Book Summary: The End of Overeating

A couple times every year, there are big book sales in our town. Great heaps of gently used books are sold for a dollar or two each and the proceeds benefit good causes like childhood literacy organizations and special programming at the public library. I shop these book sales with the wild-eyed enthusiasm of a kid in a candy store, trying not to throw myself at the long tables filled with books. It is a win-win-win situation because you get to clear books out of your house and into new hands, find fresh books at rock bottom prices, and raise money for community good. Every time I hit one of these book sales, I buy a few books that look interesting and squirrel them away. But then I usually end up reading library books and these books are always saved for later.

By this time in lockdown, I have burned through my library books, "later" is here, and I have started to read through my rainy day book collection. My attention span isn't very good these days. I started on two novels of the family drama genre- Dinner at the Homesick Restaurant by Anne Tyler and The Burgess Boys by Elizabeth Strout and neither of me was able to hold my attention. They went into the donation pile and will end up at one of these book sales in the future. The circle of life; used book edition.

This week I grabbed a nonfiction book from the "later" bookshelf and ended up devouring it (no pun intended)- The end of overating: Taking control of the insatiable American appetite by David Kessler, MD. This book was published in 2009- 11 years ago at this point- but everything it says remains relevant. I read lots of books about food and nutrition every year and there wasn't anything in this book that was particularly new but it was a good read all the same. The food industry parts of the book were fascinating in a horrifying, train-wrecky way and the food rehab parts of the books were a good reminder of the urgent need for change in food culture in the US, and increasingly all over the world.

The book is written in easily digestible, bite-sized chapters. While it mentions the research early and often, it is not science-heavy. For more of the neuroscience behind many of the concepts mentioned in this book, I highly recommend Hungry Brain by Stephan Guyenet.

The central question asked in this book is: What drives us to overeat? I would guess that this is a relatable question to most of us. For instance, those bowls of snacks like roasted nuts, chaklis and kettle cooked chips that we might set out for visitors. My dad calls this "veda khaana" in Marathi, which translates into "mad food" or rather, mindless food, which most people will eat almost automatically regardless of whether they are actually hungry or not. And often will keep eating until the bowl is empty.

Many people who are smart, self-aware, disciplined and successful in other parts of their lives are nevertheless frustrated by their loss of control around food. The author blames it on conditioned hypereating- we eat too much (more than what our bodies need) because we have too much tasty food around. Humans are biologically wired to respond to stimuli like nicotine, alcohol, illegal drugs, gambling. "..for most of us, food is the most readily available and socially acceptable stimulus."

Part 1 of the book is titled Sugar, Fat, Salt.

Human body weight stayed remarkably stable for most of human history, but in the last 40 years or so, something has changed and humans are getting heavier. Weight gain is primarily due to overeating; factors like genetics, metabolism and diet composition play a minor role.

More food is available, portion sizes are bigger- true- but just having food available does not mean we have to eat it. What is driving the out-of-control eating?

Our body systems- temperature, blood pressure, etc.- are kept stable through elaborate homeostatic processes. There is also such a homeostatic system for energy balance, that is, weight regulation. But it is not the only system in charge of food intake. A different system called the reward system is also involved. The reward system is a powerful biological force, encouraging us to seek out pleasurable things like food because in the past our survival depended on it."..in America, in the fight between energy balance and reward, the reward system is winning." 

Salt, sugar and fat make us eat more salt, sugar and fat because they are all highly palatable and we keep eating these foods because of the stimulation rather than genuine hunger. The biological system that is designed to maintain energy balance can go awry when animals (including humans) have easy access to a variety of foods that are highly palatable foods.

The restaurant industry creates highly stimulating foods. Sugar, salt and fat are either loaded onto a core ingredient, layered on top of it, or both. In typical restaurant spinach dip, the spinach only adds a bit of color and health appeal. A high-salt, high-fat dairy product is the main ingredient. Salads use a bit of lettuce as a carrier for ranch dressings and are loaded with cheese chunks, bacon bits and fried croutons. All foods are made more compelling and more hedonic.

There is substantial scientific evidence that rewarding high-fat, high-sugar foods tend to be reinforcing, meaning that they keep us going back for more. Our desire for more is also influenced by portion size (if more food is served, more will be eaten), the concentration of fat and sugar (up to a point) and variety- in the number of foods offered but also in contrasting textures and flavors.

Rewarding foods are becoming increasingly more complex and stimulating. Ice cream used to come in three flavors, then more and more flavors became available, followed by premium, higher-fat ice cream and then mix-ins of candy into ice cream. Similarly, other foods like bagels that once came in a single flavor are increasingly tricked-out with flavor combinations that are loaded with sugar on fat on salt.

Over time, sights and smells, times and locations become cues that lead us to eat rewarding foods. Particular foods become linked to nostalgia and emotion. The opioids produced by eating rewarding foods can relieve pain and stress and calm us down, making us feel better in the short run. We cannot control our responses to highly palatable foods because our brains are rewired by eating these foods.

My thoughts on this part of the book: The term "layered and loaded" is going to stick in my brain. As a home cook, I try to cook food that is tasty. But it is oh so easy to overdo it with the sugar, salt and fat in the name of making a dish irresistible. The problem is then you succeed and the food is impossible to resist and you end up eating more than you want to.

The layered and loaded phrase also reminded me of chaat- those tempting Indian snack foods and some of my personal favorite things to eat. They are a good example of how deep fried dough (puris) and contrasting tastes (spicy chutney, sweet chutney) and textures (creamy yogurt, crunchy sev) are all layered and loaded and made completely irresistible. A lot of our favorite foods in every cuisine are fried, salt, spicy and/or sugary even when they start from wholesome ingredients or are made at home.

The next part of the book talks about The Food Industry.

The food industry has discovered what sells. Chain restaurant entrees are composed of chopped and ultrapalatable components that look appealing, need minimal chewing (refined food simply melts in the mouth) and are very high-pleasure, with very high calorie density. Very little in the appearance or flavor of chain restaurant food would point to just how much salt, sugar and fat it is loaded with, or how easily it goes down.

The development of Cinnabon cinnamon rolls is a great case study of how the industry creates products that are indulgent and irresistible with a combination of visual appeal, aroma, texture and consistency.

Purchasing indulgent food is an inexpensive form of entertainment, so the food industry increasingly behaves like the entertainment industry. Indulging in a premium snack is seen as a small moment of relaxation in a stressful life, a bit of 'me-time'.

Fats and sugars used to be scarce and therefore we developed the biological tools to seek out and appreciate them. Today oils and sugars are among the cheapest commodities because of rapid changes in agriculture and commerce. The food industry has enthusiastically embraced this business opportunity to use oils and sugars for a profit.

Where traditional cuisine is meant to satisfy, American industrial food is meant to stimulate. It is mostly composed of easy calories that need little chewing.

We are taking products of other cuisines- eg. Chinese, Vietnamese- and making the dishes distinctly American, usually by adding more sugar and more fat. And also taking American processed foods and sharing them with the rest of the world.

Sophisticated food technology- artificial flavorings- are often used in addition to salt, sugar and fat to make food hyperpalatable. Traditional Italian gelato is made with whole milk, eggs and sugar but most commercial gelato in the US begins with a processed base made with ingredients like milk solids, glucose solids and a gum and emulsifier combination, along with a host of artificial flavors. Flavor chemists can develop any type of flavor to transform a food. "A topping that covers tortilla chips can look like cheese but contains mostly oil and flavoring."

There is constant eating opportunity. "Call it the taco chip challenge- the challenge of controlled eating in the face of constant food availability". Every single day and everywhere you go, foods are available, plentiful and cheap.

My thoughts on this part of the book: It is interesting to get a sneak peek into the food industry but it left me feeling sad, angry and disgusted. Because for large swaths of the US population, processed food is the only food that's available and affordable. You might think you are eating a simple burrito in a chain restaurant, but it is a food-like substance designed to cater to your tastebuds rather than actual food served to fuel your body. It is devastating to think of the millions of people who are heavily overfed and facing chronic health consequences while simultaneously being completely undernourished.

It is SO SO tricky and hard to find wholesome foods in a standard supermarket setting. I'll give you an example of common items that most American families buy regularly- cereal, granola bars, peanut butter, canned fruit, applesauce, pasta sauce. For each of these items, what you will typically find in supermarkets is loaded with sugar and fat. Granola bars are just refined cereal and sweeteners, applesauce is spiked with sweeteners, canned fruit is packed in heavy syrup, peanut butter has added sugar and oils. The list goes on. If you want wholesome versions of these items, it takes careful label reading, and shelling out money for premium brands. Or having the time and expertise to make items from scratch at home without added sugar, salt and oils.

The rest of the book has chapters titled Conditioned Hypereating Emerges, The Theory of Treatment, Food Rehab and The End of Overeating. These chapters reiterate the issue of why we overeat and what we can do about it as individuals and as a society. Some of the stuff in these chapters could have been better organized. I'm pulling out some take-home points below.

Food-related reward learning becomes highly automated and below the level of conscious awareness. The weight loss drug phen-fen worked effectively because it lessened the drive for reward and stopped people from being obsessed with food. It has serious side-effects and is not in use any more but taught us a lot about the biology of overeating.

Why can't we just say no to food that we don't want to eat? The short answer is that high-reward foods engage fundamental neural mechanisms that can interfere with how we rationally want to act.

Conditioned overeating is a biological challenge in our current food environment. Overeating is not a character flaw or a lack of willpower.

The food industry has cracked the code of conditioned hypereating and knows how to manipulate people's eating behavior and get us to pursue the foods it wants to sell. The challenge is knowing how to respond. It is possible to learn to eat the food you want in a planned and controlled way as individuals.

Some specific tips gleaned from this book-

1. Avoid risky situations (but that may be difficult in a world of omnipresent food cues.) 
2. Be aware of how food reward works. 
3. Look at food and see it for what it is- real food or something loaded with sugar, salt and fat? 
4. Change behaviors: eg. taking different route that doesn't go past your favorite bakery, taking a list to the grocery store and sticking to it. 
5. Formulate new thoughts to replace old ones: "I'll just take one bite" to "I can't eat just one bite; it always leads to twenty."
6. Think differently about food, as nourishment rather than reward. 
7. See hyperpalatable foods as enemies, not friends. Stop thinking, "I deserve this"or "I'll only eat a little". 
8. Planned eating: Instead of eating whatever, whenever in a chaotic way, have a predictable structure for eating- what foods you will eat, how much will you eat, and when you will eat. 
9. Just-right eating: Learning to eat the right amount of foods to satisfy until the next meal. 
10. Choose satisfying, fiber-rich whole foods.
11. For emotional eaters, choose a different response to negative emotions and stress. 
12. Know your trigger foods and avoid them.
13. Purchase high-reward foods in reasonable quantities and eat them in the right settings.
14. Food can be an occasional reward but when all eating becomes rewarding it is a problem. 
15. Find alternative rewards. 
16. Find food that provides emotional reward without driving overeating.
17. Understand yourself and become your own food coach. 

As a society, we need to rethink our ideas about the right time and place to eat in the home, in a social and in business settings. Redefine norms. Smoking is a great example of how the norms have changed completely. Smoking used to be considered cool and glamorous and widely accepted. Today, smoking is known to be deadly and it is rarely accepted in public spaces.

Some suggestions for policy changes that would help:

1. List calorie counts of food in restaurants.
2. Better labeling to see added sugars, fats and refined carbs.
3. Educate people about "big food" and the way they push food layered and loaded with salt, sugar and fat.
4. Regulate marketing of food.

The food industry says it is only giving people what they want and that individuals have responsibility for what they put in their mouths. They are designing highly stimulating products that hijack our brain circuitry.  What is industry's responsibility?

My thoughts on this last part of the book: All of these are good and valid questions. This was not mentioned in the book, but I think the government subsidies on corn sweeteners and refined oil are a big part of the problem.

A big reason why this book resonated with me at this time is because I have been consciously changing my eating habits in small ways for the past two years. I have learned first hand that changing habits is hard but very rewarding. Unlike short-term diets, changing my attitude and habits around food is slowly making me more confident about being able to stick to a sustainable and quietly enjoyable way of eating for the rest of my life.

I wish you all a safe and healthy June. How was the month of May for you?