Up until about two weeks ago, I would say that I had the same idea about obesity that most people, including obese people themselves, have. You’ve heard of the ELFS diet? “Eat Less Food, Stupid!” It’s offensive, but I think it about sums up what most people think is the problem: obesity is a personal failure to control oneself.
But in the last two weeks, I have thrown myself into a Psychology course Yale offers free online, and I have been immersed in a new way of thinking about obesity and overweight in general.
I have listened to scientists talking about the animal studies they have conducted indicating that high-fat or high-sugar foods are addicting in a way very similar to cocaine, alcohol and nicotine. Animals eat normally when exposed to healthy foods but overeat when they are allowed to eat fat and sugar. Rats exposed to sugar develop tolerance to it which makes them need more of it to get the same dopamine reaction. Rats will choose sugar over cocaine or alcohol. Fat and sugar cause changes in the brain scans of obese humans that are indistinguishable from the changes that cocaine cause. This addiction, like that of other drugs, appears to prime the victim to lifelong cravings for the substance. There are opioid-blocking drugs, usually used for alcoholics, that work to treat binge eaters [Contrave is a combination of several of them]. As with other addictive substances, habitual ingestion of sugar causes the body to prepare for it when cues are received (sight, smell causes insulin increases, etc.). When people experience these cues without taking the expected cocaine, alcohol, nicotine, or sugar, they experience strong cravings because their bodies are prepped. People and animals both need more of the sugar and fat over time to maintain the same levels of dopamine in their brains. Patients with overeating problems use the language of addiction, “craving,” “loss of control,” and experience visible and measurable withdrawal symptoms, such as change in body temperature. People continue to overeat despite clear negative consequences physically, socially, and healthwise. It is not clear whether it is only sugar which is addictive, or whether it could be fat, chemical additives, or other ingredients such as High Fructose Corn Syrup. All these professionals say that more studies are needed before any of these ingredients are labeled addictive substances, but as you can see, they are well on the way.
If alcohol or cocaine were available everywhere, dumped into school lunches and products aimed at children, advertised all day, and pushed on people constantly, through office candy bowls and birthday celebrations, school parties, miles of fast food joints, and shelves of junk in gas stations and pharmacies, would we be surprised that people had a problem resisting it? Nicotine was once advertised to children, loaded into vending machines, and sold for a quarter a pack, and no one thought anything of it. When we learned how addictive it was, we put a stop to it. If it turns out that sugar is addictive, as it appears to be, what ramifications will that have?
I have learned that sugar is jammed into things it has no business in, such as peanut butter, Dinty Moore Beef Stew, and ketchup. Why? Because it tastes good and increases sales. It reminds me of the way Coca-Cola got its start; now it just relies on a HFCS high.
Our bodies’ biology evolved in a world of scarcity, and that biology fights us in a world of overabundance. We developed very strong tastes for sugar and fat, the hard-to-come-by energy-dense foods that would help us survive through the lean times. Our bodies are designed to store this energy as body fat, and to conserve it in lean times. Our bodies don’t care that we are trying the newest diet – it thinks we are facing starvation, and cuts our metabolism and increases our desire for food.
We are often under stress, and stress leads to unhealthful eating. In the Yerkes primate study, subordinate monkeys (who experience more stress) ate a little less of a healthy diet than dominant monkeys, but when sugar and fat were introduced, dominants ate a bit more but subordinates ate a lot more, especially at night. The fat and sugar was a comfort to them, an efficient dopamine-stimulating coping strategy.
How about genes? It is estimated, using twin studies, that 25-40% of population weight variance is due to genetics. Adopted children’s weights show a strong correlation to their biological parents’ weights, and little to their adopted parents’ weights.
“Genetic influences largely determine whether a person can become obese, but it is the environment that determines whether a person does become obese and the extent of that obesity.” – Stunkard & Meyer 1993
“Genes load the gun and the environment pulls the trigger.” – Bray 1988
You know how some people can eat and eat and never gain a pound? I’m not totally like that, but I have to admit, I have never had a problem with weight. But people with the obesity genes would have had great advantages thousands of years ago. They would have been the ones who could starve and starve and never lose a pound. That’s what they’re up against when they try to diet.
An economist pointed out that once upon a time work was hard work. People toiled and sweated. Some still do that, but many perform more sedentary labor, which means that instead of being paid to spend calories, it has become more expensive, primarily in lost leisure time. Everyone is busy, but it doesn’t take too much imagination to consider a hard life of stand-in-one-place retail work sandwiched with a bus ride home and caring for children in a difficult neighborhood which does not give an opportunity for an hour of jogging. This probably isn’t an uncommon situation, and can you blame them for not getting enough exercise?
Whose failure is it that our government’s farm bill subsidizes exactly the crops that go into the worst foods? Corn and soy are converted into animal flesh and most of the unidentifiable chemicals that populate processed food ingredient lists. The resulting artificial cheapness of these foods explains why they are so profitable, so heavily advertised, and so prevalent. How many times have you wondered why vegetables are so expensive? It’s the other way around – American spend less per capita on food than any other nation. Vegetables, even organic ones, probably are a truer reflection of the actual cost of food, and they don’t seem expensive until you compare them with our dirt-cheap processed food and 99 cent menu items. Our laws encourage consumption of food that will make people sick. The Physician’s Committee for Responsible Medicine makes the connection between this issue and our hair-tearing about the high costs of medical care:
“Even if the steak and cheese produced on American farms foster health problems, our government rallies behind agribusiness all the way to the emergency room. Sadly, every administration in recent decades has been caught up in a system that not only tolerates ill health, but encourages it.” – Barnard
“A good source of 7 vitamins and minerals”
Food manufacturers have most of us outsmarted. They deliberately tweak their marketing and the product itself to trick us into eating more than we think we are. They sneak in unhealthy fat and sugar, they cause us to increase our portion sizes by making the product more nonuniform (studies show people will eat more of a snack mix than a homogeneous snack such as plain pretzels), they put health claims on packages that are usually inversely related to the healthfulness of the product within (compare health claims on packages of Cocoa Puffs “now with Whole Grains” to a package of carrots), they trumpet the vitamins they added to Pop-Tarts, for Pete’s sake. Vitamin deficiencies are not really a problem for most Americans – Pop-Tarts are the problem! Restaurants know that we think a good deal is more food for the same price, and so we come back to establishments that load up our plates, so now they all do, and it is now very difficult to have restraint when we eat out – our whole sense of how much is reasonable to eat has been sideswiped. Industries study us and tweak their approach to push our buttons. We don’t stand a chance.
Diets don’t work. How many obese people do you know who followed a diet, took off weight, and kept it off for five years? When diet promoters give statistics of success for their products, they tout how fast the weight comes off and usually use a six-month standard, but that isn’t good enough. Here is a study that followed several diet and exercise combinations for two years, and at the end of that period there was little net weight loss and two of the three groups ended up heavier. The best-rated diet, Weight Watchers, repeatedly says you will keep weight off “if you stick to it.” That’s the whole point. People with with a chronic addiction to unhealthy foods, immersed in a toxic environment of cheap, tasty, ubiquitous, artificial foodlike substances, are unlikely to be able to resist for long.
Click to zoom in on this amazing picture.
Look at the food in the grocery store. If you did an item-by-item analysis, I think you would find that the vast majority of it is crud that no one should be eating. What are the percentages of white pasta to whole wheat? How about for bread products? What is the proportion of truly healthful cereals to the rest? How many of those peanut butters and jellies are the best they could be? How many aisles are dedicated to snacks and sodas? Compare the number of bags of white flour to whole wheat. White rice to brown. Juices with sugar to juices without. There’s a little tiny shelf dedicated to dry beans, and an entire aisle of freezers dedicated to processed meals, fried whatever, and desserts. Half an aisle honors ice cream. There is more space dedicated to candy than to canned vegetables. Remember the food pyramid? How is all that candy going to cram into that teeny tiny little triangle at the top??
I was talking about this toxic environment with my Dad and he said he wondered why he overate the stuff he bought, and then started wondering why he bought what he did at all, and the answer was, it was there. He would wander down an aisle and, oh, that looks good, and here it is in the store, people must eat this, so why shouldn’t I?
Now, you can very reasonably counter that the stuff is there in those proportions because that’s what people demand. That may take the blame off the store, but how does it help the person who’s trying to lose weight? Having one person go on a diet in the midst of this feeding frenzy is like putting one of your fingers on a diet. How can we blame individuals for this collective and often state-sponsored mess?
Yes, people can make better choices, but the deck is vastly stacked against us: a biology designed for scarcity, a food economy which separates food as a commercial commodity from food as nutrition and encourages consumption of unhealthy foods, nutrition education that is designed not by health advocates but by industry interests, and food manufacturers whose object is to manipulate us into eating more and more of food that’s worse and worse for us.
In these studies, in the articles I have read, the doctors, lawyers, economists, psychologists,and researchers I have heard speak in their own words, I have found a new compassion for and understanding of the problem of obesity, which may even surpass what obese people feel about themselves. They think it’s all their fault, too.
One thing that all these professionals seem to have in common is that they do not know what to do about the problem. The answer doesn’t seem to be diets, litigation (suing manufacturers), or even education. How well has blaming or shaming the obese worked? Maybe we should abandon that tactic. A vaccine was mentioned as a possibility, something I would have scoffed at two weeks ago as a pharmacological solution for a lifestyle problem. Now I’m not so sure. Prevention of this chronic disease was discussed, particularly in light of all the marketing towards children. Sugar taxes are unpopular with the public because they don’t want anyone telling them what to eat. If you think there aren’t people all day telling you what to eat, through ads, your tax dollars, the USDA in your child’s classroom, and on and on, you haven’t been paying attention. Wouldn’t you prefer it to be someone who cares about your health?
I’m coming to the conclusion that a huge part of the problem is the farm bill, a result of our senate system being skewed for more representation for less populated (farming) states. I’m not opposed to farmers and I have no informed opinion on farm subsidies in general, but it doesn’t seem to make much sense to subsidize unhealthy food and then wonder why our health is so poor. But no one can be sure. Some of those professionals I heard felt that a variety of societal approaches should be tried to determine what works, and this is happening now, but in a haphazard, segmented way. One suggestion was that a governmental department for food health be created, basically breaking that task away from the catastrophically conflicted USDA, which is primarily charged with promoting agriculture. There’s no H or N for health or nutrition in “USDA.”
I’ve tried to present here an overview of thinking about obesity in a new way. If this topic interests you, I would urge you to find out more through the Yale course linked above and through the Yale Rudd Center.