A Big Fat Crisis (21 page)

3
. LaVallee RA, Yi HY. Apparent per capita alcohol consumption: national, state, and regional trends, 1977–2010.
http://pubs.niaaa.nih.gov/publications/Surveillance95/CONS10.htm
. Wash, DC: NIAAA, USDHHS;2012.

F
IGURE
5
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US Annual per Capita Alcohol Consumption
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Nearly everyone can become addicted to substances like heroin. And most of us would become addicted to tobacco if we smoked it early and often enough in life. We generally locate the source of addiction to tobacco and heroin in the substance rather than in the person.

Is it fair to compare potentially addicting substances like alcohol, tobacco, and heroin with food? The confessions in the beginning of
Chapter 1
about how difficult it is to control a ravenous appetite sound very much like what alcoholics might say about drinking or what drug addicts say about their favored substances. Is it possible that people who have trouble controlling how much they eat are addicted to food?

Addiction vs. the Imperatives of Our DNA

Technically, the term “addiction” refers to dependence on a substance or a practice one does not need for survival. The dependence is usually characterized by physiological, and sometimes life-threatening, withdrawal symptoms when an addicted person tries to stop using the substance. Given the first part of the definition, food would
not
qualify as an addictive substance because we must have it for survival. Notwithstanding that, the criteria for dependence would make us all addicts because we would all suffer physiological “withdrawal” symptoms signifying hunger if we stopped eating.

Scientists like Dr. Nora Volkow, Director of the National Institute on Drug Abuse, have also shown that the neural pathways that are responsible for addiction to drugs are the same ones that are involved in the desire to eat.
¹²
Some researchers use the term “addiction” loosely and consider any persistent substance use or compulsive or repetitive behavior that brings short-term pleasure an addiction if there are long-term negative consequences that interfere with a person’s well-being and functioning.

Still, the issue remains as to whether the concepts of willpower and self-control are actually relevant when it comes to eating behaviors. Is the source of obesity and overeating the mutable characteristics of individuals, or is it inherent in the food itself and the physiological effects it has on individuals?

We are all endowed with the drive and desire to eat, especially when tempting food is at hand. Just as self-control is limited among individuals who feel they need substances like tobacco, alcohol, or other drugs, the degree to which most of us can refrain from eating may be limited. If weight is a measure of our ability to control how much we eat, it is pretty clear that most of us fail.

None of us can use willpower to stop our hearts from beating, although some have learned to slow their pulse through meditation. Most
of us can control our breathing for brief periods of time; we can slow it down or speed it up, but sustaining such control for more than an hour or so is extraordinarily demanding. If our heart stops beating or we stop breathing for more than a few minutes, we will die. If we stop eating, we can survive quite a bit longer, but not more than a couple of weeks, depending upon whether we drink water. Thus, it is for good reason that fasting, or any kind of dieting, is significantly more difficult than eating.

Most people cannot routinely control how much they eat in the face of excess availability of food. Replacing the popular misconception that people can always control their diets with a more realistic picture of human limitations is the most important initial step we can take to stem obesity. Once we accept that most of us need help to control our dietary intake when too much food is available, we will feel justified in taking actions to protect ourselves.

Many of the solutions our society adopted to limit the consumption of alcohol are entirely appropriate to help people moderate their food intake. Just as alcohol control policies work by limiting when, where, and how much alcohol is served, similar regulations could very likely offer substantial support to individuals who want to control their weight. The following suggestions will catapult us toward a solution to the obesity epidemic. One of the most powerful would be having standardized portion sizes.

Standardized Portion Sizes

As mentioned earlier, restaurants, unlike bars, have no standard serving guidelines, which means there is no common yardstick for us to judge the number of calories we are consuming when we go out to eat. This may be the most important cause of the clear association between eating food prepared away from home and unwanted weight gain.
¹³

“Unit bias,” a term coined by scientists Andrew Geier, Paul Rozin, and Gheorghe Doros from the University of Pennsylvania, refers to the idea that people judge how much to eat based on what they are served. If we are served one apple, the entire apple is the unit, and we will typically eat the whole thing. If the unit is a half cup of applesauce or a cup of rice, that is the amount we think is appropriate to consume.
¹⁴

Geier and his colleagues documented that people served themselves more when the unit presented was larger, and less when it was smaller. In their experiments, people ate more M&M’s when a quarter-cup scoop was in the serving bowl than when a tablespoon was; they helped themselves to fewer Philadelphia-style soft pretzels when they were cut in half than when they were displayed whole. Yet people are usually just as satisfied when they are served a smaller amount.
¹⁵

Having standardized portions will not only establish the appropriate amount to eat, but will also make portions uniform across all food establishments. Standardized portion sizes have already been determined by the USDA and the FDA. The FDA’s system is the basis for the labeling on packaged processed foods. Labeling was mandated by the FDA as part of the 1990 Nutrition Labeling and Education Act. Both the USDA and FDA initially based serving sizes on how much people typically ate in a single meal during 1977–1978—before the obesity epidemic accelerated. However, the FDA adjusted some of its sizes based on food consumption data from 1985–1988, which is why some of its portion sizes are larger than those of the USDA.
¹⁶

When New York City’s Mayor Michael Bloomberg floated the idea of capping the servings of sugar-sweetened beverages to sixteen ounces, a common refrain from his critics was that this type of policy would interfere with a person’s free choice. At the other extreme, some thought the sixteen-ounce cap on soda was ridiculous. People would just order more than one soda, so it would likely have no impact on the obesity epidemic. In fact, the “standardized” portion size of soda is eight ounces, so the regulation, had it been approved, would still have New Yorkers consuming double what people drank thirty years ago.

Moreover, an eight-ounce size is more in line with the 2009 recommendations of the American Heart Association on daily added sugar intake: about six teaspoons is the maximum added sugar recommended for women, the amount in one eight-ounce cup of soda. For men, 150 calories is considered the maximum, or about twelve ounces of soda.
¹⁷

Bloomberg’s proposal to ban serving sizes of soda larger than sixteen ounces was overturned, primarily because it had many loopholes. It applied only to sodas rather than all high-calorie drinks, and it covered only a subset of food outlets, excluding convenience stores like
7-Eleven, which is known for serving the Big Gulp, a thirty-two-ounce serving of soda, and the Super Big Gulp, at forty-four ounces. A comprehensive system of standardized portions would overcome these legal concerns because it would apply to all eating-out establishments and all food products prepared and sold for immediate consumption.

The scientific support for standardized portions is extremely robust: people invariably eat more when they are served more, and they typically do not feel any less satisfied when they are served smaller amounts.
¹⁸
Efforts made to train people to control mindless eating and to pay attention to portion sizes generally fail in the long term.
¹⁹
Cornell University professor Brian Wansink, author of
Mindless Eating
, says that even when he challenges his students not to eat too much from big bowls, they nevertheless do. Wansink’s solution to mindless eating is to use small bowls—a different method for ensuring smaller portions.

Because eating is typically an automatic behavior, the quantity that people eat depends on the quantity they are served. Therefore, if all restaurants serve customers food using standardized portions (based on the national Dietary Guidelines for Americans), we could very likely make a real dent in the number of us who gain unwanted pounds.

The primary requirement of a standardized portion system would be that all foods
must
be available in single portions. But this would not necessarily preclude restaurants from offering the same dishes in larger sizes. Practically speaking, some foods, like a whole fish, cannot easily be divided into a single portion without ruining the presentation. Items that are larger would simply have to be presented with the number of serving units they contain and priced proportionally. For example, many restaurants that offer “family-size portions” would need to state that the serving contains three or four portions, or however many servings it actually has. Given that a single serving of meat is three ounces, a twelve-ounce steak would have to be described as containing four portions.

Standardized portions would serve as a benchmark that would make it much simpler for people to figure out how much to eat. They would also serve as a guide to make adjustments for individual differences. A triathlete might ask for two portions, someone who wanted to
lose weight could ask for a half portion, and most people who ordered one portion could be reasonably confident that it would be the right amount.

When foods that are associated with chronic diseases are served in portions that exceed a single serving, there should be a notice that such consumption may increase one’s risk of chronic diseases. True consumer freedom is having relevant and accessible information, with the consequences spelled out loud and clear at the time people make their selections. People would still have the right to order and consume as much as they want.

There is no doubt that most restaurants would vehemently protest, no matter how logical or beneficial the new regulations are. Standardized portion sizes would likely have to be implemented over the objections of the food industry.

Restrictions on Impulse Marketing

Another regulation that could help people moderate their food intake would be the restriction of impulse marketing strategies, like displays of candy, chips, and sodas at the cash register that invite us to spontaneously grab sweets and other snacks on our way out the door. Impulse marketing is intended to disrupt cognitive decision-making and encourage impulse purchases based on emotion, contextual cues, and instant gratification. Because our self-control tends to wane on any shopping trip due to all the decisions and trade-offs we need to make, many of us are highly vulnerable to impulse marketing strategies when we shop.

A number of regulations are already in place to protect people from the impulse marketing of alcohol. For example, some states have limits on how alcohol can be displayed and sold.
²⁰
Many states don’t allow the sale of alcohol except in specific state-run stores. In California, selling beer from iced barrels or from temporary displays placed within five feet of the front door or the cash register in outlets also selling gas is prohibited, presumably to discourage impulsive purchases that lead to drinking and driving.

A parallel policy for reducing impulsive choices in a supermarket
or restaurant would be to limit what products can be displayed in salient locations. For example, the end aisle displays in supermarkets account for 30 percent of sales, and people are two to five times more likely to buy products when they are displayed in these locations than when they are displayed elsewhere.
²¹
A regulation that restricts what can be displayed at the end aisle areas or at the cash register could help people reduce unhealthy impulsive choices.

During experiments testing self-control, some children were able to resist marshmallows by keeping them out of sight or covering their eyes. Using the same principle of “out of sight, out of mind,” moving candy and other junk foods to less salient locations in retail outlets would help people avoid them. Foods that are high in sugar and fat might be restricted to locations such as the back of the store, the bottom shelf, above eye level, behind the counter, or at locations other than the end aisles or at eye level. Such foods might even require clerk assistance. But these policies would still allow people who really want to buy these foods to do so.

Limiting impulse marketing like displaying candy at the cash register will likely affect hundreds of thousands of businesses that sell only snacks. A national assessment found that candy, sweetened beverages, salty snacks, and/or sweetened baked goods were available in 41 percent of all retail outlet stores, usually within arm’s reach of the cash register queue. This included 96 percent of pharmacies; 94 percent of gas stations; 55 percent of hardware stores, automobile sales, and repair outlets; 29 percent of bookstores; 22 percent of furniture stores; and 16 percent of apparel stores. Candy was offered for free in 22 percent of these outlets.