This article is related to Anthony Biglan’s new book Rebooting Capitalism: Forging a Society that Works For Everyone.
My son Michael is addicted to sugar. About three years ago he announced on Facebook that he would not be eating anything that had added sugar--no cookies, cakes, ice cream, even my coleslaw to which I always add a bit of sugar. He immediately lost 15 pounds.
Mike was not terribly overweight; about 210 at 6 foot 1 inch.
At the end of the year, he went back to eating things with sugar and quickly found that just a day of having some cookies and other sweets produced a craving that resulted in his eating incessantly and regaining much of the weight he had lost. So he made another public declaration and went back to not eating sugar.
I was vaguely aware of some evidence that sugar could have this effect, but I also thought that he could just put some limits on when he would eat sweets. Behaviorists call that “stimulus control.” Forty years following behavioral principles had allowed me to establish stimulus control over some of my behaviors. For example, I would engage in a behavior like overeating at a party, but not at other times. I got so I could click into gorging, but it would not carry over to other times and places. Similarly, I established the habit of writing first thing in the morning, and got so I could readily click into writing at that time.
But Mike found it difficult to control the behavior. Based on what I have learned about the addictive effects of heavy sugar consumption in childhood, I suspect that his problem resulted from the fact that he was exposed to a lot more sugar as a child than I was, when I was growing up in the 1950s. Yet Mike has established a form of stimulus control –his publicly stated intention to not consume sugar--for a year.
Anyway, my research on this topic has convinced me that Mike is right. The consumption of large amounts of sugar, especially when you are a child can establish a craving and dependence for sugar that is functionally the same as the craving for alcohol or other drugs.
So this essay is dedicate to Mike. Teasing each other over who is right is unfortunately a manly tradition in our family. So Mike you were right and I was wrong!
There is a large and growing literature on the problems with the American diet and the role the food industry has played in the problem. A recent analysis estimated that more than 500,000 Americans die each year due to unhealthful eating habits.1
I will only discuss the problems involved in children’s poor diet and obesity problems. That will be enough to illustrate how this industry’s practices have evolved as a result of market forces. There are other examples of how the industry has harmed health in the process of expanding its markets and profits, but one example will do. The story is fairly simple:
- Childhood obesity is a huge problem. (No pun intended.)
- Children’s diets are at fault.
- Their poor diets are the result of the products the food industry has created and marketed to children.
- The practices of the food industry are simply the result of the evolution of the industry. They were selected by their contribution to profits. They evolved increasingly effective ways to design foods that children will crave and to market them to children.
- As the harmful impact of the food industry on children became apparent to the public health community, the industry has evolved lobbying, public relations, and marketing techniques to prevent regulation of their business practices.
Obesity in America
America has an obesity problem and it has been getting worse for at least 25 years.2 In 1990, 15% of adults in Mississippi were obese and that was the highest rate in the country. By 2016, Mississippi’s obesity rate was 37% and every other state had seen a dramatic increase. Colorado, the state with the lowest rate in 1990 went from 6% obese to 22% in 2016. Across the nation, about 36% of people are obese.3
Increases in obesity among children has been especially dramatic. About one in five children are obese.4 In six states, more than 35% of children are obese or overweight. The lowest rate of obesity or overweight is in Utah, at 19%. The highest is in Tennessee at 37.7%.
Why should we care about obesity? Well, an obese child risks developing major diseases as an adult. They include diabetes, cardiovascular disease, some types of cancer, and kidney disease. An obese girl is more likely to have complications if she becomes pregnant. A child who is obese is also more likely to develop high blood pressure, osteoarthritis, and sleep apnea.5 Pediatricians are finding that obese young people are developing adult onset diabetes, something that was never before seen in children and adolescents.6 For the first time in history, public health officials are predicting that the younger generation will have a life span shorter than their parents.7
Why do we have an obesity epidemic? One of the major reasons is that the American diet has changed dramatically over the past fifty years. In particular our consumption of sugar has gone off the charts.
Stephan Guyenet, a neurobiologists has studied records of the production of sugar in the U.S. since 1822. His data show that our consumption of sugar climbed steadily from 6.3 pounds person in 1822 to 107.7 pounds in 1999.8 Think about this from an evolutionary perspective. I am pretty sure that the level of sugar consumption in 1822 was already way above the level that human consumed for the previous ten thousand years in which many of our genes were selected.
This is an example of what evolutionists call an evolutionary mismatch. We evolved to find sugar reinforcing, undoubtedly because the humans who found it reinforcing were likely to get good at finding and eating foods that were high in calories and were thus more likely to survive. However, few places in nature had large amounts of the stuff. That changed when we learned how to massively increase the production of sugar. Our current obesity epidemic is the result of the fact that we simply weren’t built to consume that much sugar.
In fact, the World Health Organization's (WHO) recommends that ideally less than 5% of our caloric intake should come from added sugar.9 That’s about 6 teaspoons. Yet the most thorough study of American children’s intake of sugar shows that on average, about 16% of the calories come from added sugar.10
Children’s breakfast cereals contain forty percent more sugar than cereals popular with adults. They average more than two and half teaspoons per serving, well over twice the limit recommended by the World Health Organization.11 However the serving size that most cereals list on the box is less than most children consume at a meal. So even if a cereal seems to have a low level of sugar, your child is probably getting more of it than the nutrition label suggests.
In addition to there being more sugar in the foods we eat, the size of the portions we eat have increased. Selling bigger portions of a food is one way food manufacturers can sell you more of their product. Over the past 70 years the typical size of soft drink bottles has gone from six and a half ounces to 12 ounces, then 20 ounces, and then to 42 ounce bottles. By 2004, children were getting 11% of their calories from soft drinks. The number one calorie source for teens is sugary drinks!12
Designing, Manufacturing, and Marketing Foods That Harm Us
The development of the food industry is another evolutionary story. It involves the rise of corporations, the use of science and technology to produce products that will sell, and the evolution of marketing to maximize sales. It also involves the evolution of lobbying and public relations practices to prevent regulation of the industry.
The food industry did not set out to make us ill, that is simply a by-product of their efforts to compete successfully in the marketplace. The generic principle that explains the development of harmful marketing of any product is that market competition motivates companies to innovate in whatever ways work to improve their profits. In the case of the food industry, this has included extensive research on what makes foods irresistible and how the companies can market their products to as many people as possible.
Designing and Manufacturing Irresistible Food
If you are troubled by my referring to the food industry and the manufacture of foods, let me explain. The major corporations producing and marketing food in this country, carefully research the impact of different formulations of their products to identify the ways to make these foods as irresistible as possible.
Michael Moss, the Pulitzer prize winning investigative journalist has written about the precision with which the food industry has pinpointed what it takes to make you love a processed food. The key ingredients are salt, sugar, and fat. The best-selling foods are loaded with them.
Here are some examples of how the industry developed and manufactured foods that are far different from any food humans have eaten prior to the advent of the food industry.
The bliss point. Through careful and precise experimental research food technicians study what level of sugar is most preferred by the most people. They call this the bliss point. Most manufactured foods are made to have the level of sugar that tests have shown are going to be the most satisfying to the most people. The typically preferred level is not the highest you could possibly make it, but it is far higher than the amount of sugar that you will find in any natural food such as an apple, orange, or other fruits or vegetables. Oh and it turns out that the bliss point for sugar is higher for children than for adults. That is why there is so much sugar in cereals for children.
Convenience. Moss describes how over the past fifty years the food companies competed to make foods that could be prepared quickly with as little work as possible. He tells the story of General Foods which was trying to make a pudding that would take less than two hours to prepare. (This was at a time when women were beginning to work outside the home. Two hours of meal preparation might not have seemed that much of a problem when few women worked outside the home, but for the increasing number of women who did work outside the home, the convenience of quick meal preparation was huge.).
At the time, General Foods refused to use additives to make the pudding quicker to prepare. Until, that is, another company was about to market a pudding mix that was likely to capture the market for instant pudding. The company then told their chief chemist, Al Clausi, to find whatever additives he needed to make an instant pudding. He succeeded, General Foods captured the market in puddings, and the company’s restrictions on the use of additives became a thing of the past.
These are just two examples of the way in which the food industry has evolved its ability to design and manufacture foods that make it easy and irresistible to consume foods that aren’t good for you—but are good for the companies. Read Michael Moss’ book, Salt, Sugar Fat: How the Food Giants Hooked Us, to learn about how good the industry has become in designing food products that will sell.
Unhealthful Foods Are Being Marketed To Children
So if children are getting fat, is it the fault of the food industry? Like the tobacco industry, the food industry has put the blame on parents for not properly supervising their children’s eating habits. But that argument ignores how successfully the food industry has made it nearly impossible for parents to combat their children’s desires for fattening foods.
Public health researchers have been appropriately cautious in evaluating whether food marketing is a factor in childhood obesity. A report from the Institute of Medicine reviewed the evidence available in 2006 and concluded that the food industry’s marketing affects children’s food preferences and “likely” contributes to poor diets and obesity. However, the report said that there was insufficient evidence to conclude that marketing was affecting adolescents. At that time, only the marketing to children was indicted.
More evidence has accumulated however. A report from the Rudd Center for Food Policy and Obesity13 summarized the evidence. The industry spends $1.8 billion a year marketing to children and adolescents. Most of this is spent marketing food products that are high in fat, sugar, and salt and have little nutritional value—fast foods, high sugar cereals, sugar-sweetened beverages, candy, snacks, and deserts.
Only four tenths of one percent of the companies’ marketing is spent advertising fruits and vegetables. Children’s and teens’ exposure to ads has been increasing in recent years, with children seeing an average of 12.8 ads per day and teens seeing 16.2 per day. In addition to ads, product placement in movies and TV shows is quite common. One study found that for the 20 most popular movies between 1996 and 2005, 69% of them had at least one food or beverage shown and that a total of 1,180 brands were placed in these movies.14 And in recent years, companies are increasingly advertising in social media, which is expanding the companies’ ability to reach youth and may be more effective than TV ads.
If you are inclined to believe that companies are spending more and more on advertising because it works to get children to demand their products, you probably don’t work for a food company. But I can tell you from experience in U.S. vs. Philip Morris et al. that the companies will continue to claim that the problem of children eating too much fattening food is due to parents, not to their advertising.
The best way to address this argument is to see if food ads affect children, regardless of how vigilant their parents are. Such a study has been done. Rodrigo Uribe and Alejandra Fuentes-García14 in Chile randomly assigned 483 children between the ages of 9 and 15 to one of four conditions: (a) viewing ads for McDonald’s, (b) viewing a video of Richie Rich in which McDonald’s products were placed, (c) viewing both ads and the product placement, and (d) a control group which saw neither ads nor product placement. They found that both ads and product placement increased children’s awareness of and preference for McDonald’s over other fast food brands. Notice that in this study the degree of parental influences on children’s inclination to want to eat at McDonald’s was controlled for. That is, by randomly assigning kids to these conditions it made it very likely that there were just as many kids with vigilant parents in each condition.
Lobbying and Public Relations
Another practice companies have evolved over the past 150 years is the use of lobbying and public relations to protect the public image of the company, to ensure that they are not prohibited from engaging in profitable activities, and to give the company any advantage it can in the competition for customers. Here are two examples from the food industry.
Blaming fat and exonerating sugar. Cristin Kearns, Laura Schmidt, and Stan Glantz15 obtained and analyzed internal documents from the Sugar Research Foundation. They discovered that the foundation sponsored research on the causes of cardiovascular disease. A review paper that they funded was published in the New England Journal of Medicine. It emphasized the impact of fat consumption on cardiovascular disease, but downplayed the role of sugar. The foundation’s role in this research was not revealed.
As public understanding of the role of fat in heart disease grew, the food companies responded by offering low fat foods. However, since the public was not aware of the impact of sugar on heart disease, and given that sugar is highly reinforcing for human beings, the sugar content of our foods skyrocketed. So has our obesity and diabetes, both of which contribute to heart disease.
Facing up to the impact of sugar on health? Upton Sinclair once observed that it is difficult to get a man to understand something when his salary depends on his not understanding it. So too for whole industries.
Michael Moss begins Salt, Sugar, Fat with the story of the fateful day on which the industry almost faced up to the harm that their sugar-filled product marketing was doing to American’s health. Almost, but not quite.
On April 8, 1999 the heads of eleven of the largest food companies gathered in Minneapolis for a secret meeting to discuss the fact that obesity was becoming a major concern of Americans. With talk of a tax on sugar, the companies felt threatened. A few of these executives had been paying close attention to the obesity epidemic and the growing criticism of the food industry. They hoped that through this gathering the industry could honestly address the problem. Michael Mudd, vice-president of Kraft Foods made the first presentation, reviewing the extent of obesity and criticism of public health experts. He posed the question, “What’s driving the increase?” His answer was “Ubiquity of inexpensive, good-tasting, super-sized, energy dense foods.”16
Mudd and the executives he had been working with had developed a proposal for how the industry could address the problem. The companies would join together to get a better understanding of why Americans were overeating and to establish restrictions on how much salt, sugar, and fat they would put in their products. They would also promote physical activity through public service announcements.
When Mudd finished talking, Stephen Sanger, the CEO of General Mills stood up and essentially ended the meeting. He made it clear that his company would not alter its practices. He claimed that the industry had weathered other storms, such as the concerns about trans fats or the need for more fiber in the diet. The heads of the other companies didn’t say anything; they didn’t need to. The matter was closed.
If you are concerned about public health and don’t own stock in any of these companies, this story may make you angry. But it may be more productive to put yourself in the shoes of these executives. These men (apparently there were no women at the meeting) had all become very successful and very wealthy thanks to the years of successful product development and marketing. What psychological benefit would there be for them to believe that they were causing disease? Certainly there could be no financial benefit to facing up to the problem. Their salaries and wealth depended on not understanding that they were contributing to disease and death.
Lobbying. Rather than do what Mudd had proposed, the food industry has invested in lobbying to prevent laws and regulations that might impinge on its profits. The Center for Responsive Politics has a database on the lobbying done by companies. Across all companies, expenditures on lobbying have grown from $1.45 billion in 1998 to $3.37 billion in 2017.17 For the food industry, they report that, in 2017, 250 food companies or trade associations have lobbyists working for them on a total of 1,016 issues.18
Variation and Selection
The evolution of the food industry over the past hundred years illustrates the evolutionary principles of variation and selection. The industry experimented with various formulations of their products and various ways of marketing them. They kept the ones that increased sales and profits, and dropped the ones that didn’t work or didn’t work as well. Their practices were shaped by their consequences in the marketplace. This same process explains the evolution of all of the industries I am discussing.
The Evolution of the Food Industry Has Taken
Us Where We Didn’t Want to Go
I have given you just one example of the way that the food industry has evolved to market products that harm our health. We have an epidemic of childhood obesity that is shortening the lives of many of our young people.
The food companies did not set out to do this. They just set out to be profitable companies. The health of their customers was simply not a consequence that affected their profits. Their volume of sales was.
And if you are not much of a capitalist and think that the pursuit of profit is necessarily a bad thing, I ask you to consider abandoning your cell phone, automobile, television set, and the many other modern conveniences that you enjoy, all of which would not have been developed in the absence of the profits that motivated companies to innovate.
The problem is that capitalism, as it is currently practiced in the United States, has no system for assessing the risks of companies’ products and marketing practices. So long as our default assumption continues to be that we will all benefit if companies are free to pursue their profits with as little regulation as possible, we will have a food industry that continues to undermine our health.
Advocates for a healthier food system, such as Michael Pollan, Marion Nestle, and Michael Moss, are having an impact on the eating habits of many Americans. And we are beginning to see some regulatory actions that could reduce childhood obesity and prevent some cardiovascular disease.
However, advocates for healthful food are fighting a very difficult, uphill battle so long as most Americans’ basic belief is that limited government is essential, regulation is usually bad, and government efforts to protect our health will impinge on the rights of Americans to do as they please.
- Change your diet. Michael Pollan has summarized what we need to do to improve our health. He argues that over the past fifty years we have become obsessed with avoiding some nutrients (e.g., fat, sugar, and salt) and consuming others (e.g., omega 3, folic acid, fiber). He suggests that a simpler approach is to look at what humans ate before processed foods took over our lives. Here are two straightforward facts that I think capture what you need to do to protect your health and the health of your family:
- Fact 1. “Populations that eat a so-called Western diet - generally defined as a diet consisting of lots of processed foods and meat, lots of added fat and sugar, lots of refined grains, lots of everything except vegetables, fruits, and whole grains - invariably suffer from high rates of the so-called Western diseases: obesity, type 2 diabetes, cardiovascular disease, and cancer. Virtually all of the obesity and type 2 diabetes, 80 percent of the cardiovascular disease, and more than a third of all cancers can be linked to this diet. Four of the top ten killers in America are chronic diseases linked to this diet.”
- Fact 2. “…there is no single ideal human diet but … the human omnivore is exquisitely adapted to a wide range of different foods and a variety of different diets. Except, that is, for one: the relatively new (in evolutionary terms) Western diet that most of us now are eating. What an extraordinary achievement for a civilization: to have developed the one diet that reliably makes its people sick!”
- Pollan goes on to cite a third fact: “People who get off the Western diet see dramatic improvements in their health.”
- The result is Pollan’s simple and straightforward advice: “Eat food. Not too much. Mostly plants.” For the details, go to: read his Food Rules: An Eater’s Manual, which you can get free with one google search. http://www.grubstreet.com/2018/03/ultimate-conversation-on-healthy-eating-and-nutrition.html
- Advocate for Better Policy. In looking for advocacy organizations that are focused on this problem, I was surprised to find that there do not seem to be many. Healthy Food America (http://www.healthyfoodamerica.org/) seems well organized to advance the cause. They have an extensive set of materials to support getting taxes placed on sugar-sweetened beverages. There are also centers such as the Rudd Center at the University of Connecticut (http://www.uconnruddcenter.org/), which is doing research on the industry and food policy and providing resources to anyone who is concerned about the problem. You can support these organizations and use their information to educate others about the extent of the problem.
Organizations and Resources
- Center for Science in the Public Interest (CSPI, see https://cspinet.org/) is probably the biggest player in this field.
- Marion Nestle (see https://www.foodpolitics.com/about/) is in this area as well.
- Environmental Working Group (https://www.ewg.org/)
- Food Tank (https://foodtank.com/)
- Healthy Food America (http://www.healthyfoodamerica.org/) - focus on sugary drinks.
- Food and Water Watch (https://www.foodandwaterwatch.org/)
- Institute for Agriculture and Trade Policy (https://www.iatp.org)
- Center for Food Safety (https://www.centerforfoodsafety.org/)
- National Sustainable Agriculture Coalition (http://sustainableagriculture.net/)
Read the Full "Cultural Evolution of Social Pathologies" Series by Anthony Biglan:
1. Introduction by David Sloan Wilson
- U. S. Burden of Disease Collaborators, Mokdad AH, Ballestros K, et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444-1472.
- The State of Obesity. Adult Obesity in the United States. The State of Obesity 2017; https://stateofobesity.org/adult-obesity/. Accessed July 8, 2018.
- U.S. Department of Health and Human Services. Adult Obesity Facts. 2018; https://www.cdc.gov/obesity/data/adult.html. Accessed November 1, 2018.
- U.S. Department of Health and Human Services. Childhood Obesity Facts. 2018; https://www.cdc.gov/healthyschools/obesity/facts.htm. Accessed November 1, 2018.
- U.S. Department of Health and Human Services. Health risks of being overweight. Health Information n.d; https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight. Accessed November 1, 2018.
- Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Current diabetes reports. 2014;14(8):508-508.
- Olshansky SJ, Passaro DJ, Hershow RC, et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. New England Journal of Medicine. 2005;352(11):1138-1145.
- Guyenet S. By 2606, the US diet will be 100 percent sugar. 2012; http://wholehealthsource.blogspot.com/2012/02/by-2606-us-diet-will-be-100-percent.html. Accessed November 1, 2018.
- WHO. WHO calls on countries to reduce sugars intake among adults and children. 2015; https://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/. Accessed November 1, 2018.
- Ervin RB, Kit BK, Carroll MD, Ogden CL. Consumption of added sugar among U.S. children and adolescents, 2005-2008. NCHS data brief. 2012(87):1-8.
- EWG. Children's cereals: Cereals contain far more sugar than experts recommend. 2014; https://www.ewg.org/research/childrens-cereals-sugar-pound/cereals-contain-far-more-sugar-experts-recommend. Accessed November 1, 2018.
- Department of Nutrition at Harvard School of Public Health. Sugary drinks and obesity fact sheet. 2012; https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/. Accessed November 1, 2018.
- Harris JL, Heard A, Schwartz MB. Older but still vulnerable: All children need protection from unhealthy food marking. Rudd Brief. 2014:1-14. http://www.uconnruddcenter.org/files/Pdfs/Protecting_Older_Children_3_14.pdf. Accessed March 5, 2019.
- Uribe R, Fuentes-Garcia A. The effects of TV unhealthy food brand placement on children. Its separate and joint effect with advertising. Appetite. 2015;91:165-172.
- Kearns CE, Schmidt LA, Glantz SA. Sugar industry and coronary heart disease research: A historical analysis of internal industry documents. JAMA Internal Medicine. 2016;176(11):1680-1685.
- Moss M. Salt, sugar, fat: How the food giants hooked us. New York, NY: Random House; 2013.
- The Center fro Responsive Politics. Lobbying Database. n.d.; https://www.opensecrets.org/lobby/. Accessed November 1, 2018.
- The Center fro Responsive Politics. Food industry: Issue profile, 2018. 2018; https://www.opensecrets.org/lobby/issuesum.php?id=FOO. Accessed November 1, 2018.