sugar-sweetened beverages and fast food choices on obesity
and other health outcomes.^5
This study is similar to another presented in the British
Medical Journal in which researchers classified food items
according to a food classification system called NOVA, which
is based on the extent of food processing. For example, mini-
mally processed foods include fresh, dried, or frozen fruits and
vegetables; grains; legumes; meat; fish; and milk. Processed
culinary ingredients include table sugar, oil, fats, and salt.
Ultraprocessed foods include those in which colors, sweeten-
ers, emulsifiers, and other additives are used.^16
Some consumers attempt to simplify the concept of
clean eating or choosing fewer processed foods by following
common headline nutrition tips. One popular suggestion is to
shop the periphery of the grocery store. Another is to choose
foods with three or fewer ingredients on the label, which could
indicate a less processed food product. Dietitians know that
a food having fewer ingredients doesn’t necessarily make it
more healthful. A box or can could have a long list of vegeta-
bles, herbs, spices, grains, and beans and still be a very nutri-
tious food. Clients should be educated to better understand
how to read ingredients on labels to determine whether the
products are highly processed or based on whole foods.
Shopping the periphery of the grocery store to avoid pro-
cessed boxed or canned foods, however, may exclude poten-
tially healthful products such as beans, whole grains, frozen
vegetables, or tomato sauce. When assessing whether a food
is more or less processed in an effort to eat clean, clients
could erroneously perceive foods labeled “gluten-free,” “natu-
ral,” or “low-sodium” as being more healthful or “clean” prod-
ucts. Clients also may misunderstand words and phrases
such as “organic,” “natural,” “light,” and “zero trans fats” while
shopping, believing that these products labeled with those
words are automatically “clean” because they don’t contain
certain ingredients or forms of processing. In a recent report,
“Consumers and ‘Clean’ Food,” Shelley Balanko, PhD, states
that “for the majority of consumers, clean eating is still about
avoiding things that sound artificial or unnatural, or, put more
simply, eating food that is ‘made simply and grown naturally.’”^18
Education on these topics is needed from dietary profession-
als who can help consumers understand whether the product
they’re consuming is truly minimally processed.
As consumer interest grows, food companies are introduc-
ing more labeling pertaining to clean eating and the desire to
eat fewer processed foods. For example, Panera has a clean
food promise to its customers: “100% of our food is 100%
clean.” To this company, that means no artificial preservatives,
sweeteners, flavors, or colors. It applies to the chain’s US food
menu and Panera at Home grocery products. Its “No No list”
includes more than 80 items not allowed on the menu, includ-
ing lard, sulfites, or artificial smoke flavor.19,2 0 Other com-
panies on the same path responding to consumer desire for
fewer ingredients that appear to be unnatural include Subway,
which has stopped using a dough conditioner called azodicar-
bonamide, and Chipotle, which now touts all non-GMO ingredi-
ents.^21 As consumer interest in clean eating continues, it likely
will drive further change to businesses and health care.
Because highly processed foods that are energy dense and
high in fat, sugar, and salt are linked in some studies to obesity
and obesity-related diseases, working with clients to create
a diet based on fresh, whole foods as opposed to highly pro-
cessed foods may be a good strategy.5 ,15 ,16 To educate clients on
eating less processed foods, the term “clean eating” doesn’t
have to be used unless clients already associate it with eating
a primarily whole foods diet; in these cases, there’s a possi-
bility that using the term could be helpful.^22 Dietitians should
remove any of their own biases and use motivational inter-
viewing to determine a client’s drivers for change and then
move into a personalized nutrition plan.Avoiding GMOs
Clean eating, to some, means avoiding GMOs. Consumer
questions about GMOs and health are important to address,
and they may come up in the context of clean eating. For exam-
ple, Chipotle touting all non-GMO ingredients may raise the
question for some clients of the importance of doing so.^21
While some consumers already have strong opinions and feel
passionate about the subject, studies show that consumer
knowledge of GMOs generally is low, so clients may have a
variety of questions.^23 Consumers likely will have noticed
“Non-GMO Project Verified” symbols on labels in grocery
stores; this is a project driven by a nonprofit organization “ded-
icated to building and protecting a non-GMO food supply.”^24 As
a result, questions about labeling of genetically modified (GM)
ingredients also may surface. Whether a dietitian or client isaugust 2019 http://www.todaysdietitian.com 45