# What Is “Healthy” Food? A Cross-Sectional Evaluation of Foods and Beverages Consumed by US Adults That Satisfy the US Food and Drug Administration’s Updated “Healthy” Claim Criteria

## TL;DR

This study evaluates how well the FDA's updated 'healthy' food criteria align with other healthfulness measures, finding that few foods meet the criteria and moderate agreement with other models.

## Contribution

The study provides new evidence on the validity of FDA's 'healthy' claim criteria by comparing them with established nutrient profiling models and food processing classifications.

## Key findings

- Only 14.9% of food items met the FDA's 'healthy' criteria, with significant variation by food category.
- Healthy items were lower in saturated fat and sodium and higher in fiber and vitamin C compared to non-healthy items.
- Moderate correlations (ranging from 0.41 to 0.56) were found between FDA criteria and other healthfulness models like Food Compass 2.0 and Nutri-Score.

## Abstract

The Food and Drug Administration (FDA) recently updated criteria for the “healthy” claim displayed on foods and beverages in the United States. However, it is unknown how updated criteria compare to existing methods for evaluating healthfulness of food and beverages.

To evaluate correlation between “healthy” criteria and three nutrient profiling models used to evaluate food and beverage healthfulness, and with Nova food processing classification. Exploratory analyses compare the nutritional profile of “healthy” items and items not meeting “healthy” criteria.

In this cross-sectional analysis, we identified individual “healthy” items reported in the 2017–2018 National Health and Nutrition Examination Survey. We used descriptive statistics to characterize “healthy” items across food categories, nutrient profiling models (Food Compass 2.0, Nutri-Score, and Health Star Rating), and Nova. We used point-biserial correlation to evaluate correlation between FDA criteria and nutrient profiling models, and rank point-biserial correlation to evaluate correlation with Nova. We used t-tests to compare nutrient content of “healthy” items and items not meeting “healthy” criteria across food categories and Nova categories.

Overall, 14.9% of items qualified for the “healthy” claim. While the majority of fruits (60.9%), vegetables (59.6%), and nuts and seeds (68.8%) qualified, few meat, poultry, and eggs (3.0%); grains (4.8%); or savory snacks and desserts (1.3%) met criteria. Criteria were moderately correlated with Food Compass 2.0 (r=0.56), Nutri-Score (r=0.46), Health Star Rating (r=0.41), and Nova (0.49). “Healthy” items were lower in saturated fat and sodium and higher in fiber and vitamin C across nearly all food categories and Nova categories.

Findings suggest few foods met “healthy” criteria. Moderate correlations between “healthy” criteria, Nova, and validated nutrient profiling models provide evidence of convergent validity, yet underscore the challenge of classifying foods by healthfulness, and highlight uncertainty about whether discrepancies reflect real differences in model performance and food healthfulness.