Is surgical treatment for obesity a good and effective treatment for preventing the life-threatening complications and serious degenerative problems associated with pathological obesity? Do drug and medical device companies cash in to unprecedented degrees? Will overweight- and obesity-attributable spending continue to increase and government will continue to finance a sizable portion?
IIP > read on here > http://www.nytimes.com…
Carbophobia, the most recent in the centurylong series of food fads to wash over the American table, seems to have finally crested, though not before sweeping away entire bakeries and pasta companies in its path, panicking potato breeders into redesigning the spud, crumbling whole doughnut empires and, at least to my way of thinking, ruining an untold number of meals. America’s food industry, more than happy to get behind any new diet as long as it doesn’t actually involve eating less food, is still gung-ho on Low Carb, it’s true, but in the last few weeks, I can report some modest success securing a crust of bread, and even the occasional noodle, at tables from which such staples were banned only a few months ago.
Surveying the wreckage of this latest dietary storm makes you wonder if we won’t someday talk about a food fad that demonized bread, of all things, in the same breath we talk about the all-grape diet that Dr. John Harvey Kellogg used to administer to patients at his legendarily nutty sanitarium at Battle Creek, Mich., or the contemporaneous vogue for ”Fletcherizing” — chewing each bite of food as many as 100 times — introduced by Horace Fletcher (also known as the Great Masticator) at the turn of the last century. That period marked the first golden age of American food faddism, though of course its exponents spoke not in terms of fashion but of ‘’scientific eating,” much as we do now. Back then, the best nutritional science maintained that carnivory promoted the growth of toxic bacteria in the colon; to battle these critters, Kellogg vilified meat and mounted a two-fronted assault on his patients’ alimentary canals, introducing quantities of Bulgarian yogurt at both ends. It remains to be seen whether the Atkins-school theory of ketosis, the metabolic process by which
the body resorts to burning its own fat when starved of carbohydrates, will someday seem as quaintly quackish as Kellogg’s theory of colonic autointoxication.What is striking is just how little it takes to set off one of these applecart-toppling nutritional swings in America; a scientific study, a new government guideline, a lone crackpot with a medical degree can alter this nation’s diet overnight. As it happened, it was an article in this magazine two years ago that almost singlehandedly ushered in today’s carbophobia, which itself supplanted an era of lipophobia dating back to 1977, when a controversial set of federal nutritional guidelines (”Dietary Goals for the United States,” drafted by a Senate committee led by George McGovern) persuaded beef-loving Americans to lay off the red meat. But the basic pattern was fixed decades earlier: new scientific research comes along to challenge the prevailing nutritional orthodoxy; some nutrient that Americans have been happily chomping for years is suddenly found to be lethal; another nutrient is elevated to the status of health food; the industry throws its marketing weight behind it; and the American way of dietary life undergoes yet another revolution.
If this volatility strikes you as unexceptionable, you might be interested to know that there are other cultures that have been eating more or less the same way for generations, and there are peoples who still rely on archaic criteria like, oh, taste and tradition to guide them in their eating decisions. You might also be interested to know that some of the cultures that set their culinary course by the lights of pleasure and habit rather than nutritional science are actually healthier than we are — that is, suffer a lower incidence of diet-related health troubles. The ”French paradox” is the most famous such case, though it’s worth keeping in mind the French don’t regard the matter as a paradox at all; we Americans resort to that word simply because the French experience — a population of wine-swilling cheese eaters with lower rates of heart disease and obesity?! — confounds our orthodoxy about food. Maybe what we should be talking about is an American paradox: that is, a notably unhealthy people obsessed by the idea of eating healthily.
This obsession has been recognized as a distinctly American phenomenon at least since the early decades of the 20th century. Harvey Levenstein, a Canadian historian who has written two fascinating social histories of American foodways, neatly sums up the beliefs that have guided the American way of eating since the heyday of William Sylvester Graham and John Kellogg: ” . . . that taste is not a true guide to what should be eaten; that one should not simply eat what one enjoys; that the important components of food cannot be seen or tasted, but are discernible only in scientific laboratories; and that experimental science has produced rules of nutrition that will prevent illness and encourage longevity.” The power of any orthodoxy resides in its ability not to seem like one, and, at least to a 1904 or 2004 genus American, these beliefs don’t seem controversial or silly. The problem is, whatever their merits, this way of thinking about food is a recipe for deep confusion and anxiety about one of the central questions of life: what should we have for dinner?
That question, to one degree or another, assails any creature faced with a wide choice of things to eat: call it the omnivore’s dilemma. The koala bear certainly doesn’t worry about what’s for dinner; if it looks and smells like a eucalyptus leaf, then it is dinner. His culinary preferences are hard-wired.
But for omnivores like us, a vast amount of brain space and time must be devoted to figuring out which of all the many potential dishes nature offers are safe to eat. We rely on our prodigious powers of recognition and memory to guide us away from poisons (isn’t that the mushroom that made me sick last week?) and toward nutritious plants (the red berries are the juicier, sweeter ones). Our taste buds help, too, predisposing us toward sweetness, which signals carbohydrate energy in nature, and away from bitterness, which is how many of the toxic alkaloids produced by plants taste. Some anthropologists believe that one reason we evolved such big and intricate brains was precisely to help us deal with the omnivore’s dilemma…
One way to think about America’s national eating disorder is as the return, with an almost atavistic vengeance, of the omnivore’s dilemma. The cornucopia of the American supermarket has thrown us back onto a bewildering food landscape where we once again have to worry that some of those tasty-looking morsels might kill us. At the same time, many of the tools with which people historically managed the omnivore’s dilemma have lost their sharpness, or simply failed, in the United States today. As a relatively new nation drawn from many different immigrant populations, each with its own culture of food, we Americans find ourselves without a strong, stable culinary tradition to guide us…
Food marketing in particular thrives on dietary instability and so tends to heighten it. Since it’s difficult to sell more food to such a well-fed population (though not, as we’re discovering, impossible), food companies put their efforts into grabbing market share by introducing new kinds of processed food, which has the virtue of being both highly profitable and infinitely adaptable. Food technologists can readily re-engineer processed foods to be low-fat or low-carb or high in omega-3’s, whatever the current nutritional wisdom requires. So while the potato growers shudder before the carbophobic tide, the chip makers have been quick to adapt, by dialing down the spud content in their recipes and cranking up the soy.
Yet the success of food marketers in exploiting shifting nutritional fashions has a cost. Getting us to change how we eat over and over again tends to undermine the various social structures that surround (and steady) our eating habits: things like the family dinner and taboos on snacking between meals or eating alone. Big Food (with some help from the microwave oven) has figured out how to break Mom’s choke hold on the American menu by marketing directly to every demographic, children included. The result is a nation of antinomian eaters, each of us trying to work out our dietary salvation on our own.
So we’ve learned to choose our foods by the numbers (calories, carbs, fats, R.D.A.’s, price, whatever), relying more heavily on our reading and computational skills than upon our senses. Indeed, we’ve lost all confidence in our senses of taste and smell, which can’t detect the invisible macro- and micronutrients science has taught us to worry about, and which food processors have become adept at deceiving anyway. Most processed foods are marketed less on the basis of taste than on convenience, image, predictability, price point and health claims — all of which are easier to get right in a processed food product than its flavor. The American supermarket — chilled and stocked with hermetically sealed packages bristling with information — has effectively shut out the Nose and elevated the Eye.
No wonder we have become, in the midst of our astounding abundance, the world’s most anxious eaters. A few years ago, Paul Rozin, a University of Pennsylvania psychologist, and Claude Fischler, a French sociologist, began collaborating on a series of cross-cultural surveys of food attitudes. They found that of the four populations surveyed (the U.S., France, Flemish Belgium and Japan), Americans associated food with health the most and pleasure the least.
Asked what comes to mind upon hearing the phrase ”chocolate cake,” Americans were more apt to say ”guilt,” while the French said ”celebration”; ”heavy cream” elicited ”unhealthy” from Americans, ”whipped” from the French. The researchers found that Americans worry more about food and derive less pleasure from eating than people in any other nation they surveyed…
Perhaps because we take a more ‘’scientific” (i.e., reductionist) view of food, Americans automatically assume there must be some chemical component that explains the difference between the French and American experiences: it’s something in the red wine, perhaps, or the olive oil that’s making them healthier.
But how we eat, and even how we feel about eating, may in the end be just as important as what we eat. The French eat all sorts of ”unhealthy” foods, but they do it according to a strict and stable set of rules: they eat small portions and don’t go back for seconds; they don’t snack; they seldom eat alone, and communal meals are long, leisurely affairs. A well-developed culture of eating, such as you find in France or Italy, mediates the eater’s relationship to food, moderating consumption even as it prolongs and deepens the pleasure of eating.
”Worrying about food is not good for your health,” Rozin concludes — a deeply un-American view. He and Fischler suggest that our anxious eating itself may be part of the American problem with food, and that a more relaxed and social approach toward eating could go a long way toward breaking our unhealthy habit of bingeing and fad-dieting. ”We could eat less and actually enjoy it more,” suggests Rozin. Of course this is easier said than done. It’s so much simpler to alter the menu or nutrient profile of a meal than to change the social and psychological context in which it is eaten. (There’s also a lot more money to be made fiddling with ingredients and supersizing portions.) And yet what a wonderful prospect, to discover that the relationship of pleasure and health in eating is not, as we’ve been hearing for a hundred years, necessarily one of strife, but that the two might again be married at the table…
Calorie counter
Daily requirement:
Man 3,000 calories Woman 2,300
Food: 4oz cheeseburger
Calories: 525
Food: Chicken chow mein
Calories: 750
Food: Kebab and chips
Calories: 1,000
Food: Pack of crisps
Calories: 130
Food: 1 croissant
Calories: 235
Food: 1 cup popcorn
Calories: 135
Food: 1 oz roast peanuts
Calories: 165
Food: 12 fl oz regular cola
Calories: 160
Food: Slice pizza
Calories: 290
Food: 1 oz raisin bran
Calories: 90
Food: 1 oz chocolate
Calories: 150