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America is in, to quote the title of a new book, "A Big Fat Crisis."
The crisis in question is what the surgeon general nominee, Dr. Vivek Murthy, this week called the defining public health challenge of our time. So we need more than ever to understand,"The Hidden Forces Behind The Obesity Epidemic — And How We Can End It," to quote the subtitle of that new book.
Author Deborah Cohen, an MD and senior scientist at the RAND Corporation, makes two powerful points (among others):
• Given human nature — particularly all the ways we're hard-wired to perceive and eat food — the current food environment (or "food swamp," as she puts it) pushes most of us willy nilly into extra weight, and we cannot realistically expect most people to have the superhuman self-control needed to resist it.
• Given that obesity has become a major public health problem, it is time for the government to step in, as it has in past public health crises — including, most classically, bringing in better sewage systems in the 19th century to stem water-borne diseases like cholera. Government measures could range from restricting displays of junk food to rating restaurants on how healthy their menus are.
I leave it to others to debate those central messages; I asked Dr. Cohen instead to expand on a more minor point that particularly rang true for me. On page 184, she includes this little coping tip: "Look at the current food environment and purveyors of processed foods with suspicion." She writes:
"If we start viewing the worst offenders in the food and beverage industries with disdain, their efforts will fail to persuade us to buy their products. We will have inoculated ourselves against companies that sell us junk foods and that advertise and market those foods relentlessly. The best thing about this approach is that we won't have to use up any of our willpower or limited cognitive capacity to reject these unhealthy foods — we will say no automatically, as we do when faced with anything suspicious."
Recent books and media coverage can certainly help fan our suspicion, particularly the rising criticism of "Big Food," and marketers whose products have been clearly shown to be obesogenic — soda, candy, junk food in general. Personally, I've found my own food attitudes shifting as my distrust of food-makers has risen, as I've read more about how marketers develop "hyper-palatable" foods to hook us, and stores design their shelves to maximize impulse buying. (In fact, Dr. Cohen cites findings that supermarkets often gain more income from vendors who pay for the prominent placement of their foods than from selling the food itself.)
It's reached the point that, if I find a truly indefensible bit of junk food in my pantry, I may declare it "non-food" — "They only want us to think that it's food, but it has no redeeming nutritional value whatsoever!" — and throw it out. My tainted attitude vastly diminishes any appeal it may have. Eating it would make me a sucker.
We’re being tricked into spending our limited resources on food that will lead to chronic disease.
So Dr. Cohen's prescription for suspicion made sense to me, and I asked her to expand on it further: Can we really use our own disdain and distrust to lose weight and improve our health?
Our conversation, edited:
Deborah Cohen: First, I want to say that I actually think that trying to have each person solve this problem on their own is doomed to failure, because the environment is so powerful and it affects us in ways that we can’t always recognize. Unless we can control the environment, we’re not going to be able to control ourselves very well. That's for most people. Yet there will be some people who can take this advice and put it to good use to lose weight, but that’s not going to be everybody.
Point taken, and I must say, I found your emphasis on the power of these automatic responses to food, that most of us cannot control, very comforting, because it has long baffled me that so many of us — including me — can accomplish so many other things but not lose unwanted weight. So how can distrust help us?
The easiest things to give up are junk food items like candy, sugar-sweetened beverages, chips. Let's start there, because those are generally very recognizable, and they’re placed in our faces everywhere we go. If we can look at those items and think, 'Those are being made to trick me, to dupe me and to take my money' it will be easier to resist them. If you think about a bag of potato chips, that might be less than half a potato in there, the ingredients might cost a few pennies, but they’re going to charge you a dollar or more. The ingredients are cheaper than the labor, packing and advertising that are used to sell them.
So if we think that junk food is ripping us off, maybe we’re going to be less likely to buy it. We're being ripped off financially, we’re being tricked because this food will increase our risk for chronic disease, and they’re exploiting our human nature to want something quick, convenient and tasty. So be suspicious.
Also, think about sugar-sweetened beverages.
I stopped drinking them years ago, and it’s not because I didn't like them. I used to love root beer, for example, but I haven't had it in years because I'm angry at the soda industry. Sugar-sweetened beverages are making a lot of people sick. Beverage companies are targeting their marketing at people who really can’t afford to buy them.
The sodas are being sold as fun, as high-status, to trick people who are of lower status into buying them. Many people who spend money on sodas could more profitably use that same money to buy nutritious food — fruits, vegetables, whole grains, milk — or even to go on a trip to a park for a day.
We can use the money in better ways, but we’re being tricked into spending our limited resources on food that will lead to chronic disease. That makes me angry.
How else would you use distrust — to the extent it can help individuals? Say, when you're sitting in a restaurant?
Yes, that's another good place, because most restaurants are serving too much food, too many calories, more than we can burn. The portion sizes are way too large, so maybe what we can do is share one meal with a dinner companion, just divide it up at the outset.
Right, and how about our attitude toward understanding the motivations of the restaurant?
Say you come into the restaurant and there’s a free basket of chips or bread in the middle of the table. You can think, 'They’re putting that there so we’ll fill up and not notice how bad the food is — or how unbalanced or bad for us it is.' So maybe we could immediately think: 'They’re putting all these chips and bread and sort of garbage food in front of us and we should say, 'You know what, they’re tricking us, they’re going to make us eat too much. We’re going to immediately tell them to take it off the table.'
Another thought about using suspicion in restaurants: People should realize that if restaurants are serving such large quantities of food — especially in all-you-can-eat places — the quality cannot be very good. A restaurant is probably serving low-grade foods or food that is not very fresh if they can afford to offer as much as you want.
What about when you walk into a supermarket? How can distrust be a good tool there? I really was amazed by that factoid that supermarkets bring in more money from food vendors for shelf placement than from selling the food itself.
Yes, that came from a book by Herb Sorensen called "Inside the Mind of the Shopper." In the supermarket, it’s really amazing how things are being shifted right now. If you go to the fruit and vegetable section, there are going to be non-fruits and vegetables there. They might put a bottle of wine; they might put some chips to go with the guacamole. They'll put other things that will condition you to make associations so that you’ll not just buy something healthy but something unhealthy along with it. So just trying to notice how items are being manipulated to increase your spending might help people resist. If you recognize that 'It's placed there because they want me to be impulsive,' that might help you counter the effect.
For example, if you go to the yoghurt section, there are all these different flavors, or the soup, all these different styles. When there's so much variety or they have a special, say 10 for $10, it actually encourages you to buy greater quantities, and then eat more, than you would have otherwise. Variety makes us buy more, as does the suggestion that you're getting a bargain because you're buying in bulk.
I also found it eye-opening when you wrote that items on display at the ends of the aisles sell at far higher rates.
Yes, there's something about the arrangement of food, when it’s on special display or at the end of the aisle, that it gets more attention. I don’t know if it’s a column effect, that draws your eyeballs there, but there's something irresistible about it. First of all, we have to pass them every time we go to other aisles. We can't avoid them the way we can the products that are in the middle of aisle. But perhaps it's the height of the end aisle display, and the way it juts out from the rest of the products that really captures our attention.
I’ve heard advice to stay on the outside walls of the supermarket, where the fresh rather than the processed food tends to be.
That might help a little bit, but that won’t solve the problem because now they’re putting junk food on the outside walls of the supermarket, too. And they put items that you might want very often, like milk, way in the back so you have to go around the whole store and pass everything else just to get what you want.
Going to a market with a list, and being very careful to stick to the list, can protect you from buying too much. And even better is if you can order online and have your food delivered or just pick it up instead of having to shop yourself. You're not going to be exposed to all of those temptations.
What about ways that it actually helps to distrust yourself, to distrust your own brain, your own instincts? You write about these automatic unconscious responses to food, everything from eating more if we're served in a bigger bowl to eating more when we're distracted. What would you highlight?
For one thing, when we look at food, it can make us feel hungry. So if might help if we have a rule of thumb to leave a gap of three to five hours between any eating. We don’t need to eat constantly but yet if we see food or something that suggests it's time to eat, we can still feel hungry even though there is plenty of food in our stomachs still being digested. Maybe if we check our watches more and pace out how often we’re eating, that could help some of us reduce the frequency and quantity of what we’re eating. It might help people on diets.
And portion size?
Yes, if you’re served too much, you eat too much. Some people, unfortunately, if they really want to control what they eat, will have to use measuring cups and kitchen scales to limit portions, because we are terrible judges of quantity just by eyeballing.
How else do our own brains conspire against us?
Our brains can perceive things that our conscious awareness cannot. Television is one of the triggers that make people feel hungry and want to eat something. We may not realize that it was an image on TV that made us want to eat something. If we're watching TV and all of a sudden somehow feel hungry, we have to just discount that right away and instead of walking to the refrigerator maybe walk in the opposite direction and do some calisthenics. Just think: the TV is forcing us to be sedentary and even just being sedentary itself is a risk factor for chronic diseases.
Let’s end on possible public health solutions. How would you sum up your biggest recommendations?
The main thing is that it's too much of a burden for individuals to fight this battle on their own. This is a public health problem — it needs a public health solution. Standards and regulations are the backbone of public health, and we need to develop and implement a series of standards and regulations that will make the food environment safer, so people will automatically get the food they need and not be undermined and influenced to consume food that leads to chronic diseases.
Part of why I think it's too difficult to be suspicious all the time is that it will put us in an unhappy frame of mind. If we're going to be asking people to do that, we’re asking them to make themselves miserable, angry and upset all the time. We have to eat three times a day. That's a lot of negative vibe.
It is. And for many of us, our relationship with food is already so complex, so often a battle of "goods" and "bads."
And it didn’t used to be like that. It’s only because our country has been turned into a food swamp, and there's danger everywhere we go. And that's a shame. That’s why these standards and regulations are necessary to protect people.
Readers, reactions? Are you already on the Distrust Diet? How do you see it?
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