In a nation where obesity and health loom large in our public dialog, there is no escaping the simple fact that we eat too much.
On average Americans consume 500 more calories per day than we did in 1970 (more than we ever have), mostly in the form of refined and processed foods. This corresponds with a 25-30 pound increase in body weight and obesity rates near 30%.
Debates rage over the specifics of what is causing our weight and health problems, but it seems clear enough that the critical element is the amount of food we choose to put in our mouths.
But does everything we eat represent a true choice?
In his book The End of Overeating, former FDA commissioner Dr. David Kessler examines the role of the brain in eating behavior and the mechanisms involved in what he calls conditioned hypereating.
According to his findings specific combinations of sugar, fat and salt hijack the reward pathways of our brain and force us to behave more like food addicts than hungry organisms. This leads to a cycle of conditioned hypereating that makes the habit harder to break with each repeated episode.
But whether or not we are addicted to food is a point of debate. In an interview Kessler made clear he does not use the word addiction for fear of oversimplifying conditioned hypereating. Our relationship with food is more complicated than it is with something like alcohol or tobacco because a human can live without cigarettes, but food is vital to survival.
When pressed to describe the neural differences between addiction and conditioned hypereating, however, Kessler conceded, "The fundamental circuits are the same."
For this reason, treatment of conditioned hypereating can draw from the success of substance abuse treatments. These tactics involve cognitive and behavioral therapies we can use to train ourselves to override our instincts and adopt new behaviors in response to stimulus cues.
For conditioned and compulsive behavior, cognitive strategies are necessary because intuitive inclinations and "listening to your body" do more harm than good. If your body is telling you to have a cigarette, this does not mean it is in your best interest to do so.
At the FDA Kessler was instrumental in the fight to regulate tobacco, and now he believes some of the same lessons can be applied to the treatment of overeating.
"What took me a decade to understand is you need to change the valence of the stimulus."
The positive emotional reaction associated with indulgent foods is at the center of our motivation to seek them out. Twenty years ago cigarettes had tremendous allure. But the FDA was successful at demonizing the tobacco industry, and the public no longer sees smoking as glamorous and attractive.
And smoking rates have plummeted.
Changing a conditioned behavior requires a fundamental shift in how we think about a stimulus. In conditioned hypereating the stimulus is food, which makes the task especially difficult, but not impossible.
To break the cycle of conditioned hypereating we must redirect our automatic response to the kinds of foods that cause us to overeat. Kessler calls these hyperpalatable foods, which are loaded with layers upon layers of sugar, fat and salt. The goal is to replace our automatic responses to these foods with different, equally enjoyable actions that are not detrimental to our health and do not reinforce compulsive behavior.
I asked Kessler what is the first step in controlling our eating habits and overcoming conditioned hypereating.
"I can tell you the last step. Change your relationship with food. If sugar, fat and salt are your friends, you will lose. You have to get to the point where that is not what you want."
The End of Overeating outlines the four basic steps of habit reversal: awareness, competing actions, competing thoughts and support.
But Kessler believes the critical step is fundamentally changing the way we view what we eat, cooling down our emotional response to hyperpalatable foods. In essence, we must train ourselves to stop wanting what we believe we want.
According to the book, the first step in this transformation is becoming aware of the power food holds over us, which requires understanding how our brains work. We must recognize that when we are tempted to indulge, the urge is not generated internally but is a reaction to a cue that makes us respond automatically. You may think you are hungry, but really you are just reacting to an emotionally charged stimulus that tells you to eat.
Once you recognize a cue for what it is you have a brief moment to decide not to take the bait. To successfully divert yourself to another course of action you must have a plan ready in advance that allows you to do something completely different.
Considering alternative activities and the reasons you might prefer them can help you tremendously at this point of decision. Rather than focusing on the positive emotions you will experience by giving in to your desire for hyperpalatable foods, also remember the negative emotions that follow if you give in and the positive aspects of the alternative action.
For instance, it may help to remember that every time you get cued and give in, you are strengthening the neural circuitry that compels you to this behavior in the first place. If you even briefly entertain the possibility of indulging, you create a state of ambivalence that leads to torment, obsession and cravings. However, when you successfully divert your attention to another rewarding activity you have made a small step toward cooling down the positive valence of the food.
It is the state of mental torment and ambivalence that increases the positive emotional charge of a food, building and strengthening the neural reward circuitry that causes conditioned overeating. This may be one of the reasons dieting almost always results in long-term weight gain, since constant deprivation makes hyperpalatable foods more difficult to resist and creates severe anxiety.
Mentally, the best strategy to overcome conditioned hypereating is to develop new, positive associations with food that are independent of palatability-something you care more about than the fleeting reward of overeating. Kessler says this is a deeply personal process and must reflect an individual's own set of values. For example, it helps some people to become vegetarian, while others value organics or local food. These decisions remove virtually all hyperpalatable food from the lives of people who choose these paths.
It also helps to develop aversions to hyperpalatable foods. Some may learn to demonize "Big Food," while others turn away after educating themselves about health concerns. Developing a more sophisticated culinary palate can help make hyperpalatable foods less palatable. Kessler himself developed an aversion to over-sized portions, which he now sees as repulsive piles of sugar, fat and salt.
Developing positive associations with healthier foods while demonizing the hyperpalatable foods we have been conditioned to crave can fundamentally change your emotional response to stimulus cues. As you learn to recognize your brain's response to cues, you can override conditioned behavior by consciously deciding to take alternative actions because you want to.
You will never win an internal battle with yourself. Instead use what you know about the brain's reward system and give up trying to summon willpower to resolve the torment of conflicting desires. Reprogram your habits by closely examining your relationship with hyperpalatable food and begin making deliberate decisions that are consistent with your goals, breaking the cycle of conditioned overeating.