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“Dr. David Kessler has written a fascinating account of the science of human appetite, as well as its exploitation by the food industry. The End of Overeating is an invaluable contribution to the national conversation about the catastrophe that is the modern American diet.” —Michael Pollan, author of In Defense of Food
“David A. Kessler, who led the battle against the tobacco industry, now joins the fight against obesity. His message is important: The problem is not only the behavior of profit-driven food companies, but also the daily choices that each one of us makes.” —Eric Schlosser, author of Fast Food Nation
“David Kessler's fascinating book is essential for anyone interested in learning more about how corporate greed and human psychology have created a national health crisis. ” —Alice Waters, chef and owner of Chez Panisse
“Disturbing, thought-provoking, and important.” —Anthony Bourdain, author of Kitchen Confidential
“A compelling book about overeating and the obesity pandemic. Dr. Kessler thoroughly examines the nature of our relationship with food and why it is critical to understand and modify our behavior to reverse this global threat to health and well-being.” —David Satcher, former Surgeon General and director of the Centers for Disease Control and Prevention
“A fascinating, unique book by a brilliant public health leader.” —Donna Shalala, former Secretary of the U.S. Department of Health and Human Services
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CHAPTER 1
Something Changed... America Gained Weight
For thousands of years human body weight stayed remarkably stable. Throughout adulthood we basically consumed no more than the food we needed to burn. People who were overweight stood apart from the general population. Millions of calories passed through our bodies, yet with rare exceptions our weight neither rose nor fell by any significant amount. A perfect biological system seemed to be at work.
Then, in the 1980s, something changed.
Katherine Flegal was one of the first to recognize the trend, but like many good researchers faced with an unexpected finding, she thought her numbers must be wrong. A senior research scientist at the federal Centers for Disease Control and Prevention, Flegal had been studying data from an enormous federal government survey of the health and nutritional status of American households. Her figures indicated that the number of people who were overweight had spiked dramatically.
Researchers had never seen such extreme numbers. In earlier decades, American adults typically gained a couple of £ds between the ages of twenty and forty and then lost a couple of £ds in their sixties and seventies.
The shift that riveted Katherine Flegal's attention came from government survey data collected from 1988 to 1991, which revealed that fully one- third of the population aged twenty to seventy-four weighed too much. In fewer than a dozen years, 8 percent more Americans--about 20 million people, roughly the population of New York State--had joined the ranks of the overweight.
Her training and professional experience had taught Flegal to be cautious. In a complex and ambitious survey, errors can creep in at many points, and data often show anomalies that disappear with further scrutiny. She knew her information had to be accurate before she sounded an alarm.
"We checked it to a fare-thee-well," she said, describing her research team's review of regional analyses, time trends, and quality- control techniques. Nothing seemed out of place. The evidence of an abrupt increase in the number of overweight Americans appeared to be valid.
Still, she was nervous, especially since no one else seemed particularly aware that Americans as a group were becoming heavier. Hoping to find studies confirming these provocative data, her team scoured the published literature, but few journal articles were relevant. At professional meetings Flegal casually asked other researchers what they thought was happening with weight in America. Most thought it was the same as it had always been.
Americans were gaining millions of extra £ds, yet at first these £ds remained invisible. The medical community, the scientific community, and the federal government were not quick to notice the trend.
And so Flegal's team wrote up its data and went to press. The study, published in the July 1994 issue of the Journal of the American Medical Association, reported that a comparison of current and earlier data on the weight of Americans had revealed "dramatic increases in all race/sex groups." When a respected academic journal calls something dramatic, it's the equivalent of a red alert. The results were consistent virtually across the board--among men and women, young and old, black and white. The rate of obesity in America had evidently exploded.
I asked Katherine Flegal to tell me how average weight had changed over time. Her graphs showed that the population had gotten bigger over the decades. In 1960, when weight was still relatively stable in America, women ages twenty to twenty-nine averaged about 128 £ds; by 2000, the average weight of women in that age group had reached 157.
A similar trend was apparent in the forty-to-forty-nine-year-old group, where the average weight had jumped from 142 £ds in 1960 to 169 in 2000.
Also striking was the evidence that we were entering our adult years at a significantly higher weight, reflecting the gains that had taken place during childhood and adolescence. And from age twenty to age forty, many of us kept gaining. Rather than a few £ds, the average adult man was gaining more than a dozen £ds in those years.
Flegal observed something else. While on average everyone was getting heavier, the heaviest people in the population were gaining disproportionately more weight than others. The spread between those at the upper end of the weight curve and those at the lower end was widening. Weight gain was primarily about overweight people becoming more overweight.
What had happened in such a short time to add so many millions of £ds to so many millions of people? Many years of research led me to an unexpected answer.
Certainly food had become more readily available in the 1970s and 1980s: We have larger portion sizes, more chain restaurants, more neighborhood food outlets, and a culture that promotes more out-of-home eating. But having food available doesn't mean we have to eat it. What's been driving us to overeat?
It is not a want born of fear that food shortages lie ahead. Once this had been so. In the Bible, seven years of plenty were inevitably followed by seven years of famine, so we needed to build storehouses of fat in preparation. But in America, where even northern supermarkets are filled with summer fruits much of the year, that logic doesn't apply.
Nor is it a want rooted in hunger or the love of exceptional food. That kind of logic is not what's driving the out-of-control eating we see in Sarah, Andrew, Claudia, and so many others like them.
We know, too, that overeating is not the sole province of those who are overweight. Even people who remain lean, like Samantha, feel embattled by their drive for food. For them, it takes the most determined restraint to resist what feels like an almost overpowering push to eat.
Little help has been available. Family members, friends, and colleagues have not had the knowledge to offer support. Many, including doctors and health care professionals, still think that weight gainers merely lack willpower, or perhaps self-esteem. Few medical personnel or nutritionists, few psychological experts or public health advocates, have recognized the distinctive pattern of overeating that has become widespread in the population. No one has seen loss of control as its most defining characteristic.
Those who have succumbed to the pull of food are spending billions of dollars in search of a cure, determined to rid their bodies of the burden of weight. But they are squandering most of their money, finding only short- term weight loss and a vain hope that it will last.
That is because we have not understood why eating certain foods only makes us want to eat more of them. No one has recognized what's really happening. Let me try to explain.
著者について
DAVID A. KESSLER, MD, served as commissioner of the US Food and Drug Administration under presidents George H. W. Bush and Bill Clinton. He is a pediatrician and has been the dean of the medical schools at Yale and the University of California, San Francisco. A graduate of Amherst College, the University of Chicago Law School, and Harvard Medical School, Dr. Kessler is the father of two and lives with his wife in California.
