The End of Overeating offers an intriguing set of foundational principles for what Dr. Kessler calls Food Rehab. To provide a sense of those principles, here’s a summarized list.
Conditioned hypereating is a biological challenge, not a character flaw
Conditioned hypereating is a chronic problem that must be managed, not cured
Effective treatment breaks the cue-urge-reward-habit cycle
Diets that leave us feeling deprived magnify the loss of control at the core of conditioned hypereating
New learning sticks only when it generates a feeling of satisfaction
Restoring control over eating requires a comprehensive approach
Lapses are to be expected
Eventually, we can begin to think differently about food
The core of the program requires us to replace unplanned eating with planned eating. Planned eating is much less subject to impulse. It replaces chaos with structure. It’s important that we plan meals that will satisfy us and that we enjoy but which do not fuel hypereating.
Dr. Kessler outlines the shape of a rehab plan and many of the elements it must contain to be successful. Moreover, he makes the information readily accessible while recognizing that each person is unique and no one size fits all cookie-cutter approach exists.
As approaches for treatment of hyperconditioned overeating are outlined, the End of Overeating next focuses on the essential nature of clear and easily remembered rules we can actually follow. Hyperconditioned overeating is intrinsically impulsive, so we must break the grip of that impulsive behavior. Concrete “if-then” rules are an important part of that battle.
I was reminded in this section of the effort Michael Pollan has invested in constructing clear, simple food rules. His rules are things like, don’t eat anything with more than five ingredients or with ingredients you can’t pronounce or don’t recognize. He also has rules like, don’t eat anything your great-grandmother wouldn’t recognize as food.
These are the same sort of rules. Clear and categorical rules — “I don’t eat french fries” — are the easiest sorts of rules to follow consistently. As people with celiac disease, my younger children and I are familiar with that sort of rule. “I don’t eat gluten” must be an absolute rule for us.
The book provides some good examples of the sorts of rules Dr. Kessler and researchers have found effective. It doesn’t simply provide the theory.
Dr. Kessler, in his book the End of Overeating, devotes the latter section of his book to the theory of treatment. And before we can even begin to protect ourselves from all the stimuli, we have to recognize just how vulnerable we are. And to do that, we must be mistrustful of our brain. We have to learn to recognize when a conditioned response is being triggered and stop our response. And that’s not easy.
Effective intervention draws us away from the conditioning power of a stimulus before it triggers its usual response. It reminds us that it’s possible to say no. Intervention begins with the knowledge that we have a moment of choice — but only a moment — to recognize what is about to happen and do something else instead.
Our vulnerability to the stimuli will not disappear. Once those pathways have been established in our brain, we can lessen their force and we can build new ones, but the old connections will remain. Dr. Kessler uses ex-smokers to illustrate the way the connection between a cue and a memory is never fully severed.
Cigarettes are a good illustration because they build the same sort of highly reinforced connections as hyperconditioned overeating (and cocaine addiction, for that matter). For many people, the urge for a cigarette never completely goes away and can resurface at certain times or in response to certain triggers even decades after you’ve quit smoking. While the substance itself may have been removed from the body and we have worked through any systemic physical withdrawal, our brains have been rewired by the addiction.
I could certainly empathize with that description. I quite smoking on July 26, 1996 after smoking — often quite heavily — for roughly two decades. That was almost sixteen years ago, but hardly a day goes by that something doesn’t trigger a desire for a cigarette. I can still remember the sensation and anticipate the “rush” from that initial drag. And it takes an act of will each time to tell myself I’m not a smoker. After this many years, it’s not particularly difficult to resist anymore, but those old pathways are definitely still there.
Of course, we can live without cigarettes. We can’t live without food. So how do we overcome conditioning and create a more healthy pattern of eating? The very first step is awareness.
Being aware means that you have a conscious knowledge of the risks of a given situation. “You have to figure out the situation that leads you to eat, that leads you to start the chain of behaviors,” said Miltenberger. “That is the absolute first step — to catalogue all of the stimuli, all of the situations, all of the cues that start that chain.”
Once we can identify the premonitory urge, the initial step in the compulsion, we can begin to train ourselves so we don’t respond to it. We can set up competing behaviors. And we can formulate thoughts to quiet the old ones we are trying to remove. Most of us also require support. We can’t do it on our own. But it all starts with awareness.
Before I move on to the next section of the End of Overeating, I wanted to explore one underlying contributing factor to conditioned hypereating that I had not thought much about, namely our culture of eating in general. Dr. Kessler devotes a chapter to the topic. He opens with an intriguing observation.
The question “Is food available?” once had social and economic implications. We were really asking “Are we facing famine?” “Can we afford food?” That framework has changed in Western societies. Now we usually mean “Can I buy food nearby?” “Can I eat it anywhere?” In today’s America, the answer to these questions is usually yes.
An important change in our culture of eating in the United States is that we now believe it is okay to eat almost anywhere and everywhere. Eating while walking down the street, in class, in a meeting, or while conducting business is no longer considered rude. I’ve grown up in that environment and had never even thought about it before. Dr. Kessler shares the impressions of people from other cultures in a way that really drives the point home.
Of course, our culture of eating is beginning to infiltrate even anti-snacking cultures with extremely strong meal patterns. The French pattern of eating only at set mealtimes was once so strong that restaurants wouldn’t even serve food outside those traditional periods. As that cultural norm weakens, we are seeing a rise in weight in France, though not yet anywhere near the scale we see in America.
With hyperpalatable food readily available everywhere we go and few cultural restrictions on when and where we eat, those susceptible to conditioned hypereating live in an almost constant state of stimulation. It’s little wonder we’re suffering from an obesity epidemic.
Next the End of Overeating explores why the syndrome Dr. Kessler calls conditioned hypereating is an emerging threat in our modern world. For centuries, homeostasis kept our consumption of food as a population more or less in balance. That balance has now been overturned. In large part that’s because our brains are actually being rewired. Dr. Kessler notes this phenomenon in his book.
I began to develop an overarching theory about eating for reward: Chronic exposure to highly palatable foods changes our brains, conditioning us to seek continued stimulation. Over time, a powerful drive for a combination of sugar, fat, and salt competes with our conscious capacity to say no.
So, how do we become trapped in this cycle of conditioned hypereating? When the chemical reward from eating a hyperpalatable food has made us feel better in the past, we become conditioned to associate that feeling with the food. And it tends to work. We crave that Butterfinger because we have felt good when we’ve eaten them in the past. So when we obtain one and take that first bite, we tend to feel that same sensation.
In many ways, conditioned hypereating is like many afflictions with both a genetic and environmental component. That’s similar to celiac disease. Some people never suffer from conditioned hypereating, just like a third of the population lacks the genes necessary for celiac disease. But even among those with the genetic predisposition for hyperconditioned eating, like those with the genes for celiac disease, not everyone will manifest the condition. For the rest of us, again like celiac disease, conditioned hypereating could be triggered at any time.
However, it’s certainly clear that a significant portion of the global population is susceptible and as we import the highly processed and hyperpalatable American diet into other parts of the world, the obesity epidemic begins to take root in those countries as well.
The next section of the End of Overeating includes a lot of stories of different restaurants, foods, and techniques for generating repeat business. I think an excerpt quoted from the first such illustration will give you a sense for the way this section of the book is constructed. It’s very interesting, I think, and will change the way you read restaurant menus.
The first story involves Dr. Kessler’s observation of an overweight woman eating the Southwestern Eggrolls at a Chili’s Bar & Grill in O’Hare airport.
I watched as the woman attacked her food with vigor and speed. She held the egg roll in one hand, dunked it into the sauce, and brought it to her mouth while using the fork in her other hand to scoop up more sauce. Occasionally she reached over and speared some of her companion’s french fries. The woman ate steadily, working her way around the plate with scant pause for conversation or rest. When she finally paused, only a little lettuce was left.
Next, he provides the report from his industry source on the actual contents of that woman’s meal.
The woman might have been interested in how my industry source, who had called sugar, fat, and salt the three points of the compass, described her entree. Deep-frying the tortilla drives down its water content from 40 percent to about 5 percent and replaces the rest with fat. “The tortilla is really going to absorb a lot of fat,” he said. “It looks like an egg roll is supposed to look, which is crispy and brown on the outside.”
The food consultant read through other ingredients on the label, keeping up a running commentary as he did. “Cooked white meat chicken, binder added, smoke flavor. People like smoky flavor — it’s the caveman in them.”
“There’s green stuff in there,” he said, noting the spinach. “That makes me feel like I’m eating something healthy.”
“Shredded Monterey Jack cheese…. The increase in per-capita consumption of cheese is off the chart.”
The hot peppers, he said, “add a little spice, but not too much to kill everything else off.”
He believed the chicken had been chopped and formed much like a meat loaf, with binders added, which makes those calories easy to swallow. Ingredients that hold moisture, including autolyzed yeast extract, sodium phosphate, and soy protein concentrate, further soften the food. I noticed that salt appeared eight times on the label and that sweeteners were there five times, in the form of corn-syrup solids, molasses, honey, brown sugar, and sugar.
“This is highly processed?” I asked.
“Absolutely, yes. All of this has been processed such that you can wolf it down fast … chopped up and made ultrapalatable … Very appealing looking, very high pleasure in the food, very high caloric density. Rules out all that stuff you have to chew.”
By eliminating the need to chew, modern food processing techniques allow us to eat faster. “When you’re eating these things, you’ve had 500, 600, 800, 900 calories before you know it,” said the consultant. “Literally before you know it.” Refined food simply melts in the mouth.
Dr. Kessler goes on to examine other foods and restaurants and performs the same sort of analysis on each. Food has become a form of relatively cheap entertainment for us. In a later chapter, a restaurant concept designer calls processed food a sort of “adult baby food.” Basically, they are trying to make food irresistible and largely succeeding through a wide array of techniques, including extensive use of chemical flavorings. I like the way he summarizes it in the final chapter in this section.
In industry shorthand, it all comes down to the difference between brown cows and purple cows, according to marketing expert Seth Godin. Brown cows are products that, while perfectly adequate, are fundamentally boring. But a product that’s a purple cow — now, that’s something that stands out. “The essence of the Purple Cow,” writes Godin, “is that it would be remarkable. Something remarkable is worth talking about, worth paying attention to.”
And that’s what the food industry is trying to develop.
How many of your memorable dining experiences have been “purple cows”? Think about it for a bit.
So, the End of Overeating next addresses the big question — why is homeostasis under assault? And there are multiple levels to that answer.
First, it’s critical to understand the scientific concept of palatability. In our common usage, it just means that food tastes good or is pleasant. In scientific usage, it refers to the capacity of a food to stimulate the appetite, thus prompting us to eat more. And the most palatable foods, in that sense, are usually foods that contain sugar, fat, and salt. Why? In large part, that seems to be because those are relatively uncommon in natural food, yet are pretty important to our survival.
However, it’s not simply the case that we can keep piling on sugar or lard and make something palatable. We will quickly begin to interpret that sensory input in negative ways as cloying or greasy or too salty rendering the food unpalatable. No, it’s the particular combination of sugar, fat, and/or salt that makes a food highly palatable. And both human and animal research indicates that the right combination of sugar, fat, and salt creates foods that many of us will eat in excessive amounts.
Dr. Kessler provides many examples throughout his book of the ways different foods are processed and cooked to make them highly palatable. By way of illustration, I’ll quote just one such example here. It’s the Bloomin’ Onion, something I used to enjoy at Outback before I was diagnosed with celiac disease.
“Bloomin’ Onions — the trademark Outback Steakhouse dish — are very popular, and they too provide plenty of surface area to absorb fat. Fried in batter and topped with sauce, their flavor comes from salt on sugar on fat.”
Our constant access to foods high in sugar, fat, and salt is pushing up our bodies’ settling point, the homeostatic point which your body believes is your proper weight. And once the settling point has been adjusted upwards, it’s very difficult to reset it to a lower weight. That’s one reason our weight as a population is increasing even as our obsession with diets also increases. In a way, that’s somewhat ironic.
Sugar, fat, and salt are also clearly reinforcing. In animal studies, scientists focus on two questions to determine if a substance is reinforcing.
Are they (the animals) willing to work to obtain it?
So they respond to other stimuli they’ve learned to associate with the substance?
In this section of the book, Dr. Kessler outlines many scientific studies illustrating the ways that sugar, fat, and salt — especially in combination — are reinforcing. He also details studies that show that three additional features exert a powerful influence on our desire for more.
First, quantity. Give a rat two pellets of food rather than one, give a person two scoops of ice cream rather than one, and they’ll eat more. Portion size matters.
Second is the concentration of rewarding ingredients. Adding more sugar or fat to a given portion boosts its desirability (although only up to a point; in excess, either one can lessen its appeal).
Finally, variety plays an important role.
Dr. Kessler then spends a number of chapters exploring the different ways these stimuli impact and condition our brains. He makes the studies extremely accessible to the lay reader; I learned a lot as I read this part of the book. One of the interesting things I discovered was that we become conditioned by stimuli suggesting that a rewarding food is nearby. Our brains release dopamine when we encounter such cues in order to encourage us to seek out and obtain the food. We are rewarded more for the hunt in some cases than for the actual experience of the food itself. When you think about the way things work in nature, that makes sense, of course. But it works against us in an environment full of highly palatable and highly available foods.
Emotions also help make foods memorable. If you think about meals you remember in your past, most of the time it’s not so much the food itself that makes it memorable. It’s the setting, the people, and the events associated with the meal that fixes it in our memory. And all of that leads to an emotional attachment through association. A particular food spurs a memory of emotion and we begin to link the emotion with the food. The food industry tries to tap into that sort of association in much of its advertising.
Ultimately, our brains can be rewired and a particular eating behavior habituated. I was struck while reading this section of the book how much that habituation resembles what the Christian Fathers have called a ruling passion. It’s a process where trigger leads to action without the deliberate activation of our will. We do something without thinking about it and sometimes even without awareness. Obviously, some of us are more likely to reach that point with highly palatable food than others, but as a population we are clearly susceptible.
The End of Overeating begins with something that we are only now truly recognizing. For thousands of years, typical human body weight was pretty consistent. In fact, it was so stable and consistent that scientists believed we had biological systems operating in most of us to keep our weight within certain norms — automatically balancing our consumption with the calories burned.
In the eighties we began to realize something had changed. Or rather, one researcher, Katherine Flegal, began to recognize the new trend. At first, she thought her numbers were wrong. They indicated that in fewer than a dozen years, 20 million people had joined the ranks of the overweight. Her team checked and double-checked their data and finally published the results in 1994. The average weight of Americans had greatly increased since the sixties and the rates of obesity had exploded.
This discovery upended conventional scientific understanding. Dr. Kessler’s book attempts to gather both existing and new research together in a way that makes it accessible to those of us without a scientific background.
One of the first points, and a critical one, is that we get fat mostly because we eat more food. While that may seem obvious, it was not clear in the research initially. And one of the reasons it wasn’t clear is that people tend to underreport how much food they eat when they track it themselves. It’s not that people are being deliberately deceitful. Rather, we tend to hide the reality from ourselves and we tend to underestimate how much we are actually eating. So we had to improve our study techniques. Dr. Kessler puts the finding this way.
How much we eat predicts how much we weigh. Sometimes the most obvious explanation turns out to be the right one.
Ok, so it’s important to start with the right basis. But our bodily homeostatic system, which scientists thought was more powerful than it actually appears to be, kept our weight as a population more or less in balance for much of our history. What has changed over just the last few decades to overpower it and render it less effective?
The answer seems to be that the reward system in our brains has overpowered our homeostatic system. In the first part of his book, Dr. Kessler explores the different ways our reward system has been supercharged and the impact that has had on us.
The End of Overeating was released in 2009 and led to a number of news stories and interviews. I purchased it in 2010 and have read and absorbed it over the intervening years. As those who read this blog are probably aware, I don’t rush to review the latest thing. When I decide to write about something, it tends to be more in depth and after a period of time.
I want to begin this series with a brief introduction of Dr. David Kessler. He’s both a doctor and a lawyer — which is a significant achievement in and of itself. He was also the Commissioner of the FDA from 1990-1997, first appointed by President George H.W. Bush and later reappointed by President Clinton.
The content of the book and the collection of the science behind it was researched and developed over the course of seven years spurred by a desire to discover what drove people to eat to excess — even when they reported that they hated themselves for doing so. And specifically, what has changed over the past fifty years to make us significantly heavier as a population?
Dr. Kessler introduces the book with a simple statement: You are the target. It’s not accidental, even if those producing our modern highly palatable foods know little or nothing about the neuroscience behind their creations. Those foods are designed to create repeat customers.
In 2009, Dr. Kessler gave a talk at Google. It’s an interesting presentation and covers some of the highlights of the book. His talk is worth the time it takes to watch.
The Wolf Gift is Anne Rice’s latest foray into the realm of the supernatural. Within its pages, she makes werewolves human as she has done for vampires, djinn, and even angels. By human, of course, I mean beings with whom we can relate and empathize. She transforms them into vulnerable, three-dimensional beings.
I won’t describe the nature of the beasts or their history other than to say she makes them sympathetic figures. In fact, though brutal in their attacks, we can all sympathize with them as they are driven to remove evil among men. There is a certain purity in the nature and focus of the savagery of her werewolves.
I did find it interesting that those who receive the wolf gift call the transforming element in the saliva “Chrism.” Within Christianity, that’s the oil with which the newly baptized (in ancient times and still in Orthodoxy) are sealed with the gift of the Holy Spirit. The wolf gift does transform the recipient, if it doesn’t kill them, down to the cellular level. They are also sealed by it in their new state.
Christian baptism and chrismation is supposed to similarly, though perhaps over a longer period of time, work its way throughout our bodies — our being — transforming and sealing us as truly human. The Spirit, though, will not overpower our will as the Wolf Gift often does in the book. And that, I believe, is a key difference. We have to attune and submit our wills over and over and over again in order to see lasting change. Nor do we have any special gift for sensing evil — even the evil we commit ourselves.
As with every Anne Rice book, it’s interesting and entertaining. And the book will make you think. I highly recommend it.
My daughter recently read the first three volumes of Anne Rice’s Vampire Chronicles and she’s hooked. She’s now reading The Wolf Gift. When I told her Anne Rice would be in Austin for a book signing, she squealed. So I pre-ordered her a copy from Book People and we’ll be standing in line at the signing this evening. Should be fun, even if it’s not the sort of thing I would normally do myself.
The End of Overeating offers an intriguing set of foundational principles for what Dr. Kessler calls Food Rehab. To provide a sense of those principles, here’s a summarized list.