of this, however. After all, it could be that those with better dietary habits are healthier, and thus, better able to complete school and work productively. It is also possible that the traits that lead one to do well in school and at work — an ability and willingness to absorb information and act on the implications of that information — also lead individuals to understand and act upon dietary advice.

Note that none of this seems to indicate that nutritional education is likely to change behavior of the great majority of people. This is especially true if the change is likely to be unpleasant. In other words, we may be able to switch people from one sweet fruit to another based on the idea that one is more healthful than another. We have zero evidence that the reason people buy Haagen-Dazs rather than Mustard Greens is that they don’t realize the ice cream is more likely to promote obesity.

What the industry could actually use is some controlled trials that test what actually motivates consumers to buy fruits and vegetables. Let us assume our goal is to sell more berries. Which would be a more effective commercial: one that features a group of doctors detailing the beneficial attributes of berries, or one that shows beautiful berries bouncing onto mounds of ice cream and being enjoyed by beautiful young children at a family picnic celebrating Grandma’s 80th birthday?

We don’t really know the answer to that question because, to my knowledge, the test has either not been done, or if done, the results were not released to the public. But this author’s money is going down on the side that says that selling delicious flavor and an emotional connection to friends, family and good times will beat out the doctors every time.

Perhaps this approach will work for Whole Foods, but the chain has atypical customers and its interests are more about repositioning the chain from a place that sells pricy food to a place that sells good food. That is a different task than simply selling more produce to the general public. We should do a lot more research before endorsing such a medicinal approach.