“The Nutri-Score, a system straight from the 1980s” Jean-Michel Lecerf (interview)

Having worked in Lille for his entire career, both at the Lille Regional Hospital and at the Pasteur Institute where he founded a department on nutrition, Jean-Michel Lecerf is one of France’s most renowned nutritional experts. Known for his clinical research activities and for his uncompromising views, Mr. Lecerf also sits on a number of academic associations, as well as public (national agencies) and private (food industry) scientific committees. His work focuses mainly on clinical research into the lipid metabolism, a topic about which he has published numerous papers. He has authored more than 600 printed articles and has presented over 400 discussion papers. In addition, he has also written for a generalist audience, such as in his latest book “La joie de manger” (“The Joy of Eating”) that was recently published by Éditions du Cerf. In a wide-ranging exclusive interview, Mr. Lecerf gives his expert opinion on a range of subjects, from the risks of food shortages to the EU’s strategic choices and the questions raised by the link between Covid and obesity.

The European Scientist : Given the heated international context, let me start with a rather difficult question: how does an expert on diseases related to food overconsumption view the risks of shortages that are looming on the horizon? As there is a real risk that our societies will be affected, do you have any recommendations? How could the French adapt their daily diet?

Jean-Michel Lecerf : Having just published “La joie de manger“, I am not in the camp of those who say that the war and shortages will help educate the public on food consumption! Overconsumption of food is an overused term. It is true that our food production and availability is the highest it has ever been. But to say that our populations are overconsuming food is not true! Although there is food waste, there is no generalized overconsumption of food. People eat less and less and are more and more careful, except for the usual 10-15% who overindulge. We are living in a world of food abundance, where there is food waste both in the production chain and on the plate. 

But any potential shortages will have an effect on the poorest people because the cost of raw materials will increase. In terms of food production, we must be careful not to allow our country’s agricultural capacity to drop too much (see the interview with Léon Guéguen on your website). The great potential of our country in terms of food production has so far been curbed for various reasons, but this will have to change in the context of the current crisis.

We are lucky to have accessible and cheap food (the French population spends 14% of its income on food, whereas at the beginning of the 20th century it spent more than 50%); perhaps, with the current crisis, we will realise that is rather a precious commodity. Our available production capacity, however, is far from being exploited. And the desire to achieve food sovereignty should encourage us to produce more at home. We have lost our competitiveness because of environmental regulations and wage costs, and – as a result – we have to import. But what we need to do is reconcile the need for a productive agricultural system and a return to exports with reduced environmental emissions. Plant-based biotechnology may be able to help us in this quest, but we must continue improving our understanding of these innovations. 

TES. : Can we say that the agriculture and food industries are currently doing enough to address the public health issues at hand?

JML. : Absolutely. 95% of manufacturers strive to produce quality products. We can always improve. But I think it is rather hard to ask for manufacturers to sell sweets without sugar or chips without fat. Most of them try to have safe and healthy products, even if sometimes accidents happen. There are also several sanitary and microbiological requirements in France that are not enforced abroad. Most of them have departments and engineers who try to reduce salt, fat, additives… but doing so is not always possible. We cannot sell cheeses without fat, for instance, which would be flavourless. 

Food products must remain in their most natural form. Rillettes or sausages without fat are unimaginable. These are not toxic products; you just shouldn’t eat astronomical quantities of them. There are people who eat badly, but no food can be blamed for all the troubles. Industrialists are making efforts, but, unfortunately, they are nevertheless blamed for nearly everything. While big food manufacturers still need to improve their product and marketing strategies, their responsibility when it comes to public health problems should be shared with the root causes that lie within socio-economic, behavioural, psychological and environmental factors. The issue lies with the 20% of the population that cannot afford to buy good quality products because they are too expensive. This is a socio-economic problem, not an agri-food problem. Industry sells what people can afford to buy. 

TES. : We saw during the Covid pandemic that obesity was one of the main co-morbidities. Do you have an explanation for this? Do you think that the health authorities have grasped the extent of this problem?

JML. : We have to be careful on this topic. Obesity and diabetes, as we have seen, were indeed associated with a greater health risk from Covid. But there is another side to the story: most overweight and obese people were singled out to some extent. Nobody chooses to become obese. On one side, the health authorities and broader public displayed a constructive attitude by trying to support prevention, because it’s useful. On the other hand, On the other hand, some people wanted to stigmatise the “fat people who clutter up the hospitals”, and I find that unacceptable.

I would also like to add a caveat: the literature has shown that certain dietary patterns are associated with a possible decrease in Covid risk. Nutrition has an impact on the microbiota, on the immune system and on inflammation. But while people were made aware about the importance of barrier measures, there was very limited awareness about the role of vitamin D, Omega 3, probiotics, polyphenols… It’s a shame.

TES. : The surgeon Patrick Pessaux and Anne-Sophie Joly, president of the National Coalition of Obesity Associations (Collectif National des Associations d’Obèses), recently published an article in Le Monde calling for the fight against obesity to be made a key issue in the next five-year presidential term and a strategic priority for the EU. What do you think about this initiative?

JML. : I know Anne-Sophie Joly very well, we worked together on a book and several conferences. I think there is no reason not to make fighting obesity into a national cause. However, I have one small reservation about the constant need to use fear and sensationalism: in France 95% of children are not obese, 15% are overweight or obese. Naturally, there are some reasons for concern, but obesity is not a nutritional disease. Nutrition plays a role, but obesity is a multi-factorial and multi-faceted problem. Also, there’s a layer of guilt that comes with obesity that I talk about in my book, La joie de manger... And I believe that we shouldn’t encourage this feeling through by guilt-tripping people.

TES. : Do consumers have all the information they need to tackle the scourge of obesity? What more can be done to raise awareness?

JML. : In 2019, I published “Le surpoids, c’est dans la tête ou dans l’assiette?” (“Being overweight, is the problem in your head or on your plate?”) and I edited a huge 800-page scientific book with 200 authors on the subject of obesity to show that it is a disease of such complexity that no single factor can be identified: there are genetic, psychological, environmental, nutritional and lifestyle factors (e.g.: stress, sedentary lifestyle) … We can work on our diet and amount of physical activity, we can educate people to avoid embarking on “toxic” diets, we can dispel the belief that there are foods that make us put on weight, showing people that is it a combination of elements.

Normally, we should not get fat. But there are many disruptors that we are beginning to identify: the suppression of meals, the de-structuring of meals, stress, lack of sleep, spending time in front of screens, sedentary lifestyle … all these factors are very important … the mode of birth, delivery by caesarean. Being aware of this and helping people regain a calmer and natural eating behaviour. We talk a lot about the environment: having access to green spaces for physical activity is also important… We need to work on prevention. Eating a variety of foods is a message that is not often conveyed.

TES. : In a recent study, you stated that the Nutri-Score was not really appropriate for cheeses. Can you elaborate on this point?  

JML. : The Nutri-Score has a few qualities, but also several flaws. The first flaw is that it does not take into account the matrix effect (1). Nutrients do not have the same impact when they are contained in different foods. This is the case for saturated fatty acids. For instance, when contained in dairy products, these saturated fatty acids are not associated with an increased cardiovascular and cardiometabolic risk. But the Nutri-Score does not take this into account and that is a shame.

Another mistake that Nutri-Score makes is that is bases its score on 100-gram portions, but I’ve never seen anyone eat 100 grams of Roquefort. A typical small portion is 20 grams . And this is a drawback in the system.

The Nutri-Score also does not score products with animal proteins as positive unless there is a quota of fruit and vegetables. And because proteins are not counted positively, calcium is not counted as a positive nutrient in the Nutri-Score.

The authors of the algorithm claim that calcium is correlated with protein, but this is not always the case. It depends on the type of cheese and, since protein is not valued, the Nutri-Score unfortunately classifies most cheeses as D or E. This is discouraging and a negative sign.

The Nutri-Score gives certain foods a worse score as a result of this incomplete and biased analysis. Cheeses, which are naturally fatty and salty, are especially hard hit despite having their own health benefits. In my opinion, the Nutri-Score is outdated. And because it doesn’t take into account the matrix effect, nor does it give worse grades to ultra-processed foods, manufacturers are increasingly manipulating the composition of their products to get their products scored as a more favourable letter. 

The Nutri-Score needs to be improved in several ways: firstly, it should incorporate scientific knowledge, such as the matrix effect and saturated fatty acids; secondly, it should accept exceptions; thirdly, it should include the importance of food variety on every label to explain to people that just because the colour is red doesn’t mean they are faced with bad food or a bad product. It should also be explained that the Nutri-Score is designed to compare foods in the same category, not in different ones. For example, comparing two cakes is fine, but comparing leeks and sausage makes no sense. 

For example, the algorithm could be improved by weighing up whether a food is ultra-processed (2), even if this would make everything more complex. It would be a good idea to also include new positive nutrients such as omega 3, polyphenols, calcium, iron… For certain foods, another good idea could be to give the Nutri-Score of a recipe. For example: eating sausages on their own is not a balanced meal, but sausages with lentils are. Giving the Nutri-score of a recipe would mean getting closer to the scientific reality and, most of all, the reality of what people cook. There is a lot of room for improvement, but there seems to be a form of ideological opposition. 

To sum up, the Nutri-Score is, if you will, a nutritional concept from the 1980s… we’re in 2022. Food is much more complex than a sum of selected foods. It only offers a reductionist approach. 

TES. : As you may know, in the framework of the F2F plan, the EU is currently considering which food labelling system it will put in place: would you have any recommendations for the experts working on this issue?

JML. : Informing consumers is a good idea, but finding a simple system is not easy. The Nutri-Score has the advantage of being easy to understand, but on the other hand, it is not always used properly. People say A is good, Green is good, E is bad. It gives the impression that there are bad foods and good foods and it makes people feel guilty for buying the bad foods. 

The whole thing should be revise, especially since its impact is extremely weak. We set up experimental retail shops to conduct studies on Nutri-score. They showed that the algorithm was easy to understand for the public, and produced a very small difference in relation to purchasing choices; but on the other hand, there is no study that shows Nutri-score’s impact on health. Therefore, politicians should not think that the Nutri-Score is a silver bullet, as it is far from being the sole determinant of having an appropriate diet. If it is not replaced, it must absolutely be complemented with messages on food variety, recipes and quantities. As far as other systems are concerned, there was the Italian system, the battery score, which is a bit more technical.

The problem with the Nutri-Score is not that it provides people with information, but that it provides them with an interpretation of the information. The information that it is meant to be giving people is whether there are fats or calories. The interpretation is to say that product is a red on the scale. But just because you eat a ‘red food’ doesn’t mean that everything is bad. You have to learn to eat red foods, sparingly, with pleasure and in moderation – that’s what I say in my book “La Joie de Manger”. You have to learn that all foods have their place, no food is toxic, and variety is the key.

TES. : What other public policy solutions would you recommend for the EU to tackle obesity?

JML. : Politics always has a tendency to look for simple solutions to complex problems (e.g. the Nutri-Score), which are based on simplifying shortcuts or assumptions. The focus is on the food on the plate rather than the deeper, more complex causes of the problem. Unfortunately, this type of the well-meaning bad idea is rather widespread, as I explain in my book “Le surpoids, c’est dans la tête ou dans l’assiette?” (P.120-121)

(1) https://academic.oup.com/ajcn/article/105/5/1033/4569873?login=false

(2) https://www.sciencedirect.com/science/article/abs/pii/S195725571830107X

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