Harvard Book Store; WGBH Forum Network; David A. Kessler: The End of Overeating

Good evening my name is Rachel Kassen on behalf of Harvard bookstore. I'm very pleased to welcome you to this evening's event with Dr. David Kessler author of the newly and paperback book The End of Overeating Taking Control of the Insatiable American Appetite. Tonight's event is one of many that Harvard bookstore is hosting this fall. We still have tickets on sale for Monday evening's event with Broadway legend Patty lipoma missile tone will be reading from her new memoir entitled Patti Lapan a memoir on Monday evening at 6 p.m. at First Parish Church and $5 tickets are on sale now both at the registers and on line at Harvard dot com. We are also hosting events next week with mathematician Amir AXO on the experiments of the Large Hadron Collider with Mark Vonnegut on living with mental illness with historian Jill Lapore on the various ways that groups have co-opted the American founding narrative. End with former auto's are Steven Rattner about the auto industry bailout last year. Earlier this year. So for more information about those events or other upcoming events please visit us online at Harvard dot

com slash events and you can pick up in October events fly or on your way out this evening. And now it's my pleasure to welcome to the store David Kessler. Dr. Kessler is a pediatrician and lawyer who learned his who earned his law degree from the University of Chicago while also working on his medical degree here at Harvard while completing his pediatric residency. He also served as a consultant for Senator Orrin Hatch on issues of food and tobacco regulation. And he has spent time teaching both medicine and law. In 1990 Dr. Kessler was appointed commissioner of the Food and Drug Administration by President George H.W. Bush a post which he held till 1997. While there he championed transparency and product labeling introducing the now ubiquitous nutrition facts labels we find on food and fought hard hard battles against the tobacco industry. Dr. Kessler's New York Times bestselling book The End of Overeating tells the disturbing story of the food industry is manipulation of our natural appetites

while our bodies are clearly designed to alert us when we need to eat or drink. Dr. Kessler shows that through this strategic layering of fat salts and sugars. Restaurants and food manufacturers have short circuited those natural processes to make us crave unhealthy foods and to keep us from knowing when enough is truly enough. After the talk this evening we will have time for questions followed by a signing here at this table. As always I'd like to thank anyone who purchases a copy of the book here this evening. By doing so you're supporting both a local independent bookstore and this author series. And now please join me in welcoming Dr. David Kessler. I say that was a terrific introduction. It was just there were some phrases in there that the manipulation of our natural appetites. I really appreciate that. Thank you Harvard bookstore. This

is this is very meaningful. This is very special. I left here 19 79. I remember the annex and just thank you all for being here. It's because of places like Harvard bookstore and publishers working with independent bookstores that I have the opportunity for me to come in and connect because when you write a book it's very interesting. You know this is that distance and the opportunity to go around and to talk to people. And what I'd like to do is just spend a few minutes tonight because there's something that maybe that can happen. I mean anything can happen for a few of you.

But what I will try to lay out know the answer to a very simple question. Why is it so hard to control for some of us are either. And if you can leave here with a greater understanding of that if the lightbulb can go off that's something that's very special to me. So look let me see if I can put this together. The books are really limited the question you start off with is never the question. Certainly for me that I ended up writing about. So the question that I started writing about was if you want to stay alive what can you do. What's the evidence based literature and on prevention. Three quarters of us are gonna die from cancer disease cardiovascular disease or stroke. And what do we know that prevents those diseases so I'm at the little medical school that south of us in a city that goes unnamed

and I was sitting there with a group of residents and fellows and asked that question What's the prevention based literature. What's the scientific evidence and what works. And there was a librarian who was helping me collect all the literature. And I noticed over a three month period she lost 30 pounds. And because she was reading everything right. And we know it's not good for us but she was actually by reading it. She just it mean it finally hit her. And she lost 30 pounds. Then I you know if it was just it was a question of diet and exercise. I mean when someone one of your colleagues in the audience tonight remembers about seven years ago I went out. What was it the American diet tatic speciations. Because I wanted to know what was driving this. So I went out to listen to all the dieticians and I will confess I did not find the answer

there. Right. I mean it was very interesting because it was diet. And exercise. They were saying and if that were the case you know we'd all do it. So so where to. Where did I. I'm I'm I'm listening. I'm trying to understand this. And I'm all for some trying to understand what's changed what's happened because back when you know when we were when I was a kid in 1960s certainly the country was very different then we had this problem of of weights much more under control. So I called my friend Catherine Flegel is one of the great epidemiologist at the Centers for Disease Control and I said explain to me when I was growing up what was wait over a lifetime What did they look like. So you enter your 20s maybe you gained a few pounds between 20 and 40 you were relatively flat you know for between 40 and 60. Then you lost a few pounds but weight was relatively stable over an adult lifetime. Right. And she sent me the curves for the 70s and then the 80s and then the

90s and then 2000. You enter your adult years about 18 pounds heavier. And you also keep on gaining weight much later. So by definition that can't be genetics because genetics don't change in four decades. So what was going on. So I didn't find the answer at the American Dietetic Association weight management. I'm surfing through the channels and I'm watching Oprah one night and there's a Dr. Phil segment Don't get me started on Dr. Phil.. And there's a woman really please is a woman who's on that segment who is well-educated very well spoken you know on the set and said I I eat when my husband goes off to work in the morning I eat before he comes home at night. I eat when I'm happy I eat when I'm sad.

I eat when I'm hungry I eat when I'm not hungry. And then she looked in the camera and said and I don't like myself that Oprah moment. Right. And I was trying to listen and listen as a physician. What was what was driving this woman to do what she didn't want to be doing. That was the question as I'm studying this. My sister in law who's here in the audience said something also there was profoundly important. She says Please don't give us an answer. It's something we have to obsess about. Right. I've had it with obsessing about anything else. So I'm watching this over right. My sister in law uses the word obsession. I'm trying to understand why is this woman eating when she's hungry and when she's not when she's not hungry. That's what I wanted to understand as a clinician. What was I here.

So let me give you five pieces of the science and I promise not to lose you. OK. And then we'll put that together and see if we can explain why this woman and millions like her do what they don't want to be doing. And what's going on and what's changed over the last three four decades. First piece of science. Walk into the American supermarket buy what's off the shelves put it in a animal cage and feed it to those animals. If you give animals just laboratory Chow their weight from birth to adult is about like this. Add to the cage just in a limitless fashion varied and limitless diet at the American supermarket diet bread crackers chocolate to that cage and weight is like this. Take away that American super market diet put them back on animal show and their weight comes down but doesn't come all the way back. The first thing just in a buried and limitless diet.

People and animals tend to eat excessively that's the first piece of science. Number two what is it about. We published an article called Deconstructing the vanilla milkshake. Right. Not the typical scientific title in a scientific journal what's it in the vanilla milkshake that drives wanting not liking one. Not whether it's going to taste good but whether I want it. Is it the sugar. Is it the fat. Is it the flavor. How many of you think it's the sugar. Raise your hands. About a third. How many think it's the fat. Or how many think it's the flavor. Not the third. How many think it's all three. Is. Sugar is the main driver. Animals and people will work more meat again wanted to expend effort. I mean sugars I mean dairy. But and fat to it. And it's synergistic. They'll work more. So there's something about fat and sugar fat

and salt fat sugar and salt stimulate you to want it more. Third piece of science called a college of tiny cherry one of the great pharmacologists in Italy. Tanos major work in the 1980s was to find the one unifying feature of drugs of abuse. So he studied He studied brain dopamine. What does dopamine do in the brain. What stable dopamine responsible for what happiness. Pleasure. That's actually the opioids dopamine is responsible for your attention. It gets your attention it locks in certain neural circuits. Right. So there's a it's sort of a filter it also has an effect on learning. So when you're sitting there if that siren goes by outside you you have an elevation your attention shifts off me the bear walks in here and now you start focusing on that bear if your kid's sick

or whatever it is you know is salient in your environment. You're going to focus on dopamine plays that role. And what we found is that amphetamine cocaine heroin and morphine will elevate brain dopamine and elevated. Every time you give those drugs of abuse first time second time third foods. If you read the textbooks food to give you a little bump in brain. But the second and third time is what scientists call it a bit UAD. You didn't get a rise in as powerful. So I said to gitana Let's feed animals and animals because you're sticking in electrodes right. Let's feed these animals fat and sugar over a prolonged period of time. So you're conditioning the animal and then measure what happens when you expose them to the fat sugar and salt. What happens to brain dope don't mean I remember he sends me the e-mail important results. He says I get major rises in brain Dopa Mean each and every time it doesn't habitue. So if I get very salient stimuli and give it repeatedly

you can have continued elevations in bring forth besides I wanted to understand how many people were like that woman on Oprah. So we did the epidemiology. What was I hearing when I was listening to that woman I was hearing what was she saying when she said I eat when I'm hungry I eat when I'm not hungry I eat when I'm I'm happy I eat when I'm sad. I eat all the time but was a hearing as a clinician I was hearing a hard time resisting her favorite food. Sort of a loss of control self-report. Of course she was in control and she was conscious but she had a hard time resisting food. We're calling after a hard time stopping a lack of satiation 3 a preoccupation a thinking about foods you know that pizza box is there is one slice left you with your friends or family and you're thinking to yourself am I going to get that slice. So you have these three characteristics loss of control lack of satiation a preoccupation with thinking about foods that some

of you in the audience have no idea what I'm talking about I can't relate. Seriously I can't relate to this at all. I just diverge for a second. The graphic was done by Chip Kidd the great graphic designer. If you understand this cover you understand the neurobiology of eating. OK. Tell me honestly how many of you look at the cheesecake. Raise your hands captures your attention. Now how many of you look at the carrots. You're the you're. I want to study your brains not the folks who look at the character I we. So again this is the concept of attention. What grabs your your attention. So what we found was those Street characters and about 50 percent of people who are obese 30 percent of people who are overweight fit that 20 percent of people who are healthy weight. So it's not just people who are obese.

Score very high on those three characteristics. And you say well how could people who are a healthy weight score very high on those three characteristics. How can they have loss of control lack of satiation a preoccupation. I think it would still be healthy way. I remember my sister in law said Don't give me something else to obsess about. Right. So what happens is because most psychologists and scientists thought those characteristics were only people were only happened in people who were obese or overweight. They can happen in people who are healthy weight because either. I mean and who do they tend to be higher socioeconomic women. Right. Because of their society and the social norms have learned to condition themselves and learn either tricks to be able to deal with it or they're living with this internal torment. Right. Because I have to be able I have I react the same way as somebody who is much bigger than I am.

But I've learned to control it. And I'm living I still have this these feelings of loss of control lack of satiation. So we see so we see about a significant number of people and if you extrapolate the number of people who have these three these three sort of conditions the symptoms right. You extrapolate that some 70 million people. It's a lot of people in this country who would score very high on that characters. Now this is not a disease I use or it's symptoms is really not. This is not a disease. I mean these are the normal circuits of the brain being captured because this I mean when I say loss of control lack of satiation a preoccupation with thinking about foods that's evidence of a conditioned and driven behavior. And so that means we're involving the learning memory habit and motivational circuits the brain it's not separate circuits in the brain that are just for food. So now here's a last piece of science. So we take people who score very high on those three those three characteristics that sort of conditioned hyper eating. And

we scanned their brains and we do it in two phases. The first phase we just cue that I mean where does the power of food come from. It's really the para food comes from. Well it certainly comes from taste or neophytes if you think about your favorite food right now the memory. Right. You can almost taste the food. You could smell it. Yeah. I mean. Right. So I mean but interestingly it's not just the taste. As you said it's the anticipation of that taste. So what you have to really do if you want to study how people react to food and do it in two stages. First you just cue the what's a could be the site. It could be the smell could be the time of day. Every time I land in San Francisco airport I start thinking about these dumplings. The plane is the cube. You know it is. I mean I just come to Harvard Square and I get cute and start having memories of places 30 years ago that are no longer here. Right. With such effective learners.

So we get cued right. And so what we do is when you scan people of this conditioned hyper eating right and you cue them what do you say you see exaggerated. I mean it is an increased activation of the brain's amygdala. So this access to the brain to make sure that's the emotional core of the brain. And when you give them the food see the amygdala stays activated excessively until all the food is gone. So there's a biological reason. And I can show it to you on these brain scans of why people are have a hard time resisting. Right. So for the first time you sit there and you say that I say that to people in the light bulb goes off and they say you're telling me because this is automatic behavior. I mean if Freud had gotten it right he would have talked about automatic many unconscious is really about automatic behavior because this this this response my

brain is being activated before the conscious elements of my executive control go into effect. So you have people say for the first time that you mean this is not to blame. This is my brain. And that is you know a very important point. The problem is not weight. The problem is what we're eating. Let's see if we can put this all together. Let's see if I can make sense of this thing. We're all wired to focus on the most salient stimuli in our environment what's salient stimuli. You know the great Harvard psychology I mean I emailed them back couple years ago. I said What makes something reinforcing. What's something that. What's the characteristics and drum Kagin said to me it changes. It's anything you can change how you feel. So that bear who comes in here can make me feel bad. Right.

Or that carrot cake right can make me feel good. And both are salient stimuli. So we're all wired to focus on the most salient stimuli. What could that be. Could be alcohol could be tobacco it could be illegal drugs it could be sex it could be gambling. What's the most socially acceptable salient stimuli in our environment and what's at the core of that food today. Fat sugar and salt. So pick any. And I understand this is Cambridge and we're living this is not how do I say this this is not America. Right. When it comes to food. Right. But pick any appetizer you've all traveled. All right. Pick any appetizer in a modern American chain restaurant. I mean what do we eat to it. I mean pick Buffalo wings. What are you. You start off the fatty part of the chicken. You load 30 40 percent fat when you fry it in the manufacturing plant that pushes out 30 40 percent of the water.

It's fried again in the kitchen usually of the restaurant that loads another 30 40 percent fat in there. The red sauce. What is it. Right. When the white creamy sauce fat and. Right. So what are we eating. Fat on fat on fat on fat on sugar and fat sugar and salt. I mean with a little little problem right. I mean if you look at salad salad has become one salad as salad as the delivery vehicle for fat. Right. I mean look at I mean I I I. Kennedy Airport I now have restaurant calorie menu labeling for calories. The salads. Fifteen hundred calories with the dressing with the bacon and with the cheese with the crew tons. If you look at France I mean what did we do in the United States. What's been the business plan of the modern American food company.

You got to make profits right. How do you make profits. You've got to have increased revenue how do you have increased revenue. You have to have growth right. You want to increase profits increase growth. How do you do that. You've got to either you got to either raise the price of your food wine increase or you got to sell more food whether we need it or not. You've got to put more calories out there. But what's been the business plan. Take fat sugar and salt put it on every corner make it available 24/7 make it socially acceptable to eat any time make food into entertainment. Add the emotional gloss of advertising. Walk into a food mall in America and we're living in a food carnival. What did we expect to happen. Right. But how does this work. OK. So we get cued right. AQ can be the site it could be the smell. It is going to differ for all of us. It's based on past learning in past memory. Was a guy who told me the hardest thing

for him to do every day is to get on that train. At the end of the day at work of course that new stand that he has to go by those kick cats he had a run past that new staff. You know somebody you may react to it. I mean for him that past experience with the cats it was you know this guy was a huge guy strong in everything. And it was kick cats he couldn't deal with. Right. So he gets cued right. Q activates the brain causes arousal. It causes increased attention. These thoughts of wanting it activates the brain and you're not thinking about anything else you're just thinking about this. I mean all cognitive control sort of dissipates because I mean you really feel. I mean the urges the feelings. Right. I want this. I eat the food for the. I have that momentary bliss right. Two minutes later I say to myself what did I do. The next time I'm cute what do I do. I do it again and every time I do it I strengthen the neural circuits.

And I mean just compare us to the French the French of eating highly palatable foods but they had certain they've always had why haven't they until recently gotten obese. One is portion sizes. But also if you look they have erected they've always had certain barriers the built in barriers to this chaotic and continuous eating. There are social norms they would never eat between meals they would never walk down the street either. They would never eat in the car. They would never eat at work they would never you know be drinking coffee and things. I mean in a lecture right. I mean what are we done in the United States. We've taken down all those berries. The tagline for Taco Bell the fourth meal write me so I'm invited to a one of the global multinational food companies and they say all right tell us as it is

we need to hear the reality. So I said let me explain this to you. And you got to be careful with this analogy because there are similarities and differences. Nicotine nicotine is a moderately reinforcing chemical. Animals will work for it but it's not that reinforcing add to the nicotine. The smoke the throat scratch the cellophane crinkling the pack. The color of the pack the image of the cowboy the sensitive was sexy and glamorous. I mean to smoke and certainly in my parents and my parents grandparents generation what did we do we took a reinforcing chemical and we made it into a highly addictive product. I give you a package of sugar and say go have a good time. You're going to say what are you talking about. Add to that sugar fat add texture add color add mouthfeel add the emotional gloss of advertising put it on every corner say you can do it with your friends. What did we expect to happen.

The consequences the health consequences. I mean understand this this hard time resisting this. This conditioned and driven behavior. Again it's not a disease. Our brains. You cannot walk down the street without being queued for 10 feet. And and those are very very powerful cues. So now you want to know how do I how do I turn it off. Right now this is the hard part. Right. Because if it was the easy part everybody would have figured this out. And in some ways the harder you work at it it's the more you think about it the more you focus on it the more that stimulus stays in working memory the harder it is. I mean those circuits continue to focus you know that inner dialogue. And this would look this would taste great. No not now. I should do this as you're thinking about it right. Because you're this is not only the condition circuits but the motivational

circuits. Right. But if you understand the cycle of cue activation arousal reward release where can you intervene. What can we do. I mean am I ever going to you ever get to get rid of those circuits. No. So you you're always going to be able respond to the most salient stimuli in your environment. Except there's a small percentage of the population. What was the name of the pilot Sully Sullenberger. He's the guy who just lost both engines over the Hudson. I have no power and I just have to land this plane in the Hudson River. No problem. Right. No emotional reactivity right. So there are people like that right now. You've got to wonder what else he finds so you but maybe not other things but there are some people who who are low dopamine receptor we don't fully understand this. You know I go into restaurants and I watch people eat. I watch couples. And one of them eats three quarters of their sandwich

and the other reaches over to eat the fries of the other one right there. There probably is some genetics here but it's not about food. Some of us are more outgoing. We don't have a good word in the English language some of us are more impulsive when it comes to external stimuli. Others of us are more resistant. Right. So there is that underlying trait but a lot of this is experience and past memory. So right now I've given you the cycle. How do you prevent it. You can't you can't prevent it. But how do you cool it down. I can't change you going to respond to say stimulus. So now that you know that diet is going to work well the diets are not going to work but certainly you'll lose the weight. Right. So 30 days 60 days 90 days I deprive myself. Right. But if I want it and I haven't done any new neural circuitry if I haven't laid down any new learning I'll lose the weight I'll just white knuckle it. But then after the diet is over I go back into my environment I get cued again. I haven't laid

down any new neural circuitry new learning. I'm still going to respond to those cues. What is what's going to happen. I'm going to I'm going to go all the way. So so so what what what are my options. You know how this works now what can you do. Right. How to how do I change my behavior. How do you change how to relate what's new. How do you lay down new neural circuits. How do you do that you know your cues. You are. So let's talk about. So I get rid of the stuff in my house. But then I turn on TV or walk outside. All right. I mean the one thing that the dietician community I mean if you look at the does work and it's true as you look at the French and you study that that helps calm down the constant bombardment and activation if you have some structure to your ear. Right. So if you have structure your eating you know when you're going to eat and what you're going to eat that helps

a bit. But what's the great public health success today so far. Smoking What did we do. Had we changed. We didn't change a cigarette. The actual cigarette itself we didn't change not laws and regulations. It's more expensive. That helped that that changed education. But is it really about knowing why. It's ok since the social norms change. Right. So it's what psychologists call a critical perceptual shift that used to be cool to smoke. Right. This is not about infant. This is not just about information. This is not about just knowing. This is at the emotional level. You look at that. I mean I used to use use of use cigarettes as my friend that's going to make me feel not normal. Now how do we as a country you it is a deadly disgusting product. But there's a visceral reaction with

with so let's talk about processed foods. Right. Back in the 1930s and 1940s in order to feed the hungry nation. What did the food industry learn to do. They learned to process foods. There were a lot of advantage to learn to advances in processing food you can ship food over a long distance. It was cheaper it was greater shelf life foods were safer if there's greater shelf life right there advantages. What are the food industry learned to do when you process the food over time. What did you learn to dial in fat sugar and salt. What it will also do processed foods by the nature the processing it takes out anything that's objectionable takes out anything that slows down eating. I mean if you eat a real food I mean 20 30 years ago we chewed on the average of 20 30 bytes 2030 chews per bite today. I mean

if you eat processed food everything objectionable is taken out everything slows down eating any structure. Right. So the food goes down in the wash. I mean we're eating adult baby food. We're just self stimulating ourselves. We're eating for reward. I mean I understand the implications of this. I mean it's the behaviors conditioned and driven. I mean that has enormous policy implications because it's not just us it's our kids. Because once you lay down that neural circuitry you're laying down that neural circuitry for a lifetime yes you can add new learning on top of that new neural circuitry. But the average 2 year old child compensates for their eating what do I mean you give that child more food at lunch they'll eat less during the rest of the day by the time that child is four or five. The majority of them lose the ability to compensate and lose the ability to regulate their eating. All through the day. Right. But how do I cool down the stimulus. So what do we do in tobacco. We change the social norms. There was this critical perceptual shift. Tobacco though was easy.

I could live without tobacco. Food. I need food. The food has to be pleasurable. If I look at that plate of fries I can tell whether somebody is going to be able to be successful on a diet. If you look at that piece of cake or you look at that those fries and say I want that. That would taste great right. But I'll deprive myself I know over the long term it's not going to work. It's going to be torment until you change how you look at the stems. If you look at that stimulus and say I want that the emotional core is being activated. And the only way to do it is to change what you eat and what's important to you. With women very interested many women do not especially care givers. They care about everyone else. And there's a moment in their life where they finally say I'm going to do this for me. Right.

And it becomes important becomes salient. You can't I can't lecture about this. I mean I can't tell you what to eat I can't tell you what to change because you have to decide for yourself what you want. No one can can tell. I me with oil you don't sell diet books here. Right. Or did they did it they may jump. Ellen Goodman thank her. So it's the end of everything. It was the non-diet diet book I think it's the way she because it was not meant it. I can tell you no one could tell you right. What you want. No one can change that for you. Now people can help jumpstart. Right. And if you look at every every diet has some gimmick to get you started. Right. And lose weight quickly. So it's reinforcing. But unless you change you have new learning unless you change how you respond to cues unless you're

in the only way to change how you respond to choices change what you want. Why don't you open up for questions. OK. OK. All right. So you are. And you're not going to get any disagreement for me. But let's understand this. OK let's see if we can go to the level. I don't think it's inconsistent.

OK. He sighs. I mean if you supersize I mean perhaps. Right. I mean and you still are not. This is you know Burlington Vermont still you know. I mean has one up over you. Right. I mean the McDonald's moved out of town I mean. Right. So. And we will know we're on the right track. I mean when our kids come to us and say Mom Dad please don't take me to McDonald's. But but let's let's go to your three points in those institutions because I understand this. And I it's the last part of the book. It's it's the epilogue. And it's all I'm working on another book because I'm convinced that if you understand over eating what's driving over eat over eating you will understand much of our anxieties

our obsessions our phobias are some of our depressions some of our I mean because these are the same circuits that get triggered. So why does. How does yoga work. What what does it work on. Right. Right. And how does it work. Well what was the source so how does or how does exercise work when the value of exercise. Right. Is it a substitute reward. I mean if it means exercise is not your point. The reason to engage in exercise is not because you're going to lose the calories from exercise. I mean I can eat a candy bar 300 calories in a minute and a half. It would take me an hour to work it off. So it's never going to be equally balanced. But while I'm exercising I'm going to feel good about myself right. And all that stress. I mean that's a reward. It's a substitute reward. What's yoga for those

who are into it. It's a substitute reward. Right. What were your other examples. Mindfulness again. It's a lot of people that were with a lot of different meanings. Is it increased awareness right. Is it really understanding. If my brain gets cued and I have thoughts of wanting. Right. Is it to understand that thought and not that thought go right. Again no disagreement. I mean that's it. If you're going to get cued learning understanding that it's a false key. You know I think I'm hungry. It's well you know what is self-regulate. We use these words but it's being able to deal with these cues and that are that our brains are being activated. All right. And while you're at most eating occurs when most of the eating occurs between five and bedtime. Why I've had a long day.

You know I just got the kids to bed. I've had all this stress and I can sit there with the ice cream or the cereal and just continue in this automatic cycle. You know it's optimize the fat sugar and salt will optimize that bliss point. I will feel great. I mean I mean I'll have the activation of those opioid circuitry all the other stresses of the day fall off. It works great. I feel great for a couple of minutes and then after that how do I feel. But the issue with yoga or mindfulness. What was the third local food. Right. Is it does it become salient. Is it something you care about. If I look at that piece of chalk against That's what I care about. I'm going to you know I'm going to find that your warning if I care about going to my yoga class if I care about local food I mean look at I mean where are we headed as a country.

Well. Well the issue is what's the food movement that's going to emerge. And how do these things. I mean something has to become more important if you do lay down new learning new neural circuitry something has to become more important to you. That's really what new learning is and something has to have greater value to you. Right. So some people view food and they look at it and see Ethical Treatment of Animals. I don't want to eat. You know I care about that because that's what's important. Others look at I want to be a vegetarian. You know a derivative of that. Some people say I want to eat organic. Right. Some people say I want to eat just local food then that becomes the salient that becomes meaning for you. Fulci that evokes the emotional response and then you look at the highly processed food and you go. It's disgusting right now. So that's what it's going to take. I mean I can I can tell you I've

suits in every size. Right. And until you start changing how we look at food. I agree with you and provide other things we want more. We're never going to lay down the neural circuitry sir. Right. Right. So great question. All right so let's see if we can all get on the same. Because I never understood grams and no grams right. So and I will tell you do you. You said 700 relet let's not let's see if we can leave here. So the average What we did and I'll tell you the story of the food label before we leave

you mommy to tell you the story of how the food label almost didn't happen. All right. There's two numbers on the food label. This one is the amount of grams or milligrams. And you said 700 milligrams of sodium and then there's something called daily value which is 100 percent should be my daily allowance of how much sodium I should have and the daily value for sodium. I mean on the label is 24:24 100 milligrams. FDA is basically saying in any serving anything greater than 20 percent is high. Right. So you can look and see whether the percent daily value is greater than 20 percent or the amount of sodium would be greater than about 400 milligrams. Why don't they take it down. Right. They will argue look we're just giving consumers what they want. Right. And.

And if that's the case if in fact you don't buy it right and it and that will change manufacturer behavior. You know ultimately But I mean what they're doing in essence with that sodium is they just stimulating that neural circuitry. I mean fat and salt are very highly reinforcing they're very stimulating. I mean why don't I keep eating these potato chips. Right. So the question is do do I make more money with higher sodium or do I make more money with less sodium. I mean Also everyone should know the Iowa and issued a report there's really a transformational change because it used to be certainly when I was in medical school you know here across the river the conventional wisdom is that some of us not all of us are sensitive to salt. I know on the of medicine is now said is we could all benefit from a reduction in salt. And I think people want and you can see your point. Right.

You can change salt slowly over time. The palate is adaptable. I walked in I was I went to a Thai restaurant and the other day and they saw us she said it was sweet and sour and I said to her Tell me honestly do you how much sugar do you add. And I mean in your home in your home country is it a very authentic dish. Should we make it sweeter for America. I mean I mean everything is sweeter here right. I mean our palate has changed over the years and it's not just sugar please. Artificial sweeteners can stimulate manufacturers will respond to if there's enough consumer demand they will change with some other hand sir.

They care about food right. Right. So the hope is you know how do we turn this around. I gave you know the same lecture to a group of scientists and

Deibert just accepted you slides I put up the scientific data and they looked at it and they basically at the end of it said we're toast as a country. Right. Because if you understand the behavior of neural circuits get laid down right and they get laid down and children and the environment is triggering that behavior. How do you ever get out of it. I mean that's what you're asking. You know I do think and I you know how does I mean I think Michael Pollan Alice Waters with due respect to my colleagues in the diet dietician nutrition community. I think the two of them certainly Michael has done more for nutrition I mean into awareness. Right. And I think that I think if we can move I mean if we made a mistake in the food label OK we got to the point where we believed you know where it says zero fat and zero

sugar and zero. How are we that you should just look for the lowest numbers. And I fell for that right. So I sit there and I drink my diet coke and i eat my yolk frozen yogurt. That has nothing in it. And I realize that I'm not eating food. So. So the incentive we created in some ways was the food industry just to add chemicals. Right. If you just look for zero. So I think your point about you know I went into my one of my local restaurants in San Francisco and I'm certainly has the same I think the values here and I said in Cambridge I said to the chef in my local restaurant What's the most important question I can ask when I eat out when I walk into a restaurant where you think he said to ask where the food is from. I will tell you I will go next door and ask where the food is from and we'll see whether they can tell me. Right. But it's not a question I normally

ask. And I do think this is going to require a change in values. And it's going to mean one of the reasons why I didn't do it deliberately but I went inside the Washington Post. Outed me right because I went dumpster diving right. I mean to find out what was in restaurant foods and when you go in and you see the food is really just constructed it's assembled. It's not even cold. In the vast majority of places where America Eats it's so highly processed. I mean it's adult baby food. I wish I were the I could understand pricing behavior. Look I

mean somebody is going to ask me the question about you know fast food is cheaper than real food and it's a complex answer and I think we need to confront it first of all. Obviously there's no reason why to continue to subsidize fats and sugars and corn it just doesn't make sense. We should subsidize real food and make it available. Right. I can tell you know why that can is priced differently. But I can tell you if you sit there and eat junk food all the time you just you just continuously eating it. And then the end of the day it may not be. You may not you may think it's on any individual food. It's cheaper. But if you keep on eating it and you can't stop it gets pretty expensive to eat junk food. So

sir then we should sign some books right. And I'm going to tell you the sorry the food label with a couple of more questions and then we'll. Right. That's correct. But absence is not going to work.

Substitution of something else right. Now. So. He so two interesting points. What would you invest in nestle with that business model. Right. So you wanted to do healthy processed foods are like pharmaceuticals. Right. And is that going to work. Me mean you understand which circuits are we dealing with in the brain we're turning with the learning memory habit and motivational circuits is a drug going to work. Sure a drug can work it's called speed. Right. In fact those circuits. But I mean if I understand if I affect those circuits pharmacologically you'll lose weight

Fen-Phen work but you have to give me back some IQ points. Is going to have another serious adverse event cause you're fooling around with the learning memory habit and motivational circuits. My second point and I know my colleagues you know we're talking about green light red light or healthy choice and I think how could you ever think about that you're going to do processed foods that by its very nature is energy dense that takes out the hydration that takes out anything real in the food and make it healthy. So what is what's Nestle going to sell. Well I mean I wish them well. I wish them well. To your point about Michael Pollan on on eating the savannah died of 20000 years ago. I love Michael. I think his books are great and I think he's done a lot for nutrition. I'm not sure I would revert.

I mean there was a lot of heart disease you know. There was a lot of other diseases. Now there was smoking and there are other causes of those things. But if you talk it's not just calories. You talk to the great Walter Willett. I mean saturated fat you know really does have an independent risk factor for cardiovascular disease independent of calories. So I'm not sure we revert back I mean to a diet of even 50 or 100 years ago. Right. And again the most food has to be pleasurable it has to be enjoyable. Right. You've got to figure out what what you want. Right. But I think if you do that and I think of it's real food. Right. And I think it can work. Last question and I'll tell one story and we're going to sign some books. To you. I think you can explain to them right

I think it worked in tobacco. I mean you tell the kids. I mean the legacy campaign the truth campaign what does an adolescent What does a kid care about certainly an adolescent little older kid. Right. They don't want to be manipulated by adults. They want their autonomy. Right. So if you tell them that somebody is you know getting rich off hooking your brain. Right. So if you could show them really what's in the food I mean sure. I mean and if you just explain to them what's in food and get them to want you know I mean real food. Right. But it has them emotionally resonate. So I think I think you can you can you can you can explain them or you can show them you can do it. Very I mean it a very graphic level you can relate to what their concerns are. I don't want to have my brain hijacked I don't want to be manipulated by some food industry. I don't want to just eat all this processed foods because that's just going to keep me eating more. You're going to have to talking in their language or you know young kids. They want energy. I mean they want to be able to play sports.

You can relate to. I mean in those terms but again and the jury's not I mean is the jury's still out. I mean even if I'm perfect with my kids for the first five years am I going to protect those neural circuits over a lifetime. We certainly know when people who come to this country even later on in years that their brains can get hijacked so we mean vulnerable but it's likely if you really instill the values of real food the values of not eating and understand we have a choice in this country we can either with tobacco we can either demonize big food or we can celebrate the joys of real food which is going to be more effective with your kids. We certainly demonize the tobacco industry. Right. But you can't demonize food. You got to be careful. If you do that and you can get into the eating disorders and the fear is in other things you're walking a very fine line.

Last question. Sure. A lot of points in your question. A lot of great points in your question. Make sure I take them one by one no question. When people didn't have time to prepare meals and the lack of it I mean the enormous number of people who don't know how to cook. All right the juggling multiple

jobs you know male or female are all that contribute. Right. And so you have that plus the rise of food becoming convenient and mobile. You have a lot of these forces at play. But I think you're also getting at another point where eating with some structure if you look at the French and you look at the Swiss I think it's still they care about the eating dinner and eating at a meal is salient to them. That's their social norm. That's important. That has meaning for them. They don't want to just go out. We've sort of you know transposed it certainly in higher socioeconomic. We still have the meal. We do it with friends but we do it in restaurants. We take out all those meat. The important point is those social norms those change in societal sociological factors can have a real effect on

how I respond to stimuli. Right. The social norm that social value affects whether my brain is going to be activated or not. Last story the food label. You know everyone knows the nutrition facts panel right. So it almost didn't happen. You know how the government works. So a no. So cheese pizza is regulated by the FDA at peperoni to it. It's regulated by the United States Department of Agriculture. Go figure. So you add meat and poultry. It's USDA. So we wanted to do a combined label food label between USDA and FDA and all processed products including products that had meat and poultry. Secretary of Agriculture said to me one day he says I don't like the you know we showed him the label we wanted to put on the fat the sugar the calories says I don't like it on my products because meat and poultry are higher fat. So those products won't look as good.

And he said I'm going to take it to the president. That's what it's going to take it to the president. So fast forward in to the Oval Office. George Bush the father Dan Quayle the vice president Marlin Fitzwater the Press Secretary James Baker was Chief of Staff and Secretary of Agriculture the secretary of Health and Human Services. Six guys who've never cooked in their lives deciding the fate of the food label. I had been I will admit we had worked with McDonald's to put the Nutrition Facts panel right the replica on these tray liners you know these paper trail liners. No you don't even know what those are in Cambridge. Right. But I had been with the kids and I saved some of those treeline has it had nutrition facts I when the secretary of Agriculture said to the president Mr. President FDA has lost its mind. Of course the food industry millions and millions and billions of dollars in fact pull out the placemat hand the placemat. So you have this these six guys looking at this McDonald's placemat. And I

say to the president Mr. President if it's good enough for McDonald's it should be good enough for the Department of Agriculture. And the president agreed and that's how policy is made in this country. Thank you very much. Thank you. Harvard bookstore. Thank you so much again everybody for coming. The signing here at the front. Books are available at the