Is It Us Or Our Food?
From years of treating patients, I know that changing the way we eat can be extremely difficult for many reasons. It would seem plausible that we are addicted to food. Unfortunately, the research on food addiction is inconsistent. Although food can cause the brain to produce excess dopamine like drugs, food is necessary to support life, and no official diagnosis for food addiction exists in the medical profession. Almost anything can produce a burst of dopamine in the brain, causing us to want more. I see this phenomenon with some of my patients and their relationship with food. But, for the most part, I can honestly say that most of my patients are not addicted to food.
So why are 70% of us overweight or obese? The answer may lie in the subtle changes in our food supply over the last several decades. The USDA published a study in 2017 called U.S. Trends in Food Availability and a Dietary Assessment of Loss-Adjusted Food Availability, 1970-2014. The report concludes that Americans were eating 374 additional calories per day in 2014 compared to 1970. The food categories were broken down into dairy, fruits and vegetables, grains, added fats and oils, meat, eggs and nuts, and finally, added sugars and sweeteners. All categories saw a rise in daily calories except for dairy, which went slightly down. The negative change for dairy negated the slight rise for fruits and vegetables, meat, eggs, and nuts. Added fats and oils, grains, and added sugars and sweeteners accounted for 100% of the increase. The fats and oils went up the most at 225 calories per day. Grains were next at 116 additional calories per day. Lastly, sugar and sweeteners went up by 33 calories per day.
Unsurprisingly, most highly processed foods today contain grains, sugar, and seed oils as their main ingredients.
A 2019 study by Kevin D. Hall and colleagues elegantly demonstrated the effect ultra-processed foods have on us. They studied twenty individuals for four weeks. The subjects were randomized to receive either ultra-processed or unprocessed diets for two weeks immediately followed by the alternate diet for two weeks. The subjects were allowed to eat as much or as little as they desired. Free-range eating is called ad libidum eating in the world of nutrition science. Unfortunately, the ultra-processed phase of the diet resulted in an additional 508 calories per day. The additional calories were from grains, sugars, and fats, corroborating the findings of the USDA study.
Unsurprisingly, the ultra-processed food caused an average of almost two pounds of weight gain in the two-week phase, whereas the unprocessed phase resulted in exactly the same amount of weight loss.
So now we can see that the shift in our diets to more ultra-processed foods has increased the number of calories we eat and caused us to gain weight. Unfortunately, I could not find the data for the average weight of Americans in 1970, but I found The National Center for Health Statistics data going back to the period 1976-80. We have gone from an average of 172.2 pounds for men and 144.2 pounds for women in 1980 to 195.7 pounds for men and 168.5 pounds for women in 2014! You can find additional statistics in the tables below. Notice that even in 1980 we were, on average, overweight. A BMI of over 24.9 is considered overweight. Also, notice that women in 2014 almost weighed as much as men did in 1980.
1976-1980
Average weight of adult men: 172.2 pounds
Average weight of adult women: 144.2 pounds
Average BMI of adult men: 25.3
Average BMI of adult women: 25.0
1988-1994
Average weight of adult men: 180.7 pounds
Average weight of adult women: 152.3 pounds
Average BMI of adult men: 26.6
Average BMI of adult women: 26.5
1999-2002
Average weight of adult men: 190.4 pounds
Average weight of adult women: 163.3 pounds
Average BMI of adult men: 27.8
Average BMI of adult women: 28.2
2003-2006
Average weight of adult men: 194.7 pounds
Average weight of adult women: 164.7 pounds
Average BMI of adult men: 28.4
Average BMI of adult women: 28.4
2007-2010
Average weight of adult men: 195.5 pounds
Average weight of adult women: 166.2 pounds
Average BMI of adult men: 28.6
Average BMI of adult women: 28.7
2011-2014
Average weight of adult men: 195.7 pounds
Average weight of adult women: 168.5 pounds
Average BMI of adult men: 28.7
Average BMI of adult women: 29.2
Now, most of us are not binging on ultra-processed foods all of the time. But you may be surprised to know that a Starbucks Caramel Macchiato is 240 calories and a Vanilla Latte is 250 calories 1. Additionally, the ranch dressing at Macdonald's is 410 calories 2. The dressing equates to about five teaspoons of toxic seed oil and three teaspoons of sugar. I dare say that most people don't read the label on their salad dressing when they dine out. Instead, they believe that the choice of a salad is a healthy one, not understanding that they may have consumed way more calories than intended, most of it being ultra-processed dressing.
The Unintended Consequences of the Body-Positivity Movement
As you know, I am all about feeling good physically and emotionally. Therefore, I support the body-positivity movement's goal of helping people who struggle with weight not to despair. However, a recent study out of the University of East Anglia has uncovered the dark side of the movement. The 2018 results, published in the journal Obesity, show that the number of overweight individuals who are misperceiving their weight has increased over time, from 48.4% to 57.9% in men and 24.5% to 30.6% in women between 1997 and 2015. Similarly, among individuals classified as obese, the proportion of men misperceiving their weight in 2015 was almost double that of 1997. As the saying goes, the first step to recovery is recognizing there is a problem. So the unintended consequence of normalizing being overweight is that over half of people suffering from excess weight may be completely unaware of their situation, including all of the negative health that comes with it.
What We Can Do Now
Do we need to go vegan, Keto, or Paleo? No. But if we just become more aware of how sugars, oils, and grains, along with their excess calories, creep into our diets, we have taken a big step in the right direction. I don't think we need to go so far as to look at the labels of every last thing we eat. That could be taxing on the average person. But if we are mindful not to eat anything that comes with a label, we can rid ourselves of much of the ultra-processed foods contributing to our ever-increasing weight.
Food cravings and addictions may interfere with your plans. I feel for you if you find it difficult to stay away from highly processed, rewarding foods. However, incorporating whole foods into your diet doesn't have to be difficult. Start by slowly adding more nutrient-dense whole foods, such as vegetables, fruits, beans, eggs, nuts, and seeds, into your meals and snacks. They will fill you up, helping to dull or remove your cravings.
If you feel you have a food addiction, or worse, an eating disorder, there is help. First, consult with your primary care doctor to discuss your issues. Additionally, The Food Addiction Institute and Eatingdisorderhope.com are great online resources. Remember, hunger, food cravings, weight gain, and its associated medical problems are complex hormonal, psychological, and social issues. People who have problems staying healthy are not weak or flawed. Our food supply seems to be the real culprit. Raising our awareness of how our food has changed over the last several decades may empower some of us to change it back and avoid becoming unhealthy.