Heavy habits
Here’s an interesting thought: What if you’re not to blame for your weight problem?
What if the fault could be laid squarely at the feet of food manufacturers and marketers, grocery store managers, restaurant operators, food vendors -- the people who make food so visible, available and mouth-watering?
Several recent studies, papers and a popular weight-loss book argue that eating is an automatic behavior triggered by environmental cues that most people are unaware of -- or simply can’t ignore. Think of the buttery smell of movie theater popcorn, the sight of glazed doughnuts glistening in the office conference room or the simple habit of picking up a whipped-cream-laden latte on the way to work.
Accepting this “don’t blame me†notion may not only ease the guilt and self-loathing that often accompanies obesity, say the researchers behind the theory, but also help people achieve a healthier weight.
To make Americans eat less and eat more healthily, they contend, the environment itself needs to be changed -- with laws regulating portion size, labeling or the places where food can be sold or eaten. That would be much easier, the researchers add, than overcoming human nature. The theory that our society -- not us -- is to blame for our overall expanding waist size is garnering support from health and nutrition experts. To recap the dismal statistics: In the last 25 years, the number of obese Americans has increased from 14.5% to 32.2%. Two out of three adults are overweight, as are 19% of children, according to the Centers for Disease Control and Prevention.
“Almost everybody is gaining weight in almost all socioeconomic groups. It’s not limited to certain people. It’s everywhere,†says Dr. Deborah A. Cohen, a senior natural scientist at Rand Corp. and the author of a recent paper on the environmental theory of obesity. “Look at doctors, nurses and dietitians who are overweight or obese. If it has anything to do with how much we know about nutrition or how much we’re motivated, we would never see people with such expertise be overweight or obese.â€
But defining obesity as an environmental issue is a little like comparing it to global warming: The problem is all around us -- part of us -- but we, as individuals, can do little about it. Big actions by governments and societies will be needed for much to change, according to some researchers who study obesity.
Other health experts say that view is too extreme. Individuals can exert control over their own environment and lose or maintain weight despite the temptation of venti lattes, super-sized French fries and all-you-can-eat pasta bowls, they say.
“The environment, I think, to a large extent explains the obesity epidemic,†says Dr. Robert H. Eckel, a professor of medicine at the University of Colorado and past president of the American Heart Assn. “But should we change the environment to alter the obesity epidemic? And how much do we need to change it? Those are difficult questions. To blame it all on the environment is a mistake. There is individual responsibility.â€
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Eating on autopilot
To explain how so many people have become overweight, researchers start with the urge to eat.
Eating is an automatic behavior that has little to do with choice, willpower or even hunger, Cohen says. Her paper, with co-author Thomas Farley of Tulane University’s Prevention Research Center, was published online last month in Preventing Chronic Disease, the peer-reviewed health journal of the Centers for Disease Control and Prevention.
Cohen and Farley argue that automatic behaviors can be controlled, but only for a short time (the reason most diets ultimately fail). A more effective approach, they say, would be to decrease the accessibility, visibility and quantities of food people are exposed to, and the environmental cues that promote eating.
The fact that most people cannot maintain a weight loss is proof that nutrition knowledge and willpower don’t work, they and other researchers contend.
“We’ve thought for a long time that if we just suggested to people that there are negative effects from obesity and if we provided reminders, they would be able to gain control over their behavior and act healthy,†says Wendy Wood, a Duke University psychologist who studies habits. “There isn’t much evidence that works.â€
Instead, ample research demonstrates that much of human behavior is automatic. Studies of people keeping activity diaries show that about 45% of daily human behavior is repetitious and unthinking. In a study published recently in the Journal of Consumer Psychology, Wood showed that people fall back on their habits -- such as buying fast food -- even when they intend to do otherwise.
Several recent studies depict the folly of human food consumption. A 2006 study in the International Journal of Obesity found that when candy was placed in a clear dish, people ate 71% more than when it was in an opaque dish. The same study found that the closer the food, the more likely it would be eaten.
The same research group, headed by Brian Wansink, director of Cornell University’s Food and Brand Lab, also found that people don’t necessarily stop eating when full. People eating from soup bowls that were secretly refilled ate 73% more soup. That study was published in 2005 in Obesity Research.
“Eating behaviors are like a lot of other lifestyle behaviors; you tend to repeat them, often in the same context, same location, with the same people, at the same time of day,†Wood says. “When people repeat behaviors in that way, they become automatic. They are cued by the context and no longer involve decision-making.â€
That doesn’t mean people are weak or stupid, however. Human brains have to operate on autopilot sometimes in order to accomplish more difficult mental tasks that involve analytical, creative or abstract thought, Cohen says.
“There is a benefit to being automatic,†she says. “It frees us up to do what is more important. Trying to change automatic behavior is going to be an exercise in frustration.â€
The fact that food is everywhere in today’s society is a problem, Cohen says, because people appear to be biologically configured to eat, eat, eat.
“People are designed to overeat,†she says. “We have a mechanism to store extra calories when we are given too much to eat. When you increase portion sizes, whether someone is fat or thin, neurotic or not neurotic, we eat too much.â€
The fact that many people are not overweight is due to individual differences in environments and sensitivity to environmental cues. Genes vary too. Knowledge and self-control have little to do with it, she says.
“Do you think people are less responsible than they were 20 years ago?†Cohen says. “What has happened in our environment between now and 20 years ago? I don’t think responsibility has anything to do with this. That is the wrong emphasis.â€
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A long-term struggle
Good intentions are often a poor foil to such overwhelming environmental and biological cues.
“I think a lot of people know what they should be eating,†says Ruth Frechman, a spokeswoman for the American Dietetic Assn. who has a private practice in Burbank. “But because of their habits, they aren’t doing it.â€
Changing routine behavior is painstaking and slow, Frechman says. She asks clients to start by focusing on one small habit. For example, instead of going to the vending machine for candy at 3 o’clock each afternoon, she advises them to go to the office cafeteria and buy fruit.
“It’s hard,†she says. “I sometimes work with people for years to get them to change one little thing.â€
Louise Paziak, 54, of Burbank says she had some success losing weight only after she began keeping a food diary. “I would think, ‘Well, I’m not eating that much.’ But what I found out was that I was nibbling a lot,†she says.
She has lost 20 pounds over the last two years through nutritional counseling, strict shopping rules that prohibit snacks and eating only half of what she is served in a restaurant.
“I’m so aware of it now, I notice what other people are eating too,†she says with a laugh.
Whether individuals can buck their environment is hotly debated. Some experts think it’s just too hard for most people.
“It’s not that people can’t think about what they’re doing. Of course they can,†Wood says. “That’s one of the things that makes this so complex. If you ask people to limit their diet and eat healthful, everyone can do that for a short amount of time. It’s when you have to inhibit a response over a long period of time, that is where we have difficulty. It involves not just a decision to do something new, it also involves inhibiting the old one. If people rely on willpower alone, they are expecting too much of themselves.â€
It’s easier to change the environment than it is to change people, Cohen says. In her paper, she says people need protection from the “toxic environment†and calls on governments, communities and organizations to solve the obesity problem. She advocates downsizing portions, limiting access to ready-to-eat foods and curbing food advertising.
“We’ve created an environment that has resulted in our being overweight and obese and now we have to create an environment that helps us be healthy,†she says.
The antismoking campaign is a good model, Cohen says. Smoking rates have been reduced by restricting where cigarettes can be sold and used, by taxing them and by media campaigns depicting smoking as harmful.
Eckel, the past president of the American Heart Assn., agrees that an out-of-control environment, along with the biological propensity to retain weight, has caused Americans to gain weight. But he doubts change through legislation is necessary.
“There are success stories in dieting, and we have sufficient data from studies to show it begins with a high level of motivation,†Eckel says.
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Rules don’t fit all
It’s clear, however, that applying strict rules to eating behavior doesn’t work for most people, says Wansink, who was appointed in November as head of the Department of Agriculture’s Center for Nutrition Policy & Research. The office is responsible for overseeing the “Dietary Guidelines for Americans†publication and other nutrition programs. But people can have success by making small changes. Demanding sweeping environmental changes is impractical and strict dieting is too overtaxing, he says.
“I think the answer lies somewhere in the middle,†says Wansink, author of the 2006 book “Mindless Eating: Why We Eat More Than We Think.†“We need to make small changes in our environment. That can be as small as moving fruits and vegetables to the middle shelf in the refrigerator. You won’t lose 30 pounds in a month, but these small changes can make a big difference over time.â€
Changes can be also be profound if people focus on their immediate environment. As he points out: Families usually have a “nutrition gatekeeper†who, through shopping, cooking and serving food, controls about 73% of what everyone in the family eats.
Eating is strongly influenced by the environment, but each person can still exert some conscious control over it, says Dr. Harvey J. Widroe, a Walnut Creek psychiatrist and author of the 2007 book “The Smart Dieter’s Cheating Guide.†He tells his clients to start with a few simple principles, such as to eat only two-thirds of their usual portions or to replace a favorite food, such as ice cream, with a similar but healthier alternative, such as sorbet.
“People can do this,†he says. But environmental changes, such as taking vending machines out of schools and office buildings, won’t work. “People cheat. They’ll find a way to eat.â€
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