We Are Surrounded

By Michael Crupain, MD, MPH

Last week I had to 2^nd overnight ship an important package to Boston.  As the clerk at the FedEx counter finished ringing me up for the shipment, he asked “would you like to buy some candy?” 

“What?” I replied, somewhat taken aback by his question.

“We have a good selection of candy, would you like to buy some?” He repeated.

“No-no thank you.” I said in a rather dismayed tone and then I grabbed by receipt and left the store.  Shaking my head on the way out, I kept thinking that it was crazy that at the FedEx store they had tried to up sell me with candy, instead of perhaps a more express delivery!  But then, I probably should not have been so surprised.  After all, there are few places you can go these days that are not trying to sell you some type of tempting treats, be it candy or pastries, including bookstores, hardware stores, gas stations, office supply stores, furniture stores, clothing stores, and even gyms.

The fact that everywhere we go we are surrounded by high fat, high sugar, inexpensive, and heavily marketed foods that promote obesity and chronic disease is the reason professor Kelly Brownell, director of the Yale Rudd Center for Food Policy and Obesity, calls the world we live in the “Toxic Food Environment.” 

If you are reading this blog, you are likely already well aware that 2/3^rd of American adults are overweight or obese.  Just 30 years ago these rates were half of what they are today!¹  While it is common and popular to blame this increase in weight gain on a lack of will power, Dr. Scott Kahan, professor at the Johns Hopkins School of Public Health and Co-Director of the George Washington Weight Management Program, points out that it is unlikely that over this past 30 years that the innate capacity of American’s to resist unhealthy food has changed.  For that matter, either has our genetics or biology.  No, what has changed--is our environment. 

Today, modern conveniences allow us to lead more sedentary lives both at home and at work, if you add to this, a surroundings filled with an abundance of cheap unhealthy food, there is a sure recipe for obesity.  This is illustrated by studies that suggest that over the last 50 years, energy expenditure has decreased by 100 calories a day, as a result of people having less active jobs² and over the last 40 years, calorie availability from food (especially from fats, sugars, and grains) has increased by 500 calories per day³.   

Though our fundamental biology has not changed, our biology is indeed an extremely important part of the obesity epidemic.  In his book, The End of Over Eating, Dr. David Kessler describes a time in ancient history when food was scarce.  In these days humans evolved to gain weight and resist losing it.  Since our physically active ancient ancestors did not know when they were going to get another meal, this was an advantageous biological trait!  Dr. Kessler also writes about how are brains are designed to crave sugar, fat, and salt, since sugar and fat are two efficient sources of calories.  In his book he suggests that food companies use this information to create hyper palatable foods in order to increase profits and as a result the populations waistlines.

In an article in the August 2011 edition of the Journal of the American Dietetic Association, Dr. Appelhans, a professor of Preventive Medicine and Behavioral Science at Rush University, and colleagues take these ideas one step further and explain the neurological basis for three behaviors that promote obesity; Food reward, Inhibitory Control, and Time Discounting.  In the article the authors describe how the brain’s wiring creates rewarding pleasurable feeling in response to eating unhealthy foods and how the area of the brain responsible for self-control is easily interrupted by life’s stresses.  In addition they discuss how the brain circuitry promotes acting in the moment (eating tasty unhealthy food) rather than thinking about the consequences of the actions down the road (poor health).⁴ 

With the above in mind it should hopefully be clear, that the obesity epidemic that has swept the United States and the world is not simply the result of poor choices by individuals, but of an obesogenic food environment that makes those choices incredibly difficult to resist. 

In order to help people lose and keep off weight, not only due we need to help them diet, but we also need to provide and environment that supports the maintenance of a healthy weight.  This means at a minimum:

• Increasing availability and affordability of healthy and sustainable food in our schools and communities.
• Changing government farm and environmental policies so that food companies have to pay for the externalities of the unhealthy products they create and sell.
• Increasing education about food production and cooking in schools.
• Preventing companies from promoting unhealthy foods to vulnerable children.
• Fostering a business environment where companies promote the health of their employees and customers.  This would most certainly mean not selling candy at the FedEx store!

What changes to the food environment would you like to see to help promote a healthier society?

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1.     http://www.cdc.gov/pdf/facts_about_obesity_in_the_united_states.pdf

2.     http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0019657

3.     http://www.ers.usda.gov/Data/FoodConsumption/FoodAvailSpreadsheets.htm

4.     http://www.adajournal.org/article/S0002-8223%2811%2900586-4/fulltext

Comments

[Devona Sherwood]

Really enjoyed the 2 articles you posted and am interested in seeing more.

[Michael]

Thanks Davona. I'm glad you liked the posts. We will have more coming, hopefully there will be at least 2 posts per week and their will be a couple of different preventive medicine physicians writing.