Twice a year we award a student the iVein Health and Wellness Scholarship. Students must write an essay that promotes a practical approach to a healthy lifestyle in college and how these habits can be sustained over a lifetime.

This year’s scholarship was awarded to a student from Harvard Medical School. Here is the winning essay.

I met “Wanda” in the lobby of the motel that served as a family homeless shelter. At the front desk, Dr. Chatterjee and I passed a colorful display of Hostess pastries before we walked over to tour her family’s room. As she swiped her key card to open the door, we could not miss that her key card was also a $5 coupon for three Domino’s Pizzas. Yet neither these temptations nor the challenges of cooking with a bathroom sink and microwave deterred Wanda from preparing a nutritious meal for her family.

Her motivation to eat healthfully came to mind as I analyzed transcripts of focus group discussions I had with students during my senior thesis on healthy eating during college. “I’m young. I’m in college. I can eat what I want with no consequences,” explained one classmate. “Maybe if we were 60 and had diabetes we’d be more willing to make a sacrifice in our diet,” said another. I was shocked to learn that even my fellow Harvard varsity hockey teammates drafted by the NHL had little concern for healthy eating. Maybe college had too many unhealthy food temptations. I wondered if I could encourage students to overcome this like Wanda had.

As a varsity hockey player, I found that when I began to pay more attention to eating nutrient-rich foods, I noticed a considerable change in how I felt and functioned on and off the ice. I set out to learn all I could about nutrition and wellness to maximize my training. Thinking my peers would eat better if they knew more about their food, I implemented a study of traffic-light food labels (green: healthy, red: less healthy) in cafeterias on campus. My study, published in the American Journal of Public Health, included 12 Harvard dining halls which served 6400 undergraduates and over 2.6 million food and beverage portions.

Although the labels provided nutrition information in a simple color-coded format, I learned the same label could give vastly different meanings. Two weeks after I implemented the labels in Harvard dining halls, a small but important number of students raised concerns that the traffic-light labels could exacerbate eating disorders. Late one Saturday night, I received an email from “Diana,” a classmate who was disturbed by the labels and recounted personal struggles with bulimia. The issue promoted widespread discussion about the implications of food labels on campus, and I wondered if I should continue the study.

Since college-age women are at risk for eating disorders, I carefully considered the implications of a red label that discouraged selection of particular foods. Although the majority of students viewed such a label as a simple, convenient way to provide information, a small minority thought a red “stop-light” label could be triggering for those struggling with an eating disorder. On the other hand, college cafeterias could be an effective intervention site. University students gain weight faster in their first year at college than average Americans at the same age, and they begin to develop lifelong eating patterns.

Two editorials in the Harvard student newspaper, titled “A Red Light for Food Labels,” and “Cross Your T’s, Dot Your… Food?” highlighted the controversy of the labeling and how differently

people value food. One editorial believed the traffic-light labeling “let students know the moral value of their food” and that this type of food labeling is inherently faulted because “meals are not ‘good’ or ‘bad.’” To the contrary, I had a significantly different attitude towards food that I shared with many of my teammates. I found that as a varsity athlete, I felt better when I ate certain nutrient-rich, “good” foods and performed better on the ice. What began as a practical labeling study to share this knowledge with my classmates, opened me up to a totally different and important outlook on eating that I had not personally experienced. I needed to find a way to balance both of these perspectives.

I got to work immediately with the faculty advisers and student members of the Eating Concerns Hotline and Outreach group at Harvard to redefine the traffic-light label colors as “nutrient-rich choice” (green), “nutrient-neutral choice” (yellow), and “there’s a more nutrient-rich choice in yellow or green” (red). The use of “choice” in the messaging aimed to make labels less judgmental, and the use of “nutrient” highlighted that calories did not influence the label color.

Stepping back, the controversy over the labeling made me realize how complex it can be to try to influence people’s behavior to achieve good health on a wider scale. Healthy eating is extremely personal, and can carry different meanings for different people. Working with people to understand their backgrounds and helping them overcome challenges to reach their health potential is truly captivating. This cemented my desire to pursue medicine where I would be in a unique position to do just that.

I so admire women like Wanda who despite many barriers, are working hard to take care of their own health. In June 2016, I started teaching a nutrition workshop, “Cooking Without Kitchens,” to homeless families living in temporary shelters and motels. In these classes, I begin with a nutrition lesson, and then give cooking demos of recipes. Using a microwave, I craft meals that can be made on limited budgets within the shelters such as poached eggs, spaghetti, spinach lasagna, tacos, and red lentil salad. These experiences have taught me that we are unlikely to find a one-size-fits-all approach to healthy lifestyles. Efforts to improve student health on a large scale will likely require preparatory work, including student involvement at all stages of development and implementation with iterative improvements based on periodic student feedback, to ensure that interventions are effective and that people are comfortable with them. As a future doctor, I am thrilled to continue this work more broadly to inspire and empower others to explore the adoption of healthy habits that meet unique mental, physical, and social needs.