Cover Story: What's Eating Us?

How our love/hate relationship with food is changing American society

Ryan Greis and Sean Hughes

Something tastes bad. Amidst the endless search for just the right diet, we're not just getting fatter — we're getting fatter fast.

It's no longer normal to be normal weight in America. With more than 50 percent of adults overweight and one out of five adults obese, lean Americans are in the minority.

And it's not just adults who are super-sizing themselves. According to the Centers for Disease Control and Prevention, the percentage of children and adolescents who are obese has doubled in the past 20 years.

Endless opportunities to eat surround us. Shopping malls, movie theaters, airports, gas stations and amusement parks are gluttoned with food counters. Barnes & Noble offers Starbucks, and big-box stores such as Wal-Mart and Target house fast-food chains.

As if drive-up windows and packaged meals weren't convenient enough, food purveyors are competing to make food even more accessible.

McDonald's is test marketing a system that allows you to simply deduct each purchase from a personal account, while several gas stations are planning to install touch screens at the pump so you can order food directly from the mini-mart while you're filling up the ever-hungry SUV.

One of the first casualties of all this caloric consumption is the obscene rate of Type 2 diabetes. An estimated 15 million-plus adult Americans now have the disease, up from 9 million at the beginning of the 1990s. Hypertension and heart disease are also on the rise.

Eating disorders such as anorexia and bulimia continue to be the deadliest of all psychiatric disorders, killing or contributing to the deaths of thousands every year. And diet is suspected of playing a role in an estimated 35 percent of cancers.

Nobody — outside the $50 billion a year weight loss industry — is happy about this crisis. As the situation gets worse, however, we're confused as to how we arrived here and increasingly more polarized as to what to do about it.

Sustenance and symbol
If food were merely a source of sustenance, deciding what to eat would be a much simpler process. At once sustenance and symbol, food makes life possible but also demonstrates and even influences its complexity.

In the corners of the world where famine, poverty, political corruption and war still impede prosperity and shrink existence, the relationship between food and life is direct — no food, no life. But in an abundant culture that zealously celebrates food as equally as it suffers from a dysfunctional obsession over thinness, things can't help but get complicated.

While few Americans have ever known hunger as anything other than an abstraction, we have no trouble envisioning obesity and are completely comfortable with the whole concept of weight loss. The ubiquitous presence of dieting testifies to our tangled web of personal and cultural relationships with food.

Food is love. Eating together is our way of connecting. In fact, the word "companion" comes from the Latin for "sharing bread."

We dine out on dates, business lunches, mother/daughter teas, Sunday suppers and wedding rehearsal dinners. For weeks ahead of time we plan what we'll cook, prepare or eat for holiday gatherings.

Connecting over food is a pleasure to both the senses and the emotions. As someone involved in the food industry most of my life, I can attest to being driven by intense desire for sensorial pleasure and connection.

Food is a psychological tonic. From the time we were offered an ice cream cone after skinning a knee or a sucker after receiving a shot from the doctor, food — especially sugar, the great substitute for mother's milk — has helped us divert our attention from pain and anxiety, delivering instant relief from the emotional conflicts of the moment.

Food has tremendous power. It's the physical, earthy, organic, fundamental connections of eating to life itself that give food so much emotional, sexual and spiritual importance and value.

Indeed, for the past four years I've been writing for CityBeat, most of my columns have feasted on the banquet of sensual, passionate and sexual qualities of food — eating it, cooking it and playing with it.

Add to this that we're overfed, over-advertised and under-exercised, and it's no wonder we're a nation of butterballs.

We're a society weaned on control issues — so we're in control, aren't we? Isn't good ol' American we-can-fix-it willpower enough to overcome the emotional eating as well as all the tempting food choices available to us from super-sized fast food to giant candy bars to all-you-can-eat buffets?

Researchers who study diet and eating habits say willpower doesn't stand a chance unless the nation's overabundant environment changes first.

Something to chew on
One of the great ironies of global public health is that, while many millions of people lack food, millions more are so overweight that resources are diverted from prevention and education to care for those with preventable diet-related chronic diseases. Additionally, food is so overproduced in wealthy countries such as the United States that we have far more than we need.

So a sedentary lifestyle has grown in correlation with improved prosperity.

Marion Nestle, author of Food Politics: How the Food Industry Influences Nutrition and Health, believes that gaining weight is good for big business, putting much of the blame for the nation's weight problem on the food industry.

"Overabundant food forces companies to compete for sales through advertising, health claims, new products, larger portions and campaigns directed towards children," she states. "Food marketing promotes weight gain."

It's certainly difficult to think of any major industry that might benefit if we ate less food. Agriculture, food product, grocery, restaurant, diet and drug corporations all flourish when people eat bountifully; according to Nestle, all "employ armies of lobbyists to discourage government from doing anything to inhibit overeating."

Nestle, a professor in the Department of Nutrition and Food Sciences at New York University, argues that the food industry's fundamental goal is to induce the public to eat more, which inevitably contributes to the growing epidemic of obesity. As she points out, the effort to increase food consumption is legal — corporate behavior in an unfettered capitalist economy.

Beyond the gross effort to inform adults through advertising, she documents in detail the industry's behind-the-scenes efforts with Congress, federal agencies, courts, educational institutions and professional organizations to limit public access to relevant information and to promote consumption of products designed for profit rather than for health.

Nestle begins with an account of the U.S. Department of Agriculture's (USDA) early mission to prevent health deficiencies through nutritional advice. When over-consumption became the norm, complications arose with the food industry's refusal to relinquish its "eat more" message for fear of plummeting profits. Today, the USDA has an inherent conflict of interest in its dual mission to promote agriculture and to issue dietary advice.

Consider that the USDA's primary stakeholders are groups that represent the major producers in the dairy, meat and sugar industries. In this context, how could the USDA responsibly advise us to eat less food without being met by powerful resistance?

One of the hot issues in nutrition politics is the successful fight to deregulate vitamins and supplements and fortifying junk food to market it as a "healthy" product.

In the past decade, producers of dietary supplements evaded strict food and drug regulatory standards. As a result there's a blurred line of distinction between advertising and dietary advice that's led to even fuzzier boundaries among foods, supplements and drugs.

Creators of supplements and their health claims have paved the way for the marketing message of foods as "healthy" solely because of added nutrients or the removal of fat or sugar. In turn, the public has become confused by claims that hype "vitamin enriched" and "heart healthy" rather than focusing on the nutritional qualities of foods themselves.

But the most disturbing issue within food industry politics is the commercial exploitation of children. Like adults, children are exposed to intense, seductive marketing of products devoid of nutritional value but replete with calories — the difference being that children often aren't fully mature enough to make informed decisions for themselves.

Perhaps the most blatant and damaging invasion into children's diet are contracts for "pouring rights," whereby cash-strapped school systems are paid by major soft-drink corporations for exclusive rights to promote and sell their products within the school cafeterias and vending machines. Not only is this practice lucrative for current sales — just like tobacco companies, these companies in essence are training children to be consumers of their mildly addicting products. Adding insult to injury, food services in some schools are being replaced by fast-food franchises.

Supersizing America
In the new, award-winning film Super Size Me, currently playing in local theaters, director/star Morgan Spurlock takes on the fast-food giant McDonald's by documenting his physical deterioration on camera as he subsists on nothing but McDonald's burgers, fries and McNuggets for a month. It might be the greatest gluttony story ever told.

Although the shocking effects of Spurlock's diet are the film's main focus, Super Size Me journeys into the soft-drink and junk-food-laden school cafeterias to serve up the deeper message of the film — that fast food is as addictive as any drug.

"It's wreaking havoc on America's kids," he says in the film.

As parents, why aren't we outraged?

No one is immune to the pressure to buy food, Nestle says. Companies use sophisticated marketing strategies to seduce adults and introduce young children to their products.

"You can even buy textbooks on how to market to children, " she says.

In Super Size Me, children who don't recognize images of Jesus or George Washington blurt out "McDonald's!" when shown a picture of Ronald the clown.

What can be done? To ensure that the information about nutrition given to the public is based strictly on scientific evidence, Nestle suggests that governmental responsibility for dietary advice be transferred from the USDA to the U.S. Department of Health and Human Services. She claims the USDA might not be the best government agency to develop objective nutritional guidelines due to its close links with the agricultural industry. She also advocates banning in-school sales of soft drinks and foods with minimal nutritional value.

Many other "food activists" publicly support a tax on junk food, sometimes referred as the Twinkie Tax, which would subsidize the price of healthy foods so they're more affordable.

Are food companies really the big bullies here? Where does our own responsibility lay in the laws of supply and demand?

Although it has its detractors, most think a junk-food tax is just the kind of swift intervention we need because the larger process of change seems so daunting — because our food habits run that deep.

But habits can change. Who would have imagined 30 years ago that the powerful tobacco industry would be harnessed such as it is today?

We can no longer smoke in public places, cigarette taxes are considerable and tobacco companies have spent millions of dollars in lawsuit settlements. Tobacco is the most addictive substance legally sold, yet the number of smokers has fallen by half in the past four decades.

Could a similar social movement aimed at the food industry be near?

Rebuilding the pyramid
The federal government has long tried to extract the foremost science in health and diet. But bureaucratic obstacles and industry pressure often have obscured the results.

For instance, the USDA's Food Guide Pyramid — officially released in 1992 and intended to help the American public make dietary choices that would maintain good health and reduce the risk of chronic disease — is now widely viewed as grossly flawed.

The recommendations embodied in the pyramid are well known: Minimize consumption of fats and oils; eat six to 11 servings a day of foods rich in complex carbohydrates (bread, cereal, rice and pastas); eat generous amounts of vegetables (including potatoes, another source of complex carbohydrates) and fruit and dairy products; and eat at least two servings a day from the meat and beans group, which lumped together include red meat with poultry, fish, nuts, legumes and eggs.

One of the obvious shortcomings in the pyramid is its failure to recognize the important health differences between red meat (beef, pork and lamb) and other foods in the meat and beans group (poultry, fish, legumes, nuts and eggs). Secondly, it makes no distinction between "good" and "bad" fats, including trans-fatty acids (found in many margarines, baked goods and fried foods) produced by the partial hydrogenation of liquid vegetable oil, which causes it to solidify.

By promoting the consumption of a diet high in complex carbohydrates and avoiding all fats and oils, the pyramid provides misleading guidance that fats are bad and carbohydrates are good. In reality, not all fats are bad for you and not all complex carbohydrates are good for you.

This is one of the most significant "uh ohs" in recent scientific history. So how did the government get it so wrong?

In part, nutritionists tried too hard to simplify the message. Scientists have known since the 1960s from controlled feeding studies that saturated fat in red meat and dairy products can raise cholesterol levels and promote coronary heart disease. They were well aware that monounsaturated and polyunsaturated fats could be healthful and that some carbs could be harmful. They knew that, unlike butter and lard (both high in saturated fat), the oils found in fish, nuts and vegetables could actually help protect against heart disease and that many cereal grains had little nutritional value when milled into flour.

Unfortunately, many nutritionists decided it would be too large and difficult a task to educate the public about these subtleties. The USDA's rationale was that advocating a low-fat diet would naturally reduce the intake of saturated fat.

Instead, the mantra "fat is bad" was born. It didn't take long for the food industry to get on board and flood the market with "Snackwell" type foods that were low in fat but often high in sweeteners such as corn syrup and its derivatives. And the corollary to "fat is bad" led to "carbo-loading."

What we've now learned about refined carbohydrates has spawned a whole nation of glycemic index counters and "low carb" food pushers.

Unlike whole grains, which break down slowly in the digestive system, refined grains quickly convert to glucose, the body's primary fuel. But if that glucose isn't used immediately to fuel activity, the rapid increase in blood sugar stimulates a large release of insulin, the hormone that directs glucose to the muscles and liver.

A diet rich in refined carbs thus triggers the cells to become insulin resistant, forcing the body to produce it in greater amounts. Eventually the system is overloaded and breaks down, triggering diabetes and other preventable illnesses.

Overweight, inactive people are at particular risk, and since we were already overweight as a nation when carbo-loading came in to dietary vogue in the '90s, is it any wonder Type 2 diabetes has gotten out of control?

Although the USDA's food pyramid has become the icon of nutrition over the past decade, there have been few and incomplete studies evaluating the effects of its guidelines. With a recommended high intake of fruits and vegetables, it clearly has some benefit. And certainly a decrease in total fat intake would reduce the "bad" fats.

The USDA currently is working to revise the food pyramid, but in the meantime researchers at the Harvard School of Public Health have devised the Healthy Eating Pyramid. This one emphasizes weight control through daily exercise, discourages excessive total intake of calories and gives a strong endorsement for healthy fats (largely plant-based) and whole grains, vegetables and fruits.

While moderate amounts of healthy protein sources are encouraged (nuts, legumes, poultry, fish and eggs), dairy consumption is limited to one or two servings a day and refined grains (white bread, white rice and white pasta), potatoes and sugar are sent upstairs to the pyramid's attic along with red meat and butter. Trans fat doesn't appear at all, a multiple vitamin is suggested and moderate alcohol consumption is an option.

Unlike the USDA's plan, the Healthy Eating Pyramid focuses on individual foods, breaking up groups of fats, carbohydrates or proteins to highlight the best and worst sources for nutrients. This might seem obvious, but it's a critical departure from the government's "fat is bad" and "carbs are good" implications.

Although recommendations aren't revolutionary, is more information about food, nutrition and weight the way to help us make better choices? Are there other possibilities?

How do we compete with the double challenges of body-conscious advertising and entertainment? How do we properly negotiate the processed Cinnabon wilderness and the cheap, convenient, brightly packaged American way of life?

The advice to eat a diet rich in vegetables, fruit and whole grains hasn't changed in more than 50 years, yet we're increasingly confused about what to eat. We're inundated almost daily with new information and shifting messages about what's good for us and what's not.

While some of us cling to each new crumb of dietary information, the low-fat, no-fat, carbo-loading, high-fiber flip flops are enough for even the most conscientious eater to need a score card. As a result, dieting and weight loss has become a mega-billion dollar industry — one that didn't exist 40 years ago.

Swallow the leader
You don't have to get lost in a chain bookstore's huge health and diet section to realize that dieting is big business and that every pop psychologist has joined the burgeoning breed of diet book authors. For every Ph.D. and M.D., there's an equal an opposite. Where to begin?

Here's the basic formula for weight loss: Burn more calories and eat fewer calories. Most diets are successful in the short term exactly for this reason — they help people shed pounds through limiting major resources of calories.

But short-term weight loss isn't the best measure of a diet's value. There's still no actual evidence that Atkins, South Beach, Dean Ornish, the Caveman Diet, Metabolic Typing, the G.I. Diet, the Warrior Diet, the Thin for Life Diet, the Zone Diet or Dr. Phil's Ultimate Weight Solution are any better than the hundreds of other diets for helping people stay slim or whether they can create eating patterns that are sustainable over time.

Diets that severely limit large categories of foods (carbohydrates in Atkins and the Zone, for example) are much more difficult to sustain than are moderately restrictive diets. In the case of the Atkins diet, which has parlayed the low-carb concept into a business with annual revenues of more than $100 million, there are real concerns about the potential long-term consequences of eating foods derived largely from feedlot animals, which tend to contain considerably more saturated fat. Last week, a 53-year-old man filed suit against the Atkins estate, claiming the diet caused clogged arteries that required surgery.

The current diet zeitgeist — endless chatter from born-again carnivores; drastic changes in restaurant menus and food products; the low-carb, high-glycemic vernacular — prompted my initial interest in writing this article. Millions of Americans have traded in pasta for pork on the mega-popular Atkins diet. Dr. Arthur Agatston developed what could be called the "Atkins lite" version in South Beach. Dr. Dean Ornish is promoting essentially a low-fat, high complex carbohydrate vegetarian diet. And the Oprahpopular Dr. Phil is asking us to "get real."

I spoke with several people who experienced major weight loss and renewed vigor on Atkins and South Beach. I talked to a Greco-Roman soldier wannabe who found new life on the Warrior Diet, a modified fasting program. I interviewed a doctor from the University of Cincinnati who follows the ultimate extreme in dieting — controlled starvation — through calorie restriction (see the sidebar "Want to Live Longer," on this page.). Who's right?

They all are, and perhaps none of them are. In our entitled, narcissistic society, the only weight-loss program Americans are likely to embrace over the long term is one that allows us to eat anything we want, whenever we want and still lose weight.

We demand convenience and accessibility. Considering that impossibility, what are the alternatives?

It'll take more than a pyramid to improve America's diet. It demands, quite simply, a revolution.

We need science and education policy changes. We must increase our awareness of the moral, economic and emotional price we pay for the food choices we make. We must choose farm food over factory food. We must eat with mindfulness between the extremes of overindulgence and deprivation. We must redesign our buildings and, yes, communities to encourage activity and engagement.

Each and every battle of this war battle belongs to all of us. Every one of us are to be held accountable.

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