As FDA commissioner under presidents Bush and Clinton, Dr. David Kessler led the charge to regulate the tobacco industry; the landmark multibillion-dollar settlement between Big Tobacco and 46 states was largely a product of his efforts. Now he is taking on Big Food. In his new book, The End of Overeating: Taking Control of the Insatiable American Appetite (Rodale), Kessler draws on his own scientific research and that of colleagues to argue that highly processed foods fundamentally alter people’s brain chemistry, causing us to seek out these foods (and overeat them) again and again. Gourmet online editor Christy Harrison spoke with Kessler about the joint responsibility of consumers and the food industry; the need for a nationwide eating-education campaign; and why adults are addicted to baby food.
Christy Harrison: Let’s start by talking a bit about how you got interested in these issues.
David Kessler: The idea for this book started in my office when I was dean of Yale Medical School, talking with a group of Fellows in Residence. Our question was “If you want to stay alive, what are the things you can do?” We looked at the major killers. Seventy-five percent of us die from cardiovascular disease, cancer, or stroke. And as we dug, everything kept coming back to weight. Then one night, I’m watching this woman on a TV talk show and she says, “I eat when my husband leaves in the morning; I eat before he comes home; I eat when I’m happy; I eat when I’m sad.” She’s very well educated, very successful in all other aspects of her life, but she really didn’t like herself. And I sat there and I wanted to understand what was driving that. If there’s a metaphor for the book, it’s this: Why does a chocolate chip cookie, with its warm, sumptuous mounds of chocolate, have such power over us?
And that’s what I didn’t understand. Why does my hand engage before I even think about it, and I reach out for the cookie? We believe in free will and think we can make rational choices, but then why don’t diet and exercise work? If it were a matter of willpower, we would do it. I didn’t understand my own behavior.
CH: And in the book you bring up a lot of interesting points in terms of what causes us to lose control. There’s the fact that the reward centers of the brain are engaged by processed food, and there are also cultural and emotional cues that trigger us to eat.
DK: Right. Food is more powerful than we realize. It is a very salient stimulus. I mean, if a bear walked into your office right now, you would stop paying attention to me and focus on the bear. Our brains are wired to focus our attention on the most salient stimulus in our environment. What that stimulus is can vary. It’s based on our learning, our memories, our experiences. It could be gambling, alcohol, sex. For many of us it’s food. The power of food comes from our ability to anticipate its reward. In the book, I talk about how every time I land at the San Francisco airport, I start thinking about Chinese dumplings, because there’s this great Chinese dumpling place in that airport.
It’s what makes us human—our ability to focus on the most salient stimulus in our environment. It’s what has allowed us to survive as a species so successfully. But now we have these powerful stimuli—the trifecta of fat, sugar, and salt—available on every corner, 24/7. We’ve made [constant eating] socially acceptable.
When I was growing up [in the U.S.], adults didn’t snack; maybe kids snacked when they came home from school. There were built-in barriers and structure that stood in the way of our current chaotic eating. Now you have sugar and salt on every corner.
A lot depends on how I view the stimulus—as friend or foe, positive or negative. Look at what we did with tobacco: We changed how people perceive the product. We didn’t actually change the product; it wasn’t by legislation or regulation. Over the last hundred years, the industry created this image of a product that was glamorous, sexy, something you wanted, and you didn’t feel normal if you didn’t have it. But we changed that perception, so today people look at it and say, “That’s disgusting; that’s my enemy; that’s a deadly, addictive product.” So if you look at that chocolate chip cookie and say, “Boy, that looks great; that’s going to make me feel better; I really want that,” there’s nothing you can do. Because once you have that neural representation in your brain and that emotional association, your reward circuits are lighting up.
CH: But what about the chocolate chip cookie that’s made at home with butter and sugar and natural ingredients, instead of the cookie that’s made with hydrogenated oils and high-fructose corn syrup? It seems like that’s an important element to consider when you’re assigning a value to food.
DK: Right. And there’s no question that the food industry has designed foods to be very powerful stimuli, very salient stimuli. The food is increasingly pre-digested, whether it’s vacuum-tumbled or injected with sugar and fat marinades.
CH: In the book you use the phrase “adult baby food.”
DK: Right. Modern processed food, it goes down in two or three chews. And that’s why you reach again for the next round of stimulation. We used to think food was going to fill us up, food was going to satiate us; now food is designed just to stimulate us, and there’s no satiation.
What’s interesting is that this conditioned hypereating (which is what I call it in the book), this loss of control, this lack of satiation, this preoccupation with food, it affects not only people who are obese and overweight, but also a significant number of people who are healthy weights. They just learn techniques to deal with [their hypereating]. But if you talk to these people, some of them will tell you that they live in torment.
CH: Sure. I struggle with it myself. People bring in scones or something for breakfast to celebrate one occasion or another, and I have to tell my coworkers to take the leftovers out of my office because otherwise I’ll just keep eating them, even after I’m full.
DK: Because they grab your attention.
CH: Exactly. I can’t concentrate when they’re there. You quote other people in the book who say similar things, and I totally identified with them.
DK: I shared the book, an early draft, with a physician, and he said, “You’re describing me. No one’s ever described me. No one’s ever explained this to me before.”
CH: It’s surprising to hear that from a doctor.
DK: He’d never learned how it works, how he became captured. For each of us, it’s something different. For you, it’s scones; for me, it’s chocolate chip cookies. Because of our learning and our past experiences and our memories, each of us will get activated by a different set of stimuli.
For the first set of research that I published with my colleagues Jeff Grimm at Western Washington University and Diane [Figlewicz] Latteman at the University of Washington, we titled it “Deconstructing the vanilla milkshake.” We wanted to know, what drives consumption? Is it sugar? Fat? Flavor? And we found that sugar is the main driver. And then fat adds synergistically: If you add fat on top of sugar, animals will work harder for it.
If I give you a package of sugar and say, “Go have a good time,” you’re going to look at me and go, “What are you talking about?” But if I add fat, then I add color, and then I add texture and temperature, then I add the emotional appeal of advertising, and what do you expect to happen? You end up with a highly addictive product.
What we need to do is change how Americans look at food. We were able to demonize tobacco, but you don’t need tobacco—you do need food, and you can’t demonize food. You shouldn’t demonize food. But we need to be able to look at food and say, “Boy, that’s nutritious; that’s going to satiate me; I’m going to feel good after I eat that.” Or to look at that huge portion and say, “That may taste good for a couple of seconds, but I’m not going to like myself in twenty minutes if I eat that.” My mental representation of that stimulus defines my behavior to a great extent.
For decades, the food industry has been able to argue that they’re just giving consumers what they want, meaning giving them what tastes good. And it does. It’s very sensory-stimulating. We now know that certain centers of the brain become activated and don’t shut off for millions of people who overeat. For them, [those centers] don’t shut off until the food’s gone. And they stay activated. So the food industry is not just giving consumers what they want—it is also creating a product that excessively activates the neural circuitry of millions of people.
So with that, there’s a joint responsibility. Just because it affects my neural circuitry, whether consciously or unconsciously, doesn’t mean I as an individual don’t have responsibility; but the food industry also has responsibility.
CH: Do you think that people develop conditioned hypereating through exposure to industrialized food (plus the media messages and advertising that go with it), and perhaps switching off that behavior can be accomplished partially by a return to whole foods?
DK: Absolutely. Our brains have been hijacked; we’ve been captured by these powerful stimuli. And once you learn that neural circuitry, the learning is very hard to undo. The only way you can undo it is to add new learning on top of that old learning. On top of those old neural circuits, you have to condition new neural circuits to change how you perceive the stimulus: “That’s not what I want. I want food that’s going to taste good but is going to sustain me. I want food that is natural. I don’t want food that is just layered and loaded with fat on fat on sugar on fat.”
It requires a real internal shift. No diet’s going to work. I mean, if I take you out of your environment, I can give you a plan for a few days; I can give you meal replacements. But if I then put you back in your environment, you still have those old neural circuits, and when I cue you again, of course you’re going to go back [to the old habits]. So the only way to change is to really internalize what you want. It requires a fundamental shift. For each of us it’s different, but it has to be lifelong and sustainable. You’re only going to be able to cool off the stimulus if you truly don’t want the stimulus; and the best way not to want the stimulus is to want something else more.
So what is that other thing you want more? For certain people, they start exercising, and exercise becomes a substitute reward. For others, it’s natural food and more healthful foods. It’s very important to start somewhere, whether it’s exercise or the types of foods you choose, because then you start associating yourself with a healthy lifestyle.
But you can’t deny reward. Eating food that doesn’t taste good is not going to work. You have to create your own environment, and you have to decide what it is that you value, and you have to have a plan. You have to be able to limit the chaotic and constant eating that we’ve become wired to do.
CH: In the book you discuss how emotional overeating often happens when people view food as a reward. But rewarding yourself with food once in a while doesn’t necessarily have to lead to out-of-control eating, does it? Many people are able to allow themselves treats in a responsible way.
DK: Right. It’s not going to work if we don’t have rewards. Deprivation, again, is only going to increase the reward value, so that doesn’t work. But what we have to each do is decide what are the rewards we want, and then have a plan to be able to control it. So if I get cued and my brain gets activated, I can say, “I don’t want that now because I’m going to have something else later that I want more.” But if you look at everything and everything looks appealing to you, it’s very hard to resist. We’ve always had hyper-palatable foods—our grandmothers made them, too—but there was always a limit to them. That kind of food was an occasional reward. Now all eating has become the reward.
Children ages two to five used to be able to compensate for calories: If you fed them more calories [than they typically ate in one meal], they would eat less later on. But now, by the age of five, that compensation is gone; they’re just eating for reward all the time. There are children who are age five and younger who have never been hungry in their lives; they’re just eating all day. There’s no limit.
I’ve just finally gotten to the point—and it’s taken me years—where if you put a huge portion in front of me, I look at that and I say, “Boy, that’s disgusting. I don’t want that. I’d rather have something half the size that’s going to sustain me.” But that’s how we have to recondition people in America. The real problem is “big” food. You go into a restaurant and it’s easy to consume 2,000 calories in one sitting. And it’s because we look at big portions and we’ve said, “Hey, that’s great.”
CH: Right—that’s a value meal, and I’m getting such a great deal for so much food.
DK: Rather than looking at it and saying, “Every time I eat that, that’s only going to strengthen my neural circuits to eat it again.”
CH: You argue in the book that we need a public education campaign to specifically address that issue of “big” food, and we need to get people early and expose them to a lot of information about this issue. But how do we go about that when the food industry in this country has so much lobbying power, so much influence?
DK: I think the question is, now that we know that the food industry is excessively activating our brains, what are they going to do about it? Fifty years ago, confronted with new scientific information, the tobacco industry decided to deny it and deceive the American public. We now have the science to understand what the food industry is doing. They’re producing highly palatable stimuli, and there’s a responsibility that comes with that.
Of course there’s a certain percentage of people who are eating in balance, and it’s important that what I say doesn’t necessarily apply to them. But to the rest of us, who have a hard time controlling our eating, if we ate half of what we were eating, we would still be satiated. So we really need to come to view huge portions very differently. We have to change how America looks at food. Nothing short will work.
And by the way, there’s nothing wrong with a hamburger. It’s when you add bacon and cheese and sauce and add fries and everything else to it. Four or five hundred calories a meal is fine. So it’s important to be able to find what you like and be able to control the size of it, because once your brain gets activated, it’s very hard to stop. We used to think we finished [huge portions] because our mothers taught us to clean our plates. Now we know it’s because this food is hyper-palatable. For most of us, the reward centers of our brain have so overpowered the homeostatic mechanisms that we don’t even feel satiation. At least for the tens of millions of people who have conditioned hypereating.
CH: There is a segment of the population that just doesn’t have access to the alternatives—or really even know there are alternatives—to fast food and processed food. Should the food industry be offering those people something that can serve as a replacement for this hyper-palatable food? Giving them another option?
DK: It’s not only access to alternatives, it’s alternatives that I’m going to want and enjoy, that are going to taste good. And that are going to allow me to control the amount I eat. We haven’t given people the tools they need to help them control their eating, especially those who have conditioned hypereating. No one has told them, “Your brains are being activated, you’re constantly being cued, and that’s why you have such a hard time resisting, and that’s why you feel so bad about yourself.” And no one’s explained to the food industry that they’re literally hijacking the brains of tens of millions of people. This is not a small subset—we’re talking about some 70 million people. And once you understand that, then you can start thinking about how we change individually and what are the appropriate policy changes.
Tobacco was easy. Food is the hardest—but the consequences are so enormous. I don’t think doctors have understood this. I mean, none of us understood, and no one was listening. That woman I saw on the talk show—no one said, “What’s driving her?” We looked at her for decades and said she was not self-disciplined; she didn’t know how to control her eating; she lacked willpower; she was lazy. And that’s just not the case. Her brain’s being excessively activated, she’s being constantly cued, and that’s what’s driving her behavior. And it’s not fully within conscious control.