A Big Fat Crisis (4 page)

But could emotional issues really be responsible for the population-wide epidemic of obesity? Do people in modern times experience more emotional stresses or more intense feelings than in the past? Do people in the United States have more emotional issues than those in countries with lower rates of obesity, like Sweden, Ethiopia, or India? Probably not.

During the Great Depression, a lot more people suffered a great deal more stress than we do today, but there was no obesity epidemic in the 1930s. People couldn’t afford a lot of food, and so they had to resort to other ways to deal with stress. The reason we can eat too much today, whether or not we are under stress, is because food is affordable and available in large quantities.

The obesity epidemic is the result of the unique interplay between human nature and the contemporary food environment. Three aspects of human nature make it impossible for most of us to remain in control of what and how much we eat consistently, day in and day out. These are:

       
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Limited self-control
. Whether we try to study all night, watch a marathon of movies, or hold back tears when we are upset, most of us can control ourselves up to a certain point. Eventually, we all get tired and have to rest. When we are fatigued, we tend to choose foods we know we should avoid and we eat too much of them.

       
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Limited cognitive capacity
. We usually reserve our cognitive processing system, the part of our brain that handles thoughtful planning and long-term problem solving, since it is easily depleted. When it comes to eating, we tend to rely on our noncognitive processing system, which guides our food choices based on superficial characteristics like size, color, brand, or price. This noncognitive system is primarily responsible for poor dietary choices.

       
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Automatic functioning
. Eating is an automatic process that does not require our full attention and awareness. Driven by our survival instinct, we respond reflexively and rapidly to opportunities to obtain and consume as many calories as we can get our hands on. Automaticity is primarily responsible for overeating.

Today, the food environment assaults us at every turn in ways we cannot ignore, stimulating us to feel hungry or at least to think about eating. From the displays of candy at cash registers in supermarkets, hardware stores, and even clothing stores to the constant product placements of soda and junk food on television and at the movies, it’s
difficult to have anything on our minds except our next meal or snack. And when we do sit down to eat, most of us cannot easily limit the amount we consume per meal if too much food is available. That’s what happens when we dine out. According to Dr. Lisa Young and Dr. Marion Nestle, experts on the impact of supersized meals, most restaurants serve two to five times the calories we need.
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But this also doesn’t mean we are gluttons. Most of us are not eating supersized meals, dozens of candy bars, or gallons of ice cream every day. It doesn’t take much to go into a positive energy balance in which we eat more than we burn, so our bodies convert the extra calories into fat for use at a later time. An extra soda, an extra slice of cheese, an extra handful of chips can accumulate into an extra pound or two slowly, in ways that are difficult to notice, especially when we are routinely confronted with larger quantities of food than we need.

The food environment has become a tsunami. If it doesn’t drown us, it waterlogs even the strongest of swimmers, who have to exert more energy, be more alert and more conscientious than ever before just to stay afloat. Indeed, given the evolution and limitations of human nature, there is simply no way for most of us to avoid succumbing to the enticements to eat that we are bombarded with ceaselessly.

Americans today are no different from Americans of thirty years ago, when obesity affected one in six instead of the current rate of one in three. Physiologically, our capacity for self-control has not shrunk over the past several decades. Instead, the changing conditions of our modern world have ramped up requirements for self-control to such an extent that more and more of us are simply no longer up to the challenge.

The next chapter addresses the limits of self-control head-on.

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The Limits of Self-Control

In 1994 Dr. Rena Wing, Professor of Psychiatry and Human Behavior at Brown Medical School, and Dr. James Hill, Professor of Pediatrics and Medicine at the University of Colorado, Denver, started the National Weight Control Registry (NWCR). Because losing weight and keeping it off is so rare, they wanted to see if they could pinpoint exactly what explained the success of those who were able to shed pounds and maintain a lower weight. The NWCR is conducted online; those who want to participate can sign up and share their stories. The only requirement is that registry members have to have lost at least thirty pounds and kept it off for at least one year. The registry periodically asks its volunteer participants to fill out questionnaires that track their behavior over time.

For almost twenty years Wing and Hill have been studying some five thousand successful dieters, of whom 80 percent are women and 20 percent are men. The “average” woman in NWCR’s registry is forty-five years old and currently weighs 145 pounds, while the “average” man is forty-nine and currently weighs 190 pounds. They have lost an average of sixty-six pounds each and kept it off for five and a half years. Most lost weight with the help of a program—like Weight Watchers or Jenny Craig—but 45 percent lost the weight on their own.

What are these people doing to keep the extra weight off? What
do they know that the rest of us don’t? The answer might surprise you. Seventy-eight percent of them eat breakfast every day. Seventy-five percent weigh themselves at least once a week. Sixty-two percent watch fewer than ten hours of television per week. And 90 percent exercise, on average, about one hour per day.
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None of this sounds like magic, or like anything particularly special. Millions of Americans already know that they should exercise more, watch less TV, and eat at mealtimes and not in between. But millions of Americans have
not
had similar success, or any success at all, when it comes to losing weight. Does this study explain how these men and women were able to change their habits—to actually follow through and stick to the healthier routines we all know we should be following? No. What it tells us is that there is no secret weapon in the fight against fat. What it tells us is that people who can stick to a healthy routine are the exception rather than the rule.

Although the NWCR is a collection of people who represent the “exceptions,” who are self-selected and therefore not representative, we can learn more about the obesity epidemic by examining a group of people selected to be representative of a larger population. In 1976, with funding from the National Institutes of Health, a team of researchers led by Frank Speizer from Harvard Medical School chose to follow a cohort of registered nurses. The researchers believed the nurses, given their advanced training, would be able to provide very accurate reports of health-related issues, like symptoms, dietary habits, and other medical-related problems. By studying nurses over time, researchers hoped that they could provide insight into which behaviors and exposures might lead to or protect against a variety of long-term chronic diseases.

The study solicited married registered nurses, age thirty to fifty-five, living in the eleven most populous states. Approximately 122,000 nurses out of a pool of 170,000 responded.
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You might think that because nurses know more than the average person about health, they would tend to be healthier than the rest of us. Yet between 1976 and 2005, the number of overweight study participants doubled, while the number of obese participants tripled—a pattern very similar to changes in the rest of the population. By 2005
only 44 percent could be classified as having a normal weight. Excluding nurses who were pregnant or had cancer or other serious medical problems, fewer than 3 percent reported losing at least 10 percent of their weight. Of the entire group of nurses, fewer than one in three hundred were able to lose and then maintain the 10 percent weight loss for four years.
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So even among a group of people who are supposed to be experts in health issues, only a small fraction were able to reduce and maintain a lower weight. Like most of us, the nurses could not stick to a diet, even when armed with the necessary information and the best of intentions.

Why do nurses seem to be no better off than the rest of us? If you asked them for diet advice, they could probably list all the things that should be done and could tell you which foods are healthy and which to avoid. Like the advice that all experts give, the solutions they would mention would sound simple and feasible.

But how simple is following a diet? When people first decide to go on a diet, they are optimistic and think it should not be a problem. The typical advice is to restrict intake: say no to specific types of foods that are not considered healthy and are readily identifiable (like candy, cookies, pastries, sugary sodas, and salty snacks such as chips and other deep-fried foods with lots of oil and grease), and the excess weight should disappear. Some experts go further and offer a wide variety of tips and advice to help—use smaller plates, eat slowly, cut your portions in half, substitute lower-calorie foods for higher-, etc. In fact, nearly all diets work if people follow them. When a diet doesn’t work, it’s usually because of one of two things: the dieters are not following the diet and are aware of it, or the dieters are not following the diet but believe that they are following it.

My father had a problem controlling his weight his entire adult life. He was a dentist. He knew everything one needs to know to be able to control weight. Yet, as educated and intelligent as he was, he struggled and mostly gave up trying to be slim. He was short, about five foot six, and he weighed more than two hundred pounds; he should have weighed about 140 pounds or less. He would lose ten, twenty, even forty pounds with a new diet that he would follow for as long as six months. At one point, I remember, my mother prepared plain rice,
a plain chicken breast, and broccoli for him every night for months and months, and he began shedding the weight. But it didn’t last long. He fell off the wagon and returned to his old habits of going to work, dining out for lunch, coming home, having dinner and watching TV, and going back to the kitchen every night for a midnight snack.

My father knew what he had to do, and he knew when he failed to follow his diet, yet somehow he could not maintain it. He felt better when he lost weight, and he felt worse when he gained it back. He suffered constantly because of his weight. He had hypertension and had to take medications that made him depressed and sapped his energy. He was always worried about his health. Yet these risks, fears, and his knowledge were not enough to lead him to control his diet.

Dieting: The Forever Time Horizon

Whether it’s Atkins, South Beach, or Paleo, diets involve restricting intake for long periods of time and limiting the quantity of calories consumed, especially calories from foods with few nutrients. If you restrict yourself long enough, the excess weight should disappear. Here is the difficulty. Few are able to stick to a diet for more than six months.

Dr. Robert Jeffery, a professor at the University of Minnesota and a national expert in weight control, and his colleagues have tried to identify why people give up on their diets.
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They followed dieters for a year and found that after a few months, people’s experience of the benefits and rewards of dieting tended to peter out. The dieters might have received compliments for losing weight and improving their appearance at the beginning, or appreciated that their clothes fit better, but this seemed to be less noticeable later on. Even more surprising, people did not see a significant relationship between their weight loss and the time and effort they put into losing weight.

One of the problems with dieting is that our bodies respond slowly to changes in calorie consumption, unlike the instantaneous responses we get upon touching a hot stove. If we touch fire, we learn immediately to stay away or protect our hands. But if we eat an extra chocolate chip cookie every day, a scale may not register that we gained weight until a month later, so that immediate negative feedback and the associated
learning experience are not there. Instead, we get immediate positive feedback from sugar, chocolate, and fat, so we tend to view chocolate chip cookies in a very positive light and learn to desire them. Instant feedback is a wonderful behavioral learning technique when it comes to promoting eating, but it is not very useful as a tool to support dieting.

Can We Control Self-Control?

Because self-control seems so central to diet and obesity, I began to investigate the scientific literature on the subject. After reading hundreds of papers on the topic, I learned something astonishing: when it comes to eating, self-control is not what we generally believe it to be—a reflection of an individual’s character, upbringing, and moral strength. Instead, everyone faces limits in his or her ability to maintain self-control in the face of too much food. Our capacity for self-control varies by the moment, depending on whether we have just solved a difficult problem or met another demand. Moreover, self-control is often irrelevant when it comes to food, because we can be influenced to overeat by environmental cues we cannot consciously recognize. In many cases we may never get the opportunity to exercise self-control, even if we otherwise have it in abundance.