Tuesday, April 28, 2009

Are Business Leaders to Blame for our Tendency to Overeat?

According to "The Science and Psychology Behind Overeating," an April 28, 2009 Wall Street Journal review of the book The End of Overeating: Taking Control of the Insatiable American Appetite:
The Science and Psychology Behind Overeating
Former FDA commissioner David Kessler examines the causes of excessive eating in his new book, "The End of Overeating"

In a wide-ranging look at eating habits, David Kessler, the former head of the Food and Drug Administration, addresses America's ever-increasing waistlines in his new book, "The End of Overeating: Taking Control of the Insatiable American Appetite."

He interviews the overweight, who say that just the sight of a favorite snack food is enough to make them feel hungry, as well anonymous food executives who admit that fat, salt and sugar are often the building blocks of successful food products. The book was prompted by a question that had long nagged Dr. Kessler: Why is it that Americans continue to crave such foods as potato chips and candy bars long after they feel full? "No one has ever explained what's happening to them and how they can control their eating," he writes. "That's my goal in this book."

Dr. Kessler, a 57-year-old pediatrician, was commissioner of the FDA from 1990 to 1997. He is probably best known for his opposition to tobacco interests and efforts to better label food products. He is currently a professor of pediatrics at the University of California, San Francisco.

The Wall Street Journal: What most surprised you while researching this book?

David Kessler: I wanted to understand why it was so hard to control what we eat. I thought I was going to end up in the world of nutrition and endocrinology. I ended up inside the brain and inside the food industry. The metaphor for the book was: Why did the chocolate chip cookie have such power over me? I saw a woman on Oprah who said she ate when she was happy, when she was sad, before her husband left for work and then after he left. I wanted to understand what was driving her behavior. It was not just that she was eating too much -- she was eating when she didn't want to eat. And nobody could explain why. I wanted to know, how could we help her? What was driving her? The greatest surprise was understanding how highly palatable foods had hijacked her brain.

WSJ: Early on in the book, you suggest that that major food companies know what motivates shoppers.

Dr. Kessler: They know what drives demand, and they were able to design foods to be hot stimuli. The food industry says they only give consumers what they want. But what they want excessively activates the rewards circuits of the brain. They aren't selling just any commodity. They've designed highly stimulating products, and consumers come back for more. Nothing sells as much as something that stimulates the rewards-circuitry of the brain. It's all about selling product.

WSJ: What about restaurant eating?

Dr. Kessler: Much of what we eat in restaurants is fat on fat on sugar on fat with salt. Pick any dish in any mid-American restaurant. What is spinach dip? Fat on salt with green stuff. Look at the average salad we're eating. If you look at the bacon, the croutons, the cheese…it's fats, salts and a little lettuce.

WSJ: At times I couldn't decide whether you felt that the overweight were victims or undisciplined. Which is it?

Dr. Kessler: The answer is probably neither. Nobody has explained to people what is going on with them, or given them the tools to cool stimuli. Yes, you are bombarded throughout the day. You respond. And that creates torment for people. But just because we are activated and stimulated doesn't mean that that there aren't things we can do. Yes, their brains are being hijacked. But once we understand what is going on, we can change.

WSJ: What are the most important signs that people can recognize before they eat something they actually may not want?

Dr. Kessler: The fundamental question, when you look at food, is this: Is it real food, or is it food that is layered and loaded? It's easy to look at food and see what else is being layered on top of protein. I don't have a problem with a plain hamburger -- it's adding cheese and bacon. Also, you want a reasonable amount of food that you can control. Today if you put large amounts of food in front of me, I don't want it. But I used to go through big portions in an instant. We each have to decide what we find rewarding, and then decide how we control it.

WSJ: Regarding visual food cues, are you suggesting that the sight of a bowl of innocent M&Ms is enough to make us want to eat them?

Dr. Kessler: It depends on your past experience and what stimulates you. Everybody is different. For me it may be chocolate-covered pretzels. The one thing I can assure you: At the core, it's fat, sugar and salt. Not everything activates each of us the same. Here's the fundamental point: We are wired to focus on the most salient stimuli in our environment. If your kid is sick today, that's what you think about. For some people it's sex, gambling, alcohol. For many of us it's food. And within that category, different types of food are salient. You have to condition yourself to take the power out of the stimulus.

WSJ: Are we then all victims of subtle cravings whose genesis we're doomed never to understand?

Dr. Kessler: This syndrome of conditioned hyper-eating, which is what this is -- the loss of control in the face of highly palatable foods, lack of feeling full -- is reward-based eating. Not all are equally susceptible. Those obese and overweight have a greater incidence. But even 20% of the healthy report occasional loss of control. You will find people for whom food doesn't capture their interest, but it's probably a small percentage of the population. For the rest of us, it's a continuum. It's not only conditioned behavior. It's the learning and motivational circuits of the brain being captured. Is it nurture or nature? You expose children who are eating fat, sugar and salt all day. They've never been hungry a day in their lives. Once you lay down that neuro-circuitry, it's there for life. The actual act of consumption isn't as strong as anticipation. It's the conditioning associated with a cue. Once you are cued and you're activated, it amplifies the reward value. It torments you. You want it more.

WSJ: There is a lot of concern about obesity and children. What is the biggest cause? It is portions that are too large, or the wrong types of food?

Dr. Kessler: They are getting huge portions of very stimulating foods, hyper-palatable foods. You have huge portions of sugar, fat and salt. Every time they eat those foods it strengthens their neuro-circuitry to eat that food again. It activates them. Once these cues are laid down, and the information is in your brain, it stays there and drives behavior. This isn't a disease. But we've been captured by these stimuli. In the past, it allowed us to survive. Now we have health consequences because it's available 24/7 and we've added the emotional gloss of advertising.

WSJ: Is nutrition too difficult a concept to regulate?

Dr. Kessler: In the end it's not about regulation. Government can play a role. It's about how we as a country view the product. What was the real success of tobacco? We changed how we viewed the product. It was a critical perceptual shift. That's the key.

Write to Jeffrey A. Trachtenberg at jeffrey.trachtenberg@wsj.com

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