SALT LAKE CITY — How healthy is the food you're buying? You have the nutrition label on that box of Frosted Flakes, but do you know how to count the calories? Decode the sugar content? Do the math when you add a bowl of milk or a cup of juice?
Technology being developed by John Hurdle, a professor of biomedical informatics at the University of Utah, could make those mental gymnastics unnecessary.
Ten years ago, it occurred to Hurdle how little doctors know about what people eat.
"We know how to put lab values in front of blood pressures and stuff like that," he said.
But for all the medical data, family history or medication history that doctors can summon with a click, "they have nothing on diet or nutrition, even though we know it's a hugely important component of people's health," Hurdle said.
Last year, Hurdle developed a software called QualMART that analyzes the nutritional quality of your grocery basket directly from the sales data.
It's still in pilot stage, but QualMART takes the bar codes on food items and matches them up with a U.S. Department of Agriculture nutrition database. QualMART then runs the data through a healthy eating index to tell you how close you are to USDA dietary guidelines.
Choose things like fruit, whole grains and plant proteins, and your score will go up. Choose things high in saturated fats, sodium and added sugars, and your score will go down.
Public health officials say the potential applications of the software, especially for those battling obesity and diabetes, are far-ranging.
Hurdle is collaborating with several people at the U. who want to use his software to test the effectiveness of their educational programs.
One of the groups teaming up with Hurdle is the diabetes prevention program, which the U. offers for free to people at risk of developing diabetes.
Diabetes affects about 29 million Americans and costs the U.S. about $322 billion a year.
Diet is one of the most important things a patient can change to prevent diabetes, but it can be hard to change people's attitudes toward food, said Julie Metos, chairwoman of the department of nutrition at the U. who runs the diabetes prevention program.
"It's so day in and day out. It gets pretty exhausting to think about all the time. So it's hard," Metos said.
When people are surrounded by fast food and bombarded with advertising, logging every morsel of food into MyFitnessPal or your Fitbit can be a burden. Many people start off strong, then quit, she said.
QualMART would give real-time, instant data with little effort required from the consumer. Metos said she hopes the program will one day be able to spit out a printout of a person's nutritional data right with the shopping receipt.
"It would be very hands on, and then you go, 'I hit the mark here, and I’m a little short here,'" she said.
To Lauren Clark, a participant in the diabetes prevention program, it sounds like a good idea, if a little gimmicky.
In a world where you can track every calorie you consume, record every step you take and sequence your entire genome, Clark asked: Does more data actually do any good?
"At some point, I think we have to be responsible to take that information and change ourselves," she said. "Simply knowing the nutritional content of a shopping cart doesn't change behavior in a meaningful way. The ultimate change has to be with me."
The 52-year-old nursing professor joined the program because it was free and because she fit the bill: overweight, over 50 and with a family history of diabetes.
Clark started tracking her eating habits with MyFitnessPal, an online calorie counter. It helped, she said, by reminding her about portion control. When one slice of whole grain bread at Great Harvest Bread Co. clocks in at 110 calories and you're trying to stay at 1,200 calories a day, "You've just eaten one-twelfth of your daily allotment in a piece of toast," she said.
Clark has since cut out bread and most red meat, switching to a mostly vegetarian diet influenced by Indian and Thai cuisine. After losing 20 pounds, she's now 4 pounds away from being considered normal weight.
Clark has some advantages: She is well-educated, lives near several grocery stores and loves to cook.
Others are not so lucky. Using data provided by Smith's grocery stores, Hurdle's software is starting to tease out health disparities that can make attempts at eating healthy even harder.
Looking at maps of Salt Lake City, Atlanta and Seattle, Hurdle found that stores that sold the lowest quality foods often corresponded to neighborhoods where residents had less education and less income. Education was, by far, the strongest predictor of the quality of a household's grocery shopping habits, he said.
In December, Hurdle and collaborators at Utah State University won a grant from the U.S. Department of Agriculture to improve nutrition education for low-income families.
As part of the project, researchers will use QualMART to assess if nutrition classes actually work by tracking how families shop before and after the classes.
Hurdle eventually wants to partner with more grocery retailers and health insurers to provide shopping lists and offer coupons to reward healthy shopping.
"It's in their best interest to think of these shopping data as a valuable commodity for public health, but also for their customers," he said.
That will require buy-in from big grocery chains such as Wal-Mart — and from consumers. The dataset provided by Smith's did not contain any private information that might lead back to individuals, but shoppers may still be leery of allowing others to see their shopping data.
Eventually, Hurdle wants to create an app so people can receive their data in real time — and even add it to their electronic health record, so their doctors can help track their nutrition.
If he can do that successfully, Metos said, that would be a boon to public health officials battling one of the thorniest health problems facing Americans.
"The more we can nudge people with little bits of info about their own personal decisions instead of just generic information, we find they might be able to better change their habits," Metos said.
"It’s just one little nudge," she added. "The more nudges we have in our life, the more reinforcement, the more changes people will make."