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It’s the Food, Stupid. People don’t seem to understand how eating works. (from National Review Online)
By Elizabeth M. Whelan, Sc.D., M.P.H.
This piece appeared May 31, 2006 on National Review Online:
Last week an FDA-sponsored and -funded report on “Away from Home Foods” recommended ways restaurants might lend a hand in our nation’s fight against obesity. The report was based on input from a number of scientists, consumer advocates, and food-industry representatives, including members of the National Restaurant Association (which in the end did not support the report’s conclusions because they “unfairly targeted its industry”).
Among other things, the committee urged the FDA to prevail upon restaurants to reduce portion sizes; to increase the number of low-calorie dishes on menus, particularly when it comes to fruits, vegetables, and unfried foods; to use foods that are low in saturated fats and trans-fatty acids; and to provide nutritional and caloric information on all menu selections.
While well-intended, the FDA recommendations fall short for three reasons: They are largely impractical and inconsistent with basic practices of running a business; they confuse concerns about calories with concerns about “good” and “bad” fats; and they omit some more obvious changes and additions restaurants could make that would reduce caloric consumption due to “away from home” meals.
While having the government instruct restaurants that they should reduce portion sizes sounds good, it is unlikely to have any impact on the risk of obesity.
This is not to suggest that the gargantuan portions served at restaurants are not astonishing, and even sometimes horrifying; and it is extremely annoying to be chided by waiters about “not liking the meal” because it’s been left mostly uneaten. But all of that is besides the point. Many years ago, my late colleague, Harvard’s Dr. Fredrick J. Stare, expressed his concern about portion size in restaurants by writing to 100 establishments requesting that they put less food on the plates. He learned something surprising about the restaurant business; the overwhelming response from restaurateurs was: “The food is the least expensive component of a meal. We understand that only a small percentage of our patrons will eat what we serve them, but it is more cost efficient for us to serve more food than most will eat (and throw the balance away) than to make the minority of eaters who want large portions unhappy and likely to complain.”
When asked if restaurants might offer smaller portions for a lower price, the response was the same: “Our costs are the same whether the portion size is large or small, so we cannot offer reduced prices for smaller-sized meals.” The same issue would apply to meal-splitting. Many restaurants now add a surcharge onto shared meals.
Perhaps, in time, some clever marketers will find a way to base an ad campaign on the growing demand for somewhat less expensive, smaller meals. In the meantime, the solution is not to have the government telling restaurants how to run their businesses, but to educate consumers to eat only to the point that hunger is satiated — and not to feel obligated always to be a member of “the clean plate club.”
As to nutrition-labeling at restaurants, I am ambivalent: ideally, customers should be able to request such information from the restaurant — but this simply may not be practical given the constantly changing menus and ingredients (although, it is possible at restaurants like McDonald’s that offer standard fare). Further, many of us would prefer not to characterize a dinner out as a purely biological experience to be assessed in terms of grams of fat. A little common sense should do the trick: obviously fettucini alfredo is calorically loaded — and if you do order it, it might be prudent to eat only half.
In recommending that restaurants combat obesity by promoting “foods low in saturated fats and trans-fatty acids,” the FDA panel misses the point. If you are trying to cut calories, the type of fat is not your concern. No matter what the type of fat, it is calorically dense, at nine calories per gram. Indeed, this whole current kerfuffle in ads and on food labels about trans fats has become downright misleading, since consumers may think “no trans fats” means “low in calories.” It does not. Wendy’s restaurants, for example, have just switched to nonhydrogenated oil, reducing trans fats, but this is unlikely to make a significant difference in the total number of calories their customers consume or, thus, in their likelihood of not becoming obese and suffering health problems. Trans fats are just one part of a larger diet, and it’s the big picture that matters.
The FDA report also fails to suggest that restaurants add more menu options which would allow customers to enjoy the foods they love while taking in fewer calories. Offering reduced-calorie spreads (like oleo/yogurt blends) and salad dressings, or lower-calorie, full-taste “lite” ice creams, would be a good place to start. Creative chefs could be encouraged to experiment with Z-Trim or Simplesse, which are currently available fat substitutes that can be used to create such items as reduced-calorie butter, mayonnaise, cream cheese, and mashed potatoes, all nearly indistinguishable from their full-fat counterparts. If the unfairly maligned fat-substitute olestra is ever welcomed back from exile, the options for creating tasty, low-fat foods — including, for instance, French fries — will increase even more dramatically.
Restaurants, like any business, operate on the principle “give the customers what they want.” Restaurants cannot coerce patrons to choose salads over burgers and fries, and it is hopeless to ask them to do so. It is the customer who calls the shots. Until we can educate consumers about the ideal caloric intake — and the calorie content of specific foods and portion sizes — and motivate them to keep caloric intake within the desirable range, they are going to continue to order what they want. And restaurants will continue to accommodate them.
Elizabeth Whelan, Sc.D., MPH, is founder and president of the American Council on Science and Health, and writes on the ACSH’s blog, HealthFactAndFears.com.
Lance Kaczorowski (June 15, 2006)
Dr. Whelan:
This is concerning your very good article, "It's The Food, Stupid." I agree with your points, but I feel that there is a significant portion of the obesity discussion missing.
Is there some department within ACSH that addresses psychology therapies, or is the emphasis strictly on biological therapies? I ask because the act of chronically overeating is as much a psychological phenomenon as biological. I don't mean to suggest that psychologists have "the solution." Counseling frequently fails because the patients are "uncooperative" or "resistant." However, perhaps that points to the need for better psychological approaches rather than proving that psychology is irrelevant to the discussion.
You state that “the solution is ... to educate consumers to eat only to the point that hunger is satiated.” I agree entirely that education is a necessary starting point, but alone it is often insufficient. With the exception of those who erroneously place the entire blame on their genetics, I don’t know of any overweight Americans who do not realize that eating too much is at least part of their problem. So why do we continue to overeat?
I have earned a degree in engineering and am currently earning an MBA, so I am neither unintelligent, uneducated, nor unmotivated, yet my BMI is 38. I thoroughly researched physical fitness (both nutrition and exercise) two years ago, but I have not successfully integrated that knowledge in my own life. I am seeing a psychiatric counselor now because I had entirely lost my ability to sense when my “hunger is satiated.” I am being taught to regain that ability. Beyond that, my overeating bears all the earmarks of an addiction, so I am also learning (with professional help) the emotional triggers to my overeating, strategies to overcome negative habits, and new habits that will enable me to put my already existing knowledge of physical fitness into effect. In all fairness, I have to admit that I have seen that counselor twice a month for about eight months, and I have not lost any weight yet. We are making recognizable progress towards my losing the weight, but counseling is not a one-stop solution. It is taking some time, yet I believe that it is a necessary part of my bringing about the desired changes.
It takes a knowledge of human physiology to define the habits necessary to achieve physical fitness, but for many of us it will also take a knowledge of psychology to enable us to initiate and maintain those new habits. We cannot end the obesity epidemic using biological therapies alone. A little bit of the right physiological knowledge can help someone lose 10 or 20 pounds *and* keep it off, but not 50 or 100 pounds or more. Two years ago I put my physical fitness research to use and lost 50 pounds in four months. I then put it back on over the following eight months. It was my first experience with yo-yo dieting. I was driven by fear to lose the weight. The reason for that fear is too complex to relate here, but it is irrelevant. The point is that once the source of my fear subsided, so too did my success in increasing my physical fitness. In a way I was a victim of my own success, but I was smart enough to recognize the yo-yo pattern, end it, and realize that my approach was lacking something.
We aren’t fat because we’re stupid. We’re fat because we use food as an instant self-medicating solution to everything from boredom to sadness to anger. For many of us, changing that bad habit will require both a deeply-rooted personal commitment (momentary despair or fear doesn't count, as I found out) *and* professional assistance.
If my assertion is correct, however, a much more challenging conundrum is figuring out how to bring effective psychiatric assistance to all of those Americans who both need that assistance and are prepared to do whatever it takes to exchange bad habits for good ones.
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