Tuesday, October 25, 2011

Book Review: The End of Overeating, by David A. Kessler, M.D.

I've spent a lot of time in the past year reading and listening to everything I can find on the subject of nutrition for endurance athletes, and it's helped: in the two months before the Eugene Marathon this spring, I dropped from 8.5% to 5.0% body fat without losing any lean muscle mass, and while putting together the training necessary to PR two marathons in two months.  (I'm currently employing a similar protocol to prepare for Ironman Cozumel next month, and as the race gets closer, I'll explain in detail how I've been going about it.)  The conscious focus on weight was a new one for me; I've never been heavy by any stretch, and for years, it seemed like my weight was an immutable 168 pounds no matter what I did, and that there were thus few gains to realize by focusing on diet.  As a result, I acted like a typical carboholic triathlete, binging on pasta and sweets and basically eating everything in sight, on the logic that I'd burn it all off, and that, in fact, my training required gluttony.  Friends would remark that I had a big appetite, but I never believed them; I thought plowing through a large pizza by myself was normal for someone my size.  When I realized this spring that I could, in fact, get lighter, and that each pound lost equated to about 2 seconds per mile when running, I knew that the concept of "race weight" was something about which I needed to learn a lot more.

As part of my ongoing reading on the broad subject of nutrition, I picked up The End of Overeating by David Kessler, a former FDA commissioner.  The book certainly isn't intended specifically for endurance athletes; instead, it might best be described as a biological and psychological expose of the food industry.  People who have watched Super Size Me and read Michael Pollan's books will find certain of the book's themes familiar, but the thrust is somewhat different.   Super Size Me's blunt theme is that fast food is designed to make us want more of it, and that eating more of it -- 5,000 calories' worth each day, no less -- is toxic.  Pollan is more  of a guru, expounding on the health and societal benefits of eating whole, unprocessed food, and eschewing the processed gunk that clogs the middle aisles of the grocery store.  Kessler, in contrast, takes an explicitly scientific approach to investigating how the food industry exploits our brain chemistry to benefit its bottom line, and gives concrete suggestions about what we, as consumers, can do about it.

The first part of the book, titled "Sugar, Fat, and Salt," explains how, and why, this unholy trinity of ingredients triggers addictive patterns in the brain.  The discussion is clear and conversational, peppered with interesting experimental outcomes and anecdotes that underscore the disturbing fact that, when these three ingredients are found together, the body's reaction is not to be satisfied, but to demand more of them -- "priming," as it's called.  I know that, personally, when I'm trying to drop weight, having pizza, ice cream, and mixed nuts around is a recipe for disaster because, as the commercial for Lay's implicitly recognized, it's incredibly difficult to stop eating these things once I've started.  I realized that all of the foods over which I seem to lack impulse control are essentially sugar, fat, and salt, one on top of another.  And, as Kessler explains in a discussion reminiscent of Super Size Me, the food industry has long recognized this fact and tried to exploit it to the greatest degree possible.  This part of the book is particularly entertaining and concrete, with specific attention paid to Chili's, Cinnabon, and "the science of selling" food products.

The middle portion segways from brain chemistry to psychology, and explores the emotional dimension of overeating that quickly results from the sugar/fat/salt cycle.  Dr. Kessler emphasizes in several places that, for the overweight, the problem is not a lack of self-discipline, but rather is the result of patterns of behavior that are subconscious and virtually impossible to resist without explicit acknowledgment and preventative measures.  In essence, the stimulus-response pattern triggers anxiety that can only be relieved by consuming food, but the food provides only partial and temporary respite from the "war within."  And, very much like a drug, each loss in the war means that the urges grow yet deeper, and the problem becomes more intractable.

All of this is interesting and useful, but without more, the book would simply be an accusation and academic lament about the manipulability of mankind.  Happily, however, Kessler moves on to offer extensive, and very concrete, insight and guidance about how to reframe the subject of food to circumvent the biological triggers that the food industry tries to exploit.   For example, he quotes Arnold Wishton: "We talk to patients about playing the tape until the end.  The cognitive strategy is to become well practiced in recognizing when you're having euphoric recall and selectively remembering only the good parts [of overeating].  Then, in your mind, you play the scenario out to the end and you say, 'This is what's going to happen.  I'll feel good for two minutes, and then I'll feel horrible.'"  That is doubtless a familiar thought to guilty overeaters; what is more valuable is the following recognition that "new behavior must come to have an emotional value that carries its own rewards.  Unless a person makes the cognitive shift, where it's more reinforcing to have a life without the substances than it is to have a life with them, recovery is not obtainable."  To me, this sounds much along the lines of certain sports psychology principles I've learned, i.e., that one has to avoid negative expressions of goals, because the brain misinterprets them.  To wit, if the goal is to run every step of the marathon, the goal should not be expressed and repeated as "I'm not going to walk," because the brain doesn't hear the "not," but instead hears, "walk!"  The goal should should instead be that "I'm going to run to the finish line."  In short, when learning to avoid overeating, one must not focus on avoiding certain foods or the negative consequences that will come from eating them, but must instead focus on the affirmative rewards from embracing a new behavior.  "It'll feel amazing to be slimmer and lighter," rather than, "I hate my belly and can't find my abs."  Or, as Dr. Kessler summarizes, "Effective treatment of conditioned hypereating is dependent upon making that perceptual shift and learning new behavior that eventually becomes as rewarding as the old."

Another concrete emphasis is that we have to discard the notion of food as reward, because that simply reinforces the psyghological patterns that we're trying to break.  He puts his finger directly on psychological avoidance strategies that people employ: "Thoughts like, 'I deserve this' or 'I'll only have a small piece' are strategies for easing our discomfort about behavior we know is not in line with our goals."

The last example I'll mention -- although there are many others that we'd all do well to recognize -- is the power of explicitly labeling the feelings that one is feeling at a moment of craving.  The very process of objectifying the feeling brings it from the realm of primal urge to mere idea that can be accepted or rejected. As Dr. Kessler recommends, "Ask yourself, 'Will eating help me truly deal with this feeling?'"  Often, merely asking that question is enough to subvert the urge, or at least to give one a potent weapon to resist it.

Obviously, the book doesn't focus on endurance athletes.  It isn't a diet book by any stretch.  But I think its messages are valuable to us as well -- how many times do we have a burger, fries, and milkshake after a long run or ride on the logic that "I've earned this?"  Or, even if we don't think we've necessarily "earned" a 2,000-calorie meal at Five Guys, don't we find ourselves rationalizing that, "Well, I've done a lot of work, so it probably isn't as bad as it normally would be"?  The first line of thinking elevates toxic foods to the status of reward, thus reinforcing the very cycle we ought to be trying to break, and the latter is simply a "discomfort easing" strategy for consuming foods we know, on some level, we shouldn't.

In all, I found the book insightful, concrete, and useful.  It's worth a read.