Tuesday, July 14, 2009

Off-Topic: "The End of Overeating" by David Kessler

I just finished reading a very interesting book, so here's an off-topic post. I've always been interested in food and cooking - I read cookbooks for fun - and also in food policy and how growing and producing food interacts with human health and environmental issues.

This book, "The End of Overeating", is by David Kessler, who is a doctor and former head of the FDA. I've seen this book around in bookstores, but for some reason never picked it up until now. It was fascinating and I've found a number of things in it that have application to everyday eating and living. It isn't a diet book, it isn't a food policy book, it's about the interaction of changes in our culture and food production with human biology and psychology. Although it deals with a number of scientific subjects, it's not a hard book to read - in fact I found it compelling.

As many people know, big changes have occurred in America in food production and eating habits from the 50's and 60's into the 70's and 80's and on into the present. The percentage of overweight and obese Americans has greatly increased. This has coincided with increasing numbers of meals outside the home - fewer home-cooked meals - and the proliferation of processed and convenience foods and an increasing obsession with diets and dieting.

Obtaining and eating food is a goal-directed activity necessary for survival. There is a biological process for this, which involves chemicals in the brain and feedback loops from our bodies. The premise of the book is that the way many people eat now interacts with our basic biology in a way that leads to habitual, and in some cases compulsive, overeating.

As I understand it, the basic mechanism works as follows. A goal (say eating a cookie that is on the table) is identified. Anticipation of the satisfaction that will be felt when the cookie is eaten causes dopamine to be produced in the brain. Dopamine is the chemical that allows us to undertake action. The action is undertaken, the cookie is eaten, and the digestive system signals the brain, which then produces opioid chemicals - the feeling of satisfaction. In situations of food scarcity, the ability to pursue and eat food is a necessity for survival, so this process is very strongly innate in people. In an environment with structured mealtimes (and more about the content of those meals below), there is an interval between satisfaction and the goal-directed activity of eating the next meal. It's all a matter of expectation - if you don't expect to be eating for a while, you don't think about food or start the process again until it's time. Where food is constantly available, however . . .

A number of things have changed in the American way of eating:

Fewer home cooked meals - more meals out - often meals largely composed of processed foods and sugars and fats - the book has amazing information about the food served at sit- down chain restaurants that may change the way you think about these places

More processed foods - often foods that are high in sugars and fats - as part of the home diet

All the time eating - constant snacking is socially acceptable - often on foods that are processed and high in sugar and fat

Food is often eaten mindlessly - in front of the TV, in the car or on the run

Larger and larger portion sizes - Europeans often comment on this when they visit the U.S.

An obsession with food and dieting

These changes are important in a number of ways. The lack of structured mealtimes and the ability to eat constantly undermines the natural appropriate hunger/satisfaction cycle - people may have forgotten what it feels like to feel satisfied and then hungry enough to need to eat again. When we graze all day, it's easy to overeat. Processed foods are easier to chew and digest than unprocessed meats, vegetables and fruit, and our bodies have trouble recognizing that they are full when we eat them - so we eat more, and more quickly. Larger portion sizes lead us to expect to eat large amounts of food and therefore we aren't satisfied until we do.

And that "French paradox"? - the French drink more wine than Americans and eat higher fat foods, like real butter but are not as overweight as Americans - it isn't really about the chemicals in wine - it's about eating only at mealtimes, drinking wine with meals and eating real - not processed - foods in smaller portion sizes. Of course things are changing now around the world as others adopt American processed foods and eating habits.

The processed food industry, as well as the chain restaurant industry, while they may not understand the details of the science, sure understand the way to create products that play right into our natural tendencies - sugar and fat get human attention better than anything else. Due to the demands for earnings growth from the financial markets - rates of growth that are higher than the growth rate of the population - processed food companies are highly motivated to get us to consume more calories more easily.

So overeating has become widespread. And some people not only overeat, they compulsively overeat. Overeating can become a habit. A goal-directed activity becomes a habit when there is a lack of awareness of triggers and repetitive behavior - whole sequences of behavior become coded as performance units triggered by context. For example, if you respond to stress by eating, before you know it, you're eating. That's a habit, just like a smoker lighting up after a meal. A quote from the book:
Conditioned hypereating works the same way as other "stimulus-response" disorders in which reward is involved, such as compulsive gambling and substance abuse. Such disorders are characterized by a high degree of sensitivity to sensory stimuli, and they typically lead to a perceived loss of control, an inability to feel satisfied, and obsessive thinking.
If you try to suppress a habit it intensifies the power of the cue - giving in resolves the anxiety, momentarily, but reinforces the power of the cue. This is why dieting is so ineffective. Priming - having "just one" - increases desire - it stimulates the dopamine system (motivation/reward-seeking system) a little bit - enough to get it going to make you want even more. Using food as a reward ("I'll have one when I've done x", or "I deserve a reward, I'll go eat [name food]") intensifies the desire and just reinforces the eating pattern.

The most common triggers for overeating, in addition to eating mindlessly, are stress, anxiety and changes of state - times of day when things change (coming home from work, for example) or moving from one activity to another. Although suppressing the impulse to eat is doomed to failure since ultimately it just increases the desire, diversion of the goal-seeking behavior to another activity can interrupt the process.

It's also important to establish new habits - this takes time and planning. The best way to avoid automatic, habitual activity you want to change is to have a plan in place. When the urge arises, know what you will do instead. And have the new habits you wish to establish firmly in mind - rules, like no seconds, or no snacking between meals, can be helpful. Structured mealtimes, and paying attention to what you are eating, can help, as can eating real foods - real, not processed, meats, vegetables, grains and fruits that require chewing - that have substance and fiber - can slow things down and allow the body to know it has eaten. They also take longer to digest, which means you feel satisfied longer.

Now that's interesting - there is no diet plan, no calorie counting and no forbidden foods. Just an understanding, grounded in science, of human behavior and of ways to not let it lead us down the easy path of overeating. The analysis has application to other habits, such as alcoholism and compulsive gambling, and gives insight into the inability to start or complete tasks (which in many respects is the other side of compulsion).

10 comments:

  1. Oops, I just had a handful of potato chips...with some wine. Does that cancel out somehow?

    I am much better if I stick to structured mealtimes. I find I stay satisfied for longer and tend to snack less.

    Sounds like an excellent book. I will have to look for it.

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  2. Very interesting, I think I will pick this one up. It's easy to agree with all of this especially the way all meals out are super sized these days. I know too many things have too much sugar and fat in them nowadays, I can't believe I'm reading about so many children with diabetes and obesity. They just don't get enough exercise either. Thanks for the review.

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  3. I have also looked at this book a few times. Glad you read it and liked it. It sounds great, I will have to pick it up next time I am at the book store.

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  4. Jason and I have made a conscious effort to read labels at the grocery store and try to avoid preservatives such as high fructose corn syrup. My gosh that stuff is in almost everything!!

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  5. I found your post today really interesting. Locally we have a wonderful winery that does beautiful food with what I think are generous servings.My husband and I have noted recently with the arrival of Lonestar that the meals there are bigger so some of our friends feel they are getting more for their dollar. If only they realised that the food at the winery is simply superb and is a real eating experience and plenty big enough. The lonestar meals would feed a whole family!.

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  6. Very interesting.
    Now having horsefree vacation, I have had time to read some women magazines...
    I read an interesting article in one of them that touches into one of the conclusions above.
    I believe we all have read articles to why dieting often is fruitless, creating that yoyo-effect as the body is "trained" to be more effective with less. Here, the conclusion was that you could eat when you were hungry, BUT
    1) eat slowly. Enjoy every bit. Feel how it tastes in your mouth.
    Overweight people has a tendency to eat too much too quickly to get a serotinin (satisfaction)-kick, and thus don't get the "full"-signal from the stomach in time.
    2) And stop eating when you are full. Don't empty your plate as a rule.
    Nothing revolutionary, but I thought about it for a while because I know that I am often stressed, which also results in that I eat too fast.
    So I will keep it in the back of my head from now on, as they are simple rules to remember. And combining them with structured foods as you say will give an even better effect.

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  7. We try to eat whole foods and it really makes a difference in our hunger patterns. Maizie has been educated from an early age about whole foods and she is very good about liking them. We are more "old French" in our eating habits. I find it odd though how many people we know, especially older people, are "afraid" to eat with us because we use butter and cream. They have been brainwashed by man-made "natural" food. I know people who will eat something because it is supposedly "healthy" and the ingredient list is too long. They are hungry right away and cranky and headachey. All could be avoided by not looking for an ingredient list. True natural foods come as they are - without a list! Another really good book on the subject (but a super difficult read) is Gary Taubes' book, *Good Calories, Bad Calories*. This is not a diet book to lose weight. It is about the quality of the food we eat. Great post, Kate!

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  8. What a great post! Thank you very much! I am going to find this book. I've struggled with this issue for the better part of my life and think that there is always strength to fight the mental side of the battle when you understand the problem biologically. 'French Women Dont Get Fat' was a good book for talking about the differences in American and French attitude towards food. Thanks again.

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  9. Excellent post!!! That book sounds very interesting. I will have to get my hands on a copy to read.

    I have been recently trying to incorporate more whole foods into my diet. Fresh veggies and fruits and fish and chicken that don't come from a box, but are cooked at home. Time is my enemy....but I working on finding recipes that are simple and easy to make. I know that I 've got to start making the time to cook more and not be so afraid to try new things.

    It's amazing when you sit down and really think about it -- just how much processed food we consume that contains all kinds of chemicals and preservatives.

    Eating better not only means weight loss (in my case), but I'm hoping feeling better and having more energy as well!

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