Fed Up, Confused and Still Eating

By all means, see the film, if you haven't. If you aren't yet fed up with the toxic quagmire that is the typical American diet, there's a good chance it will get you there.
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I commend my many friends -- both those behind the cameras, and those in front of them -- involved in the making of Fed Up, a documentary about why so many of us are fat and sick (diabetic in particular), and I commend the movie to you if you haven't seen it. It will serve you food for thought at the very least.

The intentions of those involved are clear enough. The movie is an attempt to account for our prevailing health woes by casting Big Food in the role of tobacco, and us as the victims of rather diabolical marketing, willful deception, and unfettered greed. So far, so good -- that sounds like any given Thursday in America to me. We're not runnin' on Dunkin because it's the best way to raise healthy kids, after all.

But I must confess, the movie rather confused me -- or rather, it seemed to me at risk of confusing others. So in light of that, I want to talk about being horny.

No, I don't mean me in particular. I am committed to doing the best I can with this topic and staying out of trouble with my wife -- although I am dubious. I recall the first time we saw When Harry Met Sally together, and I reluctantly conceded that pretty much everything Harry had to say about guys was true. My wife didn't talk to me for two weeks.

So, let's be clear: This is not my fault, I'm just passing through.

For guys at least, food and sex are a lot alike. More is better, and the variety pack has an intrinsic appeal. To a lesser extent, and at certain stages in life, this is true of sex for women as well -- and certainly true of food. But for males -- Homo sapiens, most other mammals, and quite a few species in other orders -- this is just biology 101. It's about survival.

We can look at sex from the perspective of male organisms in a sparsely populated, challengingly hostile world of widely dispersed tribes; or we can look at it from the perspective of genes, as Richard Dawkins famously invited us all to do. Either way, our adaptations attract us to certain features in a potential mate (which we take to signify beauty, but which have their origins in fertility and likely reproductive success); and propagate the assembly of urges that may be discreetly translated to: more is better, and variety is nice. In the modern world, promiscuity is indiscretion. In biological context, it is efficient procreation.

Our culture knows all about the native impulses, of course, and exploits them up to a point. There are potent currents of both romance and eroticism in many, maybe even most of our marketing messages -- from cosmetics to cars. But the whole point about horniness is that it is exploited only up to a point. There is a line we do not cross in polite circles.

So, even as diverse eroticisms are used to taunt and tempt, our culture makes it quite clear that infidelity is wrong and sex cannot be indiscriminate. There is no culturally sanctioned effort to encourage indiscretions and infidelity per se. The penalties for infidelities once exposed tend to be very high. Only the lawyers win. Our culture essentially says: we will take advantage of the prevailing horniness to sell stuff, but we won't cross lines. And the lines are pretty clearly drawn. Our culture has rules about sex, and while they are often broken -- we all learn them, and pledge allegiance.

Not so with food, which is if anything more indelibly about survival than is sex. Sex is about making it into the next generation -- or sending our genes there -- whereas food is about making it to tomorrow morning. In the case of food, more is better and variety appeals because in a world where calories were generally in short supply and physical activity demands were high, more and varied food meant a greater likelihood of surviving.

So while comparisons between food and tobacco are tempting, and make sense up to a point, comparisons between food and sex may prove far more meaningful. In the case of sex, we have inherited not just the impulses from our ancestors, but a set of time-honored rules to prevent biology from running amok.

Excess food, or excessively varied food, were simply inaccessible options throughout most of human history. The closer we could get to either, the better -- because it meant "plenty," not excess. So it seems no restraining rules were required -- and perhaps none were devised.

We certainly seem to have just about none in the U.S. Bigger and more are always better here -- and we are effectively marketing that perspective, and its consequences, to much of the world. Those places with the most robust traditions providing a cultural context to bound the relationship with food occasionally defy this trend, with stunning benefits to show for it. But instead of importing their wisdom, we try like hell to export to them Coca-Cola and McDonald's.

So there you have it: being hungry is like being horny, but with no rules.

Here is one vivid, if trivial example of the consequences. Not long ago, I boarded a flight from Washington, D.C., back to Hartford, CT. Wheels up to wheels down time for that route is substantially less than an hour. But even so, as soon as the plane was level and the cart of 'complimentary' Coca-Cola products came around, virtually everyone on the plane had to have one.

Seriously? People had gotten parched, or faint from famine -- in the 18 minutes between boarding and leveling off at 27,000 ft? I don't think so. Rather, our culture has yet to shrug off the endowment of evolutionary biology as the anachronism it has become. The idea still prevails that more food and drink at lower (or no) cost is always a good thing.

But it's not. Nobody on that plane needed an infusion of sugar and calories. And let's face it, in modern context the all-you-can-eat-buffet is coals to Newcastle: a chance to get fat at no extra charge, then spend a fortune trying to lose the weight we gained for free. Tell 'em what they've won, Johnny!

So much for being fed up and horny. What about being confused?

Well, I think the movie itself got lost and confused in certain particulars.

One of these is the issue of willpower, or personal responsibility. Much of the movie made the case that pleas to willpower were tantamount to blaming the victim -- and yet the movie concludes with an invitation to join a Fed Up challenge that seems rather dependent on, you guessed it: willpower. The message here seems to be that while willpower was never sufficient before, it will be after seeing this movie. Well, maybe.

My view is different. Clearly, lack of willpower does not explain epidemic obesity. There is no basis in either science or sense to infer that the current crop of 7-year-olds lacks willpower that every prior cohort had -- yet they are much more subject to obesity and diabetes. Kids are much the same as they ever were. Their environment has changed. So, no. Willpower is not the cause.

But on the other hand, it has to be part of the cure. That comes down to distinguishing responsibility from blame. Yes, we must all share in responsibility for the solution -- because you can lead horses to water, but you can't make them drink. At some point, what happens to bodies is dependent both on choices those bodies make, and choices the body politic makes available.

Even if our culture reoriented to prioritize and promote healthful eating and activity, we would still all need to determine the daily use of our feet and forks. At the end of the day, we have choices to make. In the case of young children, those choices are made partly by them, and partly for them -- mostly by their parents. The basic unit of decision-making here is the family.

But the choices we make are, indeed, subordinate to the choices we have. We must improve the former, but depend on the latter to do so. In other words, consider the implications of that famous line from the Spider Man movies: "With great power, comes great responsibility." The obvious corollary is: before people can take responsibility, they need to be empowered. When it comes to eating well, being active, losing weight or finding health -- our culture is dazzlingly disempowering. Fed Up does an excellent job of showcasing this reality.

There are two ways to fix it: changing the world, or changing ourselves. Frankly, I like both. I have previously, on more than one occasion, reflected on the changes I would like to see in the world and our culture. As for ourselves, we need to ally skillpower to will power if we want to get there in spite of it all. We can do that, but it's not at all clear we have the cultural will to focus on the dissemination of such skill. We seem to prefer quick fixes.

The movie made what I consider the misguided decision to argue with Sir Isaac Newton, giving air time to those who contend that calories don't really count, and energy balance isn't meaningful. This is harmful both because it is wrong, and because it conveys to the audience the least helpful of all messages: On the topic of eating well, you can't trust anything you've ever heard. Experts don't know what they are talking about.

Well, then, how can we know that what we are hearing from the experts in Fed Up is different? The sensible person, convinced that no 'authoritative' information about diet and health has ever been correct, is almost obligated to think: well, I bet that's true this time, too, then. So I'll just keep eating what I like until they figure it out... If they ever do.

But we are NOT clueless about the basic care and feeding of Homo sapiens, and much of the apparent debate is all heat and no light. Of course calories and energy balance matter, but just as obviously -- so do the sources of that energy. Everyone who has ever eaten knows that some foods fill us up more than others, yet we routinely trot out experts to present this as if it refutes laws of thermodynamics. Everyone who has ever filled up a car or lawnmower knows that there is a certain kind of fuel on which the engine is intended to run. A gallon is always a gallon just the same, but of course a gallon 'of what' matters.

The fact that we don't achieve healthy energy balance does not preclude its relevance. That's tantamount to concluding that something was never broken just because we failed to fix it. As for why we can't seem to get there from here, read Michael Moss, among others. Our food supply is, indeed, engineered to maximize the number of calories it takes to feel full. Along with the divergent metabolic effects of "good" and "bad" foods, there is this simple fact: better foods generally reduce the calories it takes to feel full, junk foods do the opposite. We could, and should, defend the relevance of both quality and quantity -- but Fed Up propagates the view that we need to choose.

Finally, the film seems to land in the camp that has decided sugar is the one thing wrong with our diets. Along the way, we hear from Michael Pollan, who sagely and predictably points out that if we eat wholesome foods in sensible combinations, we really don't have to worry about sugar, per se, or calories -- or any other nutrients. They take care of themselves. But that message comes and goes, and we wind up focused on cutting sugar. I'm with Pollan here. Excess sugar is one of the salient problems in our typical diet to be sure, but we could wind up runnin' on artificially sweetened donuts; or bringing back the good ol' days of meat, butter and cheese -- and not deriving much benefit. That can't happen if we eat wholesome foods in sensible combinations.

By all means, see the film if you haven't. If you aren't yet fed up with the toxic quagmire that is the typical American diet, there's a good chance it will get you there.

But for that to matter, for us to do anything constructive with it this time, we may need to overcome our insatiable lust for over-simplified, either/or answers: either calories, or quality; either the foods we choose, or the sugar we avoid; either personal responsibility, or the nanny state; either yesterday's experts, or today's, or wait- here come tomorrow's, who by the way sound an awful lot like yesterday's.

Otherwise, we may be suitably fed up -- but still too damned confused to do anything about it, except keep eating.


And So What?

What, then, do I think we can and should do about all this? Glad you asked:

  1. Recognize that the overall pattern of the diet matters
  2. Recognize that the best way to avoid bad foods is to eat good foods instead
  3. Talk about nutrients less, and foods more
  4. Acknowledge that the quantity of calories does, of course, count
  5. Acknowledge that the quality of calories does also, of course, count
  6. Acknowledge that the best way to control the quantity of calories without being hungry forever is to improve the quality of those calories
  7. Acknowledge that daily use of feet and forks does involve personal choice, and thus requires personal responsibility
  8. Acknowledge that to be responsible for anything, people need to be suitably empowered
  9. Acknowledge that choices we make are in turn dependent on choices we have- both need to be good
  10. Acknowledge that impulses related to food are deeply rooted in both biology and culture, and thus hard to change
  11. Acknowledge that culture must adapt to compensate for Stone Age biological impulses that otherwise do harm -- whether they are about sex, or food, or anything else
  12. Acknowledge that no one thing is THE thing wrong with our diets, and no one food or nutrient change will fix it all
  13. Acknowledge that we need to change the world around us, but can't just wait on the world to change; in the meantime, we need to empower, and change, ourselves
  14. Acknowledge that most expert opinion and the weight of scientific evidence support a basic set of fundamentals of healthful eating
  15. Recognize that the imperfect knowledge we have of optimal nutrition is still enough to eradicate 80 percent of the total chronic disease burden. If ever there was a case not to make perfect the enemy of good, this is it
  16. Emphasize to the public what we know best and agree on most about healthful eating, rather than an endless "my diet can beat your diet" parade of contestants
  17. Work out what we don't know, while applying to good effect what we do
  18. Establish a reliable, objective, operationally useful definition of junk food- and then ban all of it. Junk is not food, and food is not junk.
  19. Identify gaps in the prevailing skill set for healthful living, and establish programs to fill those gaps in all of the relevant settings: schools, work sites, churches, restaurants, cyberspace, supermarkets, and so on.
  20. Keep pushing on the food supply to change, but take better advantage of the most effective, least contentious way of changing it: changing our demand.
  21. For fully fleshed out approaches to these and related ideas, see:

Dr. David L. Katz is editor-in-chief of the peer-reviewed journal, Childhood Obesity, and President of the American College of Lifestyle Medicine. He is the author of Disease Proof. Against the advice of most sensible people in the world, he tends to say just what he's thinking.