Dr. David Kessler, author of The End of Overeating, On Why We Can't Stop Eating

Last week, Dr. David Kessler, former commissioner of the US Food and Drug Administration under presidents George H. W. Bush and Bill Clinton, published The End of Overeating. During a seven-year investigation, Dr. Kessler met with scientists, physicians, and food industry insiders to learn why humans cannot resist food. For many of us—myself included—the Pringles slogan, "Once you pop, you can't stop," is true of a variety of foods, from M&M's and pretzels, to nachos and ice cream. Regardless of how hungry we are, the smell of freshly baked bagels or the sight of Girl Scout Cookies, starts a feeding frenzy that ends only when the plate or bag is empty.

In The End of Overeating, Dr. Kessler explains how humans, much like Pavlov's dogs, become hardwired to anticipate foods with fat, sugar, and salt. The food industry has learned what humans want, and is only too happy to give us what we crave. We quickly become trapped in a vicious cycle of dopamine-fueled urges when we want food, and opioid releases when we eat it. If dopamine and opioid sound familiar, it's because they play a major role in alcohol and drug addiction. Dr. Kessler draws a direct connection between food's power over people, and the pull of alcohol and drugs. It truly isn't a stretch to say, "I'm addicted to chocolate."

Today's overeating epidemic has yet to result in lawsuits or FDA warnings, but a change in public opinion towards highly salient foods is exactly what the doctor prescribes. Like other public campaigns, education is power, and the first step toward regaining control of our appetites is to read this book. On the day of his book's publication, Dr. Kessler took time from his busy schedule to speak with me about what inspired the book, what he learned, and how we can change the way we think about food.

LM: This book started while watching an Oprah episode. Prior to that, had you ever seriously considered why food has such a pull over people in general, or you in particular?

DK: We implemented and helped design the food label—the modern nutritional facts that appear on the back of most packaged foods—back in the 1990s. That label was about the ingredients and nutritional value including percentage of daily values, but I never looked at the question that way. After watching that episode and that woman who couldn't control her eating, I said to myself, "What's going on?" As a physician, I asked myself, "What's driving this?" I spent the next seven years trying to figure the answer to that out.

LM: In your book, you discuss the business of food, explain how the food industry tries to manipulate appetites, and go so far as to make comparisons to big tobacco by implying that food has a pull over people the same way drugs do. Do you think that these food industries will be vilified or held financially accountable for obesity related diseases in the future?

DK: Fifty years ago, the tobacco industry, confronted with the evidence that smoking causes cancer, decided to deny the science and deceive the American public. Now, we know that highly palatable foods—sugar, fat, salt—are highly reinforcing and can activate the reward center of the brain. For many people, that activation is sustained when they're cued. They have such a hard time controlling their eating because they're constantly being bombarded—their brain is constantly being activated.

For decades the food industry was able to argue, "We're just giving consumers what they want." Now we know that giving them highly salient stimuli is activating their brains. The question becomes what do they do now?

If a bear walked in here right now, you would stop listening to me and you'd focus on that bear. We're all wired to focus on the most highly salient stimuli. For a lot of people, that highly salient stimulus is food. It could be alcohol, it could be drugs, it could be gambling, but for many people, it's food. It's not just people who are obese, or overweight. Even for people that are healthy weight, food activates the neural circuits of their brains, and they have this conditioned and driven behavior we call conditioned hypereating.

LM: I admit I've noticed some of those same characteristics in myself.

DK: For one gentleman I spoke with, the hardest thing for him every day is to get home past the newsstand at the train station because of the Kit Kats. For him, it was Kit Kats, for someone else, it's chocolate chip cookies, but one of the key core features is sugar, fat, salt. Once your behavior becomes conditioned and driven, you get into this cycle and you get cued. When the neural circuits get activated, it focuses your attention. There's a bit of an arousal as you have increased attentional focus, and then the only way to get it out of working memory is to consume the product. The next time you're cued, you eat again, and you're in this cycle. Every time you do it you strengthen it.

Not only is there amplified neural activation in the anticipatory phase with people with conditioned hypereating, but as they're eating, the stimulation stays sustained
so it's very hard to stop. It isn't until the food's gone—considerably later—do you feel full because the reward circuits are overriding the homeostatic circuits.

LM: When you spoke with top executives at one of the world's largest global food companies, and you presented an overview of the information in this book, one executive rightly said, "Everything that has made us successful as a company is the problem."

DK: Putting sugar, fat and salt on every corner, that's been the business plan. You make it not only accessible, but you make it socially acceptable, you create the social norms, you add the advertising, the emotional gloss.

LM: You said the company began to rethink their strategies about labeling and portion size, but how realistic is it to think that companies will change their tactics if it's not financially lucrative? Do you think there will be some sort of government regulation?

DK: Government has a role to play, but if you look at the great public health successes, they come from changes in how we perceive the product.
The success on tobacco wasn't done by regulation or legislation—it was done by changing how people perceived the product. From, "That's something I want, that's glamorous, that's sexy," to, "This is a deadly, disgusting product."

The real goal is to change how you view food. If you look at something and say, "That's going to make me feel good. I want that," your brain's going to get activated. If you look at it and say, "Ugh, that's disgusting. I'd rather have something else," your brain's not going to be activated. You have to take the power out of the food by changing how you view the stimulus. It's food rehab. It's new learning on top of old learning—you never get rid of that old learning, those old neural circuits.

LM: I understand that much depends on the individual but do you have any suggestions for President Obama or the government? Is there any way they can help?

DK: The woman on Oprah had no idea what was going on. No one told her what was going on. In some ways, it's not about will power and it's not her fault. That doesn't necessarily mean there's nothing she can do, but if she's constantly being cued, constantly being bombarded with these stimuli, and her brain is conditioned and driven to respond to those stimuli, we first have to educate.

Two, is full disclosure of what's in food. If your chicken is injected with sugar and fat, and your food is loaded and layered upon layer with fat on sugar on salt, there needs to be disclosure.

It also is how you look at advertising. If advertising was meant to just convey information to consumers and it was neutral, that's one thing. But if advertising is a cue, then it gives you greater reason to regulate it, especially to kids.

In the end, it has to come from what do we want? What do we view as desirable? What do we view as socially acceptable? A lot of this is social norms. If I can walk down the street and be eating sugar, fat, and salt at any time of the day, on every corner, and that's viewed as what we find rewarding rather than disgusting, then we're going to continue with this epidemic.

LM: That ties into what you were talking about with eatertainment as an aspect of this phenomenon.

DK: If I give you a pack of sugar, and I said, "Go have a good time," you're going to look at me and say, "What are you talking about?" Now I add to that fat, and temperature, and texture, and mouth feel, and color, and I'm going to put it on every corner, and I'm going to say you can do it with your friends, you can do it at the end of the day when you want to relax, and I add all the television monitors and the color, so it's a carnival sort of atmosphere, who wouldn't want to get on the ride?

LM: What was the most surprising thing you learned during your investigation?

DK: I didn't literally understand why that chocolate chip cookie has power over me. I didn't understand why my hand was reaching. Only when I understood how my brain gets activated, how my brain gets encoded, did I learn that the power of food comes from our ability to anticipate it. Have you ever been eating and all of a sudden, as you're eating food, you start thinking about what you're going to have next?

LM: (laughing) Yes.

DK: It's sort of bizarre, right? It's that power of anticipation that drives the behavior, even more than the consumption. When you're actually eating, it, you go ehh ehh.

LM: It's not that good.

DK: It's not that good, but it's that power of anticipation. Understanding that food has more power than we realize, was the most important thing.

LM: Do you consider hypereating an effect of more disposable income or a higher standard of living? Is this unique to our period of time?

DK: We always were wired to focus on the most salient stimuli. It's just that the food industry has been able to manufacture food that's so highly salient. We always had salient foods when I was growing up, but desserts occasionally or foods that were fats on fats occasionally. Now we have them 24/7, all the time, breakfast, lunch, dinner, and throughout the day. That's the difference.

LM: It's availability?

DK: It's availability as well as acceptability—put those things together. Hypereating starts with sugar, fat, and salt, and then you add the stimuli associated with that, the emotional gloss, the availability, and the accessibility.

LM: What percentage of Americans would you say suffer from hypereating?

DK: It's a continuum. For probably 15% of the population, and that's just a guess, food is not a very salient stimuli in their life. You ask them, and they say, "I can eat or not. I have to eat in order to sustain myself, but it's not a large part of my life." That's a minority of people. If you look at the rest, and you ask them whether they have a sense of loss of control in the face of highly palatable food, if they have a lack of satiation—a lack of feeling full—when eating highly palatable food, and a preoccupation of thinking about food in between meals, about 70 million people would score pretty high on all three characteristics.

LM: Is there anything else that you would like to add or say?

DK: There's a lot out there about the food industry, and who's the villain, and who's the victim, but what's important for me is to explain to people—to the woman on Oprah—what was going on with her. I wanted to figure out what was going on, and the book was written to help people who don't understand why they have such a hard time overeating. My family doctor said to me, "You're describing me. No one ever described me to myself. No one explained to me why I keep on eating."

Follow Louise McCready on Twitter: www.twitter.com/lmccready

Comments

[RozWatkins]

It sounds a fascinating book, and I agree with many of the comments. I also think a big problem is the idea that weight loss or gain is just about calories in and calories out (the old "law of thermodynamics" principle.) This makes people think it is better to eat a "low calorie" highly processed cereal bar than, say, some nuts. It also results in fats being demonised, even natural, healthy fats.
In my work with overweight people, I find that if I get them to stop thinking in terms of calories and start thinking about how processed their foods are, I see massive improvements. They are often terrified that they will put on weight when they start eating eggs or butter again (free range, grass fed) but they actually lose weight because these foods fill them up! (I do get them to eat slowly and with their full attention on the food too.)
Must go and order the book now!
Roz
www.enlightenprogramme.co.uk

[rockyrococoAZ]

It IS a fascinating book.

Dr. Kessler makes a compelling case, but even more than that, understanding and awareness of how the food industry has been manipulating us (definitely me) for so many years has made it easier for me to "just say no" to buying the things that trigger overeating in my life.

I've been involved in the VA (US) Move! program to lose weight for a couple of years now.

www.move.va.gov

I lost more than 80 pounds in three years. But last summer I started gaining again as I had the mindset that I could eat things I wanted to eat because I wanted to pamper myself. However, I was doing that far too frequently.

As soon as I started reading Dr. Kessler's book, I was able to (again) reclaim my mindset and focus on eating only when I am hungry, making better choices and actually enjoying GOOD food more.

As a result, I've already lost 3-5 pounds in the last couple of weeks. Without even the smallest sense that I was depriving myself of anything I felt I needed.

[Broga]

This is the most encouraging interview I have read for a very long time on diet. Congratulations , and like Roz Watkins I will buy the book. In fact I have already ordered two copies. I have watched my wife weep as she endlessly lost the diet battle and she is a doctor herself. The breakthrough was when she was treated by Roz and discovered that diet involves far more than calories and a great deal about psychology, emotions and our personal histories and needs. We now freely eat eggs, butter, full cream milk and wholemeal bread and other carbo hydrates and vegetables and fruit. We excercise with enjoyment - cycling , hill walking and rowing mainly - and when our weight increases we know to cut back on the carbo hydrates.
Read the book, ignore the "diet gurus" with their phony "doctor" titles, and get to the people who will and can help you. Congratulations Huff Post, Louise McCready, Dr Kessler and Roz Watkins.

[LaniMuelrath]

I saw the cover and read the title of this book while passing through LAX on the way back to SFO from Oaxaca just 2 days ago.

And I knew right away what THIS was about. The title and pic say it all! Before reading a word of reviews, I posted on my blog my conjecture about the content of this book and then promised to go read about it and see if I was right. That is what landed me here.

And, yes, I was right. The tease of title and photo did their work!

I see several comments here suggesting " this has been said before". Well, so what. It bears repeating. It is easy to get lulled into looking for the magic bullet superfood or superworkout (or supersomething) that will solve all of our weight loss problems. But bottom line, 99% of the time, it's too much calorie content (which is EASY to do with carrot cake over carrots!). And second, not moving around enough.

So, I say more power to more awareness, and though I haven't actually read the book, looks like a thumbs up to me.

Plus I got some new vocabulary out of this column. "Salient foods"? "Hypereating"? Thanks Louise!

Lani Muelrath
http://www.thetruthaboutfatlossforwomen.com

[coldwatermd]

Dr. Kessler brings an interesting point into the discussion - but we should not forget that the present obesity epidemic has not a single cause. And blaming it all on our mental approach, is awfully close to the old hat of thinking positive.

We need to be aware that with junk food we are feeding the wrong bacteria in our gut - and they in turn crave more junk food.

He is right though in two points: That interrupting the cycle of eating junk and craving needs to be interrupted; and that we will be always susceptible to junk food because junk food contains the deadly combination of fat, sugar, salt that has ingrained into us by evolution: This was the food that saved us from starvation. We need to make informed decisions to resist that kind of food.

And one last thought: Health does not come from diet alone. In European Natural Medicine, we have the "Five Health Essentials: Water (cold from the outside, warm from the inside), movement (a little bit all day), food (fresh, varied and mostly vegetal), herbs (sprinkle them over your food deliberately - fresh or dried, and use medicinal herns when you get sick, order (balance your life with enough sleep, deep breathing, forgiveness, and lots of hugs and kisses).

Alexa Fleckenstein M.D., physician, author.

[fisharefreinds]

I think enough has been written on this topic and they usual follow with a prescription diet of some sort like, all protein, no protein, all veggies, limit veggies....
We live in our heads. Need to connect to our bodies! Its sexual.

[Ellen Bergstrom]

More informatio­n/evidence as to why the majority of Americans are getting fatter and fatter. We need to launch a solid movement, a healthy life style movement to counteract all of this or else we are all going to be devoured in fat, like a bunch of fat, listless cattle. In short, it is making us all into slaves of buying into what others want to sell us. We all need a spine transplant.
I am advocating for a very strong, yet loving way to maintain a healthy, holistic lifestyle. I lost over 40 pounds over the last 2 years doing things my way, holistically, as well as using a wide variety of other methods out there. The combination, I felt, was like selecting from a healthy "buffet" of methods to choose a joyful, healthy and fulfiling lifestyle, combined in a unique way to suit me.
I wrote a book "Weight Management Life Management, Hoslistically." Please check out my blog at www.greanwitch.spaces.live.com. Also I do consultati­ons/coachi­ngs, teachings others how to design the best approach to rerogram themselves. Each of us is unique and thus we each need a unique program. My credntials include many years experience in mental health as a licensed social worker, one year of medical school (I ran out of money to continue...support my new busines and help to finish med school), as well as many years of training and experience in the holistic and metaphysical fields.

[ScreenName05]

So many words to explain such a little idea. I don't overeat because there are candy and salt products all over the place. I and everyone working day and night overeat as a distraction to working all the time. We are not meant to sit in an office all day with short breaks. We are built to forage across a country side, eating nearly constantly to survive. We are overwhelmed by mundane and boring jobs and by not having something to actively keep us occupied. One of the things that every one learns about office work is that it never actually occupies much of your mental capacity. We get excited when we actually have to bear down and think through a problem. But that is a rarity. Remember Einstein created the theory of relativity while working full time as a patent clerk. So we return to our roots of foraging at every possible opportunity. We just don't get any exercise to go with it anymore.

[fisharefreinds]

Well, I agree with you, but he is right on this at least--I think he meant this: to many food commercials, cooking shows,...they bombard us to believe life would be wonderful if we ate a chip or make the latest recipe like Bobbie Flay & Rachel Ray. EAt eeatt eat.

[DotCommie]

If you think about it, in nature, the "sugar, fat and salt" combination does not exist. It only exists in prepared or processed foods, whether it's buttered vegetables or ice cream or potato chips.

If we only ate whole foods, with minimum seasoning, that would more accurately duplicate how humans ate for the past 10,000 years, barring the past 100 or so, and we would probably be a whole lot leaner and virtually disease free. I don't know if I could do it, though I am working toward that goal.

[ScreenName05]

Haven't eaten many nuts, avocados, bananas, cherries, apples, tomatoes, etc. lately have you? Salt, sugar, and fat are in everything we eat even if it is fresh and directly from the vine. We crave these things because they are absolutely necessary to sustain life. We just let our cravings get away and we go overboard. But don't even try to suggest that we do not need these things in our diet. Sugar is sugar, you need a bunch every day or you die. Try restricting sugar from your diet for a couple of days and then run a mile - blacking out and falling down really hurt. Without salt on a regular basis you become sterile and several bodily functions stop working. Without a regular diet of fat, you die. There have been tribes who have suffered mass starvation because they limited their intake to rabbits, which have almost no fat. It is called rabbit starvation, because while they were eating more and more they never got enough fat to sustain themselves and eventually just die.

And as far as the lean diet you suggest, when people were actually living on those types of diets they rarely lived to be over 30. Keep in mind that even with all of our problems and bad diet we are the longest living people in mankind's history.

[chamberwindow]

There is a huge difference between getting salt, sugar, and fat from avocados, nuts, seeds, and other whole foods than getting them from table salt, granulated sugar, and butter. It is even worse to have these three things in very high concentrations in processed foods filled with preservatives that are deemed "generally recognized as safe" by the FDA.
I don't think DotCommie was arguing for a diet of only food that does not cast a shadow. Just a diet that doesn't consist of twinkies, p'zones, and slushies. You can get plenty of salt, sugar, and fat (far better fats) from whole plant foods along with protein and micronutrients. The problem is that there are people that LIVE on ramens, hot pockets, soda, chips, pizza, beer, and other crap. They don't know what a turnip looks like. They have never eaten asparagus before. It is these people that are not making it to 30 in the US.

[Maykat]

If anyone doubts that the food industry manipulates the foods that we eat try looking up recipes for your favorite foods, then look at the labels in the grocery store. Hell, bread has like 5 ingredients when made from scratch but 15 in store bought. Sugar and salt are in foods that you never would imagine. There is a popular salt-free seasoning...let's call it Mrs. Cash...that has partially hydrogenated oils in it. You even have to be careful with low-cal frozen dinners because they have tons of sodium.

Other than getting people hooked can you think of any reason why canned vegetables have to have so much salt? Back in the day when people canned their own do you think they added tons of salt?

[LitDr2B]

If they were pickling they did. :) And salt was the most important preservative before refrigeration became widespread.

But yes: We no longer need that.

[Scott Shockley]

biotechwoman: the laws of supply and demand aren't that perfect. you are wrong. the demand for highly addictive products is highly inelastic, which means it doesn't change easily. when gas prices peaked recently, there was only a marginal effect on consumption... people complained a lot, but not enough got rid of their SUV's and long commutes to really change the problem. Kessler's arguments seem quite valid and I really think taxation has little to do with the decline of cigarettes.

[racje]

Food that pops:

limes, chili peppers, pomegranate, coriander, ....
lots of ways make food "salient" other than salt, sugar, and fat.

Sit up and take notice! Enjoy!

[biotechwoman]

Kessler's assertion that, "The success on tobacco wasn't done by regulation or legislation—it was done by changing how people perceived the product, " is completely erroneous. The tax on cigarettes and legislation to out law smoking in public spaces, offices, etc are the biggest contributors to the war on tobacco.

It is telling that this man, a republican, is asserting that regulation and legislation will not work to combat obesity in America. If Americans had to pay a "fat tax" or a "junk food tax" of 19.5% and companies like Monsanto (the number one to blame for obesity by putting corn starch and corn syrup in virtually every product and creating GM foods ) were to be heavily regulated, America would not be the fattest nation on earth.

[Imago]

Actually, I think you're accusing him rather unfairly. If you look at his tenure at the FDA, he actually pushed very hard to build and support anti-tobacco legislation. He even won an award for his work on tobacco regulation from the Berkeley School of Public Health.

And, I can say as a former smoker (3 whole months smoke free so far!), the taxes and limitations on where I could smoke were irritating but not nearly enough to cut through my addiction. I think higher prices and lower accessibility have certainly had an impact, but for me, it was really getting to the point where I saw the dang things as icky killers that got me ready to go through the pain of quitting. So I don't think his assertion is completely erroneous, by any means.

[alewis14151]

I was in NYC this week, where eating well is easy. But eating too much is easy, too. Too easy. Heck, I wanted breakfast with coffee at BenAsh (55/6th). Eggs with pastrami sounded great.

There must've been a POUND of pastrami with the three over-easy eggs, plus potatoes and whatall else. The pastrami was so tender it melted in the mouth. Everything was delicious, but I had to stop about 1/3 of the way into the plate, 'cause it was just TOO MUCH!

Yeah, it was $27 (it's NYC after all) so I hated to see such delicious food tossed into the garbage, but better the garbage than my belly; I'm already 10 pounds overweight and don't need any more help, thank you.

Besides, I had to save my appetite for lunch (New Zealand oysters and Caesar Salad) and dinner (redfish over spinach with Chianti).

[kankankan]

When I watch naturally thin people, unlike me, I see that while they eat no more healthily than I do, they eat sugar, fats, but they seem less off-kilter becuase of it, they seem to have less craving, they seem to eat less. Yes our food supply really really knocks us off-kilter, yes we are conditioned by our whole culture to eat bad foods and big portions, that is why the bell-curve population weight keeps going up, but still, there are many who stay thin without exercising or doing any special diet. generally any more "emotional" eaters than thin peoplem, I think the fat people get more hunger cues. I think the desire for more food is primarily a chemistry thing, which of course, eating well and exercise helps, as it imporves chemistry and burns more calories, but why do some have to be nearly perfect to keep such a zone of non-overeating, while others have no struggle, just eat the right amount of calories naturally? There is the real interesting point of research.

I appreciate this author is addressing some of the more systematic issues of conditioning and food mixes as cultural/systematic things that most change, but I think he is missing an important aspect. Its in there somewhere.

[kankankan]

I base my thing on phycial/chemistry cravings being more of an issue than habits on the following: when I have been able to get my blood sugar under control by very carefully eating at specific foods at specific times and not eating refined foods...I do not crave or desire fatty/sugar foods. My brain has not been re-wired but rather my body chemistry. Its very revealing when I am in this state of good blood sugar. Its not that apple pie does not look good, but an apple looks just as good. If you have not expereinced it, it is hard to convey. I had no idea how much my desire to taste/eat something was based on blood-sugar "hunger" and not habit/emot­ion/taste. Keeping my blood sugar level is difficult in terms of timing, having right foods available and so it is hard in a busy, chaotic day to keep it right. However, once I am in that good blood sugar zone, eating right is not hard at all, when in the zone, it is almost no effort to avoid bad foods and desire good ones, it takes no will-power­/effort/br­ain-retrai­ning, as the desire/hunger is just plain gone. My hunger when I am in a good zone is a slight nudge, not a siren song. Good healty foods, in surprisingly small portions, are enough to satisfy me, its wierd. Its not habit, its chemistry.

[Imago]

Kankankan:

I think this is a really important insight!

I suspect that it's both blood sugar chemistry, as you suggest, but also some brain chemistry as well. I think that Kessler's suggesting that this is far more than "habit" but is, instead, actually a change in our brain wiring.

But, that aside, I think that your blood sugar point is a really good one, and the implications about how your appetite changes when you've found a balance for your blood sugars levels are important. The French have a phrase --" l'appetit vient en mangeant "-- "the appetite grows with eating." I think that's true for both our digestive systems and our brains!

I've had the same experience as you -- when I get into the groove of eating well at the right intervals for my system (which has always been small quantities of food throughout the day, rather than big meals), I don't crave the junk.

Anyway, good point, thanks!

[kankankan]

I'm not sure I completely buy this. Of course some people can be addicted to overeating, as people are addicted to all sorts of things and yes, it is good to have concrete evidence food is spiked and sized in a way that ends of making us eat more, and of course the "habit" aspect of eating creates behavioral problems. But I think the "emotional" and "bad habit" part of over-eating, while certainly issues, have been way too overemphasized. The author even admits, normal wieght people are prone to bad habits, and yet they are normal weight. Why?

I really think there is something physical going on that the author is touching on but dancing around.