by Kenneth W. Krause.
Kenneth W. Krause is a contributing editor and “Science Watch” columnist for the Skeptical Inquirer. Formerly a contributing editor and books columnist for the Humanist, Kenneth contributes frequently to Skeptic as well. He can be contracted at email@example.com.
Man is condemned to be free.—Jean-Paul Sartre.
Beginning about five years ago, the chronically overweight and obese were offered a new paradigm, one more consistent with their majority’s shared experiences in the twenty-first century. Emerging science from diverse fields, certain experts argued, complicated—perhaps even contradicted—the established view that weight maintenance was a straightforward, if not simple, matter of volitional control and balancing energy intake against energy expenditure.
As a host of potential complexities materialized, the frustrated members of this still expanding demographic were notified that, contrary to conventional wisdom, they had little or no control over their conditions. The popular literature especially began to hammer two captivating messages deeply into the public consciousness. First, from within, the overweight and obese have been overwhelmed by their genomes, epigenomes, hormones, brains, and gut microbiomes, to name just a few. Second, from without, their otherwise well-calculated and ample efforts have been undermined, for example, by the popular media, big food, government subsidies, poverty, and the relentless and unhealthy demands of contemporary life.
In a 2012 Nature opinion piece, Robert Lustig, Laura Schmidt, and Claire Brindis—three public health experts from the University of California, San Francisco, compared the “deadly effect” of added sugars (high-fructose corn syrup and sucrose) to that of alcohol(1). Far from mere “empty calories,” they added, sugar is potentially “toxic” and addictive. It alters metabolisms, raises blood pressures, causes hormonal chaos, and damages our livers. Like both tobacco and alcohol (a distillation of sugar), it affects our brains as well, encouraging us to increase consumption.
Apparently unimpressed with Americans’ abilities to control themselves, Lustig et al. urged us to back restrictions on our own choices in the form of government regulation of sugar. In support of their appeal, the trio relied on four criteria—“now largely accepted by the public health community,”—originally offered by social psychologist Thomas Babor in 2003 to justify the regulation of alcohol: The target substance must be toxic, unavoidable (or pervasive), produce a negative impact on society, and present potential for abuse. Perhaps unsurprisingly, they discovered that sugar satisfied each criterion with ease.
Lustig, a pediatric endocrinologist and, now, television infomercial star, contends that obesity results primarily from an intractable hormonal predicament. In his wildly popular 2012 book, Fat Chance, Lustig indicted simple, super-sweet sugars as chief culprits, claiming that sucrose and high-fructose corn syrup corrupt our biochemistry to render us hungry and lethargic in ways fat and protein do not(2). In other words, he insisted that sugar-induced hormonal imbalances cause self-destructive behaviors, not the other way around.
Lustig’s argument proceeds essentially as follows: In the body, insulin causes energy to be stored as fat. In the hypothalamus, it can cause “brain starvation,” or resistance to leptin, the satiety hormone released from adipose tissue. Excess insulin, or hyperinsulinemia, thus causes our hypothalami to increase energy storage (gluttony) and decrease energy consumption (sloth). To complete the process, add an increasingly insulin-resistant liver (which drives blood insulin levels even higher), a little cortisol (the adrenal stress hormone), and of course sugar addiction. In the end, Lustig concludes, dieters hardly stand a chance.
Journalist Gary Taubes, author of the similarly successful Why We Get Fat, was in full agreement(3). Picking up the theoretical mantle where Lustig dropped it, Taubes expanded the list of nutritional villains considerably to include all the refined carbohydrates that quickly boost consumers’ glycemic indices. In a second Nature opinion piece, he then blamed the obesity problem on both the research community, for failure to fully comprehend the condition, and the food industry, for exploiting that failure(4).
To their credit, Lustig and Taubes provided us with some very sound and useful advice. Credible nutrition researchers agree, for example, that Americans in particular should drastically reduce their intakes of added sugars and refined carbohydrates. Indeed, most would be well-advised to eliminate them completely. The authors’ claims denying self-determination might seem reasonable as well, given that, as much research has shown, most obese who have tried to lose weight and to keep it off, have failed.
On the other hand, failure is common in the context of any difficult task, and evidence of “don’t” does not amount to evidence of “can’t.” One might wonder as well whether obesity is a condition easily amenable to controlled scientific study given that every solution—and of course many, in fact, do succeed(5)—is both multifactorial and as unique as every obese person’s biology. So can we sincerely conclude, as so many commentators apparently have, that the overweight and obese are essentially powerless to help themselves? Or could it be that the vast majority of popular authors and health officials have largely—perhaps even intentionally—ignored the true root cause of obesity, if for no other reasons, simply because they lack confidence in the obese population’s willingness to confront it?
Though far less popular, a more recently published text appears to suggest just that. In The Psychology of Overeating, clinical psychologist Kima Cargill attempts to “better contextualize” overeating habits “within the cultural and economic framework of consumerism”(6). What current research fails to provide, she argues, is a unified construct identifying overeating (and sedentism, one might quickly add) as “not just a dietary [or exercise] issue,” but rather as a problem implicating “the consumption of material goods, luxury experiences, … evolutionary behaviors, and all forms of acquisition.”
To personalize her analysis, Cargill introduces us to a case study named “Allison.” Once an athlete, Allison gained fifty pounds after marriage. Now divorced and depressed, she regularly eats fast food or in expensive restaurants and rarely exercises. Rather than learn about food and physical performance, Allison attempts to solve her weight problem by throwing money at it. “When she first decided to lose weight,” Cargill recalls, “which fundamentally should involve reducing one’s consumption, Allison went out and purchased thousands of dollars of branded foods, goods, and services.” She hired a nutritionist and a trainer. She bought a Jack Lalanne juicer, a Vitamix blender, a Nike Feulband, Lululemon workout clothing, an exclusive gym membership, diet and exercise DVDs and iPhone apps, and heaping bags full of special “diet foods.”
None of it worked, according to the author, because Allison’s “underlying belief is that consumption solves rather than creates problems.” In other words, like so many others, Allison mistook “the disease for its cure.” The special foods and products she purchased were not only unnecessary, but ultimately harmful. The advice she received from her nutritionist and trainer was based on fads, ideologies, and alleged “quick-fixes” and “secrets,” but not on actual science. Yet, despite her failure, Allison refused to “give up or simplify a life based on shopping, luxury, and materialism” because any other existence appeared empty to her. In fact, she was unable to even imagine a more productive and enjoyable lifestyle “rich with experiences,” rather than goods and services.
Like Lustig, Taubes, and their philosophical progeny, Cargill recognizes the many potential biological factors capable of rendering weight loss and maintenance an especially challenging task. But what she does not see in Allison, or in so many others like her, is a helpless victim of either her body or her culture. Judging it unethical for psychologists to help their patients accept overeating behaviors and their inevitably destructive consequences, Cargill appears to favor an approach that treats the chronically overweight and obese like any other presumably capable, and thus responsible, adult population.
Compassion, in other words, must begin with uncommon candor. As Cargill acknowledges, for example, only a “very scant few” get fat without overeating because of their genes. After all, recently skyrocketing obesity rates cannot be explained by the evolution of new genes during the last thirty to forty years. And while the food industry (along with the popular media that promote it) surely employs every deceit at its disposal to encourage overconsumption and the rejection of normal—that is, species appropriate—eating habits, assigning the blame to big food only “obscures our collusion.” Worse yet, positioning the obese as “hapless victims of industry,” Cargill observes, “is dehumanizing and ultimately undermines [their] sense of agency.”
Education is always an issue, of course. And, generally speaking, higher levels of education are inversely associated with the least healthy eating behaviors. But the obese are not stupid, and shouldn’t be treated as such. “None of us is forced to eat junk food,” the author notes, “and it doesn’t take a college degree or even a high school diploma to know that an apple is healthier than a donut.” Nor is it true, as many have claimed, that the poor live in “food deserts” wholly lacking in cheap, nutritious cuisine(7). Indeed, low-income citizens tend to reject such food, Cargill suggests, because it “fails to meet cultural requirements,” or because of a perceived “right to eat away from home,” consistent with societal trends.
Certain foods, especially those loaded with ridiculous amounts of added sugars, do in fact trigger both hormonal turmoil and addiction-like symptoms (though one might reasonably question whether any substance we evolved to crave should be characterized as “addictive”). And as the overweight continue to grow and habituate to reckless consumption behaviors, their tasks only grow more challenging. I know this from personal experience, in addition to the science. Nevertheless, Cargill maintains, “we ultimately degrade ourselves by discounting free will.”
Despite the now-fashionable and, for many, lucrative “Fat Chance” paradigm, the chronically overweight and obese are as capable as anyone else of making rational and intelligent decisions at their groceries, restaurants, and dinner tables. And surely overweight children deserve far more inspiring counsel. But as both Lustig and Taubes, on the one hand, and Cargill, on the other, have demonstrated in different ways, the solution lies not in mere diet and exercise, per se. The roots of obesity run far deeper.
Changes to basic life priorities are key. To accomplish a more healthful, independent, and balanced existence, the chronically overweight and obese in particular must first scrutinize their cultural environments, and then discriminate between those aspects that truly benefit them and those that were designed primarily to take advantage of their vulnerabilities, both intrinsic and acquired. Certain cultural elements can stimulate the intellect, inspire remarkable achievement, and improve the body and its systems. But most if not all of its popular component exists only to manipulate its consumers into further passive, mindless, and frequently destructive consumption. The power to choose is ours, at least for now.
(1)Lustig, R.H., L.A. Schmidt, and C.D. Brindis. 2012. Public health: the toxic truth about sugar. Nature 482: 27-29.
(2)Lustig, R. 2012. Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. NY: Hudson Street Press.
(3)Taubes, G. 2012. Treat obesity as physiology, not physics. Nature 492: 155.
(4)Taubes, G. 2011. Why We Get Fat: And What to Do About It. NY: Knopf.
(5)See, e.g., The National Weight Loss Control Registry. http://www.nwcr.ws/Research/default.htm
(6)Cargill, K. 2015. The Psychology of Overeating: Food and the Culture of Consumerism. NY: Bloomsbury Academic.
(7)Maillot, M., N. Darmon, A. Drewnowski. 2010. Are the lowest-cost healthful food plans culturally and socially acceptable? Public Health Nutrition 13(8): 1178-1185.