The Role of the Food Industry and Its Impact on Global Health

On April 20, 2011 Dr. David Kessler, former FDA commissioner and author of the 2009 book The End of Overeating, spoke about the culture of overeating in the West and the critical role of multinational corporations have played by driving the epidemic.  In this lively discussion with faculty and students, which was part of the seminar series "The Impact of Multinationals on Global Health," Kessler described the science of appetite and how the exploitation of these basic physiological concepts by food corporations has led to a culture of excess and an addiction to overeating.

Kessler began by describing his interest in preventative medicine, which began with research on the tobacco industry.  However, as he further explored the most meaningful fields for disease prevention, he realized that three-fourths of people in the U.S. will die from cancer, heart disease, or stroke – and that excess calories and extra weight are risk factors for all three of these conditions.  Furthermore, he noticed along with his colleagues that mean weight by age has been consistently increasing over time.  In the year 2000, young people were entering adulthood an average of 18 pounds heavier than they were in 1960.  The United States is surpassed only by Mexico in the percentage of the population that is overweight, and it ranks first worldwide for largest percentage of the population that qualifies as obese.  Amazed to see these dramatic trends over the past four decades and certain that improved diet and appetite management could play an important role in disease prevention, Kessler began exploring the factors driving these significant changes in diet and health.

In discussing his findings, Kessler described some basic principles governing food intake and appetite.  First, he claimed that in the presence of a varied and limitless diet, animals and people tend to eat excessively.  Second, he described what drives a desire for food, citing studies that have measured how many times a rat will press a lever to obtain food or how much a person will pay, quantifying the desire for food in order to demonstrate sweetness as the primary driver.  Third, Kessler emphasized that food can become addictive by utilizing dopamine circuitry in the same way addictive drugs do.  Repeated intake of fat, sugar, and salt stimulates dopamine in the brain, focusing the individual on the stimulus and promoting continued, increased intake.  This effect is intensified in an environment with limitless access and variety.

Next, Kessler explained some of the causes of overeating, identifying three “domains” or characteristics that make it difficult for individuals to control what they eat – loss of control of eating, lack of satiation, and obsessive thoughts.  In one study, 50 percent of people who were obese, 30 percent of people who were overweight, and 20 percent of people of a healthy weight self-identified with all three of these characteristics.  Kessler believes that the high percentage of the population falling into these domains makes it clear that this is not a disorder, nor is it a small problem – millions of people have a hard time controlling what they eat.

Kessler and his colleagues found that people who were hypereaters and self-identified with the three domains that he described had high activation in the amygdala, a center of the brain responsible for memory and emotions and, therefore, anticipation or desire.  This suggests that the power of food comes from peoples’ anticipation of it – the amygdala produces a stronger stimulus for the millions of people who have difficulty controlling their eating, causing increased focus and obsession on the food that they crave.  This biological correlate for overeating suggests that this is a particularly difficult problem to overcome.  Kessler believes the high levels of activation in the amygdala mean that the signals stimulating hypereaters to eat sugary food are stronger than those in most people, making them particularly difficult to withstand.  Furthermore, diet drugs are not an effective solution.  By shutting down the dopamine circuitry in the amygdala that rewards the brain for consumption of sugary food, they shut down the system that rewards learning, habits, and motivation.  An obsessive craving for sugary food, therefore, is a common misuse of brain functions that are essential to a person’s continued learning and success.

Unfortunately, Kessler explained, multinational food corporations have created a stimulus that is particularly difficult for a large portion of the population to dismiss.  The business plan of these companies has been simple – to produce a cheap food product full of fats, sugars, and salts that is available anywhere, at anytime.  In addition, companies put an enormous investment into advertising to draw in customers and compete with other companies.  People are wired to focus on the most salient stimuli, and these images of food are designed look captivating and delicious.  Kessler claims that highly palatable foods are “hot stimuli,” effectively drawing customers in.  Individuals are susceptible to these visual cues that activate their neural circuitry and then result in cravings. Eating the food becomes rewarding, and ultimately self-sustaining.  As one company executive noted in dismay during a meeting with Kessler, “Everything that made us successful as a company is the problem.”  While this cycle does not affect everyone, Kessler’s research suggests that enough people are affected by the images used in competitive advertising that the stimuli are a significant cause of overeating.

Because this revelation undermines the basic business models of these food corporations, companies face a tension between promoting health and having continued success.  Many companies have chosen to focus on encouraging exercise, a tactic that Kessler says will not do enough to solve the problem.  He suggested that a decrease in portion size without much of a decrease in price could be profitable for companies, while also creating “speed bumps” for individuals who are consuming too much.  Ultimately, however, Kessler believes some corporations such as those in the soft drink industry will have difficulty remaining profitable as consumers become more and more aware of the health risk of consuming their products.  Some companies seem to have realized this and already have begun diversifying beyond the sale of soft drinks.

In closing, Kessler said he is passionate about preventing companies from exploiting natural brain circuitry to circumvent peoples’ power to resist unhealthy food choices.  In his view, the government has a role to play in preventing this by ensuring full disclosure of what is in products and by helping educating consumers. However, Kessler is poised for an uphill battle, noting that many Americans are ambivalent about the seriousness of the problem.  He also cautioned that it would not possible or advisable for the government (or health advocates of any sort) to demonize food in the way tobacco has been demonized in the United States. Yet, with one-third of the U.S. population predicted to have type II diabetics by 2030, a solution is urgently needed.  Policy makers and health advocates alike need to find other ways to make excess consumption less desirable.  Finding an answer, insisted Kessler, is vital to the health of millions.