What would you do if you checked into your hotel room and found there a welcoming plate of freshly baked chocolate chip cookies waiting for you? I know what I’d do – I’d have a cookie. And then, because it tasted so darned good, I might eat another. And then, while I unpacked my suitcase, maybe just one more. And then, particularly if I were feeling tired or stressed or hungry, I might even say to myself: “Oh, what the heck! It’s been a hard day – and I deserve this little treat!” – and there goes the rest of that plate of cookies.
But that’s not what Dr. David Kessler decided to do when this very situation presented itself to him. As a person who had battled his own weight problems for years, he knew that he could have easily eaten all of those cookies in one gulp, but he also knew with equal certainty that he did not want to do that this time. There was only one way to gain the upper hand, and he had to act quickly.
He tossed all those cookies into the trash, getting them out of his sight in order to stop what he calls this conditioned eating behaviour before it even began.
Most of conditioned eating behaviour – believing that tempting food is somehow calling our name and that we are simply powerless to refuse it – is a common cycle of overeating that’s actually fairly recent in modern society. Dr. Kessler explains:
“For thousands of years, human body weight stayed remarkably stable. Throughout adulthood, we basically consumed no more than the food we needed to burn. People who were overweight stood apart from the general population. Millions of calories passed through our bodies, yet with rare exceptions, our weight neither rose nor fell by any significant amount. A perfect biological system seemed to be in place.
“Then, in the 1980s, something changed.”
So begins Chapter One of Dr. Kessler’s remarkable little 2009 book, The End of Overeating: Taking Control of our Insatiable Appetite. As a heart attack survivor who grew up in a Ukrainian family where butter, bacon, sour cream and my mother’s luscious homemade pies were dietary staples (and where we considered dill pickles to be a vegetable course!), I simply could not put this book down, and here’s why.
Dr. Kessler is a pediatrician, former head of the FDA, a former medical school dean, and more to the point, a former fat guy who knows what it’s like to try to stare down an ooey-gooey chocolate chip cookie – and lose.
His expert opinion is that the reasons for obesity are likely the same worldwide, and he lays much of the blame for this at the doorstep of the food industry.
“As the research reported in this book demonstrates, foods rich in sugar, fat and salt promote continued intake, pushing us to keep on eating. The food industry dials sugar, fat and salt into just about everything it sells, makes food available on every corner through widening distribution networks, and uses marketing to persuade us that eating anytime, day or night, is a socially acceptable form of entertainment.”
Dr. Kessler found that “highly palatable” foods – those containing fat, sugar and salt – stimulate the brain to release dopamine, the neurotransmitter associated with the pleasure centre:
“In time, the brain gets wired so that dopamine pathways light up at the mere suggestion of the food, such as driving past a fast-food restaurant, and the urge to eat the food grows insistent. Once the food is eaten, the brain releases opioids, which bring emotional relief.
“Together, dopamine and opioids create a pathway that can activate every time a person is reminded about the particular food. This happens regardless of whether the person is hungry.”
He cites research scientists like Dr. Katherine Flegal of the Center for Disease Control and Prevention, who was the first to notice that the number of people who were overweight had spiked dramatically during the 1980s. In fact, never before had researchers seen such extreme numbers.
In earlier decades, for example, North American adults had typically gained a couple of pounds between the ages of 20 and 40, and then lost a couple of pounds in their sixties and seventies. But Dr. Flegal found that government survey data collected between 1988 and 1991 revealed that fully one-third of the population were now considered overweight.
Adults were gaining millions of extra pounds, but at first these pounds seemed invisible, writes Dr. Kessler. The medical community, the scientific community and government health experts were not quick to notice the trend. But in 1994, results of Dr. Flegal’s research were published in the Journal of the American Medical Association. Her comparison of current and earlier data on weight revealed “dramatic increases in all sex/race groups”.
The obesity rate had suddenly exploded.
Her follow-up research, explains Dr. Kessler, showed that back in 1960, when weight was still relatively stable, the average woman at age 20-29 weighed 128 pounds. But by the year 2000, the average weight of women in that age group had reached 157 pounds.
A similar trend was showing up in women in the 40-49 year old group, where the average weight had jumped from 142 pounds in 1960 to 169 in the year 2000.
Also striking were Dr. Flegal’s findings that people were now entering adulthood “at a significantly higher weight” – reflecting weight gains that had taken place during childhood and adolescence.
And from age 20 to 40, many of us just keep on gaining. Dr. Flegal also observed that, while in general everybody was gaining weight, the heaviest people in the population seemed to be gaining disproportionately more weight than others.
“Weight gain was primarily about overweight people becoming more overweight.”
Studies now suggest that even a 5% weight loss can lower a person’s risk for diabetes, heart disease and other health problems associated with obesity. And this is equally important for those of us who have already been diagnosed with heart disease; the biggest risk factor for heart attack is having already had one.
In a nutshell, here’s how Dr. Kessler sums up why people get fat: because they eat more than people who are lean.
What about exercise? As a former distance runner, I know that during those decades when I ran 4-5 days a week in training for our road races, I could eat pretty well whatever I liked and stay lean as long as I was keeping up my training mileage. Doesn’t inactivity help to explain why we gain weight?
Actually, says Dr. Kessler, the true value in exercise is not so much that it burns calories, but that it helps us achieve a longterm sense of wellbeing. And exercise is essential over the long run.
“Indeed, exercise may well be the most important predictor of sustained weight loss, because it engages the same neural regions as other mood-enhancing rewards and produces similar chemical responses in the body. Just as smokers believe they need a cigarette, someone who exercises regularly comes to depend on the positive effects it produces. And exercise can also reinforce an altered self-image.
“You begin to identify yourself as a healthy, athletic person, someone capable of making positive choices, and that in turn gives you an incentive to maintain control. New habits begin to substitute for old ones.”
That “altered self-image” is a crucial element in being able to sustain lifestyle changes like exercising more and eating less. Many of us who have yo-yo dieted for decades, for example, may fatalistically believe that, no matter what the scale says, being thin is really just a temporary state of being for us, and that we’re just one gooey Tim Hortons maple dip away from gaining all that weight back. We even talk about certain foods as if they are “evil”, and we are “bad” if we give in to those maple dips.
As David Kirchhoff once wrote (he’s the CEO of Weight Watchers International, and also a person who lost 35+ pounds himelf on the W.W. program 10 years ago):
“One of the aspects of maintaining my goal weight that I struggle the most with is the following thought in the recesses of my mind: that any day I will receive the following notice:
“Dear Mr. Kirchhoff,
We have reviewed our records, and it has come to our attention that your visa in our beautiful country has expired. You are now in violation of our laws, and we are beginning steps to have you immediately deported.
Thanks for visiting us.
The citizens of Thin-landia.
“That’s right. I am afraid that I will be discovered as an intruder and not a native citizen of the land of naturally thin people. Now they want to send me back to where I came from, Heavyopolis.”
But David Kirchhoff does lots of exercise. He bikes, works out at the gym – if he stopped doing all that exercise, wouldn’t inactivity result in weight gain? Dr. Kessler offers this surprising answer:
“While vigorous exercise can help control weight, a body of research shows that inactivity does not necessarily predict weight gain.
“More surprisingly, defects in metabolism are not an explanation either. In fact, most studies show that people who are obese – defined as having a body-mass index (BMI) of 30 or above) or overweight (BMI of 25-30) – actually burn more energy than their lean counterparts.
“How much we eat predicts how much we weigh.”
The National Weight Control Registry is an agency that tracks 10,000 people who have lost weight and have kept it off. Dr. Rena Wing, a professor of psychiatry and human behavior at Brown University’s Alpert Medical School, helped create the registry. She explains:
“We set up this Registry in response to comments that nobody ever succeeds at weight loss. We had two goals: to prove there were people who did, and to try to learn from them about what they do to achieve this long-term weight loss.”
Anyone who has lost 30 pounds and kept it off for at least a year is eligible to join the study, though the average member has lost 70 pounds and remained at that weight for six years.
How have they accomplished what many say they cannot do? Registry members reportedly tend to:
- exercise about an hour or more each day (the average weight-loser puts in the equivalent of a four-mile daily walk, seven days a week)
- get on a scale every day in order to keep their weight within a narrow range
- eat breakfast regularly
- watch less than half as much television as the overall population
- eat the same foods and in the same patterns consistently each day
- don’t “cheat” on weekends or holidays
- eat less than most people, with estimates ranging from 50 to 300 fewer daily calories
Dr. Wing told The New York Times recently that she agrees physiological changes probably do occur that make permanent weight loss difficult, but she says the larger problem is environmental, and that people struggle to keep weight off because they are surrounded by food, inundated with food messages and constantly presented with opportunities to eat.
“We live in an environment with food cues all the time. We’ve taught ourselves over the years that one of the ways to reward yourself is with food. It’s hard to change the environment and the behaviour.”
Dr. Wendy Wood of the University of Southern California confirmed this observation in an NPR interview recently:
“To battle these behaviours, one answer is to disrupt the environment in some way. Even small change can help – like eating that ice cream with your non-dominant hand. What this does is alter the action sequence and disrupts the learned body sequence that’s driving the behaviour, which allows your conscious mind to come back online and reassert control.
“It’s a brief sort of window of opportunity to think, ‘Is this really what I want to do?’ “
A considerable chunk of Dr. Kessler’s book The End of Overeating deals with how food manufacturers, marketers and restaurants continue this inundation, taking strategic advantage of “cues” to get us to eat more of their fatty, sugary, salty foods. Restaurant portion sizes, for example, have doubled in the past two decades. If the cues keep coming – if you keep returning to locations where you habitually overeat, for example – you’ll just be relying on sheer willpower, day after day after day, to try to resist those highly palatable foods.
Even people who are not overweight at all self-confess to this apparent inability to gain control once they begin eating these fat/sugar/salt culprits.
We need to change the way we look at these fatty, sugary and salty foods, warns Dr. Kessler. Much as we have changed the way we look at cigarettes (as something now unhealthy and even downright disgusting), we need to start looking at food choices in the same way.
Breaking the grip held by this trinity of fat, sugar and salt, he advises, begins with eliminating most culprit foods altogether from your day-to-day life. Don’t put those candies and chips into your grocery cart in the first place! Do not walk into Tim Hortons. Total abstinence from the foods you have trouble resisting, he adds, is necessary only until you have learned to manage risk.
Until then, here are some of Dr. Kessler’s key guidelines for avoiding those cues to overeat:
1. Figure out what leads to your overeating. Make a list of the foods and situations you can’t seem to control. Knowing what generates an urge to eat and ultimately hijacks your behaviour allows you to erect barriers against it. Be especially alert to the power of location as a cue.
2. Refuse everything you can’t control. Don’t expose yourself to situations that promote the cycle of overeating behaviour. At the grocery store, don’t buy products that are high in sugar, fat and salt. Avoid meals with people whose food habits set your eating spiral in motion.
3. Have an alternative plan. If habit dictates that you always stop for those fried dumplings when you’re in a certain neighbourhood, train yourself to take a different route to avoid walking past.
4. Limit your exposure. If you can’t avoid an eating cue entirely, then limit the amount of time you’re exposed to it. The longer you spend in an environment that stimulates you to overeat, the more you’re likely to consume. That’s often the problem in a social situation – you may be able to turn away from an eating cue initially, but its presence will be a continued temptation until you give in. As soon as you’ve eaten what you know will sustain you, go somewhere else. Don’t hang around the buffet table! Otherwise, the activated brain that characterizes conditioned overeating will keep fueling your desires.
5. Remember the stakes. Along with devising a plan, remind yourself what unfolds if you don’t move away from cues. Think through your habitual response. Remember how you feel when you overeat.
6. Direct your attention elsewhere. Keep your working memory engaged with other thoughts in order to crowd out cue-generated responses. When you’re bored or distracted, give those thoughts a place to reside.
7. Learn active resistance. When other people are putting you at risk, you have a right to resist. Protect yourself by framing seemingly well-meaning acts as hostile ones. It’s okay to feel angry at the marketing and advertising techniques designed to get you to eat more, at the huge portion sizes served in restaurants, and at the salt, fat and sugar-loaded foods you encounter everywhere.
UPDATE, January 5, 2012: Excess food consumption, rather than any specific caloric mixture of protein, fat, and carbohydrates, is an important driver of obesity and will be key in curbing it, suggests new research published in the January 4, 2012 issue of the Journal of the American Medical Association (Bray GA, Smith SR, de Jonge L, et al. Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating. JAMA 2012; 307:47-55)
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