The Obesity Epidemic – Part 3

I’m Dr. Michael Greger and this is Nutrition Facts.

There’s one thing we’ve been thinking about a lot lately, and that’s how to stay healthy in the middle of a global pandemic. Especially since we’ve learned that those with underlying health problems like obesity, hypertension, diabetes, and heart disease are more likely to have serious complications if they contract COVID-19. So what do we do? We try to stay healthy with evidence-based nutrition.

We all like to think we make important life decisions like what to eat consciously and rationally, but if that were the case we wouldn’t be in the midst of an obesity epidemic. Here’s part 3 of our Obesity Epidemic Series starting with the role of food advertisements.

The opening words of the Institute of Medicine’s report on the potential threat posed by food ads were: “Marketing works.” Yeah, there are a large number of well-conducted randomized studies I could go through showing advertising exposure and other marketing methods can change your eating behavior and get you to eat more, but what do you need to know beyond the fact the industry spends tens of billions of dollars a year on it? To get people to drink their brown sugar water, do you think Coca-Cola would spend a penny more than they thought they had to? It’s like when my medical colleagues accept “drug lunches” from pharmaceutical representatives, and take offense that I would suggest it might affect their prescribing practices. Do they really think drug companies are in the business of giving away free money for nothing? They wouldn’t do it if it didn’t work.

To give you a sense of marketing’s insidious nature, though, let me share an interesting piece of research published in the world’s leading scientific journal: “In-store music affects product choice” documented an experiment in which either French accordion or German Bierkeller music was played on alternate days in the wine section of a grocery store. On the days the French music was playing in the background, people were three times more likely to buy French wine, and on German music days, shoppers were about three times more likely to buy German wine. Despite the dramatic effect; not just a few percent difference, but a complete three-fold reversal when approached afterwards, the vast majority of shoppers denied the music had any influence on their choice.

We all like to think we make important life decisions, like what to eat, consciously and rationally. However, if that were the case, we wouldn’t be in the midst of an obesity epidemic. Most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we’re tired, stressed, or preoccupied. The unconscious part of our brain is thought to guide human behaviors as much as 95 percent of the time. This is the arena where marketing manipulations do their dirty work.

The part of our brain that governs conscious awareness may only be able to process about 50 bits of information per second, which is roughly equivalent to a short tweet. Our entire cognitive capacity, on the other hand, is estimated to process in excess of 10 million bits per second. Because we’re only able to purposefully process a limited amount of information at a time, if we’re distracted or otherwise unable to concentrate, our decisions can become even more impulsive. An elegant illustration of this “cognitive overload” effect was provided from an experiment involving fruit salad and chocolate cake.

Before calls could be made at a touch of a button or the sound of our voice, the seven-digit span of phone numbers was based in part on the longest sequence most people can recall on the fly. We only seem able to hold about seven chunks of information (plus or minus two) in our immediate short-term memory. Okay, so here’s the setup: randomize people to memorize either a seven-digit number or a two-digit number, to be recalled in another room down the hall. On the way, offer them the choice of a fruit salad or a piece of chocolate cake. Memorizing a two-digit number is easy, and presumably takes few cognitive resources. Under the two-digit condition, most chose the fruit salad. Faced with the same decision, most of those trying to keep the seven digits in their heads just went for the cake.

This can play out in the real world by potentiating the effect of advertising. Have people watch a TV show with commercials for unhealthy snacks, and, no surprise, they eat more unhealthy snacks (compared to those exposed to non-food ads). Or, maybe that is a surprise. We all like to think that we’re in control and not so easily manipulatable. The kicker, though, is that we may be even more susceptible the less we pay attention. Randomize people to the same two or seven-digit memorization task during the show, and the snack attack effect was magnified among those who were more preoccupied. How many of us have the TV on in the background, or multi-task during commercial breaks? This research suggests that it may make us even more impressionable to the subversion of our better judgement.

There’s an irony in all this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious control? A senior policy researcher at the RAND Corporation even went as far as to suggest that given the dire health consequences of our unhealthy eating habits, insidious marketing manipulations “should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”

In our next story, how the power of the “eat more” food environment can overwhelm our conscious controls.

Food and beverage companies frame body weight as a matter of personal choice. Even when we’re not distracted, the power of the “eat more” food environment may sometimes overcome our conscious controls over eating. One look around the room at a dietician convention can tell you that even nutrition professionals are vulnerable to the aggressively marketed ubiquity of tasty, cheap, convenient calories. This suggests there are aspects of our eating behaviors that defy personal insight by flying below the radar of conscious awareness. Appetite physiologists call the result of these subconscious actions “passive overconsumption.”

Remember that brain scan study where the thought of a milkshake lit up the same reward pathways in the brain as substance abuse? That was triggered just by a picture of a milkshake. Dopamine gets released, cravings get activated, and we’re motivated to eat. Intellectually, we know it’s just an image, but our lizard brain just sees survival. It’s just a reflexive response over which we have little control––which is why marketers ensure there are pictures of milkshakes and their equivalents everywhere.

Maintaining a balance between calories in and calories out feels like a series of voluntary acts under conscious control, but it may be more akin to bodily functions such as blinking, breathing, coughing, swallowing, or sleeping. You can try to will yourself power over any of those, but by and large, they just happen automatically, driven by ancient scripts.

Not only are food ads ubiquitous; so is the food. The types of establishments selling food products expanded dramatically in the 1970s and 1980s. Now there’s candy and snacks at the checkout counters of gas stations, drug stores, bookstores, and places that used to just sell clothes, hardware, home furnishings, or building supplies. The largest food retailer in the United States is Walmart. There’s that jolt of dopamine, and the artificially-stimulated feelings of hunger around every turn. Every day we run the gauntlet.

And it’s become socially acceptable to eat anywhere—in your car, on the street, or packed in a crowded bus. We’ve become a snacking society. Vending machines are everywhere. Daily eating episodes seem to have gone up by about a quarter from the late 1970s, increasing from about four to five occasions a day, potentially accounting for twice the calorie increase attributed to increasing portion sizes. Snacks and beverages alone could account for the bulk of the calorie surplus implicated in the obesity epidemic.

And think of the children. Here we are trying to do the best for our kids, role-modeling healthy habits, feeding them healthy foods, but then they venture out into a veritable tornado of junky food and manipulative messages. This commentary in the New England Journal of Medicine asked:  why should our efforts to protect our children from life-threatening illness be undermined by massive marketing campaigns from the manufacturers of junk food. Pediatricians are now encouraged to have the “french fry discussion” with parents at the 12-month well-child visit and not wait all the way until year two. And even that may be too late. Two-thirds of infants are being fed junk food by their first birthday.

Dr. David Katz may have said it best in the Harvard Health Policy Review: “Those who contend that parental or personal responsibility should carry the day despite these environmental temptations might consider the implications of generalizing the principle. Perhaps children should be encouraged, but not required to attend school and tempted each morning by alternatives; such as buses to the circus, zoo, or beach.”

Finally today, like the tobacco industry adding extra nicotine, the food industry employs taste engineers to accomplish a similar goal: maximizing the irresistibility of their product.

The plague of tobacco deaths wasn’t just due to the mass manufacture and marketing of cheap cigarettes. Tobacco companies actively sought to make their products even more craveable by spraying the sheets of tobacco with nicotine, and additives like ammonia, to provide a bigger nicotine “kick.” The food industry employs taste engineers to accomplish a similar goal: maximize the irresistibility of their products.

Taste is the leading factor in food choice. Salt, sugar, and fat are used as the three points of the compass to produce “superstimulating” “hyper-palatability” to tempt people into impulsive buys and compulsive consumption. Foods are intentionally designed to hook into our evolutionary triggers and breach whatever biological barriers help keep consumption within reasonable limits.

Big Food is big business. The processed food industry alone brings in more than 2 trillion dollars a year. That affords them the economic might to manipulate more than just taste profiles, but public policy and scientific inquiry as well. The food, alcohol, and tobacco industries have all used similar unsavory tactics: blocking health regulations, co-opting professional organizations, creating front groups, and distorting the science. The common playbook shouldn’t be surprising, given the common corporate threads. At one time, for example, Philip Morris owned both Kraft and Miller Brewing.

In a single year, the food industry has spent more than $50 million to hire hundreds of lobbyists to influence legislation. Most of these were “revolvers,” former federal employees in the revolving door between industry and their regulators, who could push corporate interests from the inside, only to be rewarded with cushy lobbying jobs after their “public service.” In the following year, the industry acquired a new weapon. A stick to go along with all those carrots. On January 21, 2010, the Supreme Court’s five to four  Citizens United ruling permitted corporations to spend unlimited amounts of money on campaign ads to trash anyone who dared stand against them. No wonder our elected officials have so thoroughly shrunk from the fight, leaving us largely with a government of Big Food, by Big Food, and for Big Food.

Globally, a similar dynamic exists. Weak tea calls from the public health community for voluntary standards are met with not only vicious fights against meaningful change, but massive transnational trade and foreign investment deals that cement protections of food industry profits into the laws of the lands.

The corrupting commercial influence extends to medical associations. Reminiscent of the “Just what the doctor ordered” cigarette ads of yesteryear, the American Academy of Family Physicians accepted millions from the Coca Cola Company, in part explicitly to “develop consumer education content on beverages and sweeteners.”

On the front line, fake grassroots “astroturf” groups are used to mask the corporate message. In the footsteps of Get Government Off Our Back (memorably acronymed GGOOB,) a front group created by RJ Reynolds to fight tobacco regulation, Americans Against Food Taxes may just as well be called Food Industry Against Food Taxes. The power of front group formation is enough to bind bitter corporate rivals: the Sugar Association and the Corn Refiners Association linking arms with the National Confectioners Association to partner with Americans for Food and Beverage Choice.

Using another tried-and-true tobacco tactic, research front groups can be used to subvert the scientific process by shaping or suppressing science that deviates from the corporate agenda. Take the trans fat story. Food manufacturers have not only long denied that trans fats were associated with disease, but actively worked to limit inquiry and discredit research findings.

At what cost? The global death toll from foods high in trans fat, saturated fat, salt, and sugar are at 14 million lost lives. Every year, the inability of countries around the world to turn the tide on obesity “is not a failure of personal will-power,” said the Director-General of the World Health Organization. “It is a failure of political will to take on the powerful food and soda industries.” She ended her keynote address before the National Academy of Medicine, entitled “Obesity and diabetes: the slow-motion disaster,” with these words: “The interests of the public must be prioritized over those of corporations.”

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To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts Podcast landing page. There you’ll find all the detailed information you need – plus links to all of the sources we cite for each of these topics.

For recipes, check out my How Not to Die Cookbook. It’s beautifully designed, with more than 100 recipes for delicious and nutritious meals. Speaking of new books, I have a new book just out – How to Survive a Pandemic – now out in audiobook, read by me, and e-book with physical copies out in August. Pre-order the physical copy now or download the e-book and audiobook now as well.

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Thanks for listening to Nutrition Facts. I’m your host, Dr. Michael Greger.