The Cure for Obesity is Processed Food: When the Poison is the Antidote (Part 1)

  “We have a war between two food systems, a traditional diet of real food and ultra-processed food”

…tweeted Dr. Robert Lustig, a fellow Professor at UCSF School of Medicine. He’s right. But I replied with the inconvenient truth few are willing to admit: “processed foods have won the war.” Rather than be disillusioned that the obesity epidemic is unstoppable, we must soberingly admit our current strategy for curbing the tide is doomed. But there is another way. When other strategies fail, psychologists sometimes use “paradoxical interventions” where the symptom is counterintuitively prescribed as the cure. So this is a radical manifesto about how processed foods have not only caused the obesity epidemic, but can also cure it. To paraphrase Robert Frost:

“The only way out is through.”

S.A.D.! The Standard American Diet is 2/3 Processed Foods!

Dr. Dariush Mozaffarian, Dean of the Tufts School of Nutrition, and colleagues published one of the most eye-opening studies on the Standard American Diet (or what I humorously like to call “S.A.D.!”). Astonishingly, they showed that only 1/3 of calories from ‘whole’ foods (unprocessed or minimally processed) anymore. The other 2/3 of calories come from a combination of 10% from ‘processed foods’ (like cheese, which one could potentially make in a kitchen) and a staggering 57% from ‘ultra-processed foods’ (like Cheeze-It crackers, which can only be manufactured in a factory).

The evidence is clear. By a 2:1 margin, processed foods have dominated whole foods in America like Mayweather over McGregor. It’s no wonder, processed foods are widely perceived as cheaper, tastier, and more convenient than whole foods. But what people don’t fully realize is that processed foods are actually a technology developed by a multi-trillion dollar food industry, and we are never, ever going back to the pre-industrial way things were. We live in a world of transformative technologies, and in a nation were 98% of Millennials own ‘smart’ phones, our society will clearly never go back to ‘dumb’ phones and pagers. So why do we expect any differently with food?

On an individual basis, it is possible to eat 100% whole foods, but on a societal basis, it is clearly not. Expecting the majority of Americans to never eat processed foods is like teaching “abstinence only” sex education, and expecting most people to never engage in sexual activity until marriage. Educational strategies that aren’t realistic about human behavior are ineffective, when what we really need are strategies that acknowledge people will enjoy themselves, and at least teach them how to reduce harm when they do so anyway.

Convenience is the Only Sustainable Choice.

You cannot tell people to just make “healthier choices" and expect results. Every doctor tells their patients to “eat right and exercise” out of ethical obligation, despite research studies showing that advice alone fails to work. In fact, in the so-called “placebo” or control group of the Diabetes Prevention Program clinical trial, which was designed to show no effect, patients were told anyway to lose 5-10% of their body weight. Surprise, surprise! they didn’t, and sometimes even gained weight. Even the lifestyle (intensive counseling) and metformin (medication) groups, which did significantly slow the onset of diabetes, eventually regained all the weight lost they lost after a decade:

According to the law of inertia, any clinical treatment for obesity that expects patients to significantly do more work, not less, will eventually fail in the long-term. Eating 100% whole foods was only sustainable in a pre-industrial farming area, where the only foods we could eat were the ones we hunt, picked, and planted ourselves (that’s the real Omnivore’s Dilemma. Sorry, Michael Pollan). But people no longer have the time, energy, or resources to eat three home-cooked meals per day. Modern households are no longer inter-generational, with fewer grandparents or stay-at-home spouses to bear the responsibility of communal food preparation.

Those days are long gone, and we must accept the reality that was ushered in the 1950s with TV dinners, which even then, “came as a great relief for housewives burdened with baby-boom offspring.” Convenience is king. But it’s not just because we don’t have time to prepare whole foods, it’s because the alternative is so behaviorally irresistible.

Obesity is More a Behavioral than a Biological Problem.

In the medical community, obesity is considered a part of ‘metabolic syndrome’, since it shows up externally, as stubborn belly fat, but also internally as high blood sugar, high blood pressure, high cholesterol, and high blood fats. But these are actually symptoms of the problem. While obesity is a complex, biopsychosocial problem with no one easy explanation, the explosion in obesity rates suggest there’s something radical going on. If you look at this CDC time lapse of obesity rates from 1985-2010, most states went from <10% obesity to >30% obesity in the span of only 25 years!

In this period of time, the main driver is that the way we eat has changed dramatically: with people cooking less, eating out more, and relying more on processed, carbohydrate-rich foods. Thus, the data suggest that obesity is more of a behavioral problem than a biological problem. And these foods also serve a psychological need as well. Despite the current opioid crisis, eating is actually America’s favorite narcotic: with 38% of adults reporting “they have overeaten or eaten unhealthy foods in the past month because of stress.”

Most Ultra-Processed Foods are ‘Designer Drugs’, and We’re Hooked.

In Waistland: A (R)evolutionary View of Our Weight and Fitness Crisis, psychologist Deirdre Barrett argues out that human beings evolved to crave certain stimuli: fats, salts, and sweets, to help us store fat for leaner winter times. “Big Food” companies exploited these natural cravings by designing processed foods that are far fattier, sweeter, and saltier than anything that normally exists in nature. Thus, processed foods are “supernormal stimuli” that are purposefully designed to be addictive, and effectively outcompete whole foods on our tricked taste buds. Even birds, who preferentially care for their larger eggs because they’re more likely to survive, can be tricked into taking care of super large fake eggs and neglect their smaller real eggs, because they are supernormal stimuli:

Lest you think this is a conspiracy theory—Big Food industry scientists have admitted on record that they use such scientific principles to create addictive foods. A 2013 New York Times article, “The Extraordinary Science of Addictive Junk Food”, revealed that companies like Frito-Lay have $30 million R&D budgets to fund a research staff of 500 chemists, psychologists, and technicians. They create ‘frankenfoods’ like Cheetos with technologies like “vanishing caloric density,” that makes foods melt in your mouth so quickly “your brain thinks that there’s no calories in it . . . you can just keep eating it forever.” In light of such irresistible foods, why do we actually expect people to exercise self-control and just “stop it”?

All Drugs Aren’t Bad. All Processed Foods Aren’t Either.

In the modern era, we treat addiction as a disease, and often replace addictive and impure street drugs like heroin, with prescription opioid medications like methadone that are purified and better controlled to prevent deadly withdrawals and carefully wean people off. Street drugs and prescription drugs are both “drugs”, but can hardly be equated since the former often takes lives, while the latter can often give it back in the right circumstances.

Similarly, we can’t lump all processed foods together as being “bad, m’kay?” Unsweetened yogurt, butter, and cheese, have been minimally processed foods for millennia and also ultra-processed more recently. Studies show dairy consumption is actually associated with lower risk of type 2 diabetes. The devil is always in the details though, and a ball of handmade burrata cheese is hardly the same thing as plastic packaged cheese slices that have so little actual cheese in them the FDA requires legally labeling them as “cheese product.”

So we should just look at the ingredient labels and avoid all those chemical sounding ingredients we can’t pronounce, right? While this is a helpful rule of thumb, chemistry teacher James Kennedy illustrated that it’s not always accurate. If you analyze any whole food like a Kiwi, it’s technically made up of a lot of ‘chemicals’ that naturally exist in nature:

Intentions Matter: Processing for Health vs. Wealth

So just because a food is ultra-processed or fortified with added ingredients doesn’t inherently make it unhealthy. While the World Health Organization educates mothers that breastfeeding for the first 6 months is the “optimal way of feeding infants”, it also acknowledges that infant formula can play an essential or supplementary role in keeping infants alive and healthy when mothers cannot breastfeed regularly. The problem is that unlike infant formula, most ultra-processed foods are not formulated for optimal health, but for best taste and low cost.

I recently spent a lot of time in the food industry to understand how foods are manufactured. If you want to bring a food you make in your kitchen to be sold in stores, it has to survive a 4x price markup in order to pay the manufacturers, distributors, and retailers along the way, which often forces producers to choose cheaper ingredients just to launch a product. And of course, businesses need customers to keep buying to stay in business, so sugar is added in many processed foods because it is addictive and increases repeat purchases.

Processed Foods are not Nutritionally Superior. They are Behaviorally Superior.

The fortunate exception to this trend is the emerging craft/artisanal food movement, which tends to make processed foods using quality ingredients from organic, sustainable, or healthier sources. Unfortunately, these foods are usually at a price point that’s out of reach for non-affluent consumers. Thus, governments should use behavioral economics (just as they did with cigarettes and alcohol) to tax unhealthier processed foods, and actively subsidize healthier processed foods, so that consumers are financially incentivized to make better choices.

Let’s stop idealistically arguing that whole foods are nutritionally superior. That’s not the point; it’s that processed foods are behaviorally superior in terms of what most people actually eat. So processed foods are not going away, the only realistic solution we face is to make better processed foods that are optimized for health…

Continued in: The Cure for Obesity is Processed Food: A Realistic Solution (Part 2) [coming next week, so subscribe to my newsletter to be notified]