Nutrition Action Healthletter
July/August 1998 — U.S. Edition

The Pressure to Eat
Why We're Getting Fatter

Kelly Brownell is a professor of psychology, epidemiology, and public health at Yale University in New Haven, Connecticut. He is one of the nation’s leading obesity experts and is a member of Nutrition Action Healthletter’s Scientific Advisory Board. Brownell spoke to Nutrition Action’s Bonnie Liebman by telephone.

You notice it especially at the beach. With one out of two adults and one out of four children overweight, it’s almost abnormal to be normal weight.  Fewer manual jobs, more computers and television, parents afraid to let their kids outside to play without supervision, and increased dependence on cars all contribute to the fattening of America. But that’s only part of the equation.  The food industry spends billions of dollars each year on advertising and promotion to create an environment that constantly pressures us to eat. And it’s not hawking carrots and celery sticks.

Q: Why is there an obesity epidemic in the U.S.?

A: There are several logical places to look for the answer. Our culture and the medical profession may be looking in the wrong places.
    Culture has blamed obesity on the individual. We assume that people are overweight because of personal failings, that they’re lazy, weak, and gluttonous. An imperfect body reflects an imperfect person.

Q: Don’t people need to watch what they eat?

A: Yes, but the pressure on people to take responsibility for what they eat is staggering already, and I wonder whether more pressure will be counterproductive and make people even more obsessed with what they eat.
    A good example is the Shape Up America! program, which is spearheaded by former Surgeon General C. Everett Koop. Its basic message is that the American public should weigh less and exercise more. Is there anyone in America who doesn’t know that?

Q: What’s wrong with the medical profession’s approach to obesity?

A: People are in hot pursuit of the obesity gene, and perhaps something will come from genetic discoveries that will help some people lose weight. But, I ask you, do genes explain the epidemic and will they provide the solution? I don’t believe so.
    Developing drugs to solve the obesity problem might help some people, but the effort might be likened to developing drugs to repair the damage caused by smoking, and not attending to its cause.
    And searching for the gene for obesity may be like searching for the gene to discover who will get lung cancer once they smoke. Yes, it would be interesting, but the cause of the lung cancer is smoking, not biology.

Q: What’s causing obesity rates to soar must be something that has changed recently.

A: Right. The prevalence of obesity has increased dramatically since 1980. And obesity is on the rise in country after country, as each becomes more like America.
    Can we explain the increase because we have less willpower than we did ten years ago? Are we so different? Can we explain it with biology? Has the gene pool changed in ten years? Evolution takes millions of years. We ignore the obvious.

Q: The constant pressure to eat?

A: Yes. I believe that Americans are exposed to a toxic food environment. The word ‘toxic’ is not too strong. There are dangerous agents in the environment that are widely available and that cause people to be sick.
    Americans have unprecedented access to a poor diet—to high-calorie foods that are widely available, low in cost, heavily promoted, and good tasting. These ingredients produce a predictable, understandable, and inevitable consequence—an epidemic of diet-related diseases.

Q: Is the food industry to blame?

A: The food industry certainly contributes, but it’s hard to know whether the industry is responding to demand from consumers or is shaping food preferences. Either way, the environment is terrible.
    The New York Times recently ran an article on McDonald’s. It said that three new McDonald’s come on line every day, that a corporate goal is to have no American more than four minutes from one of its restaurants, and that seven percent of Americans eat at McDonald’s on any given day. And that’s only one chain.
    This is capitalism at its best to be sure, but what effect is it having on us? McDonald’s signs now say ‘billions and billions served.’ When it becomes ‘trillions and trillions,’ will we be better off?

Q: Why is the fast food industry so successful?

A: It has made many marketing breakthroughs. One was serving breakfast. Others were the drive-in window and package meals—what McDonald’s calls super-value meals. And now we have very large sizes—what they call supersizes.
    The industry’s influence is so pernicious and pervasive that many, perhaps most, American children recognize the word ‘supersize’ as a verb. It’s just part of our culture.

Q: It’s not just fast food. Our studies show that a typical meal at an ordinary restaurant has 1,000 calories, and that’s without the dessert or appetizer.

A: One of the first things people from other countries notice when they visit the U.S. are the large portions served in restaurants. In most of the world, there’s no such thing as a doggie bag.

Q: And food is available everywhere, all the time.

A: Yes. It seems like every service station has been remodeled to put a food market inside. You can drive down the road in many communities and pass five or six service stations, fast food restaurants, and convenience stores in less than a mile.
    One Exxon station near my home has not only a food market with the usual chips and snack foods, but also a Dunkin’ Donuts franchise inside it. And a Texaco station off the interstate had a food market, Dunkin’ Donuts, and Subway.
    Fast food is infiltrating our culture. There are fast food restaurants inside some schools. Malls have food courts. Fast foods are showing up on airline flights and in airports. It’s basically everywhere.

Q: And schools that don’t house fast food chains serve hamburgers, pizza, tacos, or other fast foods anyway.

A: Right. You can argue that we’re biologically programmed to eat such food because it’s high in fat and sugar. Laboratory rats will eat that kind of food if you give them access to it, and they can become quite obese.
    Animals—and people—evolved in an environment where food was scarce and calorie expenditures were high. Under those conditions, being programmed to eat high-calorie food is adaptive. Those ancient genes wouldn’t be a problem if the environment weren’t so damaging.

Q: The ancient genes programmed our ancestors to eat high-calorie foods to sustain people in times of scarcity?

A: Exactly. But there’s no scarcity today, and we expend far fewer calories. The environment has only changed over the past hundred years, and it takes thousands or millions of years for evolution to catch up and change our ancient genes. The environment has changed too quickly.

Q: What about sedentary lifestyles?

A: This is terribly important. The toxic environment is a combination of food and lack of physical activity. The remote control, video games, the automobile, television, and to some extent the computer are all part of the toxic environment because they discourage people from being physically active.

Q: Aren’t there barriers to physical activity?

A: Some people live in neighborhoods where they can’t go outside because walking or running is too dangerous, and they don’t have money to join health clubs. Plus, given that we’re becoming fatter as a society, it becomes less appealing to exercise.
    And energy-saving devices are part of who we are. We can’t get rid of the remote control or the computer. Those devices will continue to creep into our daily lives so there’ll be even less need to be physically active. That means that people are going to have to get physical activity on their own time and in their own way.

Q: Do other countries have less-toxic environments?

A: Yes. And they have less obesity, too. There’s an alarming increase in obesity, like we see in the U.S., but they start at a lower level. As the environment changes, those countries will have more diet problems, as we do.

Q: What about the social pressure to eat? Has junk food become synonymous with fun?

A: As in most cultures, food has tremendous social meaning. People can feel like they aren’t part of the group if they don’t eat like everybody else does.
    Food also has personal meaning. It can be a person’s best friend, and it allows some people to numb out from a difficult world. Some people look forward during the day to being alone with their food in the evening. It represents comfort, soothing, and nurturance that may not come from other people.

Q: Is that a result of the toxic environment?

A: Some people would be drawn to food regardless of the environment, but just as the alcohol industry glorifies drinking and makes people feel cool and part of a group if they drink, the food industry makes eating seem pretty special.

Q: What’s the answer?

A: I recommend that we develop a militant attitude about the toxic food environment, like we have about tobacco. And that leads to certain actions to change the American diet to be more healthy.
    The specific proposals I’ve made are: subsidize the cost of healthy foods, so they cost less; increase the cost of bad foods, so they cost more; regulate food advertising aimed at children; and develop more opportunities for people to be more physically active.

Q: How do people react to your bad-food-tax proposal?

A: The knee-jerk response has been: ‘Where does it end? Are you going to tell us how to lead our lives and intrude on personal decisions?’
    But if you went back 20 years and said ‘I propose we recover money from the tobacco companies to repay states for expenses caused by smoking’ or ‘we should ban smoking in public places’ or ‘take Joe Camel off the billboards,’ people would have thought you were crazy. Government intrusion, they would have charged.
    But all that changed as we recognized the overwhelming toll produced by smoking. It became so serious that society overlooked the intrusion on individual rights for the greater social good.
    With 425,000 people dying each year from smoking-related diseases, this is a crisis. Yet 300,000 die from diet-related diseases and a sedentary lifestyle. This certainly seems serious to me.

Q: So even though french fries aren’t as addictive or harmful as cigarettes, in both cases there’s an industry manipulating us, from a young age, to do something unhealthy?

A: Exactly right. I have asked myself whether Joe Camel is different than Ronald McDonald. One could claim that they both encourage children to adopt habits that could be bad for their health.

Q: Aren’t our growing waistlines a sign of the food industry’s success?

A: There are probably many factors that explain the growing national waistline. But it’s difficult to be optimistic about the future when we see record levels of obesity in our children and phenomenal sales of snack foods, fast foods, and soft drinks.


Supersize Food, Supersize People

"The food industry is selling food in larger portions," says Marion Nestle, chair of the Department of Nutrition and Food Studies at New York University.

"There’s been a steady progression of restaurants and manufacturers dropping small sizes. Starbucks doesn’t have ‘short’ drinks on its menu any more, only ‘tall,’ ‘grande,’ and the even-larger ‘venti.’ "

Nestle and colleague Lisa Young asked 100 college students taking a nutrition course to bring in a bagel, baked potato, muffin, or cookie that they considered "medium." Then they compared those foods to serving sizes that the U.S. Department of Agriculture—which advises the public on how much of what to eat—calls "medium." The results:

"It’s a great sales technique," says Nestle. "People buy larger sizes because they perceive them as good value. If they’re going to spend all this money on food, especially in a restaurant, they figure they might as well get a lot to eat."

And more food doesn’t cost much more. At many United Artists movie theaters, a small drink (22 oz.) costs $2.50, a medium (32 oz.) costs $2.75, and a large (44 oz.) costs $3.00.

Why is it profitable to sell giant servings? "Only about 20 cents of every food dollar goes to the producer of the food," explains Nestle. "The rest is for packaging, transportation, advertising, and marketing." And those costs don’t change much as the serving size soars.

Movie and a Measuring Cup

OK, so foods come in bigger sizes. Does that make us eat more? Yes, says Brian Wansink, director of the Food and Brand Research Lab at the University of Illinois at Champaign-Urbana.

Wansink sent 79 parents home with a video and either one- or two-pound bags of M&Ms plus either a "medium" or "jumbo" movie-theater-sized tub of popcorn for each family member.

"On average, people ate 112 M&Ms from the one-pound bag and 156 from the two-pound bag," says Wansink. Likewise, the average person ate roughly half a tub of popcorn, whether it was medium or jumbo (which held twice as much).

"People can often eat about 50 percent more of hedonistic foods like candy, chips, and popcorn when they come in bigger packages," says Wansink. "With other foods, the increase is usually about 25 percent."

Why? "I think we’re hard-wired to believe that bigger equals cheaper. So people feel that it costs nothing to use more."

More evidence: People poured themselves about 20 percent more bottled water when it came in a two-liter container instead of a one-liter container. But when the containers were labeled "tap water," they poured the same amount from each.

"People see tap water as free, so there’s no size quantity discount," says Wansink. "And for most products, you do save money by buying a larger size."

Drop Anchor

Signs in supermarkets can also encourage people to buy more food. In Wansink’s studies, people buy more of an item—often twice as much—if the sign uses:

"Just putting a specific number on a sign will stimulate shoppers to buy more than the one or two they ordinarily would," says Wansink. "When consumers shop, they anchor on a suggested number to buy and then adjust that up or down, depending on the circumstances."

Most people anchor on one or two, and usually buy one to three of the item. "But when the sign suggests a different, higher number," he explains, "many consumers unconsciously adopt this as their new anchor and adjust down a few units from that."

How to avoid eating more?

J. Amer. Dietetic Assoc. 98: 458, 1998 — U.S. Edition.
Journal of Marketing 60: 1, 1996.
Journal of Marketing Research 35: 71, 1998 — U.S. Edition.


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