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Dr. Dean Ornish’s Prescription for the Quick-Service Restaurant Industry.

For nearly 30 years, Dean Ornish, M.D., has been trying to show America and the rest of the world that comprehensive lifestyle change, not drugs or surgery, is the key to combating illness and disease. To help spread his message, he partnered with McDonald’s several years ago and continues to consult with the quick-service giant on issues of food functionality, nutrition, wellness, food quality, and lifestyle initiatives. The founder of the non-profit Preventive Medicine Research Institute in Sausalito, California, and author of five best-selling books, including Dr. Dean Ornish’s Program for Reversing Heart Disease and Eat More, Weigh Less, recently spoke with QSR about his work with McDonald’s and the role the industry plays in the health of its consumers.

As a doctor and author of diet books, why have you chosen to work with a fast-food company?

I began working with companies like McDonald’s because they’re in the behavior modification business, too, when you think about it. I reasoned that if they could use their considerable resources for advertising and celebrities and marketing to make it fun and sexy and hip and crunchy and convenient to eat more healthfully and to exercise and to manage stress and so on and make it more convenient for people to eat that way by making foods that are both convenient and inexpensive and wholesome and nutritious, that can make a huge difference in the lives of literally tens of millions of people everyday—not only in this country, but also around the world.

When McDonald’s asked me to consult with them, I welcomed the opportunity because I thought this could make a real difference in the lives of so many people for the better. And it has. For example, the Fruit & Walnut Salad that I counseled them on has caused McDonald’s to become the largest purchaser of apples in the [United States, according to the U.S. Apple Association]. Who would have thought five years ago that would be the case? There’s an opportunity here to educate people about nutrition and active and healthy lifestyles, as well as a way of making it easier for people to eat and live this way.

But it also goes into the whole ethos of how we view foods and how we view our lives and to get away from the idea that there are good foods and bad foods. My next book is called The Spectrum, and it’s about how you can customize a diet and a lifestyle program that’s just right for you based on your own needs and preferences.

Part of what we’ve learned is that the whole language of behavioral change has this kind of fascist and even moralistic quality to it. We talk about cheating on our diets or bad foods or “I’m a bad person because I ate bad foods,” or patient compliance, one person manipulating and bending their will to another’s. Those are all terms that I have found in my 30 years of research are counterproductive.

Rather than viewing foods as good or bad, for example, some foods are clearly more healthful for you than others, but it doesn’t mean that you should never eat [the others]. It means that there’s a spectrum of choice from the least healthful to the most healthful. Consider if someone goes on a diet: Sooner or later, they’re likely to get off of it. Say[ing] eat this and don’t eat that…really doesn’t work in the long run or even in the short run for many people because the other issue is that even more than being healthy, people want to feel free and in control. As soon as somebody says don’t eat this and do this, they immediately want to do the opposite. It goes back to the first dietary intervention that failed, when God said don’t eat the apple.

So by categorizing foods as a spectrum, we get away from all of those problems…If you’re trying to reverse heart disease, you’re going to need to make bigger changes than if you’re just trying to stay healthy. If you indulge yourself one day, it doesn’t mean that you cheated on your diet or you ate bad foods; it just means you indulged yourself, so eat healthier the next day. If you’re trying to lower your cholesterol level, you can begin by making moderate changes. If that’s enough to get it down, great. If not, then you can make bigger changes. I like that because it’s very empowering for people. It gives them the full range of choices, and it respects people by enabling them to make healthier choices that are easier and that they can afford.

One of the other reasons that I [provided insight based on my research for] the Fruit & Walnut Salad is that the diet we found that can reduce heart disease and, more recently, prostate cancer is the diet that people in Third World countries were eating, more fruits and vegetables and whole grains and legumes and soy products and so on. And yet, if you go into the lower socioeconomic areas, these foods, which were traditionally the least expensive, are often the most expensive or aren’t even available. So by making healthier foods available through McDonald’s, it can often reach the people who most need it.

Besides the Fruit & Walnut Salad you counseled them on, how else are you working with McDonald’s?

Well, I’ve been a part of almost everything that involves diet and nutrition and exercise and healthier products. I’ve been consulting with them behind the scenes for several years now. [I provided insight based on my research for] the Premium Salads that came out even before the Fruit & Walnut Salad. I give lectures to dietitians and to foodservice industry people and to doctors and scientists and thought leaders about, first of all, the power of diet and lifestyle and, second, the kind of work that I’m doing with McDonald’s that can really be to everyone’s advantage.

Fast-food chains, especially McDonald’s, have taken some flack in the media, so, to some people, this might seem like an odd pairing. How have your peers reacted?

Well, I think initially some people did see it as an odd pairing, or not so much as an odd pairing, but they would just wonder, “What is Dean Ornish doing working with McDonald’s?” But then…I explained to them how this is an opportunity to make a difference in the world at a time when there’s a real receptivity to it.

At the time that I began working with McDonald’s several years ago, there was a convergence of forces that made it possible to affect change much faster than I thought otherwise would have occurred. There were concerns about litigation with John Banzhaf, the person who did the anti-tobacco lawsuits. I was at a foodservice meeting with him, and he kind of pointed his finger at the food executives and said, “You’re next.” [There were also] concerns about legislation, for example, vending machines being banned from schools, taxing foods, and so on, as well as realizing that there’s a real market opportunity. For example, I’ve been consulting with Pepsico, and they found that last year two-thirds of their revenue growth came from their healthier foods. McDonald’s sold [more than 450 million salads since 2003]. So there’s a growing realization that this is not only the right thing to do; it’s good business.

And this is a trend that’s only going to increase over time because, number one, there’s a growing awareness of how important diet and lifestyle choices play in people’s lives at a time when the limitations of high-tech approaches and drugs are becoming clear, like Celebrex and Vioxx and drugs that have been withdrawn from the market because of side effects. And the limitations of interventions, like angioplasties and stents, which the studies are now showing really don’t prevent heart attacks or don’t prolong life in most people who receive them [are also becoming clear] at the same time that there’s more evidence than ever that diet and lifestyle changes are so powerful.

These very simple, low-tech approaches—what we eat, how we respond to stress, whether or not we smoke, how much exercise we get, and the quality of our social relationships—can make such a powerful difference in people’s lives. In our research, we’ve used these very high-tech, expensive, state-of-the-art measures to prove how powerful these very low-tech and low-cost and often ancient interventions can be.

And another trend…is an interest in alternative medicine and complementary medicine, innovative medicine. I was appointed to this White House commission on complementary and alternative medicine policy a few years ago and spent two years on this commission. We learned that there’s more money spent out-of-pocket for alternative medicine than traditional medicine. So there’s a real interest that people have in empowering themselves with information so they can make healthier choices. And as the Baby Boomers from the age wave are getting near 60, the number of older Americans is increasing, so there’s a greater interest in health issues.

And finally, health care costs have been going up exponentially. They already account for 16 percent of the GDP, and by five years from now it’s expected to be 20 percent. Many companies are finding that they just can’t sustain this. At Starbucks they said that they spend more money on health care for their employees than they do for coffee beans. At General Motors they spend more money on health care for their employees than for steel. And if that’s not bad enough, in two or three years many companies are projecting that they’ll spend more on health care than their entire profits, which clearly isn’t sustainable.

These approaches aren’t only medically effective; they’re also cost effective. They can help people reduce their costs at a time when the population is getting older and older. So for all of those reasons, there’s been a convergence of forces that’s made a receptivity at McDonald’s and other companies much greater than anything I would have projected. Are they moving as fast as I’d like? Of course not. But are they moving faster than I ever dreamed possible? The answer is yes.

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