The Weight Is Over

America is tipping the scales, and psychologists disagree on whether the government or individuals should be responsible for a more balanced diet. But one thing’s for certain: There’s no time to lose.

Psychological scientists are wading into the thick of a food fight over the super-sizing of America – from Big Macs and Big Gulps to all-you-can-eat buffets, 20-ounce restaurant steaks, and supermarket shelves stocked with “economy-sized” everything from soup to nuts.

At issue: What can be done about the obesity that results? Is it a question of behavior modification or should governments and courts step in aggressively?

The numbers are numbing. Two-thirds of American adults are considered overweight, the National Center for Health Statistics reported in October 2004, almost half of them obese, double the rate 40 years ago.

And being overweight is no longer only an American problem. It is globalizing at an alarming rate, according to University of North Carolina economist Barry Popkin, who studies worldwide nutrition trends. In August 2001, he reported to an international meeting on “Nutrition Transition and Its Implications for Health in the Developing World,” held in Bellagio, on Lake Como, Italy:

“Modern societies seem to be converging on a pattern of diet high in saturated fat, sugar and refined foods and low in fiber – often termed the ‘Western diet.’ … In a very short time many low-and middle-income countries have attained rates of overweight and obesity greater than or equal to those of the USA and Western Europe.”

Getting fat is an evolutionary advantage embedded in our genes. Early humans who could best store energy in fat times for use in lean times survived to pass down their genes. “We’re hardwired to spend as little energy as possible,” said APS Fellow Paul Rozin, University of Pennsylvania. “A general rule that animals follow is to do as little as you can to do what you have to do. They try to get more calories, but use up the fewest calories getting them. Project that to today: You sit on your can and have food served to you. Or you stick it in the microwave, go sit down, then get up and take it out. We are constitutionally lazy.”

It’s not only genetics, however. Americans seem to do “big” with more relish than most – whether it’s mega-meals or SUVs and jumbo pick-up trucks. “The American obsession with quantity over quality leads people to believe that large amounts of food are the major goal,” said APS Fellow and Charter Member Kelly D. Brownell, director of the Yale Center for Eating and Weight Disorders.

“We are a culture of bigness,” agreed Rozin. “When someone comes to your house, the worse thing you can do is not give them enough food. The French would be more concerned about giving them food of not good enough quality. Big is part of our nature: We have a big open country, a bountiful supply of food. Thanksgiving is a big meal. People get so stuffed. It’s part of the American ideal.”

Rozin began focusing his research on comparing human eating habits and attitudes across cultures, because, as he put it, “I saw Americans screwing up one of the great joys of life.” We should be more like the French, he said. Compared to them, Americans eat more but enjoy it less, hurrying through meals faster and fretting more about the healthfulness of their food. Even in fast-food outlets the French dawdle more over food.

“Ironically,” Rozin reported in 1999*, “although the Americans were the leaders in … modification of their diet to make it healthier, the French subjects considered themselves healthier eaters!”

“We are now surrounded by ‘huge food,'” wrote Barbara J. Rolls, a nutrition scientist at Pennsylvania State University, in “The Supersizing of America.”* “Muffins can weigh half a pound, and pasta bowls in restaurants hold more than two pounds. A plate of steak or fish that weighs more than a pound is no longer unusual restaurant fare. In a movie house, a ‘medium’ popcorn is 16 cups (with up to 1,000 calories), and the soft drink that accompanies it may contain 500 calories.”

Our eyes rule our bellies, Rolls said, probably because we were told to “clean your plate” when young: Three-year-olds stop eating when they’re full. When Rolls served adults macaroni and cheese on four different days, the larger the portions, the more they ate, even though they all reported similar levels of satiety. Served a 12-inch submarine sandwich, men consumed 56 percent more calories than when given a six-inch sandwich; women consumed 31 percent more.

Does the size of the package matter? Rolls found:

• Men ate 37 percent more potato chips from a 170-gram bag than from one half that size; women ate 18 percent more.
• Adults ate twice as many M&Ms from a jumbo bag as from a small one.
• Movie-goers who liked their popcorn’s flavor ate 60 percent more from jumbo buckets than from buckets half as big; those who disliked the flavor ate 50 percent more.
• Told to prepare dinner for two, women used 29 percent more spaghetti from a two-pound box than from a one-pound box.
• Frying chicken, adults poured almost a fourth more oil from a quart bottle than from a pint.

Bargain-hunting plays a role. “In most fast-food establishments,” Rolls wrote, “there is a choice of sandwich sizes; often the larger sandwiches are purchased because they are perceived as being a better value because they offer more food per dollar.”

Still, it’s not how much you eat, but what you eat, she wrote: “It is not portion size that is the problem, but rather big portions of energy-dense foods that encourage excess energy intake. Large portions of foods low in energy density, such as fruits and vegetables, not only are acceptable but also should be encouraged.”

To that end she developed a diet – “volumetrics” – that allows diners to continue eating mega-portions, but shifts the ingredients from high-caloric fats and sugars to lower-energy, water-intense fruits and vegetables. “I think the ‘eat less’ message isn’t very helpful,” she said. “We want them to eat more of the foods that are lower in calories. Then they can have a full plate but eat fewer calories.”

Brownell calls ours a “toxic environment” of food: “Unhealthy food is highly accessible, it’s convenient, it’s engineered to taste good, it’s heavily promoted, and it’s inexpensive. If you wanted to engineer a good food environment, you’d have the reverse of all that.”

The politics and economics of modern agriculture are a major factor. They encourage over-production of food, which then has to be sold. “You sell the food by sweetening it, by offering it in larger portions, and by promoting it very heavily,” Brownell explained.

He traces the sweetening craze to large agricultural subsidies enacted during the Nixon administration. Coupled with genetic modification of plants and the heavy use of fertilizers, pesticides, and herbicides, this led to massive harvests. Scientists discovered how to turn one large harvest – corn – into high fructose corn syrup, sweeter and less expensive than sugar. “This made it possible to sweeten food very inexpensively,” Brownell said, “making it cheaper both in processing and sweetening foods like biscuits and rolls and peanut butter and on and on.”

Something else changed. A generation ago, being overweight was considered a self-control problem. Today, even Medicare recognizes it as a medical problem. It took a long time to convince the world of that, Brownell said, and only during the 1990s did the issue begin to be framed as a public health problem. “That was a major breakthrough, because it led to acceptance that conditions needed to be changed,” he said. “Letting it rage out of control unchecked would lead to significant public health consequences.”

Then the battle lines began to emerge over what to do about it.

After their four-day conference in Italy in 2001, international nutrition experts issued a “Bellagio Declaration,” stating that nutrition-related chronic diseases “are now the main causes of disability and death, not only globally but also in most developing countries.” They unanimously declared prevention “the only feasible approach,” because treatment and management would impose “an intolerable economic burden on developing countries.” They called on governments to partner with related constituencies “to integrate strategies to promote healthful diets and regular physical activity throughout life into all relevant policies and programs.”

Brownell agreed. As he wrote in Overfeeding the Future: “Blaming individuals with the problem, pounding the table with exhortations for increased personal responsibility, and protecting food industry interests by insuring the status quo has been tried for years and has failed, but is precisely what many in government propose as a means for moving ahead.”

He has urged a laundry list of reforms, including regulating portion sizes, taxing junk foods, and using the revenue to promote healthy eating. “No one thing is likely to change the direction of obesity,” Brownell said. “Do we need to change foods in schools? Yes. Do we need to change advertising? Yes. Do we need to change the fundamental economics of food? Yes.”

Kenneth Resnicow, University of Michigan, is dubious. While he agreed that policy changes are needed, particularly in school cafeterias and advertising that targets children, he called legislation to reduce or tax portion sizes “a very touchy issue.”

Legislation may not be as relevant as it was against smoking, Resnicow said, because the food industry is more diffuse. The food chain extends from mega-farms to corporate food processors and distributors to outlets as diverse as vending machines, supermarkets, and restaurant chains. “I just don’t know what taxation or warning labels will accomplish,” he said. “A lot of it will boil down to personal choice. We will still need individual level interventions.”

He has developed and tested behavior modification interventions among African Americans – both adults and adolescents – recruited through churches. Blacks, he said, are both more overweight and more sedentary than whites, and whereas obesity declines among whites as income rises, the same isn’t true for blacks, “suggesting there are some powerful cultural factors” at play. For one thing, blacks are less fixated on slimness: Adolescent girls in a focus group found “thick” boys and girls attractive, while whites would consider the same group overweight.

Resnicow’s intervention combined culturally sensitive videos, cookbooks, exercise guides, and other aids with “motivational interviewing,” in which counselors help clients express their own reasons for and against change. Three trials with adults ended with increased consumption of fruits and vegetables and less fat consumption, but a trial with 12- to 16-year-old overweight girls showed no significant difference, except that one-third of those who attended at least 75 percent of weekly sessions over six months showed a drop in body-mass index.

Rolls agreed with Resnicow. She has a laundry list of what’s needed, including education and consumer awareness; prominent portion-size information on food labels; more point-of-purchase nutrition information; and incentives for food industry to improve nutrition guidance and reduce portion sizes. “Ultimately, solutions depend upon consumers understanding and accepting the value to their health of eating reasonable portions,” she wrote in Nutrition Today. “Clearly individuals bear the ultimate responsibility for how much they eat, but innovative initiatives to help them to resist our abundant environment could help to slow the obesity epidemic.”

Rozin said he doesn’t see what all the fuss is about, that Americans are too obsessed about their food intake when graver health risks abound.

“Some of the most calorically dense foods are very cheap,” he said. “That has had many good effects on the world. The cheapest way to deal with malnutrition is dense food. If you’re a poor person, you want to get your calories for minimal expense. Wouldn’t it be better to have a high-vegetable diet? Yes. But on the other hand, vegetables do cost more.”

Rozin agreed that “we live in a toxic environment” but, like Resnicow, doesn’t think government regulation can work. “Taxing junk food would be a tremendous legal morass,” Rozin said. “The jockeying that went on to set up the food pyramid would be nothing compared to trying to regulate what is junk food or not.”

Better, he said, “to develop strategies in which the food industry’s interest is the interest of public health,” as happened when consumers demanded low-fat and “low-carb” foods: The industry rapidly obliged.

“They want to make money,” Rozin said. “We need to make that serve the interests of public health. We’re in a peculiar situation now, where food companies that try to reduce the American food size put themselves at a competitive disadvantage. Here’s our situation: We have all this really good, highly dense food, and it’s all over the place, and it’s cheap. And we have no cultural restraint.”

While Rozin conceded it’s “probably a bad idea” to promote sugar snacks, “I don’t like the idea too much of government saying what you can advertise, unless it’s clearly harmful. The question is what choices you make. We need to set up a world more like the French have – one in which it is easier to walk and harder to snack or to stuff yourself. I don’t have a simple solution, but I don’t think legislation is the way to go.”

Recent signals from the federal government have been contradictory. In 2004, Kentucky Fried Chicken signed a consent decree with the Federal Trade Commission to end false nutrition and health claims in its advertising. At the same time, however, the US government, heavily pressured by the sugar industry, stiffly opposed a World Health Organization report that called for a global strategy to confront the causes of obesity, including decreasing sugar intake.

“Government is doing precious little,” Brownell insisted, “And the logical explanation is the heavy financial influence of the food industry.” Change, if it comes, will start at the local level, he said. “If you look back at the anti-smoking victories, they were won from the bottom up, not the top down. The same thing is happening with food. The central government is not doing bold things, but in local communities, people are making changes that we hope will become contagious and result in changes at the state level. And then we’ll get to the point where the federal government can no longer look the other way.”

As examples he cited school systems that are removing soft drink machines, farmers’ markets answering consumer demands for more fresh produce, and parents complaining about Disney and Nickelodeon cartoon characters selling unhealthful foods.

“The do-nothing approach is a failed experiment,” Brownell said. “We have embraced the do-nothing approach with zesto and what we’ve had to show for it were horrible chronic diseases. Society steps in and takes action when we cross some threshold of harm. Tobacco crossed that threshold. It seems to me that we’ve now crossed the threshold of harm in unhealthy foods and sedentary lifestyles. And we’ve been sitting around doing nothing all these years. It’s clearly time to take action.”