Obesity: Hedonist Choice or Caloric Ignorance?

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Are you surprised to learn that each cup of eggnog you sipped merrily over the holiday season set you back 306 calories per cup? And that slice of pecan pie, another holiday favorite, cost you anywhere between 500 and 800 big ones at the calorie counter. If you ate a large tub of popcorn (with butter) and an accompanying 32-ounce Coke at the movie theatre over the holidays, then you satisfied a 2,000-calorie per day intake requirement in a single sitting.

Were you unaware of how many calories you were packing away or did you know and continue eating anyway?

The Food Dichotomy

One of the many questions before health professionals, policymakers, and Americans troubled by the obesity epidemic ravaging the country, bringing with it a host of interesting policy predicaments, is what's responsible for the growing waistlines of Americans: Is it pervasive caloric ignorance, or are we knowingly sacrificing our long-term health for the transient pleasures excessive consumption and indolence beget?

The calorie counts above aren't meant as a guilt trip.

Holiday overindulgence and consequent repentance in the form of New Year's resolutions is an annual balancing act arising from the dichotomy that food presents us with: the aesthetic, pleasurable, even spiritual experience of eating vs. its nutritional and life-sustaining aspect.

Activists and policymakers who try to solve the obesity crisis tend to dismiss the importance of the first aspect, focusing exclusively on the second. Any proposal that stands any chance of success must strike a balance between both aspects. Put simply, people will not tolerate counting calories during Sunday Mass.

Weight Gain: The Bottom Line

There have been many misguided attempts by policymakers, self-appointed advocates, and presidential candidates, among others, intent on casting the debate in terms of good and bad foods, rather than good and bad diets. This leads to unscientific solutions such as anti-fast food litigation, so-called fat taxes, and attempts to blame advertising. Sen. Joseph Lieberman (D-CT) has even called for Federal Trade Commission investigations into the alleged link between junk-food advertising to children and increases in childhood obesity never mind that Sweden has never allowed junk-food advertising to children and its progeny are just as chubby as those of neighboring countries.

Just as the principle tenet of toxicology the dose makes the poison is often forgotten in debates over toxins and carcinogens, so too does the dichotomy of food into "good" and "bad" tend to distract people from the simple fact that how much they eat is the crucial question. Both French fries and avocadoes will add inches to your waistline if consumed in excessive quantities it's just that French fries are much easier to make people feel guilty about and thus easier to target (and much more lucrative for trial lawyers who stand to feast on American food companies, raising companies' costs of business and thus their prices and in effect taxing consumers through litigation).

The lawsuits are really an attack on a simple truth: weight gain is due to a calorie imbalance, an excess of calories consumed relative to calories expended in other words, higher calorie input than output.

Indeed, data indicate that Americans are consuming more calories than ever before. During the past two decades average daily calorie intake went from 2,080 to 2,347 for adult men and from 1,515 to 1,658 for adult women. National food survey data indicate that Americans are consuming more of their calories from increased snacking.

Despite the $33 billion spent annually by American consumers on weight-loss products and services, it's likely that many of us still have little or no idea how many calories we're consuming or even how many we're supposed to be consuming as determined by gender, age, size, and physical activity level. Given the ambiguity of serving size information on food labels, more consumer-friendly information seems overdue. Also needed are efforts to reach Americans with information about the origin of the 2,000-calorie-per-day intake requirement, the recommended level for moderately active postmenopausal women included on food labels as an average figure, not an individual prescription (as noted in the fine print on some labels).

Favorable Food Economics

Studies show that portion size affects how much people eat. Brian Wansink, a professor at the University of Illinois, known as the "food psychologist," gave moviegoers large or extra-large popcorn containers on their way into the theatre and found that those given an extra-large tub of popcorn ate 44% more than those handed the smaller containers even if the popcorn was noticeably stale. Similarly, Barbara Rolls, a nutrition researcher at Pennsylvania State University, reported that subjects served larger portions ate 27% more, on average, than those given smaller portions, without feeling any fuller.

Given these findings, proposals requiring food purveyors to decrease portion size might seem to make sense at first glance. However, there's little reason to think that preventing consumers from doing what they do best pursuing more for less is even possible.

Serving larger-sized portions, at miniscule incremental costs to the food industry, makes customers feel they've gotten a better deal. Who wants to buy the smaller size when the larger is just a few pennies more? Reversing the "super-size" trend is no easy feat. However, the laws of food economics needn't be repealed; consumers armed with information and cognizant of portion-sizes can exploit the cheapness of food without adding inches to their waistlines.

Savvy consumers wouldn't be that interested in doubling the amount of food they buy without getting any perceivable net benefit not even noticeable levels of increased satiety. Interestingly, Wansink also found that men and women feel better after eating small amounts of comfort food, suggesting that such foods needn't be excluded from the diet, but rather that we should recognize the psychological benefits they can confer without overindulgence. Increased awareness, paired with an appetite for the best deals, would seem to dictate that the savviest consumers may come to take pleasure in small portions, finding ways to get more for less while saving the leftovers once they're aware of the health costs of overweight and obesity.

Unsustainable Hedonism: Consequences of Overweight and Obesity

Hedonism is part of human nature, but the public is becoming more aware that it is not without consequence. The health stakes are extremely high for excessive consumption and physical inactivity. Some public health experts have attributed around 300,000 premature deaths each year in America to the consequences of excess weight (though this figure is not without dispute).

Overweight and obesity are known risk factors for diabetes, heart disease, stroke, hypertension, gallbladder disease, osteoarthritis, sleep apnea (stopped breathing during sleep, usually for periods of ten seconds or longer), and some forms of cancer, including uterine, breast, colorectal, kidney, and gallbladder. Obesity is also associated with high blood cholesterol, complications of pregnancy, menstrual irregularities, presence of excess body and facial hair, stress incontinence (urine leakage caused by weak pelvic-floor muscles), psychological disorders such as depression, and increased surgical risk.

Despite these adverse health outcomes, there's reason to be optimistic. Research indicates that weight loss often improves health outcomes and can even resolve many of these conditions. Even a relatively small weight loss - five to ten percent of body weight - can decrease some risk of disease if maintained. While losing weight is difficult and many people fail in their initial attempts, research indicates that continued attempts can be successful.

Science has solved the ancient problem of food scarcity, and we now enjoy record levels of abundance. Science will likely also solve the overweight and obesity problem, but until it does we must re-acquaint ourselves with the timeless, self-imposed principle of moderation, and in turn enjoy both the short-term pleasures that food brings and the long-term benefits of good health.

Informed Decisions

In the end, it's up to individuals to decide which treadmill to climb onto the metaphorical hedonic treadmill or the real one at the gym. It's up to public health officials and policymakers to provide the information needed for informed health decisions information that's accessible without being strident to consumers who want to know what their individual caloric intake levels ought to be, and the health consequences of caloric imbalances.

Much of this information is already offered by the private sector. Consumers can log on to the McDonald's website and determine the calorie contents of all their favorite items and get advice on how to eat healthfully. Subway has even taken to putting such information literally in the hands of consumers, via printed napkins. A campaign advertising how to access such information, in addition to educational outreach efforts for those who don't log-on, may prove more effective than the Department of Health and Human Services' current ad campaign about eating habits, which serves as more of a public relations stunt for HHS Secretary Tommy Thompson.

It's time "to stand up for an important principle informed choices by people who can make informed decisions" in the words of Sen. Lieberman. It's just too bad that more often than not the proposed solutions to the epidemic decrease the public's access to good information by encouraging unscientific thinking and eroding personal responsibility, which is more effective than any law or lawsuit.

The American public largely understood the logic of dismissing the case brought against McDonald's by two teenagers alleging that McDonald's was responsible for their obesity. The public understood that the responsibility lies with the consumer, and public officials should take that message to heart, focusing on informing the public rather than offering it scapegoats. Even part-time hedonists are capable of making smart decisions when they are well informed.