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On his laptop, Kelly Brownell keeps digital slides of two rats. One shows a healthy, normal-sized rat sitting on a pile of food pellets. The rat was oversupplied with highly nutritious food in a study by Anthony Sclafani at Brooklyn College, but it never got fat. “Normally, a rat won’t overeat,” Brownell remarks.
Then he clicks to the other slide. The second rat’s cage is full of classic American junk food: Cheetos, Oreos, sugared cereal, marshmallows, chocolate. This rat is three times the size of the first. Brownell has a picture in which the two adult rats, sitting side by side, look like a mother and juvenile, or like two different species. The second rat was also offered healthy food, Brownell says, but ignored it. Rats are biologically primed to fight famine, and so are humans: “Biology is very powerful. Our bodies know that calories come most efficiently from foods high in sugar and fat. That’s why we like them.”
What happened to the second rat is essentially what is happening to the human race, with Americans leading the way, says Brownell, who is chair of Yale’s psychology department and director of its Center for Eating and Weight Disorders. It is obviously foolish to blame the rat for its unhealthy eating habits; it is also, he argues, simplistic to blame overweight humans. Given the choice between a plate of broccoli and a bacon cheeseburger, most people will find it hard to pass up the burger, despite everything they know about cholesterol, calories, and saturated fat content. Brownell says they aren’t ignorant or weak-willed so much as they are obeying a genetically determined survival instinct. The problem is that they live in a culture as abundant in junk food as the second rat’s cage. “If you want to make the personal responsibility argument, then you have to dismiss biology,” he says. Or, as Louisiana State University’s George Bray, MD, puts it: “Genes load the gun; the environment pulls the trigger.”
Brownell believes that government should take steps to rein in the problem—a position he has stated often and publicly, and which has made him one of the better-known and more controversial obesity experts in the country. His recent book Food Fight, co-authored with clinical psychologist Kathleen Battle Horgen '95, is only his latest sortie into the public debate. Brownell calls America a “toxic food environment,” and he sees no reason to put up with it. “We are literally eating ourselves to death,” he says, “and our government leaders are doing almost nothing about it.”
Human preference for the bacon cheeseburger and its ilk dates back to the days when food supplies were unpredictable, finding sufficient sustenance was a daily struggle, and starvation was an ever-present threat. Those humans who thrived were the ones who adapted to food scarcity by eating voraciously when food was available, in order to store energy in the form of body fat for the inevitable periods when it wasn’t.
Over the generations, natural selection produced a human race drawn to an energy-dense diet. The selective seeking out of foods high in fat and sugar was not a reasoned choice—not a cerebral decision to eat “what’s good for you”—but one embedded in the human body. Through a complex physiological process that begins in the nose and mouth and governs how food tastes, sugar and fat became the substances with the most appealing flavors. “If you crave comfort food,” Brownell says, “you’re probably not seeking out a carrot stick.”
Brownell agrees with many other obesity experts that the precipitous drop in our physical activity is also a major factor in the equation. Extreme exertion was once needed for hunting and gathering food, so that the human body was programmed for bursts of strenuous activity followed by periods of rest. Now that we do most of our hunting and gathering in supermarket aisles, exercise is no longer integral to the search for food, and those stores of body fat—which the body is genetically predisposed to retain—hinder survival rather than help it.
Consider the Pima Indians. About 500 years ago, a contingent of Pimas migrated from Arizona to Mexico. The Pimas who remained in Arizona have remained relatively genetically stable ever since, mixing little with other populations, but their diet and exercise patterns have changed. Eric Ravussin, a physiologist at Louisiana State’s Pennington Biomedical Research Center, compared the Arizona Pima Indians with the Pimas who had settled in northern Mexico. He found that the Arizona Pimas eat nearly twice the fat calories of the Mexico Pimas and weigh much more than the Mexicans do; the average Arizona Pima woman is 44 pounds heavier than her counterpart in Mexico. In addition, the American Pimas have a diabetes rate of 45 percent, compared with 6 percent for the group living a more traditional lifestyle. Ravussin has little doubt what caused this health disparity. “The genes didn’t change,” he says. “What drastically changed is the environment.”
In recent years, the obesity epidemic has become impossible to ignore. Health officials estimate that two-thirds of American adults, or 65 percent, are either overweight or obese. (People who are more than about 40 percent above ideal weight are classified as obese. Overweight means about 20 percent above ideal weight.) Obesity is a contributing factor in high blood pressure, diabetes, heart disease, and stroke.
Many people have decried the obesity epidemic, and there is a growing research effort to counter it. But Brownell is one of the few who have consistently framed the debate in terms of society, public health, and public policy. He has been calling for government intervention since the mid-1980s. “His main contribution,” says Michael Jacobson, executive director of the advocacy group Center for Science in the Public Interest, “is to shine a spotlight on how the food industry actively promotes bad nutrition and the need for government to correct that.”
Brownell has studied obesity for the past 25 years, starting with his graduate work at Rutgers University. (He received his undergraduate degree from Purdue University and taught at the University of Pennsylvania for 13 years before coming to Yale in 1990.) His determination that obesity is a public health problem grew out of his work as a clinical psychologist in the mid-1980s. As he studied treatments of obesity that used the traditional medical model of seeking remedies for individuals, he began to notice that he wasn’t seeing much progress. “When a problem is that difficult to treat,” he says, “it screams out for prevention. And prevention by its nature is a public health issue.”
For six years in the 1990s, Brownell was the master of Yale’s Silliman College. Living in such close proximity to students gave him further insight into the nation’s weight problem. “I saw how people even as smart as Yale students still are affected by bad eating,” he says. “They were always eating Yale’s version of Chicken McNuggets, lots of pizza, large amounts of soft drinks. It reinforced my idea that it’s not about education or being intelligent.”
Moreover, the sheer magnitude of the epidemic suggested a problem far more pervasive and complex than the plight of some overweight individuals. Instead, Brownell saw the confluence of abundant and affordable food, declining physical activity, corporate opportunism, and government complicity as the foundation of an environment in which obesity will inevitably flourish.
At around the same time, he began following the war on tobacco. “I considered the people who took on the tobacco industry—people like the former medical school dean, David Kessler—to be heroes,” he says. And when he saw the success they were having with a public health approach, he decided the same strategy might work with obesity.
Consumers no longer need to go to a restaurant or a grocery store to buy food. Today it is sold everywhere, including gas stations and drugstores—and not just sold, but marketed aggressively and tirelessly, especially to new customers. It has been estimated that the food industry spends $30 billion a year on advertising, and about a third of this goes to court children alone. Food companies partner with Disney to include Disney toys along with their meals. They offer cash-strapped schools lucrative deals in exchange for putting vending machines in school buildings. They set up fundraising arrangements in which PTAs sell Krispy Kreme donuts to students' families.
And then there is TV. “The average American child watches 10,000 food advertisements on television each year,” says Brownell. “If parents eat three meals a day with their children for a year—which no one does—that’s only 1,000 exposures. On the parents' side you have parental authority and respect, versus, on the other side, Shaquille O'Neal, Britney Spears, SpongeBob, animation, music. Who do you think is going to win?”
Indications are that SpongeBob and company are in the lead. Children today eat five times more fast food than they did in 1970, according to a recent study by David Ludwig, director of the obesity program at Children’s Hospital of Boston. Fifteen percent of American children are obese—three times more than in the early 1980s. The most prevalent form of diabetes, which has been linked to obesity, is no longer called “adult-onset diabetes”—in part because it is increasingly common in children. Brownell comments, “This generation of children may be the first in American history to live shorter lives than their parents.”
Federal efforts to promote fitness date back to at least the 1950s, when President Dwight D. Eisenhower created the President’s Council on Youth Fitness. But while the government’s strategy addresses exercising and eating less—the familiar emphasis on personal responsibility—it turns a blind eye to the marketing of unhealthy food to children. “Its position,” argues Brownell, “is indistinguishable from the food industry’s and at odds with science, common sense, and public health policy.”
Brownell is unusual among scientists in the forceful language he brings to policy debate. This January he co-authored an opinion piece for the New York Times with Marion Nestle, professor of public health at New York University, about a World Health Organization report on sugar consumption. The report, released with the Food and Agriculture Organization, recommended basic steps like eating more fruits and vegetables and less fat and sugar. But according to Brownell and Nestle, food industry associations pressured the U.S. Department of Health and Human Services to intervene—and the department accordingly issued a sharp critique of the report’s scientific and peer-review process. In Nestle’s and Brownell’s eyes, the government position was “blatant pandering to American food companies that produce much of the world’s high-calorie, high-profit sodas and snacks.”
Brownell would like to see the federal government take a strong stand nationally on the marketing of unhealthy food to children. Fast food, snacks, and soda should be banned from schools, he says. (A single 20-ounce Coke or Pepsi in a school vending machine contains 15 teaspoons of sugars; even the U.S. Department of Agriculture, not known for hard-hitting health-food advocacy, recommends that someone eating 2,200 calories a day limit added sugars to 12 teaspoons.) In addition, advertising that targets children should be regulated; for instance, the government should require equal time for ads promoting healthy eating. And school lunch menus should be overhauled, so that the school lunch is no longer treated as a venue for pizza and hamburgers but as an opportunity to teach children to eat right.
Brownell also has some suggestions for the food industry. In 2002, he and David Ludwig published an opinion piece in the Washington Post proposing that the food industry suspend all advertising aimed at children, stop selling soft drinks and sugary snacks in school vending machines, stop sponsoring scholastic activities linked to product promotion, and end political contributions that could influence nutrition policy. Four days after their proposal appeared, the Wall Street Journal ran an article about food companies that are contemplating refurbishing their images. (Their preferred methods, which differed substantially from Brownell's, included steps such as donating gym equipment to schools and recommending moderation in their ads.)
By far his most controversial idea is a federal tax on high-fat and high-sugar foods. In Brownell’s ideal world, the proceeds would go to a national nutrition Superfund, which might underwrite, for instance, grants to schools that give up their soft-drink vending machines, or ads in which celebrities promote vegetables. But when he first published the idea in the popular press, in 1994, it instantly attracted controversy. Critics dubbed it the “Twinkie tax.” “This indeed is social engineering,” said Robert A. Levy of the Cato Institute. “When government starts controlling the choices people make, then we have social engineering without any restraint. What is next after food? Will they start telling us how many push-ups to do every day?” (Brownell still thinks the tax proposal has potential, but has put it on hold for the moment so as not to distract from the larger issues.)
Brownell has been called a “wacko,” the “grand poobah of the anti-consumer movement,” and a “food fascist.” A 1998 Boston Globe editorial declared that Brownell “wants Big Brother to make you eat less junk food. Ben and Jerry will be transformed from kindly Vermont hippies to foul peddlers of heart disease.” The National Review’s commentary on Food Fight began: “It is difficult to single out what is most objectionable about this hectoring, lecturing, and altogether dejecting piece of work.”
Is Brownell a regulatory extremist? Or a health-policy visionary? Even those who support a snack-food tax say it would be tough to implement. California actually enacted a similar food tax in 1991—to raise revenue, not as a public health strategy—but repealed it less than a year later, because the categories for food that was taxable and food that wasn’t were highly arbitrary. M&Ms sold as candy were taxed, but when sold for baking they weren’t. Cupcakes sold at room temperature were taxed, but frozen cupcakes were exempt. Popped popcorn was taxed, but unpopped popcorn wasn’t.
But Brownell points out that government has stepped in at other times when personal responsibility failed to counter a genuine public health risk. Think immunization requirements, he says, or seatbelt laws. Other food scientists say he could be right. Louisiana State University’s Ravussin says the food tax “sounds totally crazy now, but I think it’s going to happen. There’s too much interest from a lot of sides.”
As for the idea that our food culture has become toxic, Ravussin thinks Brownell is just ahead of his time. People are “still outraged to hear that kind of message,” he says. “Twenty years from now, everyone will be saying it.”
Brownell settles into the corner of an overstuffed couch in the living room of his shorefront home in Branford, Connecticut. Dressed in blue jeans and a Denver Broncos sweatshirt, he looks less like a health policy firebrand than an amiable elder brother of Liam Neeson. The room is comfortable and inviting, with a fireplace, framed photographs of Brownell’s three children, and a sleepy bearded collie curled up on the rug. There is a picture window with a view of the Long Island Sound. It is an incongruously serene setting for a man who has touched off so much national controversy.
But Brownell, who sees himself as a latter-day David fighting a super-sized Goliath, welcomes all comers. “I kind of like a fight,” he says, “and their defensive reaction signals to me that I’ve hit a nerve, and that this is something we need to pursue even more aggressively.”
Brownell opens up his laptop and demonstrates a slide presentation he likes to use in lectures. One section features Centers for Disease Control data that trace the spread of obesity across the country from 1985 through 2001. The first slide shows a map of the United States in which most of the states are colored light blue, to indicate a low prevalence of obesity. A few, colored dark blue, have a high number of obesity cases. As he clicks through the slides, pointing out how the map changes year by year until most of the country is dark blue, Brownell sounds like a meteorologist explaining a weather pattern. But instead of tracking a cold front, he’s tracking a fat front.
Included in the presentation are a few slides meant to illustrate society’s unthinking, uncritical acceptance of the junk food all around us. One shows a McDonald’s in the lobby of a hospital. In the window is a poster announcing a new cheddar-bacon-sausage Egg McMuffin. “Could you possibly design a better fat delivery system?” Brownell asks, incredulously. “In a hospital, no less!” The last slide—taken by his son Matthew, a photographer—shows a shelf full of baby bottles. All of them sport soft-drink logos.
In Food Fight, Brownell and Horgen collect the most recent research on the availability of high-calorie foods and super-sized portions, Americans' increasingly sedentary lifestyle, and, especially, high-pressure marketing to children. The book is designed to “paint a picture of the total food and activity environment,” he says. “To create an 'oh-my-God' reaction.”
Sean Faircloth, a state representative from Bangor, Maine, says Food Fight is the book he always recommends. Faircloth has been pushing legislation that would, among other things, require that school vending machines offer only healthy foods and drinks; it would also earmark one percent of the gas tax for mass transit, footpaths, and bike trails. (After he introduced the proposal, Maine’s Department of Education became the first in the nation to limit school vending machines to products that meet federal standards for minimum nutrition.) The book, he says, “is the best example of moving beyond the old discussion of diets and what a big epidemic obesity is to the real issue, which is policy change.”
Despite his public health orientation, Brownell, as the director of Yale’s Center for Eating and Weight Disorders, remains close to the daily struggle of overweight individuals. The center treats patients for anorexia, bulimia, obesity, binge eating, and body image disturbance, making it one of the few clinics that deal with weight-related disorders at both ends of the spectrum. It serves about 100 clients at any given time, training graduate students in clinical psychology and drawing on faculty throughout the university.
The center also does clinical research on weight problems, which has tended to confirm Brownell in his focus on prevention. “I remember one patient, Lois, who was desperate to lose weight and willing to try anything,” he says. “But even when we put her on a strict low-calorie diet, she couldn’t lose weight. It broke my heart. Her body wasn’t letting it happen.”
Brownell himself is a large man who admits to periodic weight fluctuations. “The times I struggle with it the most are when I’m most sedentary—when I’m busy with administrative duties or working on a book,” he says. Arguably, Brownell’s own battles with his weight underscore his points. If someone who literally wrote the book on obesity has his own weight problems, it’s hard to see weight control as a simple issue of mind over matter.
Brownell finds many reasons to be hopeful. Connecticut congresswoman Rosa DeLauro has introduced a bill requiring that menu boards at fast food restaurants provide the calorie content of each item. Some fast food restaurants are adding salads, grilled chicken, and veggie burgers to their menus (though some of the salads are laden with bacon and fatty dressing). Philadelphia and Los Angeles recently banned soft drinks from public schools. Kathleen Battle Horgen senses a nascent grassroots movement. “Parents are waking up to what’s going on,” she says. “As they get involved, administrators are starting to listen.”
Horgen and Brownell agree that, beyond recent legislative and policy initiatives, there’s been a more general shift in the public’s attitude, which they attribute to the alarming statistics about the prevalence of obesity and to the media’s growing interest in the subject. “As recently as three or four years ago, the debate was focused on how to lose weight. It was a problem for the individual,” Brownell says. “Now, we’re looking at obesity as a public health issue. That’s an incredible shift.”
There’s a quote from Gandhi that has special meaning for Brownell: “First they ignore you. Then they laugh. Then they fight you. Then you win.” He says it perfectly describes his experience as a crusader in the food marketing wars: “At first I got no attention, not even from my colleagues. Then the laughing began—the 'Twinkie tax' and all that. Then came the vicious attacks from the food industry. And now, we have cause for optimism.”
Kelly Brownell is one of many researchers at Yale working to understand the causes and consequences of obesity. Much of their work falls under the aegis of the Medical School’s Diabetes and Endocrinology Research Center. Founded in 1993, the center helps support 100 investigators in 16 fields—from cell biology to psychiatry, from orthopedics to immunology. “Bringing people together from lots of disciplines, who have different points of view and experiences, is likely to create the kind of creative environment to have an impact,” says Robert S. Sherwin, MD, center director.
Because four out of five people who develop the most common form of diabetes are obese, “the epidemiology of obesity and the epidemiology of diabetes have run hand in hand,” Sherwin explains. The prognosis is grim for American society: Sherwin cites a recent article in the Journal of the American Medical Association predicting that one out of three children born in 2000 will develop diabetes, the nation’s leading cause of blindness, kidney failure, and non-traumatic amputations and a major cause of heart attack and stroke. The cost to the nation of treating diabetes is very high, because the disease is both common and chronic.
Basic diabetes research at Yale includes the work of Gerald I. Shulman, MD, who uses nuclear magnetic resonance spectroscopy to study metabolism at the cellular level. Shulman has found that the efficiency of cell metabolism naturally declines with age but that exercise can prevent this deterioration. Shulman’s colleague, endocrinologist Sonia Caprio, MD, is tracking 500 obese children and teenagers from Connecticut to see who develops diabetes. She is also studying whether an evening program of exercise, nutrition classes, and discussions of coping skills will help children lose weight. Dietitian Mary Savoye counseled one teenager who enrolled weighing almost 400 pounds and lost 150.
Obesity research extends beyond the medical school campus. Social psychologist Margaret Grey directs a research and education program in four New Haven middle schools in which 40 percent of the students are obese. She and dietitian Marita Holl run a program to teach science and physical education teachers how to instruct their students about nutrition, physical fitness, and coping skills. The researchers will closely track 250 of the 1,000 students to measure the effects of the instruction. Epidemiologist Loretta DiPietro has analyzed data from a range of exercise studies and is doing her own research to find out how much exercise older women need to keep from gaining weight. (Her tentative verdict: an hour of brisk walking four to five times a week.)
Two Yale faculty members have recently written books about losing weight. The Way to Eat: A Six-Step Path to Lifelong Weight Control is the work of internist David L. Katz, MD. Katz’s book is not a prescriptive weight-loss plan but a comprehensive look at food and diets with advice for the long term. Katz runs the Yale-Griffin Prevention Research Center, developing disease-prevention strategies including cost-effective programs to prevent obesity. Internist and clinical professor Lisa Sanders, MD, published The Perfect Fit Diet: The Customized Science-Based Plan for Your Genes, Taste and Lifestyle. Sanders identifies three basic types of weight-loss plans—counting carbohydrates, counting fat, and counting calories—and provides a questionnaire to help dieters determine which plan best suits their eating patterns and food preferences.
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