Last week, Dr. David Kessler, former commissioner of the US Food and Drug Administration under presidents George H. W. Bush and Bill Clinton, published The End of Overeating. During a seven-year investigation, Dr. Kessler met with scientists, physicians, and food industry insiders to learn why humans cannot resist food. For many of us—myself included—the Pringles slogan, "Once you pop, you can't stop," is true of a variety of foods, from M&M's and pretzels, to nachos and ice cream. Regardless of how hungry we are, the smell of freshly baked bagels or the sight of Girl Scout Cookies, starts a feeding frenzy that ends only when the plate or bag is empty.
In The End of Overeating, Dr. Kessler explains how humans, much like Pavlov's dogs, become hardwired to anticipate foods with fat, sugar, and salt. The food industry has learned what humans want, and is only too happy to give us what we crave. We quickly become trapped in a vicious cycle of dopamine-fueled urges when we want food, and opioid releases when we eat it. If dopamine and opioid sound familiar, it's because they play a major role in alcohol and drug addiction. Dr. Kessler draws a direct connection between food's power over people, and the pull of alcohol and drugs. It truly isn't a stretch to say, "I'm addicted to chocolate."
Today's overeating epidemic has yet to result in lawsuits or FDA warnings, but a change in public opinion towards highly salient foods is exactly what the doctor prescribes. Like other public campaigns, education is power, and the first step toward regaining control of our appetites is to read this book. On the day of his book's publication, Dr. Kessler took time from his busy schedule to speak with me about what inspired the book, what he learned, and how we can change the way we think about food.
LM: This book started while watching an Oprah episode. Prior to that, had you ever seriously considered why food has such a pull over people in general, or you in particular?
DK: We implemented and helped design the food label—the modern nutritional facts that appear on the back of most packaged foods—back in the 1990s. That label was about the ingredients and nutritional value including percentage of daily values, but I never looked at the question that way. After watching that episode and that woman who couldn't control her eating, I said to myself, "What's going on?" As a physician, I asked myself, "What's driving this?" I spent the next seven years trying to figure the answer to that out.
LM: In your book, you discuss the business of food, explain how the food industry tries to manipulate appetites, and go so far as to make comparisons to big tobacco by implying that food has a pull over people the same way drugs do. Do you think that these food industries will be vilified or held financially accountable for obesity related diseases in the future?
DK: Fifty years ago, the tobacco industry, confronted with the evidence that smoking causes cancer, decided to deny the science and deceive the American public. Now, we know that highly palatable foods—sugar, fat, salt—are highly reinforcing and can activate the reward center of the brain. For many people, that activation is sustained when they're cued. They have such a hard time controlling their eating because they're constantly being bombarded—their brain is constantly being activated.
For decades the food industry was able to argue, "We're just giving consumers what they want." Now we know that giving them highly salient stimuli is activating their brains. The question becomes what do they do now?
If a bear walked in here right now, you would stop listening to me and you'd focus on that bear. We're all wired to focus on the most highly salient stimuli. For a lot of people, that highly salient stimulus is food. It could be alcohol, it could be drugs, it could be gambling, but for many people, it's food. It's not just people who are obese, or overweight. Even for people that are healthy weight, food activates the neural circuits of their brains, and they have this conditioned and driven behavior we call conditioned hypereating.
LM: I admit I've noticed some of those same characteristics in myself.
DK: For one gentleman I spoke with, the hardest thing for him every day is to get home past the newsstand at the train station because of the Kit Kats. For him, it was Kit Kats, for someone else, it's chocolate chip cookies, but one of the key core features is sugar, fat, salt. Once your behavior becomes conditioned and driven, you get into this cycle and you get cued. When the neural circuits get activated, it focuses your attention. There's a bit of an arousal as you have increased attentional focus, and then the only way to get it out of working memory is to consume the product. The next time you're cued, you eat again, and you're in this cycle. Every time you do it you strengthen it.
Not only is there amplified neural activation in the anticipatory phase with people with conditioned hypereating, but as they're eating, the stimulation stays sustained so it's very hard to stop. It isn't until the food's gone—considerably later—do you feel full because the reward circuits are overriding the homeostatic circuits.
LM: When you spoke with top executives at one of the world's largest global food companies, and you presented an overview of the information in this book, one executive rightly said, "Everything that has made us successful as a company is the problem."
DK: Putting sugar, fat and salt on every corner, that's been the business plan. You make it not only accessible, but you make it socially acceptable, you create the social norms, you add the advertising, the emotional gloss.
LM: You said the company began to rethink their strategies about labeling and portion size, but how realistic is it to think that companies will change their tactics if it's not financially lucrative? Do you think there will be some sort of government regulation?
DK: Government has a role to play, but if you look at the great public health successes, they come from changes in how we perceive the product. The success on tobacco wasn't done by regulation or legislation—it was done by changing how people perceived the product. From, "That's something I want, that's glamorous, that's sexy," to, "This is a deadly, disgusting product."
The real goal is to change how you view food. If you look at something and say, "That's going to make me feel good. I want that," your brain's going to get activated. If you look at it and say, "Ugh, that's disgusting. I'd rather have something else," your brain's not going to be activated. You have to take the power out of the food by changing how you view the stimulus. It's food rehab. It's new learning on top of old learning—you never get rid of that old learning, those old neural circuits.
LM: I understand that much depends on the individual but do you have any suggestions for President Obama or the government? Is there any way they can help?
DK: The woman on Oprah had no idea what was going on. No one told her what was going on. In some ways, it's not about will power and it's not her fault. That doesn't necessarily mean there's nothing she can do, but if she's constantly being cued, constantly being bombarded with these stimuli, and her brain is conditioned and driven to respond to those stimuli, we first have to educate.
Two, is full disclosure of what's in food. If your chicken is injected with sugar and fat, and your food is loaded and layered upon layer with fat on sugar on salt, there needs to be disclosure.
It also is how you look at advertising. If advertising was meant to just convey information to consumers and it was neutral, that's one thing. But if advertising is a cue, then it gives you greater reason to regulate it, especially to kids.
In the end, it has to come from what do we want? What do we view as desirable? What do we view as socially acceptable? A lot of this is social norms. If I can walk down the street and be eating sugar, fat, and salt at any time of the day, on every corner, and that's viewed as what we find rewarding rather than disgusting, then we're going to continue with this epidemic.
LM: That ties into what you were talking about with eatertainment as an aspect of this phenomenon.
DK: If I give you a pack of sugar, and I said, "Go have a good time," you're going to look at me and say, "What are you talking about?" Now I add to that fat, and temperature, and texture, and mouth feel, and color, and I'm going to put it on every corner, and I'm going to say you can do it with your friends, you can do it at the end of the day when you want to relax, and I add all the television monitors and the color, so it's a carnival sort of atmosphere, who wouldn't want to get on the ride?
LM: What was the most surprising thing you learned during your investigation?
DK: I didn't literally understand why that chocolate chip cookie has power over me. I didn't understand why my hand was reaching. Only when I understood how my brain gets activated, how my brain gets encoded, did I learn that the power of food comes from our ability to anticipate it. Have you ever been eating and all of a sudden, as you're eating food, you start thinking about what you're going to have next?
LM: (laughing) Yes.
DK: It's sort of bizarre, right? It's that power of anticipation that drives the behavior, even more than the consumption. When you're actually eating, it, you go ehh ehh.
LM: It's not that good.
DK: It's not that good, but it's that power of anticipation. Understanding that food has more power than we realize, was the most important thing.
LM: Do you consider hypereating an effect of more disposable income or a higher standard of living? Is this unique to our period of time?
DK: We always were wired to focus on the most salient stimuli. It's just that the food industry has been able to manufacture food that's so highly salient. We always had salient foods when I was growing up, but desserts occasionally or foods that were fats on fats occasionally. Now we have them 24/7, all the time, breakfast, lunch, dinner, and throughout the day. That's the difference.
LM: It's availability?
DK: It's availability as well as acceptability—put those things together. Hypereating starts with sugar, fat, and salt, and then you add the stimuli associated with that, the emotional gloss, the availability, and the accessibility.
LM: What percentage of Americans would you say suffer from hypereating?
DK: It's a continuum. For probably 15% of the population, and that's just a guess, food is not a very salient stimuli in their life. You ask them, and they say, "I can eat or not. I have to eat in order to sustain myself, but it's not a large part of my life." That's a minority of people. If you look at the rest, and you ask them whether they have a sense of loss of control in the face of highly palatable food, if they have a lack of satiation—a lack of feeling full—when eating highly palatable food, and a preoccupation of thinking about food in between meals, about 70 million people would score pretty high on all three characteristics.
LM: Is there anything else that you would like to add or say?
DK: There's a lot out there about the food industry, and who's the villain, and who's the victim, but what's important for me is to explain to people—to the woman on Oprah—what was going on with her. I wanted to figure out what was going on, and the book was written to help people who don't understand why they have such a hard time overeating. My family doctor said to me, "You're describing me. No one ever described me to myself. No one explained to me why I keep on eating."