ADA2023: A Frustrating Quest for Healthy Food

We take it as a given – we want to eat healthy. Since 2016, FDA has been working on developing an updated definition for the meaning of “healthy” if a food seller wants to say that about one of its products. The agency is still struggling with this question today. So we were glad to have the opportunity yesterday at ADA2023 to hear from three preeminent researchers on the subject of what constitutes healthy food and healthy eating for people trying to cope with obesity.

The frustrating side of this is that the answers are not so simple as everyone would like. Especially for translating this knowledge into personal actions and public policy.

Big Portions = Big Intake

Barbara Rolls has been chasing this research topic for decades now and she presented a very cogent summary of a great deal of research. Much of it was her own and very well done. Her message was quite simple. Big portions lead to big food intake, which in turn leads to weight gain. Other food properties contribute as well, most notably the energy density of the foods we eat.

Simple enough.

Animal or Vegetable?

But then the water got a little muddier when Christopher Gardner took on a deceptively simple question: Animal or vegetable? Does the type of food matter? His answer was a qualified yes. In the process of delivering that answer he challenged a lot of conventional thinking and presumptions. The most basic concern he raised was one of context. When considering whether a particular food choice is healthy, the answer depends on what food it might be replacing and what food it might go with.

But then he obliged and delivered some sweeping generalizations to please the crowd. Whole foods that are plant-based tend to be better choices. A Mediterranean pattern for eating is a pretty good option. Minimize or eliminate added sugar and refined carbohydrates as much as possible. Include yogurt, fish, and eggs. Safe answer.

Ultra-Processed Foods?

Finally, Kevin Hall addressed questions regarding ultra-processed foods, starting with his near legendary study showing these types of foods lead to increased consumption and weight gain in a short term (two-week) experiment. But the real question, he said, is, why? And many people come forward with strong opinions about the answer to this question. “I care about your opinion on this, but not so much about the strength of your feelings,” he said. So now he is hard at work seeking answers about hyper-palatability and energy density in ultra-processed food.

No doubt, we will be seeing more enlightening studies rom his research.

Meanwhile, Back at FDA…

Despite many unanswered questions, FDA is slogging on with its effort to define which food products are and are not “healthy.” You might think that seven years is long enough to come up with a final answer, but we have our doubts. The agency may issue regulations, but that will only mark a starting point for wrangling with the food industry. It’s a bit like the song that doesn’t end.

Click here for further perspective on the FDA for defining healthy food.

An Unbalanced Diet in a San Diego Shop Window, photograph by Ted Kyle / ConscienHealth

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June 25, 2023