The End of Overeating by David Kessler April 2009
Notes by Henry Lahore, Judy Lahore, wiki, interviews, full content on Google books, … May 2009
Pg 16 rats really like ‘supermarket food’. It was a good way of producing dietary obesity in rats.
P 83 63% increase in consumption of fats and oils in last 33 years. Also 19% increase in sugars and sweeteners (I expect much more if not done by weight), 43% more grain,
Pg 86 McDonald’s buns include high fructose corn syrup and 3 types of oils
Pg 91 Snickers bar is ‘extraordinarily well engineered’ a clean getaway. The caramel, nougat, and the peanuts all disappear at the same time.
Pg 95 digestive system is adjusted to chewing and making saliva. Apple sauce, hamburger, carrot salad etc do not require chewing and the body’s apastat does not get activated. Not true with apples, steak, and raw carrots (without high-fat dressing)
Pg 102 Bread is highly salted to take away the bitter taste of flour and bring up the flavor. Bread and crackers have a lot of sugar too.
Pg 111 General Tso’s Chicken did not have sugar when it was invented by a Taiwan chef
Pg 156 concentrating on NOT eating eventually pushes us to eat more. Like trying to not think about a blue elephant.
Pg 161 hypereaters report that food become more attractive/delicious as they eat more of it. For others the aroma, etc. become less pleasant over time as we habituate to it (during a meal)
Pg 174 Business meetings in America often include food. Business meetings in Europe rarely do it – it is bizarre.
Pg 174 Back in the 1950’s “people ate meals” – as a family. Snacks were the sole property of growing children – to nourish the growing body. Adults didn’t eat snacks.
Pg 176 until recently French restaurants did not even serve food except at meal times.
Pg 224 Talking down the urge
Eating that food will only satisfy me temporarily
Eating this is going to keep me stuck in the cure-urge-reward habit cycle
Eating this will make me feel bad
If I eat this I’m demonstrating that I can’t break free
I’ll be happier if I don’t eat this
I’ll weigh less tomorrow if I don’t eat this
( I’ll be able to jog easier if I don’t eat this or don’t eat too much Henry)
Pg 240 Nicotine is an example of a multisensory additions. Even the packaging which crinkles is important. Also tactile sensation of holding the cigarette.
****************** Judy's Notes **********************
Goal is to eat smaller portions of satisfying food and not need to get so much satisfaction from sugar, fat, and salt.
Principles of food rehab:
Conditioned hypereating is a biological challenge, not a character flaw. Recovery is impossible until we stop viewing overeating as an absence of willpower.
Treating conditioned hypereating means recognizing it as a chronic problemthat needs to be managed, not one that can be completely cured. [Unlike with other addictions, one cannot simply "stop" eating.]
Every time we act on our desire for sugar, fat, and salt, and earn a reward as a result, itk becomes harder for us to act differently the next time. Effective treatment breaks the cue-urge-reward-habit cycle at the core of conditioned hypereating.
The loss of control that characterizes conditioned hypereating is magnified by diets that leave us feeling deprived.
New learning can stick only when it generates a feeling of satisfaction. We can't sustain a change in behavior if it leaves us hungry, unhappy, angry, or resentful.
Restoring control over eating requires us to take a comprehensive approach, one that has many interlocking steps. To gain the upper hand, we need strategies that address the multiple behavioral, cognitive, and nutritional elements of conditioned hypereating.
Lapses are to be expected. Most of us are never fully cured of conditioned hypereating. We remain vulnerable to the pull of old habits, although with time and the rewards that accompany success, they do lose some of their power. With practice, we can find ways to use "slips" to our advantage, as tools for recognizing where we might stumble and reminders of the need to develop new learning.
Eventually, we can begin to think differently about food, recognizing its value to sustain us and protect us from hunger, and denying it the authority to govern our lives.
To change the way you eat, you'll need to focus on how you approach food, craft a plan to which you can devote concentrated attention, and recognize that making progress is incremental and effortful.
Need to develop new eating behaviors to compete with the old ones. This approach may be called "planned eating."
Planned eating is built on four elements: replacing chaos with structure, just-right eating [portion control], choosing foods that satisfy you, and eating foods you enjoy.
At first structure is imposed from the outside - with meal plans in advance that tell you what you can eat, when, and how much. You determine in advance what you'll put on your plat at mealtimes and for snacks. You write out your menus, and block out everything else. One rigid rule will be your guide; If it isn't part of your plan, you don't eat it. You do this to eliminate your mental tug-of-war. You need to ease the tension of temptation, to quiet the voices that argue back and forth.
The rules that support your structure must be simple enough to fit with your busy life, but specific enough to remove uncertainty from the food equation.
So you need to develop a set of meal plans and a repertoire of satisfying foods. These meals should offer sufficient variety to keep you interested, but enough predictability that you can avoid being stimulated and don't have to make continuous decisions about what to eat. [Maybe a minimum of 4 choices for breakfast, lunch, and dinner, and for snacks.]
As you learn to protect yourself from hunger and realize that small amounts of food can be satisfying, you will begin to feel more comfortable adding some flexibility to your meals. As you master the art of portion control, establish new habits, and realize that the triggers of overeating are beginning to lose some of their power, you may be able to end the total ban on foods high in sugar fat, and salt.
You need to figure out how much you should put on your plate so you feel satisfied until it is time to eat again. For most people a just-right meal is one that will keep away hunger for about for hours. A just-right snack should keep you satisfied for about two hours. [This may vary at different times of day]
It is important to think in advance about what a meal or a snack should look like, and then to put only that much on your plate. It is difficult for people with conditioned hypereating to stop eating if there is more food in front of them than they intend to eat.
People with conditioned overeating tend to overestimate how much food they need to hold them comfortably until it is time to eat again.
A useful way to gauge what will truly satisfy you is to eat only half of your usual meal. Then pay attention to how you feel 30 minutes later, and 90 minutes after that. If you are experiencing real hunger, try the same experiment again with 3/4 of your standard portion. Chances are good that you will find one of those servings to be enough - beyond that, you are eating for reward, not satiety.
Rather than count calories or weigh food, try to develop an intuitive sense of how much you need to feel satisfied. By paying close attention to how much food you eat and how long it sustains you, you learn that portions smaller than you've come to expect will hold you perfectly well.
What you perceive to be satisfying will help you determine whether it actually is. If you tell yourself that you are going to be hungry after you eat that, or that won't be enough when you're served a plate of food, then you'll probably want more.
Once you learn that smaller portions won't leave you hungry, you can begin conditioning yourself to think "That was enough" or "That was just right."
Choosing Foods That Satisfy You
Choosing what to eat is as important to planned eating as deciding how much to eat.
Most people find protein the most satiating macronutrient. Simple sugars offer the least satiation. Foods high in fiber tend to be satisfying. Fat is more complex. It can increase satiety, but the body processes signals from fat slowly, and it is easy to keep eating high-fat foods without feeling full. Especially in combination with sugar, or sugar and salt, the high reward value and high caloric load of fat become problematic.
Neither sugar nor refined carbs that behave much like sugar in the body, such as white flours and pasta, belong in the diet in significant amounts.
Basic formula for satiety: foods that occur in nature, consisting primarily of high-fiber or complex carbohydrates (such as whole grains and many vegetables) combined with protein and a small amount of fat are most satisfying. This means a diet based largely on lean protein and whole grains or legumes, supplemented with fruits and nonstarchy vegetables.
Within these parameters it's important to identify those foods that will satisfy you - and this is very personal.
Eating Foods You Enjoy
The only eating plan that will work for you is one built around the personal likes and dislikes you have accumulated over a lifetime.
Most combinations of sugar, fat, and salt will remain in the danger zone because they are so stimulating that most people can't limit themselves to suitable portions [chocolate, ice cream!]
You can incorporate rewards into your structure by choosing the ones you can control.[Limit, say, to 4 pieces of chocolate]
In athletics or food, mental rehearsal improves performance.
The idea is to run through every step in advance of the [eating] event. If you encounter this situation, then you'll behave in this way.
Your aim is to focus on the task at hand, rather than becoming distracted by external stimuli.
Letting Go of the Past
For a long time to come, you'll still have to fight the conditioned responses that drive overeating.
But if you're exposed to a cue and consistently manage not to seek out a reward, new learning will take hold in your brain, and the cue will begin to lose its powerful association.
As a conditioned response becomes less automatic, the cue becomes decoupled from the reward, the drive begins to ease, and in time, the stimulus can cool.
Seizing Conscious Control
Seizing conscious control is mostly a matter of paying attention and recognizing how quickly that attention can be hijacked.
You must be mindful of the stimuli that trigger automatic behavior - a hot slice of pizza, taco chips at a Mexican restaurant, or those aromatic Charlie cookies - and replacing them with foods that sustain you.
Mindfulness also allows you to recognize how entertainment - bustling crowds, lud music, bright lights, or the company of good friends [and wine???] - and the desire to feel better can wrest away your capacity to focus on what you eat.
Staying alert to emotional stressors is part of seizing conscious control, so that instead of responding habitually, you're equipped to act defensively.
Our conditioned response to stress is to eat.
A useful tool to help you step back from the habit of reaching for food when you're under stress is to label the feelings you're experiencing. You can begin by saying, "I feel sad," "I feel tired," or "I feel fearful." Recognizing your emotions and describing them helps you to look more objectively at your options for coping.
Indeed, may of us do feel better for a brief while after we eat foods high in sugar and fat. But the distortion in our thinking is that the new mood will last or that there is nothing else we can do to achieve the same effect. Ask yourself "Will eating help me truly deal with this feeling?" Most of the time it won't.
Consider other responses. Have a list of alternative responses prepared in advance, so that when strong emotions kick in and steer you toward food, you can quickly choose to do something different.
Getting Out of the Path of Cues
Once cues condition your behavior, you'll typically experience tension when you're around them and only eating brings relief.
So, whenever possible, you want to avoid being cued in the first place.
Breaking the grip held by these foods begins with eliminating most of them altogether. But remember that total abstinence is necessary only until you have learned to manage risk.
Figure out what leads to overeating. Make a list of the foods and the situations you can't control.
Refuse everything you can't control. Cut out all the foods on your list, and don't expose yourself to situations that promote the cycle of overeating behavior. Stay away from restaurants that layer and load meals. Avoid meals with friends whose food habits set your eating spiral in motion.
Have an alternate plan. Take steps to protect yourself. Your alternate plan will allow you to resist a cue that would otherwise draw you in.
Limit your exposure. If you can't avoid the cue altogether, limit the amount of time you're exposed to it. The longer you're in a stimulating environment, the more you're likely to consume. That's often the problem in a social situation - you may be able to turn away from a cue initially, but its presence will be a continued temptation until you give in.
Remember the stakes. Remind yourself of the chain of events that unfolds if you don't move away from cues. Remember how you feel afterward.
Direct your attention elsewhere. Keep yourself engaged with other thoughts that will crowd out cue-generated responses.
Learn active resistance. When other people are putting you at risk, you have a right to resist. Protect yourself by reframing seemingly well-meaning acts as hostile ones.
Dealing with Urges
Despite your most determined efforts to stay out of the path of cues, the contemporary food environment ensures that they will find you. Techniques for dealing with the resulting urges include thought stopping, conditioning a cue with negative, instead of positive, associations, and talking down the urge.
Turn off the debate.
Thought stopping is a definitive decision not to respond to the pull of a reward. Turning off a thought has to be almost immediate. Once you begin to debate "Should I or shouldn't I?" you've lost the battle.
Experience a cue, switch off the associated thought. No ambiguity, no maybes. Don't struggle with your response. Internalize a response to urges that is absolute, even rigid, leaving no room for doubt. Until you have gained the upper hand over trigger foods, an attempt at moderation won't work.
In order to distract yourself from a reward and keep unwanted thoughts from taking hold, you need to engage your mind [and body!] with something else. [Just say "NO!" or whatever it takes to switch to another thought or course of action. Slam the refrigerator door. Take a drink of water instead. Spin around three times. Shove the plate of cookies away across the table. Whatever. Have the response ready in advance.]
Condition the cue with negative associations. Think of something bad about the food, or its bad consequences. The idea is to undercut the reward value of the food, and cool down the stimulus. Make a list of these for your trigger foods. [For example, "If I eat this, I'll feel awful or bloated or gassy later, or it will bring on a colitis flare, or it won't satisfy me, I'll just need to eat again anyway." Or, "It's not going to make me feel better. It's not going to satisfy me." "Even though I'm really hungry, I can't eat that."]
Talk down the urge with a mantra.
Repeat to yourself "I am in control" or "I am a healthy person who makes healthy choices."
Use exercise as an alternative reward.
Exercise may be the most important predictor of sustained weight loss, because it is a substitute reward. It produces endorphins. Exercise can also reinforce an altered self-image. You begin to identify yourself as a healthy, athletic person, someone capable of making positive choices, and that in turn gives you an incentive to maintain control.
Be willing to change and also develop your personal rules about eating. View control of overeating as a personal challenge.
Make it a point not to go longer than three [or four] hours without a meal or an appropriate snack, and have the appropriate foods available. Identify 3 or 4 options that would satisfy you at every meal and cut out all high-fat, high-sugar foods. Remember that you shouldn't have to eat anything you don't like or avoid all foods you love forever. But you need to understand your own vulnerabilities so you can eat in control.
Always ask yourself how eating something will make you feel. "Am I going to feel better off after I eat this? Am I going to be satisfied?" ["Will I feel bloated or gassy or have to take Maalox because my stomach hurts?" "Should I stop now?" "Should I eat something else instead?" "Do I need some protein now? Some veggies or fruit?" "Can I put this in a box to take home or keep in the refrigerator to eat later?"]
One characteristic that defines long-term success is the ability to eat normally without becoming obsessive about food. Most people with conditioned hypereating take a long time, and struggle hard, to reach that place. Many people can protect themselves only with a focus that initially does border on obsession. When you focus hard on avoiding a food reward, you risk increasing its reward value instead. Your heightened awareness of those cookies means you must repeatedly deal with the urges they provoke. The danger is in becoming overly focused on food and your eating plan. When you use all of your emotional energy to avoid a behavior, you can become anxious and tense, and begin to feel deprived. The eventual goal is to gain enough control to move past full-blown obsession. [Or maybe work on your plan piecemeal, starting with the "easy" parts, and adding rules as you feel comfortable with the habits you've developed so far?]
With the ability to control your response to cues comes the reward of self-mastery. Soon you're inventing excuses for pursuing reward. In a series of small steps, you put yourself into a position where it becomes easier to access a [food] reward, and tell yourself "I'm entitled to this - I've been good all week," and your determination to say no buckles. Accepting these realities helps to keep you vigilant. Keeping relapse at bay is not about being strong enough to beat the temptation of eating stimulating food, but about being smart enough to deal with it.
Food rehab is not only about changing your eating behavior, but also about fundamentally altering your perceptions of hyperpalatable foods. The enduring ability to eat differently depends on coming to view these foods as enemies, not friends. The moment you're thinking, "I deserve this," or "I'll only eat a little, no one can remind you that you'll feel differently after the meal. But as you learn new approaches to eating and recognize the powerful influence of hyperpalatable foods, you will internalize these ideas more fully. Only then can you accept that food rewards are short-lived and that their more enduring effect is to sustain your desire to keep eating. That's when you realize that if you stay trapped, you'll never eat enough to feel satisfied, and that's when you'll stop expecting food to make you feel better. That's when awareness of the long-term consequences of conditioned hypereating hits with full force. When this happens, you will begin to assign different value to foods. You will have made that critical perceptual shift.
To live within a framework of planned eating, you'll have to understand your own behavior around food and pay attention to everything you eat. You'll need to seek out alternative rewards that satisfy you and find support from people who care about you. You'll need to bear in mind how the brain processes stimuli and how that drives your behavior in the presence of food and food cues. And you'll always need to remember what the food industry is trying to sell you and why. You will need to figure out strategies to deal with specific situations.
Those who maintain eating and exercise behaviors that led to weight loss for a year are significantly more likely not to gain that weight back.
Giving people specific rules and telling them that they are required to follow them as part of this treatment is better than telling them about principles of energy balance.
Repetitiveness and repeatability is key. That explains the success of the Subway diet, in which a man lost 245 pounds by eating only two Subway sandwiches a day. [Of course, he then needed additional strategies for keeping the weight off!]
[Our problem is that we see food as a reward rather than as fuel, and we are being taught by the food industry to regard it as such.]
Meal replacements promote weight loss because they provide structure. [Ensure, etc.]
We have known for a long time that certain stimuli, such as alcohol, sex, drugs, gambling, and food, can exert powerful effects on our actions. Much more recently we have begun to learn that these stimuli have a common, underlying mechanism, and the same general effect: They command our attention, occupy working memory, change how we feel, and become the focus of our single-minded thoughts.
Since we can't survive without eating, we need other strategies [than those used for addictions such as tobacco, alcohol] for changing our perception of foods that are superstimulants and for keeping them at bay.
Effective strategies for weaning people from hot stimuli are often built around substitute rewards [ gum, coffee, exercise?]. The substitute for rewarding food is often other rewarding food - not the kind that drives conditioned hypereating, but the kind we can nonetheless enjoy. The choice is individual, depending on what relieves our negative feelings and makes us feel good without the baggage and calories of superstimuli [and also balances the meal or snack, and doesn't upset the stomach or induce hypoglycemia.]
Some approaches pull the desire from its internal hiding place and make it external to the body so we can see it as a foreign object that we have the power to reject. People with anorexia are taught to see their disease as an outside force. [We can learn to see the food industry - restaurants, grocery stores, food processors - as an outside evil force trying to control us that we have the power to reject.]
In conditioned hypereating, food cues are the stimulus, overeating the habitual response. The ability to respond to urges for food is built in, but if you give in to those urges too ooften, the system becomes dysregulated. Then you're hypersensitive to these cues.
To cope, you must first recognize the automaticity of the response, and understand that if you take a single bite, you'll just keep eating until the food is gone.
Intervention begins with the knowledge that we have a moment of choice - but only a moment - to recognize what is about to happen and do something else instead. [So we need to have an instant alternative response ready to use in that moment.]
It is simply impossible to avoid the temptation of highly palatable food all the time.
We never fully unlearn earlier responses. The old habit is still there. We can learn something new, but we don't necessarily get rid of the old thing. Because earlier associations linger, they can all too easily surface under the right circumstances. We can practice new behaviors and learn new thoughts to keep the old ones at bay. Eventually these can become as automatic as our past responses, and when they do the stimulus begins to cool. [But we still have to remain alert for the old responses to reassert themselves - such as when I still - after 40 years - occasionally crave a cigarette momentarily at a party! I have to laugh at myself, and shake my head that I still respond to seeing someone else smoke as a stimulus.]
In the beginning, you'll need to control your actions carefully, but in the long term, you'll replace one set of automatic behaviors for another. But to do so requires repeated practice and enough behavior change to establish a track record of success. That, in turn, will reinforce your capacity to persevere. There must also be a motivational component to enduring change. You'll have to learn new habits that are rewarding enough to keep you from engaging in the old ones. [Such as, that wheat products cause a flareup. Don't think weight loss acts as an immediate enough reward for me by itself. I need to convince myself either that I don't really like a food all that much, or that it will make me feel bloated or bad in some way. Then I can avoid it. I MIGHT be able to convince myself to stop eating if I feel that to go on will make my stomach upset.]
Four major components of habit reversal have proven effective in dealing with repetitive behaviors: awareness, competing behavior, competing thoughts, and support. A fifth, emotional learning, has not traditionally been a part of habit reversal, but it may be the missing piece for treating the most recalcitrant habits.
Awareness - being aware means that you have a conscious knowledge of the risks of a given situation. You have to figure out the situation that leads you to eat, that leads you to start the chain of behaviors. You need to catalog all the stimuli, all of the situations, all of the cues that start that chain.
Sensory signals, stressful situations, and forceful memories are all invitations to out-of-control eating. [These are the kinds of things to catalog.]
Competing behaviors - we need to develop and learn alternative responses that are incompatible with your usual behavior. This competing behavior needs to be planned before you encounter a cue. You need to know exactly how to respond when your brain receives an unwanted invitation [so you can respond with the alternative immediately!] Write a cognitive script that halps us carry out new behavior and deal effectively with the old.
Competing thoughts - instead of responding habitually to the promise of immediate reward, we can make ourselves conscious of the long-term impact of eating highly palatable food. This shift of attention is a tool for gaining cognitive control that involves changing the way you think about the meaning of the stimulus. Thinking about outcomes changes how you feel about the situation.
Support - you need to have someone around who can help you recognize and avoid cues, and acknowledge your success. Of course, you must find the right kind of support. Otherwise, your support system can work against you, endorsing the type of behavior you're trying to reverse.
Rules - because people with conditioned hypereating are so sensitive to food cues, they tend to make eating decisions on the spur of the moment. To compete with the chaotic nature of that behavior, we need to develop a set of rules to keep us from becoming aroused.
What we need is to develop a planned response when we encounter a stimulating foods that drives conditioned hypereating.
Rules work in part by giving us an alternative to a conditioned response, forcing us to engage in contrary behavior that is incompatible with habitual behavior.
Once the stimuli that have been paired with the food are gone, the preference for eating the food diminishes.
Rules aren't the same thing as willpower. Willpower pits the force of reinforcing stimuli against your determination to resist, a clash that can become very uncomfortable.
A rule makes explicit the negative consequences of giving in to your impulses and the positive consequences of not giving in. Without any kind of context or motivation, there's no reason that you would inhibit the response of wanting it.
To achieve goals like maintaining weight loss and eating healthier food, you need to behave differently. The problem is that your brain hasn't been trained to respond to the message "No, it would be better for my health and my looks if I don't do this." It is more accustomed to responding to an immediate or sensory reward. [So you need to develop an immediate response that doesn't require a cognitive process of thinking thru the long-term reward.] If you can maintain focus and just have a rule to follow immediately, you can redirect your attention away from the stimulus. And, if you don't anticipate the reward, you can eventually reduce the behavior response and the brain imaging response to the cue.
Learning to act in a new way requires either being drawn toward something you want or being pushed away from something that no longer seems desirable. Learning comes most readily when the two occur together. [So you need a substitute - something you want - and a negative thought about the cue you were drawn to. You may also need a rule that you no longer eat this food.][Negative thoughts might include, "It's too rich, too greasy, will bloat me, will stuff me, will give me hypoglycemia, has wheat, is too spicy, I really don't like this food," etc. - think of negative responses I could make to various foods.]
To alter our behavior, we need to change our emotional appraisal of salient food. We begin that process by recognizing our capacity to assign food a value, either good or bad. If we learn to view the pursuit of sugar, fat, and salt in a negative light, and to imbue with equal emotional significance behavior that encourages us to turn away from it, we can reverse a habit. [Say "It's too greasy, too salty, too sweet, will just make a lump in my stomach, won't really satisfy me, or will take a too much to satisfy me, or tastes artificial."]
You can move from one highly charged affective appraisal to another - from "That's going to be fantastic" to "That's the most disgusting thing I have seen in a long time." [Exaggeration may help here - imagine this food in your stomach, or an enormous amount of it, or grease dripping from it, or the headache it may give me, etc.][Also think of yourself drawing a sword - maybe just a knife or fork - and spearing the food created by your enemy, the food industry, to trap you. "Ha, take that!" you say as you spear it, regard it, and demolish it, not with your teeth, but by smashing it down on the plate!]
Developing negative associations, sometimes called counterconditioning, has proved useful in reducing tobacco use, and might also be useful in dealing with specific foods [Twinkies come to mind].
Unless a person makes the cognitive shift, where it's more reinforcing to have a life without the substances than it is to have a life with them, recovery is not obtainable.
Cues to foods that are high in sugar, fat, and salt create emotional tension - and eating becomes a strategy for easing the stimulus-induced tension. This becomes habit, made automatic by the repeated experience of gaining reward and the learning attached to it.
The dieter who is successful eventually manages to have negativity automatically activated in response to the presence of chocolate cake. [For me that is bloating plus wheat, which brings on a colitis flare. I can eat the frosting, but it probably isn't worth it, and certainly isn't aesthetic, especially when eating with others.]
It would help to establish my "hungry" times of day, regular meal- and snack-times, and only eat then!
Learn to automatically assess the amounts of sugar, fat, and salt in a processed food in the grocery store, or on the menu at a restaurant. Then ask myself if I really want to buy it and eat it. Hopefully there are alternatives, or I can ask - in a restaurant - for an alternate preparation, such as serving the salad dressing or sauce in a separate dish.
The homeostatic system that's designed to maintain energy balance can go awry when animals have easy access to a variety of foods that are high in sugar and fat.
Set point theory doesn't work. If it did, it would protect against weight gain as well as loss, and it doesn't. It may be more useful today to think instead about the body's "settling point." Settling point theory goes beyond homeostatic mechanisms to make room for a number of independent influences on weight. Kessler hypothesizes that the point where our weight settles is primarily the result of motivation and availability - how much we want to seek out food and how readily we can obtain and eat it. In the short term, we may be able to restrict our eating, lose weight, and reach a new settling point. But if we return to earlier patterns and familiar environments, we will pursue reward with renewed vigor, gain weight, and return to the old settling point. That's why diets fail. Constant access to sugar plus fat, salt plus fat, and sugar plus fat plus salt pushes up the settling point. We move along the weight curve because the body's furnace is not burning quite enough fuel to keep pace with our energy intake.
Animals will work for foods that are high in sugar and fat even if they are not hungry. They'll also work for salt solutions. Fat, too, is a reinforcer, with a reward value that stimulates an animal to work. Animals are willing to work even harder for foods that are high in sugar and fat.
The location where the food has previously been available and the events associated with past consumption can also become reinforcers.
Quantity - give a rat two pellets of food rather than one, give a person two scoops of ice cream rather than one, and they'll eat more. Portion matters. Also variety. Sugar and fat are reinforcing, and cues, quantity, concentration, and variety all increase that reinforcement value. No everyone will go after these foods with equal effort. But sugar and fat, as well as the cues predicting that sugar and fat are available, can condition the behavior of those who are vulnerable.
David Aaron Kessler (born May 13, 1951 in New York, New York) is an American pediatrician, lawyer, author, and administrator (both academic and governmental). He was the Commissioner of the Food and Drug Administration (FDA) from November 8, 1990 to February 28, 1997.
After graduating from Amherst College in 1973, Kessler studied medicine at Harvard University, graduating with an M.D. degree in 1979, and law at the University of Chicago, graduating with a J.D. in 1978. While serving his residency in pediatrics at Johns Hopkins Hospital in Baltimore, he worked as a consultant to Republican Senator Orrin Hatch from Utah, particularly on issues relating to the safety of food additives, and on the regulation of cigarettes and tobacco. From 1984-1990, Kessler simultaneously ran a 431-bed teaching hospital in New York City and taught at the Columbia Law School and the Albert Einstein College of Medicine.
As FDA commissioner
Although his appointment as FDA commissioner in 1990 by President George H. W. Bush won bipartisan approval, many of Kessler's actions were controversial, and he soon became more popular with Democrats than Republicans. He moved quickly to make the agency more efficient, cutting the time needed to approve or reject new drugs, including AIDS drugs, and more vigilant in protecting consumers against unsafe products and inflated label claims. It was also under his watch that FDA enacted regulations requiring standardized Nutrition Facts labels on food. In one memorable action, he had 24,000 gallons of orange juice seized because although made from concentrate, it was labeled "fresh". Kessler was reappointed to the post of FDA Commissioner during the administration of Bill Clinton.
Kessler is also known for his role in the FDA's attempt to regulate cigarettes, which resulted in the FDA v. Brown & Williamson Tobacco Corp. case. The Supreme Court ultimately ruled that the FDA did not have the power to enact and enforce the regulations in question. He was awarded the Public Health Hero award on April 2, 2008 by the UC Berkeley School of Public Health for his work in tobacco regulation. Kessler published a book entitled A Question of Intent, which gave his view of his time at the FDA, focussing on his attempts to change tobacco legislation and the interpretation of that legislation, and his battle with the then-illegal but still used Y1 strain of tobacco.
After the FDA
He left the FDA to join the Yale School of Medicine as Dean from 1997–2003. In 2003 he was recruited to a $540,000 post as Dean and Vice-Chancellor at the University of California, San Francisco Medical School. Kessler began complaining in 2005 over the difference between the annual infusion of $46.4 million to the dean's office he thought he had been promised and the $28.8 million it was actually receiving, a discrepancy he traced back to 2002 and attributed to inadequate financial controls. J. Michael Bishop, Chancellor of UCSF, acknowledged that the financial data presented to him during his recruitment might have been misleading but UC audits found no evidence of financial irregularities and, in June 2007, Bishop demanded Kessler's resignation. On December 13, 2007, Kessler was formally dismissed. Kessler alleged he was fired for whistleblowing.
WSJ Book Review April 28 2009
By JEFFREY A. TRACHTENBERG
In a wide-ranging look at eating habits, David Kessler, the former head of the Food and Drug Administration, addresses America's ever-increasing waistlines in his new book, "The End of Overeating: Taking Control of the Insatiable American Appetite."
Former FDA Commissioner David Kessler speaks to WSJ's Jeffrey Trachtenberg about eating habits to avoid.
He interviews the overweight, who say that just the sight of a favorite snack food is enough to make them feel hungry, as well anonymous food executives who admit that fat, salt and sugar are often the building blocks of successful food products. The book was prompted by a question that had long nagged Dr. Kessler: Why is it that Americans continue to crave such foods as potato chips and candy bars long after they feel full? "No one has ever explained what's happening to them and how they can control their eating," he writes. "That's my goal in this book."
Dr. Kessler, a 57-year-old pediatrician, was commissioner of the FDA from 1990 to 1997. He is probably best known for his opposition to tobacco interests and efforts to better label food products. He is currently a professor of pediatrics at the University of California, San Francisco.
The Wall Street Journal: What most surprised you while researching this book?
David Kessler: I wanted to understand why it was so hard to control what we eat. I thought I was going to end up in the world of nutrition and endocrinology. I ended up inside the brain and inside the food industry. The metaphor for the book was: Why did the chocolate chip cookie have such power over me? I saw a woman on Oprah who said she ate when she was happy, when she was sad, before her husband left for work and then after he left. I wanted to understand what was driving her behavior. It was not just that she was eating too much -- she was eating when she didn't want to eat. And nobody could explain why. I wanted to know, how could we help her? What was driving her? The greatest surprise was understanding how highly palatable foods had hijacked her brain.
WSJ: Early on in the book, you suggest that the major food companies know what motivates shoppers.
Dr. Kessler: They know what drives demand, and they were able to design foods to be hot stimuli. The food industry says they only give consumers what they want. But what they want excessively activates the rewards circuits of the brain. They aren't selling just any commodity. They've designed highly stimulating products, and consumers come back for more. Nothing sells as much as something that stimulates the rewards-circuitry of the brain. It's all about selling product.
WSJ: What about restaurant eating?
Dr. Kessler: Much of what we eat in restaurants is fat on fat on sugar on fat with salt. Pick any dish in any mid-American restaurant. What is spinach dip? Fat on salt with green stuff. Look at the average salad we're eating. If you look at the bacon, the croutons, the cheese…it's fats, salts and a little lettuce.
WSJ: At times I couldn't decide whether you felt that the overweight were victims or undisciplined. Which is it?
Dr. Kessler: The answer is probably neither. Nobody has explained to people what is going on with them, or given them the tools to cool stimuli. Yes, you are bombarded throughout the day. You respond. And that creates torment for people. But just because we are activated and stimulated doesn't mean that that there aren't things we can do. Yes, their brains are being hijacked. But once we understand what is going on, we can change.
WSJ: What are the most important signs that people can recognize before they eat something they actually may not want?
Dr. Kessler: The fundamental question, when you look at food, is this: Is it real food, or is it food that is layered and loaded? It's easy to look at food and see what else is being layered on top of protein. I don't have a problem with a plain hamburger -- it's adding cheese and bacon. Also, you want a reasonable amount of food that you can control. Today if you put large amounts of food in front of me, I don't want it. But I used to go through big portions in an instant. We each have to decide what we find rewarding, and then decide how we control it.
WSJ: Regarding visual food cues, are you suggesting that the sight of a bowl of innocent M&Ms is enough to make us want to eat them?
Dr. Kessler: It depends on your past experience and what stimulates you. Everybody is different. For me it may be chocolate-covered pretzels. The one thing I can assure you: At the core, it's fat, sugar and salt. Not everything activates each of us the same. Here's the fundamental point: We are wired to focus on the most salient stimuli in our environment. If your kid is sick today, that's what you think about. For some people it's sex, gambling, alcohol. For many of us it's food. And within that category, different types of food are salient. You have to condition yourself to take the power out of the stimulus.
Dr. David Kessler
WSJ: Are we then all victims of subtle cravings whose genesis we're doomed never to understand?
Dr. Kessler: This syndrome of conditioned hyper-eating, which is what this is -- the loss of control in the face of highly palatable foods, lack of feeling full -- is reward-based eating. Not all are equally susceptible. Those obese and overweight have a greater incidence. But even 20% of the healthy report occasional loss of control. You will find people for whom food doesn't capture their interest, but it's probably a small percentage of the population. For the rest of us, it's a continuum. It's not only conditioned behavior. It's the learning and motivational circuits of the brain being captured. Is it nurture or nature? You expose children who are eating fat, sugar and salt all day. They've never been hungry a day in their lives. Once you lay down that neuro-circuitry, it's there for life. The actual act of consumption isn't as strong as anticipation. It's the conditioning associated with a cue. Once you are cued and you're activated, it amplifies the reward value. It torments you. You want it more.
WSJ: There is a lot of concern about obesity and children. What is the biggest cause? It is portions that are too large, or the wrong types of food?
Dr. Kessler: They are getting huge portions of very stimulating foods, hyper-palatable foods. You have huge portions of sugar, fat and salt. Every time they eat those foods it strengthens their neuro-circuitry to eat that food again. It activates them. Once these cues are laid down, and the information is in your brain, it stays there and drives behavior. This isn't a disease. But we've been captured by these stimuli. In the past, it allowed us to survive. Now we have health consequences because it's available 24/7 and we've added the emotional gloss of advertising.
WSJ: Is nutrition too difficult a concept to regulate?
Dr. Kessler: In the end it's not about regulation. Government can play a role. It's about how we as a country view the product. What was the real success of tobacco? We changed how we viewed the product. It was a critical perceptual shift. That's the key.
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AMAZON 26 5 star reviews May 5
69 of 72 people found the following review helpful:
Customer review from the Amazon Vine™ Program (What's this?)
I appreciated this book. I appreciated a health-related book discussing dieting that WAS NOT trying to sell you something. The research that went into this book is impressive and the results are fascinating. Turns out that along with our waistlines, processed food manipulation has been on the rise since the 1980's.
Food producers of all types have been seeking ways to make us want their product more, and it is working. The pleasure-seeking part of your brain is hard to turn off once saturated with key combinations of ingredients, namely fat, sugar and salt. We are hard-wired to seek foods with these ingredients combined, and the public has been trained to respond. The result? Severe obesity and obesity-related health problems in the numbers we have never seen before.
This book does a wonderful job educating the reader in what they are doing subconsciously. It gives power to those who walk around inhaling food and thinking, "why the hell am I doing this?!" Once armed with the knowledge, it is amazing how you walk through the grocery store and see the companies practicing what the book preaches.
You begin to read labels in a new way and ask yourself questions like, "why would this product have so much sugar salt AND fat in it, it's just plain spaghetti sauce?!" If you are a chronic dieter, you stop looking at just fat grams and calories and start READING the whole label. The book is completely right about so many products; fat, salt and sugar are there in combinations to solely get you hooked to eat more of the product.
This book is informative and well written; the style is very easy to read and understand without feeling talked down to. If you ever wondered why we are in the state we are in as a nation of consumers, you will enjoy the education you will get from this book.
53 of 55 people found the following review helpful:
5.0 out of 5 stars Superb Book On How and Why People Overeat As Well As How to Stop Overeating, March 9, 2009
By scesq "scesq" (New Milford, New Jersey USA) - See all my reviews
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This is a well-written, easily understandable, interesting book on the very serious subject of overeating. The book is broken into six parts with relatively small chapters ranging in size from approximately three pages to eleven pages in length with many in the four to seven page range. The first part, for example, has 13 chapters so there is much information but it is presented in a way which flows well together.
When I got this book I was interested in the subject matter but I was worried that the book would be boring or so technical that I would lose interest. I read this book in two days and it has changed my approach to eating.
Part One of the book, Sugar, Fat, Salt, talks about why people eat and overeat. It looks at the physical as well as psychological aspects of overeating.
Part Two of the book (my favorite), The Food Industry, gives specific examples of how restaurants and the food industry contribute to the problem by creating food that people want to eat but is not healthy. For instance I never new that bread had so much slay because it takes away the bitter taste of the flour and brings up the flavor. The author also addresses how nutrition information on packaging is manipulated by the food industry. For instance if a food contains more sugar than any other ingredient it must go first on the list but if you use a number of sources of sugar like brown sugar, corn syrup and fructose each is listed individually and goes lower on the list.
Part Three, Conditioned Hypereating Emerges, talks about how we get trapped into an overeating pattern. It references numerous studies and explores whether overeating is nature, nurture or both.
Part Four, The Theory of Treatment, talks about the theoretical way people can break the overeating habit.
Part Five, Food Rehab, offers practical ways individuals can stop overeating. The advice is great.
Part Six, The End Of Overeating, talks about the challenges ahead to end overeating. While it will not be easy, each individual has the power to end his or her overeating despite roadblocks created by the food industry or our own physical or mental makeup.
This is a great book that has started me thinking differently about food. It is well written and the best on the subject I have ever read.
25 of 26 people found the following review helpful:
5.0 out of 5 stars Excellent Book Provides Information That Will Help You Lose Weight, March 14, 2009
By J. White - See all my reviews
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This book is written in a clear manner that is just plain enjoyable to read and keep reading. This book discusses the how and why of why people overeat. The author a former Surgeon General is an excellent writer. After reading this book readers will gain understanding of why they overeat. Using knowledge gained I have already lost 10 pounds without working very hard at it. No need to describe in detail the contents here since others have already done it. If you are overweight this book is a MUST read.
17 of 17 people found the following review helpful:
16 of 17 people found the following review helpful:
4.0 out of 5 stars Title may be a little overreaching, March 18, 2009
By Edward Durney (San Francisco) - See all my reviews
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A fascinating story about people and our food. Not a diet book, and not a medical book, The End of Overeating falls somewhere in between the two.
Written by the former head of the Food and Drug Administration, the book reads very well. David Kessler still works in the medical field, apparently, and is now at the University of California, San Francisco. I'd say he will have a pretty good second career as a writer. Some doctors (like Michael Crichton, Tess Gerritsen, and Robin Cook) have done that, making the transition to best-selling fiction writers.
But how many doctors, let alone former government bureaucrats, can write compelling and entertaining nonfiction? Like the chapter on Cinnabons, that had me salivating and smelling those wicked treats just by reading the words David Kessler wrote? Not many.
The title did seem a little overreaching, though. David Kessler tells how many of us become "conditioned overeaters." That is, we eat foods laden with fat and sugar even when we are not hungry and even though we are desperate to lose weight. We hate ourselves for it, but still we eat.
David Kessler does offer some suggestions on what to do. From other reviews it seems like those suggestions have helped some readers. But I did not see anything in the book that pointed out how to Take Control of the Insatiable American Appetite. Or that foreshadowed the End of Overeating. I learned a lot about why we eat what we do, and that was interesting.
But even David Kessler admitted that he struggles with his own weight. The End of Overeating does not provide any big secrets on how to win that struggle. Just why it is a struggle. That story it tells very well.
11 of 12 people found the following review helpful:
5.0 out of 5 stars He tells it like it is!, April 15, 2009
By EMTP EJ "EJ" (Washington, DC USA) - See all my reviews
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Finally, a hard look at why America is becoming obese, even with diets and exercise. It's because of greed.
Dr. Kessler is an expert in several ways, so we should pay attention to what he is talking about: Medical doctor (Harvard), attorney, pediatrician, former Dean of Yale's Medical School, former vice-chancellor, UC-SF, former FDA commissioner, appointed by a Republican and re-appointed by a Democrat. Under his watch, the FDA had regulations adopted to require standardized food labels. He is also a husband and father and has suffered the same attack on our waistlines and health that all Americans have had to deal with the past few decades. Therefore, I believe what he has to say.
This book is about the physical and psychological aspects of eating and how the food industry manipulates the food and you so they can make a bigger profit. It also gives you some hope that you can identify and beat the game so you can live a better life. You need to read this book so you can understand how we have been manipulated into overeating so much that obesity is now an epidemic! You would think that someone would try and squelch this guy because the healthcare industry is also getting rich on the obesity epidemic as they are scheduling more and more elective surgery for some type of gastric bypass. Surely, you, yourself, know a growing number of people who have gotten or will soon get a gastric bypass? The problem is not with the person or even with the over-abundance, but with the food industry itself.
I, for one, learned that I have been taught (properly, mom and dad) to clean my plate, but if you have a meal at a popular chain restaurant, you will probably eat at least twice what you should without even noticing! I think before I even ask for a drink refill, I will as for a `to go' box from now on! That way, I can feel good about leaving a clean plate and also feel good about not overeating. I thought I was doing pretty well by removing the top of the bun of the burger- that's just the beginning. You need to be able to learn how to control how much and WHY you eat and not feel bad about yourself which would probably cause you to eat more...the loop is endless.
NOTE: In the edition I read, no one was trying to sell anything (as opposed to some other health-related books) but it did not include the end notes or an index. There was also no reference to " `Food Rehab' TM " in my version. The chapters are short and easy to read, but are not far removed from what I imagine some presentation slides and lecture notes from a `live' version would be like. I could see this as a very effective one or two day seminar.
Still, if you think you have been defeated by food and just can't control yourself, it's not you, it's the food industry. If you are a failed dieter or caring medical professional or a parent with a child that is on the verge of obesity, you will love this book!
Some other new books that you might find interesting are: The Instinct Diet: Use Your Five Food Instincts to Lose Weight and Keep it Off and The Beck Diet Solution: Train Your Brain to Think Like a Thin Person
10 of 11 people found the following review helpful:
5.0 out of 5 stars Not A Book About Food, Not a Book About Diets, FINALLY a Book About Appetite!, March 19, 2009
By Theseus "theseus" (US of A) - See all my reviews
Customer review from the Amazon Vine™ Program (What's this?)
And that's what interests me. I could read books all day about food production, food content, the powers of healthy food and not become involved with them.
This book starts where I start -- APPETITE. The hunger for satisfaction. The cravings for foods with sugars, fats, and salts.
God, I could go for a burger right now.
The author's tone is breezy, his topic is serious, his level of committment is sincere, and the amount of information contained in his little book is awesome.
Human hunger + corporate greed + products that magnify hunger = fat people!
7 of 7 people found the following review helpful:
4.0 out of 5 stars "Certain foods seem to exert a magical pull.", March 25, 2009
By E. Bukowsky "booklover10" (NY United States) - See all my reviews
(TOP 100 REVIEWER) (REAL NAME)
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Dr. David A. Kessler's "The End of Overeating" examines how food industry executives tempt us to purchase their calorie-laden products. The author, a pediatrician and former FDA commissioner, admits that even he struggles with the urge to overindulge. Why would a health-conscious and knowledgeable individual such as Dr. Kessler respond to the lure of highly processed and nutritionally deficient foods? To answer this and other relevant questions, the author conducted a series of interviews with psychologists, researchers, neuroscientists, addiction counselors, food producers, and ordinary consumers. One person he spoke to is forty-year old Andrew, an accomplished journalist who is five foot nine and weights two hundred and forty five pounds. Andrew ruefully admits, "I wake up in the morning knowing that food is my enemy." He turns to candy, pizza, and other treats for "comfort, stimulation, sedation, happiness, [and] the chance to put fun in the day."
Dr. Kessler maintains that part of problem stems from the fact that America has become a "carnival of delicious, fatty, salty, sugary, and ... accessible and cheap delights." Food industry officials spend a fortune designing products that condition us to stuff ourselves and come back for more. In the past four decades, busy Americans have grown increasingly addicted to fast food, portion sizes have grown, and many of us fail to get enough exercise. Childhood obesity is on the rise, which could lead to serious health problems down the road. To help us understand these phenomena, Dr. Kessler explains how and why our subconscious minds respond to certain stimuli, leading to habit-forming and self-destructive behavior that is difficult to change.
The author describes the ways in which brain chemicals influence our actions and he includes scientific studies to illustrate his points. Unfortunately, he has a tendency to repeat himself, and some of what he tells us is fairly obvious. For example, it should come as no surprise that "palatable foods arouse our appetite." On the other hand, Dr. Kessler is right when he insists that we must understand our self-destructive impulses before we can devise effective tactics to counteract them. If nothing else, "The End of Overeating" relieves us of some of the guilt that we feel when we reach for that extra donut, since we have been conditioned to munch on tasty foods for years. Although this book begins as a scathing indictment of the food industry, it concludes with simple and practical strategies to help us regain control of what we eat.
18 of 22 people found the following review helpful:
3.0 out of 5 stars The Reason We Overeat, March 13, 2009
By C. Huddleston - See all my reviews
Customer review from the Amazon Vine™ Program (What's this?)
This book is about overeating and the reason that people do it. Dr. Kessler pores through the research and details the physiological and psychological reasons for why we are drawn to overeat, and the way that big corporations use this research to make food products that are guaranteed to tempt us to over-indulge. It all boils down to sugar, fat, and salt, and how companies spend millions of dollars developing recipes and chemicals that will entice us, to over-ride our natural "homeostasis" that would normally keep us at an even weight.
The first part of the book deals with the physiological research, then the psychology behind overeating, and finally, at the end of the book are chapters devoted to dealing with all of these triggers, and helping yourself to get beyond the temptations and stay at an even weight. Kessler terms the overeating that we experience these days as "conditioned hypereating," a conglomeration of most of the theories that he looks into. I thought the book was well-written and engaging, and Dr. Kessler presents the information in the form of interviews so it doesn't get bogged down in boring data and tables. I definitely saw myself and a lot of my eating habits in the people that he writes about.
Kessler doesn't give a detailed, step-by-step diet plan, but instead gives the reader various psychological strategies that we can use to overcome conditioned hypereating. Most of these ideas were good (and common-sense), though some might be hard to do. He does give a big dose of reality in stating that if we have a problem with overeating, we will always have to be extra careful around foods that use the fat/sugar/salt equation to tempt us.
I did notice one error (he calls mashed potatoes simple carbohydrates, when I *believe* they are considered complex), and one big problem with the book is that there is no index or bibliography (though I read an advance copy so it might be added in to the finished book). This is a good book for anyone who has always wondered why they can't stop eating that bag of potato chips, or why one bite ends up being the entire plate.
6 of 6 people found the following review helpful:
5.0 out of 5 stars Hypnotic lure of food preoccupies your thoughts? You MUST read this book!, March 16, 2009
By K. Robertson (southern Virginia) - See all my reviews
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I believe we've always known that food exerts a very strong pull over us, especially when you're talking about those enticing ads on TV, but until I read this book, I didn't fully know how this took place -- you know, the science of it all. The author, Dr. David Kessler, presents expert after expert that discuss the way in which food manufacturers have, over the years, learned how to "design" food which basically cannot be resisted by the normal human being.
Whereas we used to have, say, a good ol' apple pie from Grandma, we now have "super pie," in that research is done to create foods that are "hyperpalatable" and squarely hit our "bliss point" with the exact amount of sugars, fats, and salt that hit our pleasure center hard....like a drug. In fact, manufacturers have gotten really good at this, and these highly-palatable foods actually affect the electrical activity in our brains, creating an intense "anticipation" (the ultimate goal of food designers) when we're confronted with them. Also, extensive research is done on creating exceptional visual appeal, tantalizing mouth feel (even to the point of making foods soft and easy to chew, i.e. pre-digested), and enticing aroma, in order to grab us and keep us coming back.
One fascinating chapter was about the creator of Cinnabon, Jerrilyn Brusseau, and how she came about creating the "perfect" cinnamon bun. She originally made them for her famly, but this turned into a business, wherein she attempted to find that "bliss point" to make her buns the best in the world. This would make someone who can't get enough of them angry and frustrated, except for the fact that she discusses that she never intended for her cinnamon buns to be eaten several times a day -- they are "once-in-a-while" indulgences. That's all fine and good, unless you're on the receiving end of her hyperpalatable product!
Now, I know that if creating and manufacturing food is a business, then owners will want to excel and make as big a profit as possible. However, I'm sure none of us wants to feel that we are being manipulated to want (and MUST GET) anything...including a burger or a big dish of pasta (which, by the way, looks nothing like what you get in reality). We are not told in commercials or packages that research has been done to get us addicted to that food, so we'll eat it and keep coming back to get our "fix." It's not discussed that the calorie and fat count far exceeds anything that Grandma made, or that we could make at home. And we're also not told that exposing our children at a young, impressionable age to hyperpalatable foods creates an unrealistic expectation of what "normal" food should taste like, and, need I say,
has helped to create the epidemic of obesity we're having worldwide.
The last section of the book focuses on "food rehab." Of course, the majority of the book discusses the biology of how we've gotten so attached to food, and "knowledge is power." I believe this is the main draw of this book. But he also mentions several strategies to pull ourselves out of the ratrace that we are in, such as increasing structure of mealtimes so that unplanned eating is limited, behavior mod techniques of keeping your mind from focusing on food by doing other activities, and "thought stopping." I have heard of "thought stopping" technique before in helping control negative thoughts, but never heard it applied to helping control overeating. He quotes Dr Richard Rawson, who coined this term and who works with drug addicts, as saying that there is a small window of time in which we must say "no!" to a food, or continuing to eat a food, or we lose the battle when we begin to debate our decision. (I found this very valuable and have been using it successfully since I finished the book!)
I highly recommend this book for anyone who is in the daily fast-food cycle, and for anyone with children. As someone who was raised on fast food, I can identify with the struggle of thinking that a Whopper is how burgers are supposed to taste, when a homemade burger is so much healthier, but may not taste as "blissful."
5 of 5 people found the following review helpful:
5.0 out of 5 stars Best Book on Obesity and Overeating Ever!, May 2, 2009
By G. Hoza "Pax Vobis" (USA) - See all my reviews (REAL NAME)
To begin with this book is written by David A. Kessler, MD, former commissioner of the FDA and pediatrician. He is well qualified to proffer a diagnosis and treatment program for overeaters and obese people who got themselves that way by overeating. In this book which I believe is truly groundbreaking Dr. Kessler explains why we eat and then keep on eating long after we have ceased to feel hungry, and then proscribes control mechanisms to stop overeating. I must say Dr. Kessler is a great writer which is not true for most scientists. The book reads well and the topics covered are short and covered in a few pages: just enough material to get me interested and read to the end of each topic. My advanced uncorrected proof is filled, page after page with my own handwritten notations, underlining and highlighting of important and most profound statements. After reading the book I felt as though I was privileged to have been let in on the answers to my own overeating tendencies. I could never understand why I ate more than I needed to before but this book explains why and how to stop.
I had no idea that for thousands of years people ate what they needed and nothing more. Consequently with exercise most people were not obese. Dr. Kessler explains that all that changed in the 1980's where food preparers, restaurants and the like studied and learned what causes people to enjoy food and eat more. These same businesses decided to utilize this science to enhance their bottom line and the consequence for corporate greed is a nation of fat, unhealthy people. What makes all this worse is that most of these same people would most likely not be obese and unhealthy prior to the 1980's. It was the science around "sugar, fat and salt" coupled with the art of skillfully putting them together to drive our palates crazy that did us in. The more we ate what we loved to eat the more we wanted more. It is kind of like sex in a way. Apparently sugar, fat and salt in the right combinations create all sorts of stimuli in the brain and body that coupled with memories of the places and settings that we enjoyed this feast create Ivan Pavlov like cues that condition us to respond like a dog hearing a bell at the same time as food is presented. So over time driving by an Olive Garden in one's car would just make one's mouth start to water. Soon images of that cheesy pasta with free extra bread sticks would appear in one's mind. A desire to drive into the parking lot would soon ensue. Entering the restaurant and experiencing the familiar (all tied together to past memories) ambiance would reinforce action to have a seat and order that large dish which one is now craving. Taking the first bite and experiencing the right scientifically combined amounts of sugar, fat and salt sets the body's chemistry, endorphins and happiness enzymes into high orbit. Next thing one knows it that a normal portion of food was eaten 20 minutes ago and now one is still eating. It is all like Soma from a Brave New World Revised novel by Aldous Huxley where food becomes our escape from the harsh realities of the world. My Olive Garden analogy is but a "taste" of what Dr. Kessler explains very well as "conditioned hypereating." If you want to know more about why you weigh more than you should you really need to read this book. It just may save your life. It may have saved mine.
In fairness to the author, rather than give away the many secretes of changing this destructive pattern of behavior I would recommend you buying this book if you have an overeating problem. The answers that he gives will empower you to change.
7 of 8 people found the following review helpful:
5.0 out of 5 stars Why You Can't Eat Just One - It's Not All In Your Mind...It's in your Brain - How the Industry Manipulates & Contaminates Food , February 25, 2009
By javajunki "javajunki" - See all my reviews (TOP 1000 REVIEWER)
Ever wonder why those diet cookies like Nabisco Snackwell's keep you coming back for more? Is it true you really "can't eat just one"? What is "Butter Plus" and how does 1 lb of "fake" butter turn into 50 pounds of junk for your gut? These and many other mysteries are covered in this newly released book by former FDA commissioner Dr. David Kessler.
A few items worth mentioning, I am reviewing an advance copy so there may be small changes from the final product. With that explanation, there are some odd areas of the book that leave the reader wanting more. In fact, one chapter seems to end very abruptly (the description of the Cinnabunn entreprenuer) to the point that it appeared the chapter wasn't complete. Other areas of interest - particularly those related to concepts such as chemical engineering of foods and flavors - seemed very incomplete. While the author does a fine job discussing the cognitive foundation related to food addiction including brain chemisty related to the "big three" (fat, sugar and salt), little explanation was provided for how flavor enhancers, chemicals and other engineering impacted the brain. Outside of wishing more attention/depth had been provided to some of the areas, this was still an enjoyable read with some interesting tidbits. It is very reader friendly - written for the lay consumer - not scientific audience.
The author freely admits to facing his own challenges regarding his relationship with food which I suspect will appeal to readers fed up with instructive discussions about food that lack the emotional and mental pull. However, as a person with a few of my own food related vices but generally very conscientious about what I eat or bring home from the grocery store, I was personally a bit "put off" by the abundant and very descriptive examples the food relationship. I suspect a large number of readers interested in ths book will be health conscious rather than overweight...if so, be aware this book is geared toward weight loss and/or food addiction more than actual healthy alternatives to what is being done to the food supply.
There are some common sense approaches to taking control - without any attempt to sell an expensive diet plan or other services...just good advice on breaking free of the contamination and manipulation that is behind the addiction, cravings and weight gain associated with processed foods. Big tip - you need to cut and chew food! If it "dissolves" in your mouth or requires minimal chewing then avoid it. Other tidbits are scattered throughout such as how the industry avoids having to list sugar at the top of the ingredient list by using various types of sugars - for example, cereals. By using several forms of sugar they can list each individually lower on the ingredient list thereby making the food seem less diasterous than it really is.
Overall, a good read! I enjoyed the authors easy - conversational tone. It was informative yet not condescending whatsoever. Very reader friendly although I personally would have preferred more in-depth discussion of some topics and even more facts. I would have also enjoyed citations and resources for more information but guess I might be in the minority on that count. Strong appeal for those fighting against weight gain or food addiction as well as those concerned for their children's health. The author brings up startling research related to changes in diet, satiation and other factors related to children - even toddlers - which will have profound impact on the future of this nation.
Quick Addition..it has been brought to my attention via the comments section that citations and references WILL be included in the final copy - a terrific addition for those of us who are data driven. Apparently they will be fairly extensive which may widely enhance the appeal of this book for those with more than a passing consumer interest in the topic.
5.0 out of 5 stars There's A Reason Why You Overeat And It's Not What You Expect, March 23, 2009
By Livin' La Vida Low-Carb Man "Jimmy Moore" (Spartanburg, SC) - See all my reviews
As a former 400+ pound man, I know what it's like to overeat. You don't get to that level of morbid obesity without consuming food in excess and there's a perfectly good reason why so many of us have that urge to eat like there's no tomorrow. Former FDA commissioner Dr. David Kessler examines this issue and dives head first into explaining his theory behind why people can't seem to control their desire to eat, eat, eat. Not surprisingly, he says we have become so conditioned to eat certain foods that drive us to eat more of those foods (can you say carbohydrates?) that we no longer eat for hunger-but instead do it as a "reward" for our accomplishments. You'll read some fascinating research on this issue that points the finger at some of the biggest names in the fast food and food manufacturing industries for marketing to a targeted audience destined to fall lockstep into faithful obedience to out-of-control eating. This isn't an easy read, but one worth exploring if you've ever felt compelled to pounce on a Cinnabon!
Interview on Huffingtonpost
Louise McCready Posted May 4, 2009
Last week, Dr. David Kessler, former commissioner of the US Food and Drug Administration under presidents George H. W. Bush and Bill Clinton, published The End of Overeating. During a seven-year investigation, Dr. Kessler met with scientists, physicians, and food industry insiders to learn why humans cannot resist food. For many of us—myself included—the Pringles slogan, "Once you pop, you can't stop," is true of a variety of foods, from M&M's and pretzels, to nachos and ice cream. Regardless of how hungry we are, the smell of freshly baked bagels or the sight of Girl Scout Cookies, starts a feeding frenzy that ends only when the plate or bag is empty.
In The End of Overeating, Dr. Kessler explains how humans, much like Pavlov's dogs, become hardwired to anticipate foods with fat, sugar, and salt. The food industry has learned what humans want, and is only too happy to give us what we crave. We quickly become trapped in a vicious cycle of dopamine-fueled urges when we want food, and opioid releases when we eat it. If dopamine and opioid sound familiar, it's because they play a major role in alcohol and drug addiction. Dr. Kessler draws a direct connection between food's power over people, and the pull of alcohol and drugs. It truly isn't a stretch to say, "I'm addicted to chocolate."
Today's overeating epidemic has yet to result in lawsuits or FDA warnings, but a change in public opinion towards highly salient foods is exactly what the doctor prescribes. Like other public campaigns, education is power, and the first step toward regaining control of our appetites is to read this book. On the day of his book's publication, Dr. Kessler took time from his busy schedule to speak with me about what inspired the book, what he learned, and how we can change the way we think about food.
LM: This book started while watching an Oprah episode. Prior to that, had you ever seriously considered why food has such a pull over people in general, or you in particular?
DK: We implemented and helped design the food label—the modern nutritional facts that appear on the back of most packaged foods—back in the 1990s. That label was about the ingredients and nutritional value including percentage of daily values, but I never looked at the question that way. After watching that episode and that woman who couldn't control her eating, I said to myself, "What's going on?" As a physician, I asked myself, "What's driving this?" I spent the next seven years trying to figure the answer to that out.
LM: In your book, you discuss the business of food, explain how the food industry tries to manipulate appetites, and go so far as to make comparisons to big tobacco by implying that food has a pull over people the same way drugs do. Do you think that these food industries will be vilified or held financially accountable for obesity related diseases in the future?
DK: Fifty years ago, the tobacco industry, confronted with the evidence that smoking causes cancer, decided to deny the science and deceive the American public. Now, we know that highly palatable foods—sugar, fat, salt—are highly reinforcing and can activate the reward center of the brain. For many people, that activation is sustained when they're cued. They have such a hard time controlling their eating because they're constantly being bombarded—their brain is constantly being activated.
For decades the food industry was able to argue, "We're just giving consumers what they want." Now we know that giving them highly salient stimuli is activating their brains. The question becomes what do they do now?
If a bear walked in here right now, you would stop listening to me and you'd focus on that bear. We're all wired to focus on the most highly salient stimuli. For a lot of people, that highly salient stimulus is food. It could be alcohol, it could be drugs, it could be gambling, but for many people, it's food. It's not just people who are obese, or overweight. Even for people that are healthy weight, food activates the neural circuits of their brains, and they have this conditioned and driven behavior we call conditioned hypereating.
LM: I admit I've noticed some of those same characteristics in myself.
DK: For one gentleman I spoke with, the hardest thing for him every day is to get home past the newsstand at the train station because of the Kit Kats. For him, it was Kit Kats, for someone else, it's chocolate chip cookies, but one of the key core features is sugar, fat, salt. Once your behavior becomes conditioned and driven, you get into this cycle and you get cued. When the neural circuits get activated, it focuses your attention. There's a bit of an arousal as you have increased attentional focus, and then the only way to get it out of working memory is to consume the product. The next time you're cued, you eat again, and you're in this cycle. Every time you do it you strengthen it.
Not only is there amplified neural activation in the anticipatory phase with people with conditioned hypereating, but as they're eating, the stimulation stays sustained
so it's very hard to stop. It isn't until the food's gone—considerably later—do you feel full because the reward circuits are overriding the homeostatic circuits.
LM: When you spoke with top executives at one of the world's largest global food companies, and you presented an overview of the information in this book, one executive rightly said, "Everything that has made us successful as a company is the problem."
DK: Putting sugar, fat and salt on every corner, that's been the business plan. You make it not only accessible, but you make it socially acceptable, you create the social norms, you add the advertising, the emotional gloss.
LM: You said the company began to rethink their strategies about labeling and portion size, but how realistic is it to think that companies will change their tactics if it's not financially lucrative? Do you think there will be some sort of government regulation?
DK: Government has a role to play, but if you look at the great public health successes, they come from changes in how we perceive the product.
The success on tobacco wasn't done by regulation or legislation—it was done by changing how people perceived the product. From, "That's something I want, that's glamorous, that's sexy," to, "This is a deadly, disgusting product."
The real goal is to change how you view food. If you look at something and say, "That's going to make me feel good. I want that," your brain's going to get activated. If you look at it and say, "Ugh, that's disgusting. I'd rather have something else," your brain's not going to be activated. You have to take the power out of the food by changing how you view the stimulus. It's food rehab. It's new learning on top of old learning—you never get rid of that old learning, those old neural circuits.
LM: I understand that much depends on the individual but do you have any suggestions for President Obama or the government? Is there any way they can help?
DK: The woman on Oprah had no idea what was going on. No one told her what was going on. In some ways, it's not about will power and it's not her fault. That doesn't necessarily mean there's nothing she can do, but if she's constantly being cued, constantly being bombarded with these stimuli, and her brain is conditioned and driven to respond to those stimuli, we first have to educate.
Two, is full disclosure of what's in food. If your chicken is injected with sugar and fat, and your food is loaded and layered upon layer with fat on sugar on salt, there needs to be disclosure.
It also is how you look at advertising. If advertising was meant to just convey information to consumers and it was neutral, that's one thing. But if advertising is a cue, then it gives you greater reason to regulate it, especially to kids.
In the end, it has to come from what do we want? What do we view as desirable? What do we view as socially acceptable? A lot of this is social norms. If I can walk down the street and be eating sugar, fat, and salt at any time of the day, on every corner, and that's viewed as what we find rewarding rather than disgusting, then we're going to continue with this epidemic.
LM: That ties into what you were talking about with eatertainment as an aspect of this phenomenon.
DK: If I give you a pack of sugar, and I said, "Go have a good time," you're going to look at me and say, "What are you talking about?" Now I add to that fat, and temperature, and texture, and mouth feel, and color, and I'm going to put it on every corner, and I'm going to say you can do it with your friends, you can do it at the end of the day when you want to relax, and I add all the television monitors and the color, so it's a carnival sort of atmosphere, who wouldn't want to get on the ride?
LM: What was the most surprising thing you learned during your investigation?
DK: I didn't literally understand why that chocolate chip cookie has power over me. I didn't understand why my hand was reaching. Only when I understood how my brain gets activated, how my brain gets encoded, did I learn that the power of food comes from our ability to anticipate it. Have you ever been eating and all of a sudden, as you're eating food, you start thinking about what you're going to have next?
LM: (laughing) Yes.
DK: It's sort of bizarre, right? It's that power of anticipation that drives the behavior, even more than the consumption. When you're actually eating, it, you go ehh ehh.
LM: It's not that good.
DK: It's not that good, but it's that power of anticipation. Understanding that food has more power than we realize, was the most important thing.
LM: Do you consider hypereating an effect of more disposable income or a higher standard of living? Is this unique to our period of time?
DK: We always were wired to focus on the most salient stimuli. It's just that the food industry has been able to manufacture food that's so highly salient. We always had salient foods when I was growing up, but desserts occasionally or foods that were fats on fats occasionally. Now we have them 24/7, all the time, breakfast, lunch, dinner, and throughout the day. That's the difference.
LM: It's availability?
DK: It's availability as well as acceptability—put those things together. Hypereating starts with sugar, fat, and salt, and then you add the stimuli associated with that, the emotional gloss, the availability, and the accessibility.
LM: What percentage of Americans would you say suffer from hypereating?
DK: It's a continuum. For probably 15% of the population, and that's just a guess, food is not a very salient stimuli in their life. You ask them, and they say, "I can eat or not. I have to eat in order to sustain myself, but it's not a large part of my life." That's a minority of people. If you look at the rest, and you ask them whether they have a sense of loss of control in the face of highly palatable food, if they have a lack of satiation—a lack of feeling full—when eating highly palatable food, and a preoccupation of thinking about food in between meals, about 70 million people would score pretty high on all three characteristics.
LM: Is there anything else that you would like to add or say?
DK: There's a lot out there about the food industry, and who's the villain, and who's the victim, but what's important for me is to explain to people—to the woman on Oprah—what was going on with her. I wanted to figure out what was going on, and the book was written to help people who don't understand why they have such a hard time overeating. My family doctor said to me, "You're describing me. No one ever described me to myself. No one explained to me why I keep on eating."
Co-author with Kubble Ross on the Life Lessons
Interview on PBS Frontline on Tobacco
Dr. Kessler is the former commissioner of the Food and Drug Administration under both Presidents Bush and Clinton. He began looking into the regulation of nicotine as a drug and was instrumental in convincing Clinton to enact tough federal regulation of tobacco. The tobacco industry fought this in a North Carolina court and the FDA won. Kessler has been generally opposed to settlement with the tobacco industry and supports tough legislation against advertising to children.
In July 1997 Kessler became the Dean of the Yale University School of Medicine. Interview conducted in March 1998.
Q. How difficult an adversary was the tobacco industry, let's say, in 1992?
Kessler: No matter who you asked, anybody you asked whether you can take on tobacco. You get the same answer. You can't do that. It'll be hard. It's impossible. It's a fool's errand. No matter who you asked you got the same answer. You can't do that. They're just too powerful. You can't take on the tobacco industry.
Q. Politically you can't take them on? Legally? Anyway?
Kessler: In 1991 and 1992 people asked a very simple question. Why doesn't the federal government regulate tobacco? Very simple question. Everyone you asked would give you the same answer. You can't do that. You get your head handed to you. It would be political suicide. You would put not only yourself but an entire agency in jeopardy. It would be a fool's errand.
Q. You were in the Bush administration during that period of time. You couldn't do it then, why?
Kessler: We weren't ready to do it. We didn't, we had not thought through what it would take. We hadn't done our homework. It took us 2 to 3 years to write a simple three page letter. We issued that letter in February, 1994. That letter turned out to be a critical turning point. It was the first time that the Federal government it would consider regulating tobacco products. First time in 30 years since the Surgeon General's report in 1964 that linked smoking and cancer. The Federal government it would consider regulating tobacco products if there was evidence that the nicotine in cigarettes and smokeless tobacco were drugs under the federal law.
Q. How important was it that Bill Clinton was president of the United States when you did that. You got to step back.
Kessler: What happened here was we had to ask the right questions. Is nicotine a drug? You and I think we know the definition of drug and we know that a definition of a drug in common parlance, but the legal definition of a drug is different. It goes to what a company knows, what a company intends by an agent. And no one went to look before at what the companies knew about nicotine.
So, the first part was finding out whether nicotine was a drug under the Federal Food Drug and Cosmetic Act. It required us to figure out, to look for the first time and ask the question of what the companies knew. What the companies did.
Q. But if everyone in Washington, everyone you had gone to in the past said, if you go after tobacco it's suicide, political suicide and you're the head of the FDA in Bill Clinton's administration, didn't you have to check with them before you issued a letter?
Kessler: No, in fact we didn't wait until the Clinton administration. We, in fact, started looking at that question in the Bush administration. We started thinking about how could we approach that question. When we issued that letter in February of 1994 no one asked the White House permission.
Q. You didn't give them a heads up that you were about stir up the most powerful political lobby in Washington.
Kessler: About a year later a number of people in the White House said how did this start. But, in fact, I told the Assistant Secretary for Health, I told Phil Lee, my boss, but no one really focused on it. We issued... it was a very simple 3 page letter. It said that we would consider regulating nicotine if we could establish that the companies intended nicotine's pharmacological effects.
Q. So, it was a year before the White House said anything to you about it.
Kessler: We asked a question and we went to look at the facts and we asked what the companies knew. What the companies were doing and no one had really gone to look before. We see 30 years worth of sophisticated research, highly sophisticated work on nicotine. We saw how they measured how fast nicotine gets to the brain. It identified specific receptors in the central nervous system. We were able to see what they knew, I mean for years, that, in fact, nicotine was an addictive drug. And it was that evidence, it was that evidence which was absolutely critical. Without that evidence we couldn't have gone anywhere. Now that evidence... just having evidence is not necessarily going to get you where you want to get to. It's one thing when a regulator goes out and says nicotine is a drug. It's another thing when a regulator and a President of the United States makes that statement.
Q. So, how important was the backing, let's say, of Vice President Gore or Clinton in what happened next?
Kessler: The Vice President was absolutely critical.
The Vice President, in the end, made this happen. We went to the Vice President. We told the Vice President what we knew, what we found, what our conclusions were. We told him what we were ready to do and he carried it to the president.
Q. And what were you ready to do?
Kessler: We made a decision that nicotine was a drug under the Federal Food Drug and Cosmetic Act. That was our decision. We didn't ask for permission to make that decision, we didn't ask for clearance on that decision. But we did as is normal policy, have to get a clearance on any regulation. So we brought the regulation through the normal channels, but in the end it was the Vice President going into the President.
Q. Did you have a face to face meeting with the Vice President?
Kessler: It was a face to face meeting with the Vice President. My... one of the people closest to me went in and saw the Vice President.
Q. And briefed him.
Kessler: Ten minutes.
Q. I guess what I'm trying to figure out now... we have an industry up until this point that is described as being politically bulletproof. Big tobacco, big tobacco. You sitting there in your agency come up with this policy. You do your study. You walk in... you send an emissary to the White House and the Vice President says sure we'll do it. Something must have changed.
Kessler: The Vice President said that he would carry it into the President. What you saw was evidence that came out almost on a daily basis in floods of evidence. Thirty years worth of evidence that was always there, but no one had gone to look. And it was that evidence, evidence that they knew that nicotine was an addictive drug. Long before FDA knew that nicotine was an addictive drug and also the fact that they marketed it to young people. That they marketed to children and adolescents.
It's one thing... you can talk about nicotine manipulation. You can talk about what they say about smoking and health. But when you read the documents of what they... how they marketed their products to children and adolescents that's where, I think, the debate has changed.
Q. How important was Jeffrey Wigand to helping you figure out what was going on?
Kessler: I was sitting there in my conference room and I was talking to one of the most important people we would talk to during our investigation. I knew him only by his code name. I knew him as research. And I was sitting there one day and I'm looking at documents and I'm saying who's this person, who's that person. Then I go who's Jeffrey Wigand? And he looks at me and he says I'm Jeffrey Wigand. Jeffrey Wigandd was among the most senior people to come out. Not... surprisingly there were not a lot of people. Maybe it's not surprising.
Maybe when you think about it and you look at how... the costs of coming out for the people who came out. Certainly if you look at what Jeff Wigandd went through you understand why a lot of people haven't come out and talked. But the one thing that was clear when we talked to people who knew what the industry knew, who had worked for the industry, there was one thing that united them all. They were very scared. They were very frightened. They knew what the industry's modus operandi was. They knew the kind of force that unlimited resources could have on you. They understood the kind of legal proceedings that you could face. Not only today and tomorrow. But for years.
Imagine having unlimited resources to hire any lawyer, any number of lawyers you want and have them come after you. And that was generally understood to be how the industry operated. So it's maybe not surprising that there weren't a lot of people who came forward. But we didn't know that the industry had spent millions of dollars researching genetically bred high nicotine plant. We didn't know that the industry understood the effect of using certain chemicals that, in essence, were the same as free basing. We didn't know that. We learned that through people who worked in the industry. We learned it from people like Jeff Wigandd.
Q. And if I remember correctly, back in May and June of 1994, when you first meet Jeffrey Wigand and some of your people go and talk to the various tobacco industry and gather information in North Carolina, in Richmond, Virginia and they go to Louisville and ask questions and it's at that point, isn't it, that you discover that they are lying?
Kessler: We received... Jeff Wigand told us. I knew him only by his code name, Research. Research told us to look at patents filed in foreign countries. Didn't say here it is. But he led us down that path and we found the patent filed in Brazil, written in Portuguese, held by Brown and Williamson for a high nicotine, genetically bred tobacco plant that had twice the concentration of nicotine that normal tobacco has. We traced one of the individuals limit... we traced one of the individuals that was listed as one of the inventors to a small genetic engineering firm in New Jersey and began to piece together a rather remarkable story.
She told us that her company had been hired by Brown and Williamson to produce a special version of this high nicotine plant. A version of the plant that was sterile, so it couldn't be stolen by other competitors and she told us that she had actually been to Souza Cruz and seen Y-1 growing in the fields.
Q. Souza Cruz is the Brazilian subsidiary?
Kessler: She told us that she had been Souza Cruz of Brazil and had seen Y-1 growing in the fields. But that didn't mean that it came back into the United States. It certainly didn't mean that it was used in American cigarettes. We sent an FDA inspector... I remember it was literally he had just come over to the agency. It was his first day on the job and he had come over from customs and I called him up and I said come up to the Commissioner's office.
I need you to go see if there's evidence that Y1 had been brought into the United States. And he literally went up and down the ports of call on the Southeast coast. Do you have any idea how many millions of entries, each day, come into this country? And I remember the phone call when he found that one invoice on page 25 of one of the manifests. There it was in small type. From Souza Cruz to Brown and Williamson. It said your order, Project Y1. It was illegal at the time to ship seeds outside of this country unless there was an export permit. We weren't interested in the tobacco seed export laws. We were interested in understanding whether nicotine was a drug. And under the law, an article is a drug if a company intends its pharmacological properties, if it intends its effect on the body. So what we were interested in is whether a company manipulated or controlled nicotine levels. That's what we were interested in, because the issue of control and manipulation went to the question of a company's intent.
Here was research being conducted. Millions of dollars being invested in a high nicotine, genetically bred plant to boost the level of nicotine. It was the most blatant example of control and manipulation that we had seen. But they say they only use nicotine as a blend for taste. They don't use it to manipulate for addiction. The... if you look, look at patents, you will see patents held by the tobacco companies that call for the use of certain chemicals to mask the harsh flavor of nicotine. Nicotine is a very bitter, harsh chemical. Look it up in the Merck index. See what it says. See what it's taste is. And it's very harsh. It's very acrid.
Q. Over and over again they say we do not independently manipulate nicotine, right? They say it under oath. They say it in submissions to your agency.
Kessler: That's correct.
Q. They say it publicly.
Kessler: That's correct.
Q. You're saying they're lying.
Kessler: I am saying there is evidence that the tobacco companies manipulate nicotine. What they did. Understand what they did. If you put a filter in front of a cigarette what's going to get taken out? It's going to filter out the tar. It's also going to filter out the nicotine. Why do people smoke? They smoke for the nicotine. If you take out the tar and you take out the nicotine and you take out too much nicotine people are not going to smoke. So what do you have to do? You have to up the nicotine levels and that, in fact, is what we saw. We saw an industry that was manipulating the level of nicotine in the low delivery cigarettes. And the vast majority of cigarettes sold in this country are low delivery. Light cigarettes are light in what? They're light in tar. They're light in nicotine. We sent light cigarettes to our laboratory and found the light cigarettes have a higher concentration of nicotine than the regular cigarettes. How does that happen? That can't happen without manipulation and control of nicotine. At least I don't know how that can happen without some form of manipulation and control.
Look at three brands of Merits. Look at three brands of Merit. Merit regular. Merit Light. Merit Ultra Light. Merit Ultra Lights has the highest concentration of nicotine in that cigarette. I don't know how that can happen without some form of manipulation and control.
Q. The Council on Tobacco Research announced in the 1950's that they would do independent research to determine the health effects and pharmacology of tobacco. What is their role?
Kessler: The Council... It's interesting, CTR was set up by Hill and Knowlton, one of the largest PR firms. In fact, what CTR ended up funding, they funded a lot of stuff, that was on the periphery. They funded what caused cancer but it stayed away from what people really would like to know. What are the effects of tobacco? It didn't fund critical research on pharmacology and cancer. Now that research was done and it was done by the tobacco companies and when you look you see all three companies have highly sophisticated research programs on nicotine but that wasn't done by CTR. CTR was simply a PR operation.
Q. Run by lawyers apparently.
Kessler: Well there was a part of CTR that was run by scientists that gave out grants and those grants investigated a lot of things. But they didn't investigate central questions about tobacco. They looked at a lot of things but they stayed away from questions about tobacco. And then there was another arm of CTR that really was designed to defend against cases. And that's where the lawyers took over and that's what the lawyers controlled.
Q. Don't they have an obligation under the law to tell the FDA the truth? To be open about what they know?
Kessler: You can't submit a document... you can't make a statement to a federal agency that's false or misleading. That would be a violation of federal law.
Q. Of the things that they submitted to you, that they said to you, were they truthful or were they misleading?
Kessler: They said they don't manipulate nicotine. Everything I've seen suggests that they manipulate nicotine. Those two statements just don't jive.
Q. To someone listening to what you just said, it sounds like they were lying.
Kessler: The ultimate question... It's not up to me to determine whether they were lying. That's a question for the department of justice.
Q. I want to take you back to April or May of 1994 when you issued this letter and the tobacco industry has just sued ABC News...
Kessler: And they sued ABC maybe, in part, as a signal to us. It was a shot across the bow. It was the day before I was going to testify in front of the house committee. Tell me it wasn't just coincidental.
Q. And then the seven CEO's get up at the same time and say we don't believe nicotine is addictive. You didn't feel threatened politically? You didn't see your career going down the tubes?
Kessler: What would you have done? This wasn't about careers or risks to individuals. We asked a question and we started looking at the evidence and once we started down that path it was evidence that we saw that just was overwhelming. And that's what persuaded us.
Q. Did the White House ask questions and try to find out what the political cost of these regulations would be?
Kessler: The White House did conduct polls to see what the public thought of controlling tobacco use. In some ways, for years taking on tobacco was thought of impossible. For years if you went near it it would be highly controversial. People thought we had lost our minds. Speaker of the House, in fact said it, and said it in those exact words. But what people didn't realize was this wasn't controversial at all. Nobody wants vending machines out there that kids 11, 12, and 13 buy cigarettes from. Nobody wants kids exposed to these cartoon characters when they walk to and from school. Some people needed polls to see that. But it was there all the time. In fact, there was very strong support for what we did.
Q. Was it a surprise to you that the industry wanted to negotiate in the end? That they wanted to come to the bargaining table?
Kessler: Confronted with the choice of bankruptcy, it wasn't surprising at all.
Q. Did you know negotiations were in the works?
Kessler: There were many different attempts at negotiations. There were numerous attempts of negotiations here and negotiations there.
Q. Let me take you back to something else. The Medicaid suits by the states.
Kessler: Right. Mike Moore, Dick Scruggs came to my house one day in April, May of 1994 after we sent out this letter and they told me what they were thinking of doing.
Q. And what was your reaction?
Kessler: What was important, in some ways, was we kept our eye on the ball ahead of us. We were asking very different questions. And we went down to roads. We, looking at the question of whether nicotine was a drug. They, looking at the question of whether they could win in court against the tobacco companies for all the health, Medicare, Medicaid expenses that the states incur.
Q. But when they first came to you with this idea no one had ever tried that before. What was your... You're an attorney as well as a medical doctor. What was your reaction?
Kessler: They were basing their theories in some ways on similar, but not exactly, what we were looking at. We were focusing on nicotine manipulation. They were focusing on what the industry knew but never said. So, in some ways, we were on similar paths, looking at similar questions. But the approach was very different. We were focusing on federal regulation. They were focusing on state suits. I still believe that without a settlement we've only begun to scratch the surface of potential liability suits. The notion that you, the tobacco companies, fooled me, a 65 or 70 year old person with lung cancer into smoking in front of a jury, especially in this country where we believe in personal responsibility. I'm not sure you're going to win that case. Sure there may be documents that would make that jury angry. And in some ways, it's the same with the state's Attorney General cases. You fooled me into smoking and therefore you're responsible for paying all my Medicaid expenses. The jury can go either way. That's not where the industry is most vulnerable. The case where the industry is the most vulnerable is a case that says you targeted my 11 year old. You knew that that was illegal and yet you went ahead and did that. I would take that case any day.
Q. That's essentially the criminal case.
Kessler: No, the criminal case, as I understand it, is you lied. You lied to federal authorities. You lied to the FDA. You lied to the Congress. You committed conspiracy.
Q. To defraud the United States Government?
Kessler: To defraud the United States Government.
Q. And you think they did?
Kessler: I cannot reconcile their statements with the evidence. I'm not going to sit here and say they perjured themselves. I am not going to sit here and say that they lied. I'm going to tell you what the evidence looks like to me. And I see evidence of actions that just do not square with their conduct. I'm not sorry I didn't do that right.
I'm not going to sit here and tell you that they committed perjury. It's not for me to do. That's for a US. attorney to do. But I can sit here and tell you that I saw things that they did, that they manipulated nicotine when they said, and they said it to federal authorities, that they did not.
Q. When the negotiations began in earnest in March of last year, actually April 3 when they actually sat down at the table, you were invited to the table weren't you.
Kessler: I was invited to join the settlement talks.
Q. You chose not to?
Kessler: I decided not to go to the negotiating table.
Kessler: I didn't want to be captured. I wanted to be able to evaluate it for what it was. I wanted to have some distance to be able to look at it and see whether I thought it would be in the public interest.
Q. What about advertising? The courts have held, as I understand it, that the industry has a right to advertise. It's a legal product.
Kessler: You don't have a legal right to promote an illegal use. You don't have the right to deceptive advertising and in fact, if the government has significant public health interest and you take actions that are narrowly tailored. If you focused on kids, what could be more of a significant governmental interest and you focus on kids, that certainly permissible under the First Amendment. The Securities and Exchange Commission requires tombstone advertising. Three thousand kids starting everyday and a thousand going on to die is not as legitimate substantial government interest as the Securities and Exchange Act, I just don't know what is?
Q. Let me ask another question about FDA jurisdiction of it as a drug. So you get jurisdiction? What do you do with it?
Kessler: What the agency did was to look and say that this product was an unsafe product. It's a product that 50 million Americans use. Prohibition won't work. So how do you reduce the use of an unsafe product? The focus on children and adolescents wasn't because there was apple pie and motherhood. It wasn't because who could object focusing on children and adolescents. The reason we focused on children and adolescents is if you really can get children not to start, 20 years from now very few people are going to be smoking. Because very few people begin to smoke after the age of 18. That's what the industry knew.
Q. But my understanding is that in the June 20th settlement the industry agrees to fund $500 million a year in advertising and tobacco control activities to reduce that.
Kessler: The real question here is whether, for the first time, this country is going to break the hold that the tobacco industry on our elected representative. Whether for the first time in half century the real power of the industry over the Congress is going change. Whether for the first time Congress can enact a law without asking the industry for permission. That, in and of itself, may be more important than any single provision. Breaking that whole...
Q. What does that FDA control really mean? Control over the level of nicotine that's in cigarettes? Control over advertising?
Kessler: What FDA said in it's regulations was that it would assert control over the way cigarettes were sold, whether the way they are advertised, whether over the way they are promoted. That's what FDA focused on in it's ruling.
Q. But as of today, in that federal court decision in North Carolina, you have control over nicotine, but you don't have control over advertising and promotion?
Kessler: The federal district court judge upheld FDA's classification of nicotine as a drug. Upheld the restrictions on limiting access, making it harder for young people to buy. He said that the Food and Drug Act did not give FDA the ability, under the section that we use to control advertising.
Q. Now the June 20th settlement gives FDA, and the proposal in general, limits advertising. The industry gives up that control. What they won...
Kessler: The June 20th settlement is, in fact, that. The June 20th settlement is, in fact, just that. It's a settlement. It's a deal. It's a deal between state attorney generals and the tobacco industry. That's not the same thing as passing a law. The Congress of the United States doesn't pass laws by doing settlements. The Congress of the United States can pass a law that's in the public interest without asking the industry, without asking the industry whether it has it's permission.
Q. The Congress of the United States, as I understand the law, or as been expressed to me, does not have the power to stop the industry from advertising a legal product.
Kessler: That's absolutely false. The Congress of the United States can pass a law that restricts the ability to advertise. It does it in the Securities and Exchange Commission. It certainly... There are certain rules, there are certain ways you can do it. Perhaps you can't ban all advertising, but you certainly can ban advertising that causes an increase in young people to smoke. Of course you can do that under the First Amendment. You can't go yell fire in a theater. Not all commercial speech is protected. You go down your street and see ads for controlled substances. Of course there are rules and regulations that govern the form of some advertising.
Q. So you foresee that the FDA, having regulations that have now been upheld, do everything that's in the settlement without the settlement?
Kessler: There's no reason why... the Congress doesn't have to make a deal. It can accomplish everything in that settlement without giving the industry special legal protections. It can accomplish everything in that settlement without any quid pro quo, without giving the industry... The industry would love you to think that, gee, you have to give us immunity. We're not going to give that up. One of the lawyers for the tobacco industry said... It was one of the most remarkable statements that I've seen reported. He said if you don't give us immunity, if you don't give us limited liability, we just may bring back the cartoons. I thought I had heard and seen just about everything.
Q. Do you see the June 20th settlement, though, as, in a sense, a watershed? That something was actually accomplished?
Kessler: I give the state AG's a lot of credit. If I were in their position I certainly would have considered settling also. But that's a settlement. Their in a preceding where the tobacco industry is on the other side of the table. We're not, in this country, in a position where the tobacco industry is on the other side of this table. That's not the way we enact the laws. I didn't, in 1994, when we went out a three page letter say, gee, what does the tobacco industry think.
Q. But you said it yourself, earlier. You said the industry was facing bankruptcy. The industry, in the face of everything we know today, facing bankruptcy primarily from the state attorney generals and their lawsuits...
Kessler: And all the lawsuits that are potential down the road.
Q. Possibly, but the reality that we're facing where the state attorneys general, three of them became 20. Twenty became 40.
Kessler: When Mike Moore sat in my living room, it was Mike Moore. And then it was Mike Moore and Florida and then it was three of them and then it was 5 of them and then it was virtually all of them. It was very powerful force and in some ways that's what it took. It took all the state law enforcement officials to send a very clear signal to the industry that the world in which they've been operating has begun to change.
Q. But it's these same people who pushed the industry to the wall who are now saying O.K., let's have some constructive settlement of this.
Kessler: Why a settlement? Why not enact legislation? Why not enact comprehensive legislation that's aimed at reducing the number of young people who smoke? Why do you need a settlement? Why do you need to give the industry immunity? Why do you need to give the industry limited liability?
Q. Well they're saying they're not giving the industry immunity across the board.
Kessler: They're certainly giving the industry forms of limited liability. That's certainly forms of immunity.
Q. Their argument is no one has been able to certify a class action that's gotten a judgment anywhere, from their perspective. So they're giving them the ability to get out of the class actions.
Kessler: Why? Why do you have to give them that. Why does this industry deserve special protections that no other industry has?
Q. The alternative is to go back into the trenches and fight it out state by state. Go on for years and years. They'll continue to spend their $600 million a year on lawyers and more kids will keep smoking every day, more kids will die and you'll just have a bigger and bigger war and the original problem will never be addressed?
Kessler: Maybe there are people that don't believe that you really can pass legislation without permission of the industry. Many people really do think that the industry still has controls and powers. Maybe it still is big tobacco, maybe not quite as big, but I think in the end... I think if you ask the average person out there whether they want their elected representatives giving special protection, special legal protections to this industry, especially in light of everything that's come out... I certainly wouldn't want to go home as a member of Congress and say that I voted to give this industry some form of special legal protection.
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