Review: The End of Overeating

Review of

The End of Overeating:  Taking Control of the Insatiable American Appetite

By David A. Kessler MD
2009
Rodale Inc.

Reviewed By
Teresa Britton
Department of Philosophy
Eastern Illinois University
Charleston, IL

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The concept of food addiction is alive and well and it is well worth our while to understand its current versions. Dr. David Kessler M.D., a former commissioner of the US Food and Drug Administration and author of “The End of Overeating:  Taking Control of the Insatiable American Appetite” presents a detailed and well-thought out behavioral model of food addiction explained at the neuro-chemical level. And while much of the focus of Dr. Kessler’s book is on the food industry and its hard work in constructing “food” that is designed to create cravings and insatiability, not to be overlooked is Dr. Kessler’s detailed model of “conditioned hyper-eating” — the precise behavior response the food industry is seeking to stimulate.  “Conditioned” because it is a learned behavior and “hyper” because it is eating more than you need of food that no one, in any sense, needs for health.

Dr. Kessler’s contributes to exposing the food industry’s various ethically questionable practices by explaining the concept of food layering and the precise sort of chemical hits to the brain that hyped-up food produces.  He fills out the biological details on how multisensory, multi-stimulus food concoctions build heavy associations that illicit the set of eating behaviors that constitute conditioned hyper-eating at the root of obesity.  The compilation of research and weaving together of various studies over recent decades is noteworthy.  As Dr. Kessler himself explains in some cases he excavated research from decades ago and applied it aptly to the issue of over-eating and obesity.

Through a mix of anecdotes embedded in a broad research base, a compelling and well-investigated tale of food behavior emerges. Dr. Kessler argues that eating food is a specific case of the general stimulus reward model.  The stimuli of the food, mostly its taste, but also texture, temperature and other more fine grained taste activate neurons, when the neurons receive the stimuli, they are more activated and humans become conditioned to do more to acquire that higher level of the pleasurable neuro-chemical response. The body’s “opioid” pleasure system runs in full gear. The more taste pleasure we get, the more our brains are lit up. In fact, we will tend to want to go further with acquiring taste and pleasure than what occurs in nature. Inferring from non-human animal studies, Dr. Kessler explains that rats will prefer higher and higher levels of sucrose including a 10% solution, which would never be found in natural food sources.

The hedonistic opioid story that gives food the pleasurable sensation we experience and makes us want to eat is one half of the story. The more we light up, the more we will do to get lit up again. There is also a separate mechanism that moves us toward food, a dopamine -based foraging behavior which drives us up and out in search of these tastes and pleasures.  Positive emotions motivate us to seek out the heavy-hitting food.  And interestingly, once these behaviors kick in, we usually go all the way from food thought to food acquisition.  Once we start telling ourselves any kind of narrative about a particular delicious food, about how we shouldn’t eat it, or how we might get it, we will get it.  This explains why even thoughts of “I won’t eat ice cream tonight” usually end up in just the opposite behavior.  Complex stories about how one shouldn’t eat ice cream only create more embedded neural activity that ensures you’ll take it to finish.  We experience loss of control at these points and hence these behaviors certainly seem like an addiction.

One walks away from this book with a more thoughtful understanding of eating behavior. As Dr. Kessler points out, food controls us. “They command our attention, occupy our working memory, change how we feel, and become the focus of our single-minded thoughts.” (Pg. 250)

Though the book is mostly a scientific explanation of human behavior and food industry practices, he gives advice at the end of the book to enable the reader to end conditioned hyper-eating in a trademarked program that he calls “food rehab.”

Is the problem controllable?  Yes, he argues.  And, of course, he gives behavioral solutions. The cure is to develop a new set of behaviors to compete and win out against conditioned hyper-eating. His suggestions for dealing with the vulnerable time while you’re developing new habits is to get out of the way of cues, build negative associations with those eating cues, and to add exercise as an alternative award.  To put his solutions into a broader therapeutic context, I note that his suggestion to use the therapeutic process of “thought stop” to combat urges, would be disparaged by those who take a more psychoanalytic approach to thoughts, beliefs and behaviors.  The unconscious is tricky.  And Dr. Kessler’s suggestions to simply refuse to think the food thoughts that lead to unwanted behavior would be termed “thought suppression.” Suppression of deeply rooted emotionally packed thoughts is not an effective mechanism for relief.  So would be the argument from a more deeply psychoanalytical model. But Dr. Kessler’s psychological model is fully behaviorist and so are his suggested antidotes to conditioned hyper-eating.

The suggestions of using a food plan with structure, control portions, changing to a diet of high fiber and no or low refined carbohydrates diet, choosing food that satisfy and that you find enjoyable, savoring the food you do eat, incorporating reward food into your plan, is all mainstream advise.  However, having the deeper framework of the underlying psychology at play, one comes away with a clear understand of why these suggestions would work to curb over-eating. In fact, he urges us to reflect on our eating behavior in exactly this way: to consciously think to ourselves that by following the dopamine trail of food pursuit to the opioid hit of eating high fat, refined carbohydrate and high salt /sugar foods, we are no more than automatons.  And he urges the dieter to use that perspective to motivate a break from the habituation of conditioned hyper-eating and replace it with less calorie and neurally loaded and healthier eating behavior.

The book ends with a call to action, noting that we can learn to transcend addictive behavior by studying the work of 12 step programs and endorsing abstinence from the tricked out food that is served to us by restaurants and grocery stores in the U.S.  And he adds a parallel call for reform from food purveyors in the United States, suggesting that restaurants be obligated to provide nutritional information and reform their marketing of unhealthy food.

The book should be understood as a food narrative from the behaviorist perspective on addiction, a common American view of over-eating.  If you want to learn how scientific research studies on both and animals and humans support a neuro-chemical behaviorist addiction model of over-eating, Dr. Kessler’s book is a must-read.

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