Thoughts on David A. Kessler’s End of Overeating. Or, why mainstream medical authorities cannot lead food system reform.

In the End of Overeating, David Kessler, former FDA commissioner, Harvard Medical School graduate (who also earned a law degree from the University of Chicago), etc., presents a neuroscience- and psychology-based model of overeating (he calls it “conditioned hypereating”), while at the same time giving a panoramic picture of how the food industry promotes such overeating: how it engineers food to be hyperpalatable, and how it conditions and promotes, through marketing and food engineering, repeated overeating behavior.

The first three parts of his book are relevant to the food industry. They are truly one of the most compelling expositions of the subject I have read, if not the most compelling.

In parts four and five, he takes a turn, I think, for the worse. In much the same paradigm as guys like David Katz–the dieting paradigm–he offers a science-based sort of diet for resisting hyperpalatable foods. It recommends a slew of psychological techniques, all the way to the point of even advocating changing one’s path home, if it helps avoid temptations. Very much, in other words, a paradigm modeled on drug addiction. Kessler calls it “Food Rehab.”

This is where I think Kessler has things very wrong. What is the solution to the epidemic of chronic disease for Kessler? An army of psychological experts to guide and help people to suppress their eating urges, to fight against their instincts in a food system that actively seeks to undermine their attempts to control what they eat? An army of experts trying to help the population control itself against another army of experts trying to undermine that control?

It is an excellent model. For the experts.

But for the dieters? Studies consistently show the failure of weight loss attempts under paradigms like Kessler’s: 95% of dieters, in the long term, will gain their weight back. Indeed, attempts at dieting, even controlling for original weight, are linked not to weight loss, but weight gain. In other words, dieting may cause an increase in weight. Kessler himself admits to have gained and lost weight many times over the course of his life, having owned, in his words, every suit size. And he never claims that his very own dieting system reversed his yo-yo dieting.

Does this not make Kessler’s addiction-model paradigm an ideology in the worst, classic sense of the term? Kessler, in essence, layers a failed model (dieting paradigm) over a dataset that is otherwise reasonable (his diagnosis of the state of the food system), thereby concealing the failings of this model and portraying it, deceptively, as substantiated. And contradicting, it seems, his own personal experience.

Kessler seems to blow off the criticism that this is a really artificial and unnatural way of comporting oneself toward food–much less 30%+ of the population–by saying something to the effect that, it’s the human condition to be required to control one’s instincts with one’s cognition. True enough, but only at this point in history, uniquely among all others, has such control been necessary with respect to food. To me, that would suggest something quite less universal: and something alterable. Not by treating 30%+ of the population like heroin addicts. But by changing the food system.

Kessler does acknowledge that food system change is necessary, and even encourages it. But he ultimately, and explicitly, falls back into the paradigm of personal responsibility. Very 1980s. Unfortunately, I don’t think that is a future that can really function from a public health point of view. These two questions must be asked:

First, is such a public health strategy workable, i.e. will it actually bring about its effects? After perhaps 50 years of the dieting paradigm, does this seem likely–and have we really learned anything radically new in the meantime that would make Kessler’s paradigm more tenable?

Second, even if it was workable, would it be desirable? Or, would it not be, 30% of the population undergoing psychological training and constant vigilance in the presence of food—would it not be monstrous?

This is not to say that restriction cannot play a role in food policy. It can and should. But in order to endorse restriction as a policy, we have to, as a society, undergo a transition in our culture that is more basic: a shift in the way we see food. Before we make this shift, *we simply won’t accept restriction.*

As Kessler repeats over and over again, in chapter after chapter, food traditions were at the core of what was lost, with food engineering as its replacement. This led to our current predicament.

In a very typical move, then: rather than appeal to what is obvious–a return to food traditions–he appeals to science: he proposes “good guy” mind engineers to counter the corporate, “bad guy” food engineers.

But the solution is in not treating the population like heroin addicts. Nor is it menus with calorie labels. Nor psychological techniques. Nor, in a kind of neopuritanism, making everyone think that hyperpalatable food is disgusting. The solution is to cultivate in the population a deep and rich understanding of their food culture and food system. It is in a kind of education, but not—and this is the crucial point—not, as Kessler believes, a cognitive one.

In *this* kind of world, we would be less interested in the puritanical ideas of MD food writers—and more interested in their recipes, cooking techniques, and where they get their food. The latter seems trivial, not as “heavy” as the neuroscience of the universities. It *is* trivial. And that’s the point of the Farmarian concept: you don’t need MRI scans or randomized controlled trials to fix the problems with food system.

The brokenness of the food system was not caused by a misunderstanding of medical science; therefore, no amount of medical science can fix it. When we make the mistake of believing so, we are guided down the wrong path—yet again.

[EDIT: In response to comments, I have added the following (2015/09/29 8:22 CST):

Do not mistake me. Kessler did propose system-wide change. And he hit all the high points. But his detailed recommendations are all individual. He spends 13 pages on food system change, and 53 on food rehab. There is no detail on food system change; his system is entirely focused on the details of food rehab.

I’m not sure that his food rehab is good either. Not even a bandaid, dieting doesn’t even work. If it was at least a bandaid, he might have some justification. But it isn’t even that. And clocking in at over 50 pages? I’d call that a distracting ideology; even, a myth. It adheres to this ideology of hard work, etc., but it contradicts Kessler’s own experiences and the hard data itself.

As far as the food politics he *does* have, what does it amount to? Reform the food system by restricting access. Very shallow, even politically naive. How to restrict access when most people don’t think we should? Moreover, if we only restrict, what will the new food system look like? Kessler, apparently unaware of broader food movements or the current crisis of our food system, doesn’t seem to have any conception of the steps we should take to get to a new food system: except, restrict. It is not a reasonable understanding of food system change.

The Swiss, the French, the Japanese–they all have Big Food. But in the context of societies that retain strong traditional food cultures, Big Food doesn’t matter. Kessler makes a constant appeal to these societies, but he doesn’t seem to see the obvious fact: that everything he is proposing doesn’t bring us in that direction. Indeed, the restrictive political paradigm he proposes seems to propose to make us even more *unlike* food cultures that have successfully avoided the excesses of modern industrial food.

Finally, let’s take a look at Kessler’s track record: remember the new nutritional labels on the back of processed food that showed up in the 1994? The implementation of that was Kessler’s project. Kessler sincerely believed that these were a public health boon—apparently unaware (or forgetting) that anything needing a nutrition facts label probably shouldn’t be eaten in the first place. Those labels were worthless then and they are worthless now; indeed, in the 20 years since they were implemented, rates of both obesity and type 2 diabetes have soared. And yet, Kessler, even today, proposes more food labeling. Does Kessler really understand what healthy eating is?

I am not trying to review a book that wasn’t written. Just because Kessler doesn’t go into detail about system change, doesn’t make it a bad book. What makes it a bad book is the fact that his whole conception of food and food system change is based in a restrictive paradigm, is overly medicalized, has an insufficient respect for culture and authentic enjoyment, and doesn’t seem to understand the current state of the food system and its crises.]

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One thought on “Thoughts on David A. Kessler’s End of Overeating. Or, why mainstream medical authorities cannot lead food system reform.

  1. I agree that changes in our food environment over the last few decades have contributed to the obesity problem. Much of our eating is automatic, and constant psychological self monitoring isn’t likely to be easy or the answer to the problem. Whilst the individual can take steps to alter their lifestyle to ensure only healthy food is accessible, on a population level this isn’t the answer.
    A returned to natural cooking of fresh foods, a reduction in time spent on “screens” and an increase in movement that fits into our lifestyles is something that governments should be encouraging. Instead of wasting money on an army of “experts”, measures such as increasing cycle paths, subsidizing fresh fruit and vegetables and providing more green spaces would be more effective.

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