The End of Overeating by David Kessler

I've always been interested in food and cooking - I read cookbooks for fun - and also in food policy and how growing and producing food interacts with human health and environmental issues.

This book, "The End of Overeating", is by David Kessler, who is a doctor and former head of the FDA. I've seen this book around in bookstores, but for some reason never picked it up until now. It was fascinating and I've found a number of things in it that have application to everyday eating and living. It isn't a diet book, it isn't a food policy book, it's about the interaction of changes in our culture and food production with human biology and psychology. Although it deals with a number of scientific subjects, it's not a hard book to read - in fact I found it compelling.

As many people know, big changes have occurred in America in food production and eating habits from the 50's and 60's into the 70's and 80's and on into the present. The percentage of overweight and obese Americans has greatly increased. This has coincided with increasing numbers of meals outside the home - fewer home-cooked meals - and the proliferation of processed and convenience foods and an increasing obsession with diets and dieting.

Obtaining and eating food is a goal-directed activity necessary for survival. There is a biological process for this, which involves chemicals in the brain and feedback loops from our bodies. The premise of the book is that the way many people eat now interacts with our basic biology in a way that leads to habitual, and in some cases compulsive, overeating.

As I understand it, the basic mechanism works as follows. A goal (say eating a cookie that is on the table) is identified. Anticipation of the satisfaction that will be felt when the cookie is eaten causes dopamine to be produced in the brain. Dopamine is the chemical that allows us to undertake action. The action is undertaken, the cookie is eaten, and the digestive system signals the brain, which then produces opioid chemicals - the feeling of satisfaction. In situations of food scarcity, the ability to pursue and eat food is a necessity for survival, so this process is very strongly innate in people. In an environment with structured mealtimes (and more about the content of those meals below), there is an interval between satisfaction and the goal-directed activity of eating the next meal. It's all a matter of expectation - if you don't expect to be eating for a while, you don't think about food or start the process again until it's time. Where food is constantly available, however . . .

A number of things have changed in the American way of eating:

Fewer home cooked meals - more meals out - often meals largely composed of processed foods and sugars and fats - the book has amazing information about the food served at sit- down chain restaurants that may change the way you think about these places

More processed foods - often foods that are high in sugars and fats - as part of the home diet

All the time eating - constant snacking is socially acceptable - often on foods that are processed and high in sugar and fat

Food is often eaten mindlessly - in front of the TV, in the car or on the run

Larger and larger portion sizes - Europeans often comment on this when they visit the U.S.

An obsession with food and dieting

These changes are important in a number of ways. The lack of structured mealtimes and the ability to eat constantly undermines the natural appropriate hunger/satisfaction cycle - people may have forgotten what it feels like to feel satisfied and then hungry enough to need to eat again. When we graze all day, it's easy to overeat. Processed foods are easier to chew and digest than unprocessed meats, vegetables and fruit, and our bodies have trouble recognizing that they are full when we eat them - so we eat more, and more quickly. Larger portion sizes lead us to expect to eat large amounts of food and therefore we aren't satisfied until we do.

And that "French paradox"? - the French drink more wine than Americans and eat higher fat foods, like real butter but are not as overweight as Americans - it isn't really about the chemicals in wine - it's about eating only at mealtimes, drinking wine with meals and eating real - not processed - foods in smaller portion sizes. Of course things are changing now around the world as others adopt American processed foods and eating habits.

The processed food industry, as well as the chain restaurant industry, while they may not understand the details of the science, sure understand the way to create products that play right into our natural tendencies - sugar and fat get human attention better than anything else. Due to the demands for earnings growth from the financial markets - rates of growth that are higher than the growth rate of the population - processed food companies are highly motivated to get us to consume more calories more easily.

So overeating has become widespread. And some people not only overeat, they compulsively overeat. Overeating can become a habit. A goal-directed activity becomes a habit when there is a lack of awareness of triggers and repetitive behavior - whole sequences of behavior become coded as performance units triggered by context. For example, if you respond to stress by eating, before you know it, you're eating. That's a habit, just like a smoker lighting up after a meal. A quote from the book:

Conditioned hypereating works the same way as other "stimulus-response" disorders in which reward is involved, such as compulsive gambling and substance abuse. Such disorders are characterized by a high degree of sensitivity to sensory stimuli, and they typically lead to a perceived loss of control, an inability to feel satisfied, and obsessive thinking.

If you try to suppress a habit it intensifies the power of the cue - giving in resolves the anxiety, momentarily, but reinforces the power of the cue. This is why dieting is so ineffective. Priming - having "just one" - increases desire - it stimulates the dopamine system (motivation/reward-seeking system) a little bit - enough to get it going to make you want even more. Using food as a reward ("I'll have one when I've done x", or "I deserve a reward, I'll go eat [name food]") intensifies the desire and just reinforces the eating pattern.

The most common triggers for overeating, in addition to eating mindlessly, are stress, anxiety and changes of state - times of day when things change (coming home from work, for example) or moving from one activity to another. Although suppressing the impulse to eat is doomed to failure since ultimately it just increases the desire, diversion of the goal-seeking behavior to another activity can interrupt the process.

It's also important to establish new habits - this takes time and planning. The best way to avoid automatic, habitual activity you want to change is to have a plan in place. When the urge arises, know what you will do instead. And have the new habits you wish to establish firmly in mind - rules, like no seconds, or no snacking between meals, can be helpful. Structured mealtimes, and paying attention to what you are eating, can help, as can eating real foods - real, not processed, meats, vegetables, grains and fruits that require chewing - that have substance and fiber - can slow things down and allow the body to know it has eaten. They also take longer to digest, which means you feel satisfied longer.

Now that's interesting - there is no diet plan, no calorie counting and no forbidden foods. Just an understanding, grounded in science, of human behavior and of ways to not let it lead us down the easy path of overeating. The analysis has application to other habits, such as alcoholism and compulsive gambling, and gives insight into the inability to start or complete tasks (which in many respects is the other side of compulsion).