July 1, 2008

To Overcome Obesity, Change the Culture


Here's an interesting thought: What if you're not to blame for your weight problem?

What if the fault could be laid squarely at the feet of food manufacturers and marketers, grocery store managers, restaurant operators, food vendors the people who make food so visible, available and tasty?

Several recent studies, papers and a popular weight-loss book argue that eating is an automatic behavior triggered by environmental cues that most people are unaware of or simply can't ignore. Think of the buttery smell of movie theater popcorn, the sight of glazed doughnuts glistening in the office conference room or the habit of picking up a whipped-cream-laden latte on the way to work.

Accepting this "don't blame me" notion not only might ease the guilt and self-loathing that often accompanies obesity, say the researchers behind the theory, but also might help people achieve a healthier weight.

To make Americans eat less and eat more healthfully, they contend, the environment itself needs to be changed with laws regulating portion size, labeling or the places where food can be sold or eaten. That would be much easier, the researchers add, than overcoming human nature. The theory that our society not us is to blame for our overall expanding waist size is garnering support from health and nutrition experts. To recap the statistics: In the past 25 years, the number of obese Americans has increased from 14.5 percent to 32.2 percent. Two out of three adults are overweight, as are 19 percent of children, according to the Centers for Disease Control and Prevention.

"Almost everybody is gaining weight in almost all socioeconomic groups. It's not limited to certain people. It's everywhere," says Dr. Deborah A. Cohen, a senior natural scientist at Rand Corp. and the author of a recent paper on the environmental theory of obesity. "Look at doctors, nurses and dietitians who are overweight or obese. If it has anything to do with how much we know about nutrition or how much we're motivated, we would never see people with such expertise be overweight or obese."

Other health experts say individuals can exert control over their own environment and lose or maintain weight despite the temptation of venti lattes, supersized French fries and all-you-can-eat pasta bowls. "The environment, I think, to a large extent explains the obesity epidemic," says Dr. Robert H. Eckel, a professor of medicine at the University of Colorado and past president of the American Heart Association. "But should we change the environment to alter the obesity epidemic? And how much do we need to change it? Those are difficult questions. To blame it all on the environment is a mistake. There is individual responsibility."

To explain how so many people have become overweight, researchers start with the urge to eat.

Eating is an automatic behavior that has little to do with choice, willpower or even hunger, Cohen says. Her paper, with co- author Thomas Farley of Tulane University's Prevention Research Center, was published online December in Preventing Chronic Disease, the peer-reviewed health journal of the Centers for Disease Control and Prevention.

Cohen and Farley argue that automatic behaviors can be controlled, but only for a short time (the reason most diets ultimately fail). A more effective approach, they say, would be to decrease the accessibility, visibility and quantities of food people are exposed to, and the environmental cues that promote eating.

"We've thought for a long time that if we just suggested to people that there are negative effects from obesity and if we provided reminders, they would be able to gain control over their behavior and act healthy," says Wendy Wood, a Duke University psychologist who studies habits. "There isn't much evidence that works."

Instead, ample research demonstrates that much of human behavior is automatic. Studies of people keeping activity diaries show that about 45 percent of daily human behavior is repetitious and unthinking.

That doesn't mean people are weak or stupid, however. Human brains have to operate on autopilot sometimes in order to accomplish more difficult mental tasks that involve analytical, creative or abstract thought, Cohen says.

"There is a benefit to being automatic," she says. "It frees us up to do what is more important. Trying to change automatic behavior is going to be an exercise in frustration."

Food being everywhere in today's society is a problem, Cohen says, because people appear biologically configured to eat, eat, eat.

"We have a mechanism to store extra calories when we are given too much to eat," she says. "When you increase portion sizes, whether someone is fat or thin, neurotic or not neurotic, we eat too much."

Good intentions are often a poor foil to such overwhelming environmental and biological cues.

"I think a lot of people know what they should be eating," says Ruth Frechman, a spokeswoman for the American Dietetic Association who has a private practice in Burbank, Calif. "But because of their habits, they aren't doing it."

Changing routine behavior is painstaking and slow, Frechman says. She asks clients to start by focusing on one small habit. For example, instead of going to the vending machine for candy at 3 p.m. each day, she advises them to go to the office cafeteria and buy fruit.

"It's hard," she says. "I sometimes work with people for years to get them to change one little thing."

Whether individuals can buck their environment is debated. Some experts think it's just too difficult for most people.

"It's not that people can't think about what they're doing. Of course they can," Wood says. "If you ask people to limit their diet and eat healthful, everyone can do that for a short amount of time. It's when you have to inhibit a response over a long period of time, that is where we have difficulty. It involves not just a decision to do something new, it also involves inhibiting the old one. If people rely on willpower alone, they are expecting too much of themselves."

It's easier to change the environment than it is to change people, Cohen says. In her paper, she says people need protection from the "toxic environment" and calls on governments, communities and organizations to solve the obesity problem. She advocates downsizing portions, limiting access to ready-to-eat foods and curbing food advertising.

"We've created an environment that has resulted in our being overweight and obese and now we have to create an environment that helps us be healthy," she says.


Changes big and small

Some health experts say community-wide changes are required to curb the obesity epidemic. Among the proposals:

* Label all food, including restaurant food, for nutritional content.

* Reduce portion sizes.

* Remove food vending machines from schools, offices and public buildings.

* Restrict food advertising.

* Restrict where food can be sold.

* Enact zoning laws to limit fast-food outlets.

* Rate restaurants on health and nutrition information and portion sizes.

* Counter-advertise to remind people of the harm of overeating and unhealthful eating.

* Ban trans fats.

Others say that while the environment is a powerful influence on eating, individuals can fight it. Some strategies:

* Keep a food diary to become more aware of what you're eating and how much.

* Use portion-control plates and cups.

* Make one small rule change at a time. For example, substitute one favorite, but unhealthful food, for something similar but more healthful, such as air-popped popcorn instead of potato chips.

* Avoid the places where you are most likely to overeat and the people with whom you tend to overeat.

* Hide food at home. Don't leave it out on counters.

* Use life transitions (such as moving, starting a new job, having a baby, going on a long vacation) to establish healthier habits that aren't influenced by the old environmental triggers.

* Don't walk by vending machines or drive by fast-food restaurants. Change your routes to keep these cues out of sight.

* Realize that replacing old habits with new ones takes a long time.

* Restrict calories during the active phase of dieting and rely on regular exercise during the maintenance phase.

* Think of prevention. Parents should establish healthy eating habits for their children by keeping sodas and most snack foods out of the house, limiting portion sizes and never asking children to finish everything on their plates.

Shari Roan

(c) 2008 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.