Food and Health: A Chat with Christopher Gardner
This interview series is a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.
To make everyday life healthy by design, we need to understand what health means for people personally and for the systems shaping everyday life.
In this interview, we’re unpacking experiences of food. Food is not just what we eat; it’s how we eat it, who we enjoy it with, where it comes from, and so much more. What food means to us emotionally, socially, politically, as well as physically, all have significant impact on how it affects our health. To learn more, we’re speaking with Christopher Gardner, professor at the Stanford Prevention Research Center, who has spent over 20 years researching the potential health benefits of various dietary components or food patterns.
Joanne: You’ve studied the many barriers individuals and institutions face when making food choices. Have you noticed any shifts on the individual or institutional level in the last few years and since COVID-19?
Christopher: Over the last 5 years I’ve been seeing Gen Z show up for social justice. I’ve been teaching at Stanford for 27 years and I’ve seen a shift with more students caring about food and the environment. More recently, in the last three or four years, social justice has started to overwhelm the environmental aspect. The students in class want fair access. I want to talk about greenhouse gas and water, but they’re bringing up laborers and minimum wage.
And now COVID-19 has had a huge impact on decreasing how much we eat out. When we eat out, the choices we make are often driven by the food industry tantalizing us with taste — by salt, sugar, fat. But cooking at home should be better.
Stealth Nutrition
Joanne: There are parallel conversations around ethics of meatpacking industries, ethics around climate justice, as well as ethics of technology. What are other social issues that shape how people make food choices?
Christopher: A term that I use a lot now is “stealth nutrition”—it’s not stealth in the way of deception. About 15 years ago my colleague Tom Robinson and I started a class called “Food and Society” that focused on environmental, social, economic, and political issues. Personally, I felt a shift in my career trajectory after listening to the students discuss and wrestle with the class topics. At the end of the first year I asked the students to tell me what resonated the most so I could apply this to teaching the class again the next year.
One student with tears in her eyes said, “Oh my God, the animal rights thing. I went vegetarian.” And the next said, “I grew up on a ranch. We don’t treat our animals poorly. We treat them really well. I think that was an unfair portrayal. But the greenhouse gas thing blew me away. So I’ll only eat pasture raised, organic, and antibiotic free meat now.” The next student said, “I grew up Republican and that global warming climate change thing, that’s a total hoax. But, in Eric Schlosser’s book I was mad when I learned the fast food companies don’t make money off their burgers, they make money off the real estate. The franchise owners can get small business loans and they are the ones taking the risk. There’s a story in the book of 13 Wendy’s that opened up in Harlem and 10 went bankrupt, and some of the small business loans didn’t get repaid, but Wendy’s didn’t lose a dime. I stopped going to fast food restaurants as a point of fiscal responsibility.”
So I just stopped and said, wow, this is amazing. You went vegetarian, you’re only eating pastured meat, and you stopped eating fast food, all for different reasons. There wasn’t one reason that resonated across the whole class.
For some it was animal welfare, for others it was social justice, and others climate change, but they all aligned on eating better even leaving nutrition out of it.
Unapologetic Deliciousness
Joanne: It seems that food choices are about more than values. It also has to do with visceral experience.
Christopher: Definitely, some people think, “I don’t want to know that [shocking fact about the food industry] because if I do, I won’t feel comfortable continuing to buy and eat that, and I’m gonna miss this thing that I really like.” So one approach I’ve learned for addressing this came from Greg Drescher at the Culinary Institute of America — the idea of “unapologetic deliciousness”.
Lead with taste, unapologetically great taste.
That resonates particularly well with me because I realize as health professionals, many of us have been apologizing for a decade. I remember saying, “I know you really want the indulgent cookie or the ice cream, but I really think you should consider the stuff with more fiber, more antioxidants, and less saturated fat…” And in essence I would be apologizing by saying, “Please have the thing that tastes worse because of health”. Now, there’s no apologizing. I say, “I have got this global fusion flavored dish. It’s a bed of heritage grains and legumes, topped with seared vegetables, maybe with some chicken or fish on top with a tantalizing blend of Moroccan spices, it’s gonna blow your taste buds away”.
Along the way, my work with chefs has involved moving more and more towards “plant forward” dishes, and one thing that has really aligned everything is a protein flip. What I am referring to there goes back to how I traditionally remember people referring to what they were having for dinner, as “steak” or “chicken” or “roast beef” — not the entire meal, but just what was going to be at the center of the plate — high protein meat. Instead, for the protein flip, think about the center of the plate as being plant based foods, with smaller portions of meat or fish or chicken in there. This way it can still include meat, without taking it completely away and going vegetarian, which can turn a lot of people off.
Joanne: What are some ways of elevating the values-to-action conversation, that’s so successful at the individual level, to an institutional or corporate level?
Christopher: So, I do the most work with Google, Stanford University, and a little bit with Stanford Hospital. We’ve been working with the Culinary Institute of America and the chefs are strutting their stuff there. When I go to these meetings, it’s almost obscene the foods that they’re serving that are plant-based and unapologetically delicious. They’re using their craft.
So, we had a cool project with Google, where they were going to try to use less sodium, but we didn’t frame it as using less sodium. We said, “How else can you flavor your food? Try something crazy.” And they came up with these herb blends and other things without noticing they were using less salt.
The administrators and dining operators in institutional food settings are important stakeholders in this and they are another story. One thing I learned from them is that even though grains, beans, and vegetables can be less expensive ingredients than meat, preparing vegetables to be unapologetically delicious can involve higher costs in terms of more labor. And in this area I am learning there are some amazing institutional-sized cooking equipment that can help, including vegetable prep slicers and dicers. But it’s not as simple as vegetables cost less than meat.
Choice Architecture
Christopher: In some of these institutional food settings they’re playing with related issues like buffets versus plating. They’ve done a lot of work with “choice architecture” — where is the food placed, and how? Is it a square bowl, a round bowl? One particular institutional food setting with a lot of room for improvement is hospital food. Hospitals have a primary mission of promoting health, yet hospitals are often shamed for having some of the worst food anywhere. Some hospitals are now leading the way in improving the taste and healthfulness of their menus.
One interesting issue related to institutional food is employee productivity. Some worksites offer snacks to their employees, and many times those are unhealthy, high-sugar snacks. This can lead to a sugar coma in the middle of the day and a drop in productivity. Some worksites like Google are trying to find solutions to this that will be better for employee health and better for productivity. Maybe there is a choice architecture solution? Some easy-to-grab snacks are much healthier than others that look and taste better than the less healthy snacks. There are many levers to push.
Long-term, I have to say, I think the only way we’re going to get meaningful shifts in healthier food choices is to change agriculture.
We have to grow different foods. If you and I go and choose one different thing at the local market, that’s not going to do it… but if all the schools, hospitals, and worksites order and offer different food, farmers would grow something different. But only if they know there’s a market.
Systemic Shock
Joanne: We were talking about the role of familiarity but also indulgent language. Have you worked with a decision-making psychologist on if people would rather start with something that’s familiar? Or is it language that drives people to make a choice that’s a little bit out of the norm?
Christopher: That idea about “a little bit out of the norm” reminds me of some work I did in my class with Tom Robinson where we realized that people respond differently to different levels of shock. One of the things that can get people to change their behavior is to shock them that the thing that they did is bad. So, for example, “Oh, it’s horrible for animal rights.”, “It’s horrible for the environment.” But the really fascinating thing we learned was that there are different levels of shock that are required to get someone’s attention.
The challenge is to figure out how much information you give them before you get their attention. If you give them too much it can be overwhelming or frightening. Whereas other people may think, “I heard that. That’s boring.” You have to kind of ramp it up like, “Did you know how bad it was? Yeah. Did you know this? Or this?” until you get to the point of shock where someone is willing to rethink their decision. It’s complicated trying to figure how to scale that up to engage them at the point where, “This is new, and I’m willing to think about it because it seems important but not too threatening.”
Joanne: That’s fascinating especially considering how the shock from the pandemic is making businesses rethink systems.
Christopher: Well, turning that back to the topic of changing agriculture, I wonder how many farmers just lost a whole season’s worth of their crop due to COVID-related changes in food distribution systems and said, “Wow, my model is vulnerable.” Maybe it’ll inspire people to grow different food or have different vendors and consumers so they’re less vulnerable next time. Certainly, it’s got to be going through somebody’s head.
