I have read many explanations for the so-called “obesity epidemic” in the U.S. The phenomenon is undoubtedly multifactorial, with the success of anti-smoking public health campaigns and consequent postcessation weight gain numbering among the culprits. Other possible contributors include the aging population and ethnic shifts that increase the representation of groups that place less cultural emphasis on thinness, to name a couple. Overeating, however, is clearly key.
The big question is not why increases in caloric intake lead to increases in weight but why here and why now? What has happened to our food supply and the way it is marketed, and why are we so receptive? David Kessler’s latest book, The End of Overeating: Taking Control of the Insatiable American Appetite (Rodale Press, 2009), is a brilliant account of how food manufacturers, restaurants, and the advertising industry have conspired to manipulate the salt, fat, and sugar content of foods, mouth feel, portion size, appearance, etc. to maximize availability and palatability. These products — often not food in the conventional sense — are designed and tested to coopt brain reward mechanisms evolved to help us survive under very different conditions. The result is what Kessler calls “conditioned hypereating.” There may once have been an advantage in eating all the berries on the bush but not in the context of perpetual overabundance. It’s a setup for addiction that some can resist but many cannot.
Unfortunately Kessler’s proposed solution – essentially behavior modification based on a perceptual shift combined with showing the food industry the error of its ways – is less compelling than his analysis of the problem. Kessler, you may recall, devoted much of his career as FDA Commissioner to exposing the tobacco industry’s malevolence, which he documented in a book tellingly entitled A Question of Intent: A Great American Battle with a Deadly Industry. As a researcher on smoking/nicotine addiction and author of a book intended to help women smokers who struggle to control weight and keep depression at bay when they quit, I kept asking myself why Kessler is so willing to give the food industry a pass. Does he think the intent of the food industry is less diabolical and profit-driven, even though The End of Overeating is rife with evidence to the contrary? I hope he is right that re-educating them will have a big impact (maybe they have learned something from watching the travails of the tobacco industry), but pardon my skepticism.
Lest anyone think we Americans have brought our troubles upon ourselves through laziness and lack of discipline, there are already signs that the “obesity epidemic” is turning into a pandemic, and why should anyone be surprised? The laws of human biology are not suspended at national borders, and though the U.S. may be at the bleeding edge, we live in a global culture. One further point: In raising concerns about obesity it is not my intent (nor do I think it is Kessler’s) to endorse the socially-engineered preference for thinness that propels so many, especially women, to self-hatred and/or undernutrition. The issue is obesity as a health problem. You know something’s amiss when ads aimed at diabetics, peddling products that make diabetes look like fun, become mainstream.