I recently read the wonderful new book by Dr. David Kessler, The End of Overeating: Taking Control of the Insatiable American Appetite. This book, along with Mindless Eating, by Dr. Brian Wansink, and Stuffed, by Hank Cardello, puts together a wonderful diagnosis and set of recommendations for addressing the obesity crisis. These books, taken together, yield the most sensible diagnoses and solutions to the obesity crisis. They are consistent in making the following observations:
- Successfully combating obesity is simply a matter of controlling calorie consumption relative to the calories burned off through exercise and other daily activities.
- In addition to controlling overeating, good eating includes having a diet that includes the correct balance of proteins, complex carbohydrates, fat, and minerals and vitamins.
- Overeating is partially a result of a combination of the great success food companies have had in finding the “sweet spot” in the palette of eaters in which they are attracted to an optimal combination of sugar, fat, and salt. Over time, food producers, restaurants, and grocers have gotten better and better at marketing the pleasurable aspects of food. Historically, people stopped eating when they were full, and were constrained from overeating by the combination of the high cost of food, the unattractiveness of much of what they were eating, and the fact that their body signaled that they were full. Today, unhealthy food is lower cost than healthy food, unhealthy food often tastes better than more attractive options because of brilliant product development efforts, and because there is a delay between when someone has eaten too much and when they feel full.
- Combined with the brilliant product and marketing efforts of food producers and marketers is the environment in which unhealthy eating is almost inevitable. Dr. Wansink’s book, in particular, identifies opportunity and disparate availability of good and bad foods as the reason why many people unconsciously overeat unhealthy foods. Many lower-income neighborhoods are “food deserts,” which means that they lack healthy food that is affordable, available, abundant and attractive. Many public health officials have zeroed in on this problem. For example, in a great report entitled Life and Death from Unnatural Causes: Health and Social Inequity in Alameda County, the Alameda County Public Health Department states on page 97, “A lack of healthy food outlets and overabundance of liquor stores are part of the legacy left behind by several decades of systematic disinvestment in low-income neighborhoods.”
Several solutions emerge from these books, as well as other expert sources:
- Better calorie and nutritional labeling will help consumers make better-informed choices. Dr. David Katz of the Yale School of Public Health Preventive Medicine Research Center has spearheaded the creation of a single integrated rating system for all foods entitled NuVal, a nutritional scoring system, which is described in detail at nuval.com. If all those who produce, market, and serve food were required to use this evaluation system, which was approved by the Food and Drug Administration, then we would have a simple way of comparing very different foods relative to calorie consumption and total nutritional value. While there are legitimate questions about whether this is the right way to evaluate the nutritional value of food, Dr. Katz has clearly taken this debate to another level. If NuVal is not the right solution, then someone needs to improve on what we have today in a different way. We have insufficient and confusing food labeling.
- Mr. Cardello recommends that governments not try to micromanage individual ingredients, as New York City has done with transfats, but that government give food producers, marketers, and retailers calorie reduction targets, (and he might also have suggested a nutritional scoring target had he been familiar with Dr. Katz’s system), and let the food industry use its innovative capability to figure out how to make more money and deliver more nutrition with reduced calorie consumption at the same time.
- The implications of Dr. Wansink’s work, as well as the work of many public health officials, such as Dr. Tony Iton and the Alameda County Public Health Department, is that we must create environments more conducive to healthy eating.
- Finally, Dr. Kessler takes the position that overeating is an addictive behavior, and we need to approach it as such. As an addiction, it is not like smoking or consumption of controlled substances, which are bad at any level. It is more like alcohol addiction, since eating is good up to a point, but bad when it is excessive. Health insurance plans need to pay for proven programs that help individuals manage their addiction to overeating. At Pitney Bowes, we pay for a variety of weight-loss programs, including WeightWatchers and a residential program called Structure House for morbidly obese health plan participants.
This will not be an easy problem to solve, but we must begin by recognizing its root causes, and by scaling up the solutions that are working best. The most important conclusion from these books and from talking to experts like Dr. Katz and Dr. Iton is that the obesity crisis is not going to be solved primarily through clinical interventions. It will require a major shift in community values and practices.