FOOD IS MORE THAN JUST A MEANS FOR SURVIVAL

March 8th, 2010

OTTAWA — Dr. Valerie Taylor doesn’t believe that most people with a weight problem would say, “This is not my fault,” or, “This is because of McDonald’s.”

“Absolutely, they take responsibility,” says Taylor, an assistant professor in psychiatry and behavioural neuroscience at McMaster University in Hamilton, and director of the Canadian Obesity Network mental health program. Many people feel guilty about their weight, she says, “and they struggle to accept treatments like surgery because they really feel they should be able to control this problem themselves.

“Some don’t even think they deserve the kinds of treatment and care that other medical conditions receive.”

The truth, she says, is that certain people are vulnerable to overeating, “and we have created an environment in which high-fat, palatable food is abundant.”

But is the solution more self-control? More regulation of the food industry? More social pressure? In the “war” on obesity, everyone is grappling for answers.

Some say what is required is nothing less than a fundamental shift in social norms and the way we view food.

Like smoking in the 1970s, Dr. David Kessler says, there are no social boundaries when it comes to eating. It has become culturally acceptable to eat almost anywhere, and anytime — in a business meeting, in a lecture, in a classroom. “We have children who are eating almost constantly throughout the day.”

Even three meals a day are no longer enough.

“Some restaurants have been as audacious as to advertise the fourth meal,” says Kessler, a former U.S. Food and Drug Administration commissioner under presidents George H.W. Bush and Bill Clinton who led the crusade for tougher tobacco legislation in the 1990s. Taco Bell markets a late night menu called the Fourthmeal, “the meal between dinner and breakfast.”

“What the food industry did was to take fat, sugar and salt, put it on every corner, make it available 24/7, make it socially acceptable to eat any time,” Kessler says. “We’ve added the emotional gloss of advertisement, we’ve made the food into entertainment, and we’re living the consequences.

“What did we think was going to happen?”

Where do we even begin to fix it?

Today in Canada, 61 per cent of the adult population — 13.2 million Canadians — and 26 per cent of children aged six to 19 (1.4 million) are overweight or obese. “Kids are probably not going to live as long as their parents do, because of weight,” says Taylor. Doctors are reporting a rise in the “super-obese,” people with a body mass index in the 50s and 60s, something that was unheard of a generation ago. A BMI — a measure of body fat based on weight and height — of 30 or more is considered obese.

In the fight against obesity, some are pushing for public polices, such as higher taxes on soft drinks. Studies suggest sugar-sweetened beverages — the single greatest source of added sugar in our diets — may also be the single biggest driver of the obesity epidemic, especially among children.

“There seems to be something special about calories when they get delivered in liquids,” says Kelly Brownell, co-founder and director of the Rudd Center for Food Policy and Obesity at Yale University. “The body doesn’t recognize them well, and there’s less compensation when people consume too much. Third is, they’re so heavily promoted, it’s ridiculous. And fourth, you’ve got this possibility of the sugar, especially coupled with caffeine, being addictive enough to be a problem.”

In a report published last year by the New England Journal of Medicine, Brownell and half a dozen other experts in nutrition, public health and economics, called for a penny-per-ounce tax on soft drinks and other sugared beverages.

Brownell says his group’s research shows that a penny-per-ounce tax on sugary drinks, with part or all of the revenues designated for obesity prevention programs, would raise $150 billion over 10 years in the U.S. “That’s how high the consumption is.” A penny-per-ounce tax — which would add, roughly, 34 cents to the cost of a one litre bottle of pop in Canada — would lead to about a 23 per cent reduction in consumption of those beverages, Brownell says, “which, in the United States, would mean the average person would go from drinking 50 gallons (per year), to 38.5.”

Others want to require restaurants to include calorie counts on their menus. Brownell and his colleagues published a study in December that showed such labels inspire people to eat 14 per cent fewer calories.

Calorie labels, along with information on the recommended daily caloric intake for an average adult, led people to consume, on average, 250 fewer calories in after-dinner snacking than people who saw menus with zero calorie information. Another study, this one published in January in the journal Pediatrics, showed that parents presented with hypothetical meals at McDonald’s restaurants choose meals for their children containing 102 fewer calories on average when the menus listed calories for each item.

In 2006, the House of Commons voted down a private member’s bill that would have required fast food chains to post the number of calories in menu items beside prices on menu boards.

But government regulation of the food industry isn’t the only thing people are calling for. Taylor and others want tougher controls on the commercial diet industry. “People are desperate,” she says, “and they’ll do things like spend huge amounts of money on these quick-fix diets that promise losing 40 pounds in eight weeks through very unhealthy ways.

“We know that when people do that, most will rebound, and probably gain back more weight than they had lost,” she says. “Even trying to lose weight is contributing to obesity. We have a generation of people that are dieting themselves into obesity.”

But many turn to commercial diets when they can’t get the help from doctors. Taylor says her colleagues are good at treating the problems that occur as a consequence of obesity — diabetes, high cholesterol, hypertension — but, “we’re not as good at treating obesity … So, it just gets ignored.

“To tell somebody who has a weight problem to eat less and exercise more is not helpful.”

What’s more, we live in a thin-obsessed culture still steeped in the idea that if people just try hard enough, they’ll get the body they want, that fat people, somehow, “do it to themselves.”

Doctors aren’t immune to those attitudes. “Health-care professionals are human beings, and human beings, we have this aversion to the big fat slob. Do you know why? Because we’re afraid we may end up like that if we lose control,” says Dr. Nicolas Christou, a professor of surgery at McGill University and director of the bariatric surgery program at the McGill University Health Centre.

“Almost all of us are fighting, one way or another, unless we’re anorexic, to maintain a weight down to a level we’re comfortable with. These people, when you see them, remind us of that failure.”

Christou sees the extreme end of the obesity crisis, the “morbidly” obese, people “who have absolutely failed miserably at any attempt whatsoever to get them to permanently lose their weight and keep it off.” For the severely obese, weight loss surgery can be life-saving, but wait times for bariatric surgery are the longest of any surgically treated condition in the country. Christou has patients who have been waiting for surgery since 2002.

“Obesity seems to be an OK discrimination, it seems to be the last acceptable joke of society,” says Kris Greene, president of the British Columbia Association of Bariatric Advocates.

“The stigma of being obese, and living in a society that views fat as ugly and undesirable, is a huge blow to the psyche,” she says. “Not only are we judged by those on the outside, but more so by ourselves.” Obese people feel anger, she says, “anger at how we are judged, anger because we are ’stuck’ in these bodies, anger because we try and try and try, to only be pushed down again. I remember each and every diet I tried, and how I felt when, once again, the diet failed — or did I fail?”

Greene was an eater of fast food and pasta. Creamy, salty foods are what she loved, and the more the better. “It fed the emotional part of me that wasn’t being filled with happiness.” She hoarded food from an early age. “Food was my best friend, my comfort, the only constant in my life I could count on.” Chips were her addiction. She would hide chocolate bars in her car, her bedroom, and snack on them when people weren’t around.

Being obese “was horrible, it was absolutely horrible. What was worse than the physical pain was the emotional pain.”

Greene had gastric bypass surgery in November 2004, when she weighed about 330 pounds. She weighs 168 pounds today, and has maintained that weight for more than five years.

Like Greene, all of the personal stories for this series involved people who underwent bypass surgery — Francina Kehoe, of Langford, B.C., Joel Sopp, of Redvers, Sask. For them, surgery was a last resort. No one is suggesting operating on every overweight person is the solution to the obesity problem. In Canada, bariatric surgery is reserved for the severely obese, people who weigh at least 100 pounds more than they should.

Understanding how we lose control in the first place could help those who are obese control their eating, Kessler says. And then, fundamentally altering the way we think about food, and changing our eating behaviours.

In his book, The End of Overeating, Kessler describes watching people in restaurants “attack their food with a special kind of gusto,” lifting their forks before having even swallowed their last bite, watching “as they reach across the table to spear a companion’s french fries or the last morsel of someone else’s dessert.”

“The easiest solution is to go live somewhere we’re not constantly bombarded with food cues and food is not available every 20 feet,” Kessler says in an interview. “But that’s unrealistic. The problem we face is the reality that, for the global food companies, their objective is growth, and growth means increased revenue, which translates into selling more foods and increasing the caloric burden of society — whether or not we need that food.”

Social norms affect behaviour, Kessler says. We succeeded in changing how society views tobacco. “We used to see it as something glamorous and sexy and cool. Now we view it for what it is: a deadly, addictive product.”

Tobacco was easy, he says, because we can live without it. Food is much harder. “You can’t demonize food,” he says. “Food needs to be enjoyable.” The goal is to change how we look at highly processed foods and “big food,” meaning big portions. “I look at huge portions now and say, ‘That’s not what I want. That’s disgusting. That’s not going to make me feel well.”

Today, Kessler, a pediatrician and former dean of the medical schools at Yale and the University of California, San Francisco, eats about half what he once did. He doesn’t want to over generalize; he knows there are millions who don’t have enough food, and others who struggle with eating disorders. “But I think, for the vast majority of us who struggle with overweight throughout our lives, we could eat half as much, and be just as satiated.”

Ultimately, he says, “The power rests with us.”

“Does the food industry need to change? Absolutely. Does government have a role? Without doubt,” he says. But in the end, he says, we need to take steps to protect ourselves from constantly having our brains bombarded and activated by cues everywhere telling us to eat.

Published by: Ottawa Citizen
Written by: Sharon Kirkey
Photo by: Debra Brash
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