Former FDA Commissioner Says U.S. is Nation of "Hypereaters"

DOUG MYRLAND (Guest Host): I'm Doug Myrland and you're listening to These Days in San Diego. Why do Americans have such a big appetite for big food? It seems like everywhere we turn nowadays, there's a restaurant offering a new double-bacon cheese filled something or other that you can wash down with large fries and a 32 ounce soft drink. My guest is Dr. David Kessler. He's the author of "The End of Overeating: Taking Control of the Insatiable American Appetite." Dr. Kessler's a pediatrician who also graduated from the University of Chicago Law School. He also served as Commissioner of the U.S. Food and Drug Administration during the 1990s. And, Dr. Kessler, thanks very much for joining us.

DR. DAVID KESSLER (Physician/Author): It's a pleasure to be with you.

MYRLAND: I want to start the program, not so much by talking about the larger issue that we'll get to later, but I'd really like to talk about your personal story because I really thought it was an interesting personal journey that you have taken to come to the conclusions that you have about food and Americans.

KESSLER: It was very much a personal journey as well as trying to, you know, dig – understand the science. I mean I understand how it started. One night I was watching "Oprah." There was a woman on it, very well educated, very well dressed, successful in all aspects of her life, and she said I eat when I'm – my husband leaves for work in the morning, I eat before he comes home at night, I eat when I'm happy, I eat when I'm sad, I eat when I'm hungry, I eat when I'm not hungry and, she said, I don't like myself. And I was sitting there and trying to listen as a physician to what she was saying, also being able to relate to that because I have suits in every size. You know, so why were we doing things that we know they're not good for us. At least, you know, a number of us, you know, know are not good for us, yet we do it anyway.

MYRLAND: Yeah, I mean, and that's the question that I really think is kind of at the heart of your personal story. I mean, you, of all people, head of the Food and Drug Administration, both an attorney and a doctor, you – as a professional in the Food and Drug Administration, you had access to the absolute best kind of information about nutrition and health and yet you were struggling with your own weight. Can you talk about the irony of that a little bit?

KESSLER: It's the struggle, right? I didn't understand the struggle. I gave the book – I gave the book to my family doctor. He asked to read it. And, you know, he read it and he – and there was a very interesting reaction. He said, you're describing – I was describing him to him. You're describing me for the first time, he said, right. I never understood why I go reach for that donut. I didn't understand that. You know, the question is, why does that chocolate chip cookie have such a power over me? I mean, that's really, you know, what it boils down to. What I was trying to understand, you know, what was it? And I thought I would end up in the world of physiology, of endocrinology, you know, in medicine, and those are the worlds I, you know, I felt comfortable, but where I ended up, really, was, you know, very much in what makes us human. I mean, there is the neuroscience of it – I mean, but it's our brain and it's how our behavior becomes both conditioned and driven. I didn't understand that. I didn't understand why I was doing what I didn't want to be doing.

MYRLAND: Now when you started working on the book, you had to get information about what restaurants were putting into their food. And because of your knowledge as the head of the FDA, you knew what labeling requirements were there and you actually dove in dumpsters to find labels on boxes of commercially prepared food. Can you talk about that?

KESSLER: The Washington Post outed me. They wrote – I mean, I – we worked hard in the 1990s to put the nutrition facts panel on all packaged foods. You know that panel you see on, you know, when you walk into the supermarket where it tells you your percent daily value, how many calories. But what we didn't do, all right, was to require that in restaurants. We didn't have the authority to do that. You go into a restaurant, it's very hard to get that information. I, you know, I would ask people. And where did that leave me? I mean, the only way I can get it was to go look at what was actually being put in the food. And the way to do that was I had to go dumpster diving.

MYRLAND: And what did you find out when you looked at those labels and you collected the information and then you began to look at menu items and breaking down the things that commercially – that not necessarily individual restaurants but chain restaurants, restaurants with formulas were putting in our food.

KESSLER: Just take grilled chicken. You know, you're eating just plain grilled chicken, you think it's healthy, all right. But what I found, that grilled chicken is bathed, you know, in this, you know, this sugar-fat solution where it's – you know, it's mixed in these things, you know, like cement mixers where our food's injected with needles. It's as if it's pre-digested. I mean, pick any – pick a favorite, you know, American, you know what I mean, American restaurant appetizer. And you pick Buffalo Wings, all right. What is it? You take the fatty part of the chicken, you fry it in the manufacturing plants usually, you fry it again in the restaurant. That red sauce, sugar and fat. The white creamy sauce on the side, you have fat and salt. What are we eating? We're eating a fat-on-fat-on-fat-on-sugar-on-fat and salt. Now…

MYRLAND: And these commercially prepared foods are completely more saturated with those three ingredients, fat and salt and sugar, than you would typically do at home.

KESSLER: I went into one of my favorite Japanese restaurants and I was just eating string beans and, you know, they tasted great. And, you know, I knew the chef and I asked him. He said, oh, we double fry them. So you increase the fat content, you just load it. So it's thirty, forty, fifty percent fat.

MYRLAND: Now aside from the immediate health implication that that has, one of the things that you spend a lot of time in your book talking about is the longterm effects of being exposed to those foods and what that does to our desires and our palate.

KESSLER: Exactly. I mean, how our brains become conditioned and driven. Let me explain the cycle of consumption, all right. It starts, all right, I mean, it starts with – the next time you're hungry, all right, it's not – The power of food comes from its taste but it's the anticipation of the food that gives food its power. So next time you're hungry, you're picking up something to eat, try – figure out what the cue was. There's always a cue. Whenever I land in San Francisco airport, as soon as the plane lands on the taxiway, I start thinking about these Chinese dumplings. Why? Because, previously, you know, there's this place at the food court and I had been there. And just the plane landing on the taxiway, right, it enters my mind. Location. The location. We're such powerful learners. I was walking down Powell Street and I started thinking about chocolate covered pretzels. Why? Because months earlier I had been someplace on that street and bought some chocolate covered pretzels—I had forgotten about it entirely—but just being on that street was the cue. So you have this cue, your brain gets triggered, your brain gets activated. There's – It captures your attention, it occupies working memory, there's arousal, you eat. The next time you get cued, you do it again. Every time you do that, you strengthen the neural circuitry. But what's fascinating is that some of us are more susceptible than others. If – Let me give you three characteristics and three sort of behaviors. One is – and, you know, people self-report. Hard to resist your favorite foods, loss of control in the face of highly palatable foods. Two, a lack of feeling full, a lack of satiation. Three, a preoccupation, a thinking about foods between meals or sometimes when you're eating you start thinking about what you're going to be eating next. I mean, even while you're eating, you know, something, you're thinking about what you're eating next. Those three characteristics: loss of control, lack of satiation, the preoccupation with food. You know, I say that to some people and they have no idea what I'm talking about. Others say you're describing me. And what happens, if you take the people who report high on those characteristics—and there's millions, and it's not just people who are obese, it's people that are a healthy weight also have, you know, this constellation of desires and this consumer driven behavior. And you scan their brains and you just give them a cue, just the smell of food, for example, you see there's greater activation in the amygdala region of the brain. And then if – while they're eating, right, you see that that activation stays activated and then compare it to controls – I mean, it stays activated until all the food is gone. So fat – What we see is, fat, sugar and salt are so stimulating it's activating the brains of millions of Americans and getting us to come back for more, and that involves the brain circuitry. It's not a matter – This is not a matter of willpower, it's not a matter of just, you know, self-control or being lazy or not being well disciplined. Millions of Americans, their brains are literally being bombarded with these cues and it's activating them and they're coming back for more.

MYRLAND: I have to say, when I first started reading your book I kept thinking, well, some people are one way and some people are another, and then I got to the section where you talked about the studies that have been done since the 1970s showing the change of rate of obesity and the change in the American population and how even one of the researchers that you talked about didn't believe their own data until they went back and checked it because there'd been such a significant change. And the connection you make, of course, is to the food and restaurant industry becoming more sophisticated about how to create these tempting foods.

KESSLER: You're exactly right. I asked my colleague Katherine Flagel at the Centers for Disease Control, tell me how weight has changed over our adult years, you know what I mean, over the decades. You know, I mean -- You know, when we enter our adult years, right, how does our weight change over a lifetime? And if you go back to the 1960s and 1970s, weight was relatively stable. You would gain a few pounds between 20 and 40, relatively stable thereafter, then lose some pounds in your elder years. But what we see now is that the rate of increase – people continue to gain weight through their adult years but what's most dramatic is the weight at which people enter their adult years. Look at the weight of the average twenty-year-old today versus the average twenty-year-old, you know, three, four decades ago, and it's dramatically higher.

MYRLAND: And it's not just because people are generally getting a little bigger and a little stronger?

KESSLER: No. I mean, the people are getting bigger, okay, but the excess weight, which is dramatic, it's really starting in childhood, in adolescence. And what's happened? What's really happened in the last, you know, three, four decades? I mean, what's gone on is what – If you look at the business plans, you know, of the modern American food company, is they take fat, sugar and salt, put it on every corner, make it socially, you know – make it available 24/7, make it socially acceptable to eat any time. Make it into entertainment. Make it – add the emotional gloss of advertising. Say you're going to love it. You know, you do it with your friends. You know, we go out to eat and in many places, you go to a food court, it's like a food carnival. Food has become entertainment.

MYRLAND: And that's exactly what we're going to talk about for the next 20 minutes. I do need to take a quick break, and when we come back, we want to hear from our listeners as well. The number to call is 1-888-895-5727. We'll be speaking with Dr. David Kessler, author of "The End of Overeating: Taking Control of the Insatiable American Appetite." We'd love to hear from you, again at 1-888-895-5727. Dr. Kessler, thanks for being with us and we'll be right back after a very quick break.

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MYRLAND: I'm Doug Myrland. You're listening to These Days in San Diego, and our guest is Dr. David A. Kessler, author of "The End of Overeating." And, Dr. Kessler, I – when I was reading your book, I have to say that I felt a little conflicted because on one hand I was kind of appalled at how quickly we’ve changed and I really thought you made a very effective argument about all the different societal changes that have happened in the last 30 years and I was particularly struck by the one that says it's now acceptable to eat any place because that's something I've seen in my life as a baby boomer. You know, when I was young, you didn't see people eating on the street. It wasn't considered polite to be carrying a sandwich around. And now, of course, that's changed. And I began thinking about all those things but I also kept thinking, well, we live in a free society, it's a capitalist society, and these folks who own these food – these food purveyors have figured out how to get people tempted. Is this really a public policy issue? Or is it more an issue of people just becoming aware of how they're being marketed to? And I wonder, you know, especially since you were the head of the FDA and you've had to think about these things for your entire career, how do you separate, you know, individual responsibility from the need for a public policy change?

KESSLER: Very important points. Once you realize, you know, that it's our brains that are being hijacked, literally, by this sugar, fat and salt being placed, you know, on every corner and we're constantly being bombarded, does that mean that there are implications for things, you know – the food industry to change? Absolutely. Does it mean government should have greater disclosure, greater – help educate us? Absolutely. But there's still – Just because our brains are being hijacked, just because our brains are being activated, doesn't mean that we don't have responsibility to try to prevent that, to try to protect ourselves from that and to fight back. But look, if you recognize that our behavior's becoming conditioned and driven, it's not just us, it's our kids. And it's becoming conditioned and driven for a lifetime. I mean, doesn't that have implications for what we're serving in the school lunch programs? Doesn't that have implications for the kind of vending machines that are in the schools? Doesn't that have implications for the kinds of foods that we're subsidizing with our tax dollars? I think so.

MYRLAND: And I think we want to talk a little bit more about some of the suggestions that you make in your book about what kind of information would be appropriate to require that people have before they order an item from a menu but I do want to get to some of our listeners. We've got people who want to participate, and I want to turn to Tami, who's in San Diego. And, Tami, you've been waiting patiently to join the conversation. Please, welcome to These Days.

TAMI (Caller, San Diego): Hi. Thank you very much. I'm really intrigued by this conversation. I was thinking about my twenties. I could eat anything I wanted, ate everything I wanted, never gained weight. Then I hit my late thirties, I had a child, put on about 40 pounds and exercised more than I ever have in my life and can't take the weight off. But I find that my addiction or attraction to sugar and salt is overwhelming and I didn't notice it before I, you know, hit my forties and the weight wouldn't just go away anymore. I'll take any comments off the air. Thank you.

MYRLAND: Well, Dr. Kessler, do you think some of this is related to the changes that we all go through as we get older?

KESSLER: You know, I think that there's no doubt about that. You know, certainly – We certainly know the metabolism does change, you know, from adolescence and young adulthood to, you know, middle age. But, you know, the reality is that – it really is how our brains are being programmed more so than even our metabolism and what our environment is. You look at a lot of young kids today and, you know, they're – I mean, it's really concerning to me, as a pediatrician, how, you know, how big they are. So I don't think the metabolism of youth and even young adults is protecting the kids today. You know, the fact is, we were fortunate enough to grow up, you know, at a time when, you know, we ate primarily at meals, we didn't snack all the time. That's changed. That protected us in some ways. But we've now taken down those barriers and the food industry has figured it out.

MYRLAND: Let's take another call from Mike in El Cajon. Mike, you're on These Days.

MIKE (Caller, El Cajon): Hi. I have a son who's 22 years old and he's gained 50 pounds in the last five months. And he was an athlete in high school and community college and since he stopped playing sports, he's, you know, been eating more and gaining all this weight. And I bought him your book, tried to get him to read it. But it's been a hard sell getting him to change his diet because we're surrounded by all this food that's so tasty and full of fat and sugar and salt, and it's hard to find healthy food. And to find something that will actually, you know, be filling enough and satisfy your taste buds, it seems – seems hard to do.

MYRLAND: Dr. Kessler, how do you retrain your reactions that way?

KESSLER: Once that circuitry gets laid down, once that old learning is there, that old circuitry is there -- You know, please understand how powerful it is, all right. You know, and I mean, there's a part of me that just – You know, you have to be so – I feel bad – we have to be empathetic. You know, people who are big and fat, it's not that they want to be that way, it's not that – you know, the circuitry is so powerful. The only way to deal with it is to lay down new circuitry, new learning. But that's not the stuff of diets. It's not the stuff that changes, you know, automatically. You've got to change your relationship with food. You know -- You know, I would say to the caller's son, I mean, do you understand, you know, to the extent that all this fat, sugar and salt that's on every corner, sure it tastes good, but your brain is being manipulated. The industry's manipulating you. And that, sometimes, for young people, you know, I mean, helps, but they – In the end, it's only going to work if you find something you want more. It has to be internalized. No government regulation, no, you know, no policy change is going to make the difference for the individual because the circuitry is very powerful. Fat, sugar and salt tastes so good, you know, and together, you know – If you look at that huge plate of fries and say, that's my friend, that's going to make me feel better, I want that, I can't get in the way. It's very powerful. Only when you look at that huge plate of fries and say, that's not my friend, sure it'll taste good but I'm going to feel lousy afterwards, I don't want that. I don't want to just be eating food that's just going to stimulate me. I mean, fat -- You know, fat and sugar, fat and salt, fat, sugar and salt stimulate us to eat. I thought I was eating to be filled up. It only stimulates us to eat more and more.

MYRLAND: Dr. Kessler, is there a way, as an individual, when you can – to tell the difference between looking at that plate of fries because you're truly hungry or looking at that plate of fries because you've been programmed to desire it?

KESSLER: Oh, that's, you know – it's a great question. You know, people say, you know, only eat when you're hungry. Well, I was hungry all the time. I mean, I, you know – I mean, I didn't know the difference. Was I truly hungry? No. I mean, it was impossible that I was truly hungry because I had just eaten. But when your brain gets activated, when those reward pathways, I mean, are engaged, you feel hungry. And so it's very hard to sort that out. My -- You know, one of the concerns I have is, you know, I see kids ages four, five, six, I mean, who go through the day and they're eating constantly. They've never experienced hunger in their lives.

MYRLAND: I want to take another call from Marina in San Marcos. Marina, welcome to the program.

MARINA (Caller, San Marcos): Hi. Thank you. You know, this has been really great for me to hear. I'm a twenty-eight year old who's just now going through some major weight loss in my life. You know, my parents tried to educate me to eat well and it seemed like, you know, I was always struggling and then as soon as I was out on my own, I just lost all self-control. And now that I'm going back and, you know, I've lost a significant amount of weight and have a lot more to lose, it's just so hard because everywhere I go, just, you know, even things you think are going to be healthy, nothing is, and it seems like the choices, if you want to lose weight and eat healthy and you have to eat out, basically you can't or you have to just, you know, eat at home because everything that's made in a restaurant or processed or even available at the supermarket is just so laden with excess things that you can't eat anything. I'm having a terrible time dieting and going out to dinner with friends or anything like that because I – they just don't work together.

MYRLAND: Well, that brings us nicely to the public policy implications. And Dr. Kessler, you know, in your book you're certainly advocating for more regulation and more disclosure. I think it's time to talk about that a little bit.

KESSLER: But the caller just – was just so – those points were so insightful. You know, I have this cartoon in my head, you know, you look – you go to a food court, you know, and, you know, you see the signs on top of each of the stalls, and, you know, now I substitute when I look at it. You know, I think one, you know, should – the names are wrong. One should be called Fat and Sugar or the other one's Fat and Salt, the other one's Fat, Sugar, and Salt. There's noth – I mean, go into an airport, there's nothing to eat, I mean, that's just not loaded and layered with fat, sugar and salt. I mean, the real issue – I mean, again, policy's important, regulations are important but in the end, you know, how we look at the food is so key. If we look at it and say that's not what I want, I mean, I want something else, you know, I mean, that's the first – that's the real change that has to happen, the real transformation. You know, when – what was the success on tobacco? I mean, we have to be careful, there's similarities and differences. It used to be a product that we viewed as something that was glamorous, it was sexy, it was cool, that we wanted, right, and we didn't change the product but we changed how we perceived that product. You know, if we look at big food today and say that's great value, that's going to taste great, I want that, all right, you know, I mean, until we change and say, look, that's not my friend, that's not going to make me feel good, that's not going to satiate me, that's not going to fill me up, I'm not eating for fuel, I'm eating for stimulation, I'm being manipulated, I don’t want to do that. Until that happens, you know, we're not going to be able to get ahold of this issue.

MYRLAND: And in the meantime, people like Marina are, indeed, given very limited options, and eating at home seems to be the main one.

KESSLER: Well, you know, I think that's probably true but it's unrealistic, right. I mean, it's just, you know, we can create a safe environment in our home, we can get rid of all the cues, but you've still got to walk down the street. And it's so – you're going to get bombarded, you know, and so when you're out – I mean, I eat out plenty but, you know, I have a plan usually. And if you have a plan and you know what you're going to eat and you can, you know, follow that and it's something you want, a plan – food has to be pleasurable but at least you can avoid getting bombarded with the cues. Your brain doesn't get activated as much because if you know what you want then you can look at, you know, all this other food and say, that's not what I want and then your brain's not going to be activated. It's much easier knowing what you want, being able to substitute your rewards for what everyone else is trying to sell you.

MYRLAND: Let's take another couple of calls, and we'll start with Art in La Mesa. Hello. Good morning, Art.

ART (Caller, La Mesa): Good morning, Doug. First of all, let me congratulate you and the station and Dr. Kessler for the program, the nature of the program. You know, our city, like a number of other cities, are really focusing in a collaborative effort with the schools.

MYRLAND: And we're talking about La Mesa because Art is Art Madrid, who's the mayor of La Mesa. I should point that out.

ART: Thank you, Doug. Anyhow, we are one of six cities nationwide that has been funded by the Robert Wood Johnson Foundation to go ahead and address childhood obesity and childhood diabetes, exactly what the doctor's talking about. The data shows that perhaps in this next generation, it'll be the first time that kids, because of obesity and the related illnesses, may die younger than the previous generation. And I think what you're talking about is absolutely correct. It's all about education. Most of the cities throughout the country are recipients of some grants from the Robert Wood Johnson Foundation and the name of the game that we're talking now is working in collaboration with schools about educating about healthy eating, things of those nature – things like that and exercise, so it's really important. And I think the message that the doctor is giving is absolutely on target, really, really timely.

MYRLAND: Thanks for your comments. And, Dr. Kessler, I want to ask, are you optimistic about our ability to have a cultural change around food the way we did around smoking?

KESSLER: When you had a – just had a, you know, a wonderful – I couldn't have said it better than the mayor did. And when you have public officials that are as committed as he is, I mean, to working collaboratively with – the Robert Woods Johnson Foundation is one of the great foundations. I think that, you know, they really – I mean, their programs are key. I mean, our public officials have a responsibility, you know, to help educate us. I mean, that's the real goal, to give us the tools, greater disclosure, because, in the end, we're going to have to – this is – you know, we're going to have to internalize it. This is decisions we're going to have to make as individuals. No public official can do that but they can help make sure that our kids are educated, that at least, you know, the parents have a fighting chance. You can have the best foods at home, you can be the best role model, you send your kids to the school and that kid, you know, is eating just fat and sugar throughout the day. You know, you're – you know, it can be so frustrating. So we all need to be on the same page and, as the mayor said, you know, I mean, I think this is doable. It's harder than tobacco. You know, tobacco, we can live without, food we can't live without. It's very powerful, this neural circuitry. But I am optimistic. We turned around tobacco. It took us thirty, forty years. I mean, I think we can do this but we shouldn't underestimate how hard it's going to be.

MYRLAND: I want to turn to Evan in Encinitas who has a couple of comments. Even, welcome to the program.

EVAN (Caller, Encinitas): Hi. Yeah, I had a comment and a question. For the most part, I've stopped watching commercial TV. I watch PBS and listen to the radio, PBS radio. And since then I've noticed I don't have any cravings for fast food. If I get ads in the mail or grocery ads, I don't see anything there that I'd want to buy. And I wonder if there's any studies that you know of that would correlate weight gain with the number of hours that people watch television?

MYRLAND: Dr. Kessler, anything off the top of your head there?

KESSLER: I mean, you know – I certainly, you know, am not going to – you know, I'm not going to tell people to stop watching television but watch, you know – look at the ads. Look at the ads on TV for food, you know, and watch the food ads. Are they advertising nutritional value of food? No. What they're doing is they're adding the – you know, sometimes they advertise the economic value but most of the time they're adding the emotional gloss to food: You'll love it, you'll want it, you'll do it with your friends, all right. So they're creating the social norms that – I mean, that this is stuff – I mean, that I want to do, and when you're dealing with a reinforcing substances, when you add that emotional gloss, it's very powerful. If I just gave you a package of sugar and say, go have a good time, you're going to say what are you talking about? Now I add to that sugar, I add fat, I add color, I add temperature, I add texture, I add mouth appeal, I put it on every corner. I add the emotional gloss of advertising. I say you can do it with your friends. I make it entertaining. I – You can do it at the end of the day and you can release all that tension. What do we end up with? One of the great public health crises of our times.

MYRLAND: I certainly don't want to trivialize this at all but I also want to speculate about people's sales resistance. We live in a society where we get lots and lots and lots of messages about lots of ways to spend our money and live our lives. And I think, perhaps too optimistically, that most Americans have developed some resistance, some distance from those messages so that they're not vulnerable to every marketing idea. Is there something about these food messages that is more powerful than other kinds of what we consider normal marketing?

KESSLER: A wonderful question. It's very, very important. Food is not just any commodity. Food is reinforcement. You know, we all, you know, we – You look at an ad for a car or a pair of sneakers, that's not a reinforcing substance. When you start adding the emotional gloss to food—and food inherently is reinforcing—that's why it's so powerful.

MYRLAND: Well, Dr. Kessler, I really appreciate you joining us and I really appreciate all the listeners weighing in and I'm sure this is a conversation that, with any luck at all, we'll have as a larger society over the next several years. Dr. David A. Kessler's been our guest. The name of his new book is "The End of Overeating: Taking Control of the Insatiable American Appetite." Thank you very much for joining us. And we'll be back with more These Days right after this quick break.