Thursday, September 1, 2011

Book Review: The End of Overeating

The End of Overeating was written based on the personal journey of Dr. David A. Kessler (MD) to understand the obesity epidemic, and treat his own obesity in the process.  Dr. Kessler was the FDA commissioner under presidents George HW Bush and Bill Clinton.  He is known for his efforts to regulate cigarettes, and his involvement in modernizing Nutrition Facts labels on packaged food.  He was also the dean of Yale medical school for six years-- a very accomplished person. 

Dr. Kessler's book focuses on 1) the ability of food with a high palatability/reward value to cause overeating and obesity, 2) the systematic efforts of the food industry to maximize food palatability/reward to increase sales in a competitive market, and 3) what to do about it.  He has not only done a lot of reading on the subject, but has also participated directly in food reward research himself, so he has real credibility.  The End of Overeating is not the usual diet book. 

As you may realize if you've been following this blog for a while, I think food reward is a major determinant of food intake and a contributing factor to obesity.  It's great to see a book that tackles the topic in the popular press, making it accessible to nearly anyone. 

Dr. Kessler starts out by making the case that sugar, salt and fat cause overeating, and that much of the food industry is based around finding novel ways of packing more of these three ingredients into food to maximize palatability.  He repeats an idea that is common in the food reward literature, that reward and pleasure circuits in the brain override circuits that are designed to stabilize body fat stores (body fat homeostasis), establishing a higher 'settling point'.  I have a minor quibble with this; my belief is that excessive reward may partially override homeostatic circuitry, but it also re-regulates it to defend body fatness at a higher level (a hypothesis shared by certain other obesity researchers).  This may be one of the reasons why overweight/obese people 'defend' a higher fat mass, making weight loss difficult and often destined for failure.

A second problem is that Dr. Kessler didn't do a good job of clearly defining reward and palatability.  He seems to confuse palatability with reward at times:
In everyday language, we call food palatable if it has an agreeable taste.  But when scientists say a food is palatable, they are referring primarily to its capacity to stimulate the appetite and prompt us to eat more.  Palatability does involve taste, of course, but, crucially, it also involves the motivation to pursue that taste.  It is the reason we want more.
Actually, I believe the first sentence had it right.  Palatability is the hedonic, or pleasure value of food.  The motivation to pursue food, "the reason we want more", is due to the reward or reinforcing value of the food.  As far as I know, those are the accepted scientific definitions, although some people do use the term reward more broadly to include hedonic value*.  The two concepts are admittedly easy to confuse, because they overlap and in practice often travel together.  I have to believe that Dr. Kessler understands what reward and palatability are, but he does not convey that understanding effectively in the book. 

Another quibble I have is that he focuses too persistently on sugar, fat and salt.  These are clearly major reward factors, but so are calorie density, certain textures, free glutamate, starch and a few others.  In addition, many other cues (particularly flavors) become rewarding as they are associated with those factors.  Some of these are mentioned or implied (except starch, a major omission in my opinion), but the book is focused primarily on sugar, fat and salt throughout.  I suspect he wanted to keep it simple for clarity's sake, but that decision did sacrifice some amount of completeness. 

The book goes into considerable detail about the remarkable science of food engineering by processed food manufacturers.  The goal, as one executive bluntly put it for Dr. Kessler, "is to get you hooked", by creating food stimuli that stimulate reward circuits as much as possible.  It's a science and an art, where refined ingredients and synthetic flavorings are the palette they use to paint foods.  One of the great strengths of the book is the large number of interviews Kessler did with food industry executives-- and the candid information they provided.  The End of Overeating is worth the cover price for that alone. 

In the latter part of the book, Kessler provides practical advice for fat loss based on the food reward ideas.  It mostly revolves around learning how to wean yourself off junk food, using an approach similar to drug rehab strategies.  I think there are a lot of useful ideas there, but some people may need a more focused and comprehensive strategy to regain leanness in my opinion.

A final gentle critique is that the book is not very focused or well organized.  It often rambles on with long study descriptions, quotes and redundant information.  I think it would have been more effective if it were a concise and focused 200 pages (the book was 320).  It would have benefited from a thorough and assertive editor.

Overall however, I liked the book.  It contains a lot of good information and practical advice from a credible source, and to my knowledge it's the only book focused on food reward in the popular press.  I recommend it to anyone who wants to expand their knowledge on food reward, and the manner in which the processed food and restaurant industries employ it.  I've added it to my list of recommended books in the sidebar.

Melissa McEwen also commented on The End of Overeating here.  


*By this definition, reward has a hedonic (pleasure) component, a motivational component, and a learning component.  Researchers sometimes call the motivational and hedonic elements "wanting" and "liking", respectively (1).  I may switch to this definition at some point, because it's widely accepted and easier than saying "reward" and "palatability" separately every time I want to mention these ideas.

35 comments:

Princess Dieter said...

This book was instrumental in me getting a handle on appetite/binge issues. It opened my eyes. I had my epiphany and never looked back. A year plus of consistent losing and embracing a different way of being with food. Yep, I recommend this to anyone and everyone with overeating issues.

David Pier said...

I know you have had conversations in the comment sections of some of your posts, but I would like to see a full post on your reconciliation of your understanding of palatability/reward theory and Seth Roberts Shangri La diet. I know he often gets the biochemistry wrong when he delves into that, but his overall action/effect observations, and the weight loss implementation practice that follows, seems to most thoroughly explain all the previously conflicting observations. It is also a particularly easy strategy to implement for most people.

David L said...

Stephan,

I think that the Shangri-La diet has the same problem as the low carb diet -- it only works once. I have been faithfully drinking Walnut Oil with a little sugar (an water) for three weeks, and it hasn't worked even though before I lost 15+ pounds.

I am going back to bland. There doesn't seem to be any way that it won't work, I hope. Here's my bland: whole milk yoghurt, powdered whey protein, cooked rice, and some bland vegetables such as cucumbers and beets. Might add some sliced almonds. Any more recommendations for this shake?

Sam Knox said...

"Here's my bland: whole milk yoghurt, powdered whey protein, cooked rice, and some bland vegetables such as cucumbers and beets."

With respect, this doesn't seem to be an eating plan that would be sustainable in the long term.

morten_g said...

What about meal timing?
I didn't realise until I read up on intermittent fasting that I have been doing that my whole life (mainly on weekends though) and it could have been one of the factors that kept me slender.

Stipetic said...

I find it interesting that two of the three culprits (fats and sugar/fructose) are what some would call neolithic agents of disease (the fats Kessler is talking about are added fats, which if anyone has read the book will know that he's referring predominantly to vegetable oil fats, but which he suspiciously never really clarifies for certain--hint: he's a lipophobe). So, maybe these factors affect the reward centers a la "food reward" hypothesis and maybe they just damage one's metabolism (insulin and leptin resistance, etc). Or maybe J. Stanton has a valid hypothesis too. Hmmm.

David Moss said...

I raised Kessler's understanding of the reward/palatabiity distinction in the comments on your 'Simple Food: Thoughts on Practicality' post.

These quotes from a video of his stood out:
"It's very important that we emphasise this: eating has to be pleasurable, it has to be rewarding"
"...if anything you need to focus on foods you like MORE than the fat, sugar and salt."

http://fora.tv/2009/05/08/The_End_of_Overeating_Dr_David_A_Kessler#fullprogram at 51:20

So he does loosely treat reward and pleasure as equivalent, but also says that you need a certain amount, even, perhaps MORE of them. What to make of that?

My attempt to make sense of it would suggest that he has in mind a third kind of "liking" namely the more conscious or intellectual liking or pleasure one can take in food that isn't rewarding/pleasurable on account of its brute caloric properties. For example, savouring the subtlety of a very plain food. So maybe the idea is that you should come to 'like' salad more than you 'like' more highly rewarding/pleasurable junk food. Or maybe that's an overcomplicated rationale. Maybe he just means that if you find low calorie foods with high pleasure/reward, you'll be compelled to consume fewer calories. That's close to the commonsense view but, of course, goes against your view that reward raises the fat mass by itself.

ftrotter said...

You ought to link to amazon with your book list. I would be happy to click your "amazon referral" link after reading a good book review like this. Over time you actually will make money. It is a nice way for your readership to contribute to your blog. Thanks for the good food/motivation content.

Ekta said...

I have read this book by Dr.David.And i got very much inspired by him.I have lost 20 pounds within 6 months and am working hard on getting slim and get free from obesity.

Pregnancy Nausea

antispirit said...

As for a "meal plan" or whatever, I can illustrate what I do. I started off at the most rewardless level of eating. I would bring a container of lean meat, a container of something starchy and a container of "fat" to work (or the dinner table). But after a few weeks, I experienced evidence of the "starvation response" everyone talks about. The symptoms were pretty typical. So I stopped for a while and restarted recently. This time, I mix "fat" (usually butter) with everything else. I do not add spices or extra flavors to it. With the exception of salt in the butter, it's still relatively plain. It's too early to say that it's really working, but it seems to stunt my appetite a bit. I seem to be able to lose about 5 pounds before the hounds start baying.

For me, there was no need to restrict anything else. In my case, a bland, liquid meal would be overkill. I do also eat quite a bit of fresh fruit.

Elizabeth Walling said...

Kessler's book certainly clarified some points for me about industrial food and why it's so easy for people to overeat or even binge on modern fare. I am far more aware of the tricks of the trade, so to speak, since reading this book and I think this simple awareness would be extremely helpful to anyone in our current society.

However, one thing Kessler said bothered me to no end. In his Food Rehab chapter (where he offers numerous strategies for ending the cycle of overeating), he basically endorsed a certain amount of self-loathing as a motivational technique. He suggests hanging up an unflattering photo on the fridge as a reminder, for instance.

Frankly, if self-hate made people thin I don't believe there would be half so much an obesity problem as we see today. The attitude that we can somehow shame ourselves into becoming thin does nothing more than continue the cycle of eat-repent-repeat (as Michelle May says).

A small point, yes, considering it was little more than a passing comment made by Kessler. The book is still an excellent read overall, but I recommend taking some of his statements with a grain of salt.

Gabriella Kadar said...

Emotional eating is a factor as well. People who are bored and have access to food, will snack and overeat. Of course this has to do with 'hedonic' and 'food palatability' as well.

When my brother and I would come home from school and my parents were still at work, we'd snack on cookies. At one point my father put up a sign in the cupboard over the cookies "How much fatter do you want to get?"

Of course he could have just not purchased cookies. But the sign worked. We didn't snack on cookies anymore. We did have apples in the house but obviously apples don't provide the same 'hedonic' effect as cookies.

In the book 'The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-decade Study' by Howard S. Friedman and Leslie R. Martin, the singular factor of conscientiousness was contributory to long, healthy life.

Conscientiousness applies to all things: how we care for ourselves, our relationships, what we do for a living. It seems to be an outdated concept these days.

People appear to be 'flying by the ever-enlarging seats of their pants.'

antispirit said...

If it were me, I'd stick a sign on the fruit basket.

"How much thinner do you wanna get?"

I suppose I could put it on the steak, but tape doesn't stick well to meat.

montediaz said...

@David L.

Why not just follow Stephan's "level 5" diet guidelines? Pick a meat, a vegetable, and a starch. Eat nothing else and don't season them.

In setting up the low reward diet you'll want to make sure of two things:

1. It won't make you deficient in micronutrients.

2. It's below maintenance calories.

Stephan's recommendations almost make this fool proof. Almost. You'll want your vegetable to have a high ANDI score. (Aggregate Nutrient Density Index). The meat won't matter but Beef and Fish have a better fatty acid profile than chicken and pork. As far as starches go Stephan has talked a lot about potatoes.

Take a look at how a typical days worth of food following these guidelines would break down nutrition wise:

http://i56.tinypic.com/2gy5d6r.png

Beef: 450g
Mustard Greens: 1 Large Can
Potato: 1 small
Milk: 1 cup

VS

Your recipe:

http://i55.tinypic.com/2qt956a.png

I'm sure I got your recipe wrong...but I'm also sure it isn't going to be significantly different nutrition wise. Yours comes in at not quite double the calories and much less micronutrients!

This is why I think Stephan's current recommendations are spot on. You can devise a total liquid diet...but it requires a lot more work.

Cat said...

Stephen,
If you haven't already read it, Kent Berridge has done some very interesting work on wanting and liking, and dissociating the two.

Brian said...

Stephan:

"the palate they use to paint the food"

I think you meant palette. :)

antispirit said...

One thing I have noticed is that it took a few days for my appetite to decrease. Don't make the mistake of thinking that less calories right off is gonna be okay. You can't force your hypothalamus to do anything. Well, unless you have an electrode implanted in it... in which case you can have a great time. But only then.

Brian said...

Stephan:

I have been around Level 4 in your recommendations for the last couple weeks, eating primarily sweet potatoes, russet potatoes, eggs, and plain beef or fish, with the occasional prepared meal.

I've used fitday.com to estimate that I'm consuming between 1200-1600 calories a day. I've dropped 10 pounds in that time, losing weight at a rate similar to when I first went to low-carb paleo a couple years ago. I do occasionally get cravings, and find that drinking carbonated mineral water may help with those; but I don't get any real hunger urges anymore. I am also getting better sleep and supplementing iodine, so those may be factors.

I am looking forward to next few weeks, to see where this goes...

Stephan Guyenet said...

Hi David P,

I like Seth Roberts' theory and it is fairly similar to mine. The main difference is he thinks flavor-calorie associations are the central factor, while I think it's more complex. We've been discussing it via e-mail.

Hi David M,

That is a tough question. I won't put words into his mouth, but here is my view. I think that there is an esthetic side to the enjoyment of food that may not plug into those same pathways that promote overeating and obesity. Also, once a person is accustomed to simple food, they enjoy it more.

Hi ftrotter,

Good idea, I've been thinking about that.

Hi Cat,

Thanks-- I'm familiar with his work but I haven't read it in detail yet. I cited his original wanting/liking paper at the end of my post.

Hi Brian,

Thanks, I corrected it.

Hi Brian,

Great, glad it's working for you! Keep us updated.

Palmer said...

What a strange coincidence: In my NUTR class earlier this week, we were discussing Kessler's book which was assigned reading and I mentioned your articles about food reward!

Sarah Barracuda said...

Stephan, I have a minor quibble with your minor quibble with Kessler: why can't it be that excessive reward overrides the homeostatic circuits in the short term, but persistent overriding leads to establishing a higher "settling point" in the long term? That would seem consistent with your hypothesis that the body (vigorously) defends against its current setpoint. For a simple physical analogy--a spring has a "spring constant", but greatly overstretching the spring will change the spring constant and the equilibrium state of the spring.

This fits with my n=1: I was always an underweight kid and the freshman 15 brought me to a normal weight, but not without often feeling full nearly to the point of being queasy. Food reward--even though I was physically too full, there was just something insidiously addictive about dining hall food that made me (and my peers) just keep eating and eating and going back for (unlimited) seconds. I've since lost the freshman 15, so I don't think I've actually attained a higher "settling point", but it would just make more sense to me if persistent overriding of the circuitry is the means by which a higher settling point is reached.

Also, I second ftrotter's recommendation.

-Barracuda

Gabriella Kadar said...

Pet Peeve Time: we are refered to as 'consumers'. We used to be 'customers'.

I've yet to 'consume' an Blackberry...arghhh.

Galina L. said...

I found out from personal experience that Intermittent Fasting could help to tune down desire to eat highly palatable food. When food is well-spaced (at least 4 hours in-between,fasting window at least 16 hours long, duration of each meal about 45 min) and each meal is eaten to satiety, two things happened with me:
1. Even simple meals are very rewording:
2. There is not much room for a food on which it is easy to get hooked.
After eating piece of lightly cooked meat, salad ,some limited amount of starch with batter , it is barely a room left for a fruit. I know that yogurt is healthy, but I can't squeeze is into my meal plan. For a breakfast I usually have soft-boiled eggs with butter and cheese. Love it, can eat it every day , but can't eat it to excess. So, by controlling mostly if not only,food timing,it is easy to control other factors that may result in overeating. I thing the diet advice to eat frequently contributes to overeating too, together with foods designed to be addictive. I remember how during my childhood we were not allowed to snack between meals because percents didn't want us to "spoil an appetite". A fat child back then was rarely seen.(I am 50, it was in Russia) .
By the way, there are some foods and flavors, extremely attractive at the beginning, but in a while causing adverse reactions. For example,during some period 20 years ago I drank too much of Earl Gray tee and now can't stand it.

Kirk said...

@David P,

I believe the difference between David Kessler's theory and Seth Roberts theory can be explored via the following thought experiment.

Obtain two equivalent groups of lab rats. They are to be fed a cafeteria diet (store-purchased foods). The first group receives a different, unique, high-sugar grocery store cereal (or cookie brand) every day, changing the brand each day.

The second group receives the same brands of cereal/cookies, but they have been prepared in a special manner. At the beginning of the experiment, an equal-calorie amount of these brands are thrown into a food processor and ground down to a crumb, and the crumbs from all the different brands are mixed together to make a uniform mix. The second group eats this uniform mixture every day for the length of the experiment.

According to Kessler's theory, both groups will gain weight, and it will be the same amount of weight.

According to Robert's theory, the group eating the daily-unique-brand will gain no weight, while the group eating the uniform mixture will gain significant weight.

I am unsure how to adjust this thought experiment to explore Stephan's theory.

Scott W said...

@antispirit, interesting that I experienced a similar response to going very bland...it was almost as if my body did not believe I had eaten anything at all since it didn't get anything tasty.

I had to back off after about 5 days because I literally felt like I was starving to death no matter how much bland food I ate.

I recognize that I have some very deeply-conditioned responses to food that I am trying to work through, and I know these can be "retrained" so to speak, but for some of us it is not easy.

In that regard, Kessler's book has been very illuminating for me as it makes the connection with addictive behavior patterns and helps me recognize that in myself.

Scott W

David Pier said...

Kirk-
I like your hypothetical experiment, although it sounds like the second group of rats should really get one food in its native seductive texture. Pureeing them all together would destroy the texture, and as we know from potato chips, texture is an essential aspect of many of these foods.

David Pier said...

Perhaps both Stephan and Seth are entirely correct. For something as complicated and essential as food intake, it wouldn't be surprising for there to be redundant systems. Both simple strength of taste association as well as palatability/reward affect the set point.
I would like to hear ideas on how palatability/reward explains the tasteless calories leading to weight loss without simple taste connection.

antispirit said...

I forget that it wasn't long ago that I ate the same way everyone else did. My food universe is drastically different. It's probably true that I haven't allowed myself enough time to reflect on that.

I suppose I have some reading to do.

It's funny that you mention your body just not believing you've eaten enough. That is a very good way to put it. I think that being too restrictive really threw my body off of its moorings. I stopped eating salt and fat almost altogether. I think that my body just didn't know what to make of it. Perhaps if I had stuck to the super bland approach longer... The effects were just too unpleasant. I had to get off that train real fast. Then again, I have a tendency to overdo things... so we'll see if a more moderate (or even progressively more bland) approach will be effective. I personally find it fascinating to see how physiological the "conditioning" is.

vergingonserious said...

Great Review! I found this book quite intriguing, I had never considered the science/art that goes into "hooking" the eater. Crazy stuff.

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Jonathan said...

Stephan,

Despite some notable differences, your theory and Kessler's share the starting point that certain foods are inherently hyper palatable. But there is a lot of evidence that palatability and reward are plastic and variable. Cultures and individuals not used to Coke find it to taste like medicine. So there are no inherently hyper palatable foods

Once you acknowledge that food reward is not an inherent property of food, but is a conditioned response, the question is what makes some people vulnerable to it, and others not. There is a good article by Todd Becker arguing that you and Kessler might have cause and effect reversed -- that the damaged metabolism of the obese make them vulnerable to rewarding foods, rather than the other way around.

http://gettingstronger.org/2011/09/does-tasty-food-make-us-fat/

Do you think there might be some truth to the idea that it is mainly the insulin resistant who are vulnerable to "food reward"? Or does food reward come first?

Jono

gwarm said...

This was on top selling amazon books 2-3yrs ago. I have heard of him 2yrs ago, and I didn't find him 'lean' enough (whereas Michael Pollan struck me)... he does kind of ramble http://www.youtube.com/watch?v=laY7zzMCBLM&feature=BFa&list=PL53AA35449C7DD652&lf=PlayList (see top rated comment 'He reminds me of Marty Mcfly's dad from Back to the Future')