The Atlantic recently ran a cover story with the provocative title, “How Junk Food Can End Obesity.” Author David H. Freeman makes the case for why we must turn to big food companies to save us from our obesity crisis. In fact, he antagonizes this very blog along with a collection of other organizations and authors for advocating real food, or what he calls, “wholesome food.” I’ve been working on my reaction to the article (teaser: I disagree with a few points–I don’t believe processed food is just as healthy as unprocessed food–but I do agree with others–incremental changes in Big Food can have a huge impact) but my close friend Austin Kiessig beat me to it. He sent me the brilliant piece of writing below on his own understanding of our current predicament and his view on what changes are possible. It’s a great read and I’m proud to publish it on this wholesome-food-advocating blog.

First, a bit about Austin: A classmate of mine at the Stanford GSB and my Co-President of the GSB FARM Club, Austin is incredibly knowledgeable as well as passionate about the food system and nutrition. Before the GSB he worked for Roll Global: the holding company behind Paramount Farms, POM Wonderful, and Fiji Water. Since graduating in 2012, he’s spent the past year working alongside and writing case studies for management legend Irv Grousbeck at the GSB while exploring potential ventures in food and farming. I’ll let him take it from here…

Can We Be Saved From Our Own Appetites?
by Austin Kiessig

Where I live, my rent is sky-high, I can see the ocean, and I commute to work via bicycle and train.  One facet of my lifestyle that I value immensely is that my neighborhood enables regular access to nutrient-rich, fresh foods.  Farmer’s market-worthy produce and meat are available within a short walk at dozens of distribution points—Lululemon-trafficked grocery stores, cafes filled with earbudded heads floating above glowing Apple logos, and a smattering of high-priced “date-worthy” restaurants.  Oh, and farmer’s markets.

My lifestyle bears little resemblance to the average American’s.  I’m a card-carrying San Francisco stereotype.  Don’t stop reading yet, though: it’s not as bad as it seems.  I’m not cool enough to be a hipster, nor wealthy enough to be an insufferable snob.  But I am a Pollanite: a devotee of Michael Pollan’s normative proclamations about how all of us should eat.  In short, I believe that every American should seek out less packaged and/or fast food, consume far more produce, cook at home more often, and, frankly, pay more for food.  Among all economic goods, food is the ultimate “you get what you pay for” proposition.  Want readily-available, cheap burgers?  Okay.  But be prepared to foot the bill later on for the “externalized” costs of agriculture subsidies, a degraded ecosystem, waning natural resources, and skyrocketing public health bills.  Paying more for food today generally means you’re just paying those “externalized” costs up front instead of later.

But I am cognizant of a critical, stubborn fact of life: not everyone can afford to eat like a Pollanite.  And importantly, even if they could afford to, not everyone wants to.  In fact, I believe that the vast majority of Americans don’t want to.  It bears repeating—lest my Silicon Valley and Manhattan readers forget it—that my (your?) lifestyle is an anomaly in our country.  I sought out that lifestyle and made it so, particularly the food part.  But for many Americans, the aptly-named industrial food system works quite well.

In no other place on earth at any time in history have people been able to get fat (and happy?) spending such a small percentage of their incomes on food.  And, for the most part, Americans LOVE that food.  Even the most devout Pollanite must confess to the guilty pleasure of a road trip stop at In-N-Out, insulated by hundreds of miles from the judging eyes of their preachy fellow apologists.  Or the bliss of a late-night Taco Bell ambush.  I imagine that even when Alice Waters bites into a Big Mac, she cannot stem the Requiem For A Dream-style pupil dilation, heart rate escalation, and heady endorphin release.  Those physiological responses are universally triggered by the food science opus that is sugar, salt, and fat masterfully calibrated within a perfectly replicable architecture of bun, meat, and fixings.  Our corporate food giants have achieved six-sigma production of sensory rapture on a global scale, and that achievement is heralded every time a consumer opens their wallet and votes for more.  How many billions have scampered hungrily towards the Golden Arches to date?

Americans are addicted.  There is no longer a debate.  Excellent journalism has laid bare that reality.  But it’s more than just an addiction to sugar, salt, and fat.  It’s an addiction to cheap prices and convenience.  Industrial food rules the day because it has conquered the competitive (un)holy trinity: taste, price, and distribution (a.k.a. convenience).  For the average American, the Pollanite diet wins out on precisely zero of these three critical hinge points of consumer choice.  Fresh produce fails to frenzy the taste buds, is pugilistic on the pocketbook, and seems (or actually is) absent from their aisleways.

Change is Needed, but What Kind?

I want the food system to change.  But I understand the enormity of the challenge.  Agriculture subsidies for a select few crops prop up an enormous infrastructure of industry and profits.  If those subsidies were taken away, eventually Americans would be able to buy nutrition at price parity to their empty calories.  But the subsidies will not go away any time soon.  In short, that means that industrial food will continue to win on taste (the momentum of food science undergirded by a cheap ingredient menu), price (buoyed by an uneven economic playing field), and distribution (an entrenched, scaled supply chain).  Silicon Valley’s techno-optimist hackers dream of a killer app that will streamline the path of produce to farmer’s markets and grocery stores and lower the cost of “the good stuff” so profoundly that denizens of inner city food deserts will simply have to buy it.  But I don’t think nutritional food price parity is achievable in the current system.  Ever.  The current factory food machine is too damn good at what they do.  The gap is too large.

Which leaves us with one saving grace: consumer behavior change.  If Americans can’t be compelled by a better product (per the unholy trinity) that doesn’t and won’t exist, then they have to choose to spend their money in a different way.  Which leads to another big question: why would they do so?  That query demands a survey of which behavior change models tend to work.  And which don’t.

The Scared Straight Model

The reason I chose to eat healthier was because of a very acute medical problem I suffered for two years when I was in college.  I developed two benign bone tumors—cause unknown—that pitched me into the darkest emotional and physical times of my life.  As a result of losing control of my health, I vowed I would do everything in my power to avoid getting sick again down the line.  A visit with a nutritionist and reams of reading convinced me that diet was one of the most important levers in steering my health.  So I set out to understand what I ate, and stopped eating the things I determined were “bad” for me.

This past year, I’ve spent a considerable amount of time trying to develop a healthy snack for people managing diabetes (both Type 1 and Type 2).  The product development process was incredibly educational, but not principally because I learned about the science and tactics of commercializing a mainstream food product.  Rather, I was most struck by what I heard when interviewing physicians and diabetes educators who worked with Type 2 diabetics.  Nearly all of my interviewees insisted that better snack options were needed, but they also cautioned that if those products were truly healthy, their patients would not buy them.  At first, I couldn’t understand why.  In my opinion, this demographic above all others should be motivated in the search for better food solutions.  After all, those patients who had been told they were pre-diabetic or diagnosed as Type 2* had a stark choice: reform your diet (and start pumping yourself full of synthetic insulin), or get sick and die much sooner.

But what those physicians saw among most patients were reactions spanning from modest (and earnest) dietary changes to complete denial and zero changes.  Dietary pathways and food addiction were so engrained and provided so much pleasure that many patients struggled mightily to make lifestyle modifications.  (In fairness, the synthetic insulin industry represents a powerful crutch that permits people to avoid meaningful diet change.)  A pair of physicians who managed a high-touch intervention practice told me morosely that one benchmark goal they set for their most at-risk diabetics was to integrate one (!) weekly serving of broccoli into their diet.  Many of those patients bluntly failed to deliver on this seemingly innocuous target.  To those patients, a spiraling, sickly death was less intimidating than cruciferous greens on Tuesday night.

It became clear that “scared straight” by health issues worked for some people (including me), but wasn’t powerful enough to redirect many others.  It’s worth mentioning that my research was admittedly unscientific, but the anecdotes I heard took on a weighty resonance when overlaid against the tragic macro-data on our nation’s continuing obesity, diabetes, and heart disease epidemics.  Many people get sick or stay sick not because they lack options to remediate their illness.  They end up on that path because it’s hard to change.  And if people with their lives on the line can’t change, what hope is there for the rest of us?

The Education Model

There is another school of thought espoused by many food reformists: teach people (sick and healthy alike) to eat better, and they will do so.  The idea is that an informed consumer is a healthier consumer.  Undoubtedly, there is truth to this.  But nutritional education tends to come from one of a few places: corporate marketing (guess where this leads?), parents and friends (declining household cooking rates lead to less knowledge of what’s being eaten), the government (see Marion Nestle’s writing on the constantly evolving, obfuscating, and commercially corrupted “food pyramid”), or self-directed research.  (Note what’s conspicuously missing and pragmatically far-off: food education in schools.  God bless you for trying, Jamie Oliver.)

The self-directed research pathway is perhaps the most promising, but it is a difficult one.  Why?  First, it takes time and energy.  Second, it’s confusing.  Personally, I’ve been trying to understand nutritional science for over a decade, and sometimes now I feel further from the truth than when I started.  “Nutritional science” is a muddle of contradictory dictums cobbled together from corporate-funded experiments with pre-ordained outcomes, highly specific clinical studies that provide few general answers in the context of complex diets and genetic variability, and whatever “diet du jour” is being espoused by the Dr. Phils of the world.

Despite the flaws of a constantly evolving body of nutritional science, most people manage to cobble together a body of edicts that they can live by.  The average person, when asked, can readily share their “food rules”.  For instance, someone might say “I know fat is bad, fruits and veggies are good, and I shouldn’t drink too much soda.”  Great start.  But, depending on which expert you ask, each claim is subject to befuddling scrutiny.  Fat is bad?  Well, it’s true that fat is the most calorically dense macronutrient, but fat may not be what’s making you fat or causing heart disease, many fats are good for you, and fat can actually help you lose weight.  Fruits and vegetables are good?  While it’s true that fruits and vegetables are fiber- and nutrient-dense (always desirable), too much fructose or starch can be obesogenic, much produce is loaded with toxic pesticides, and french fries are technically a vegetable.  And how much is “too much” soda?  I won’t even open that can of worms.

The example above is simply meant to show that “shortcut rules” veil deep complexity.  World-class research nutritionists cannot agree with one another, much less endorse the op-ed proclamations of Dr. Oz.  So how is the average American supposed to cut through the clutter in a meaningful way?  Confusion leads to emotional flooding, and emotional flooding leads to the drive-thru.

My point is not that education isn’t worth pursuing.  It certainly is.  But unbiased or meaningfully targeted resources are rare and expensive to come by (think high-touch personal counseling by a nutrition professional).  The average American can’t (or, more sadly, perceives they can’t) afford the time and resources needed to become nutritionally savvy.  And savvy is what it takes to navigate the perilously enticing industrial food landscape.  Savvy can be the wax in your ears that helps you ignore the song of the sirens in food marketing.  But I don’t see mainstream America becoming so aggrievedly informed that they start picketing Burger King.

The Cash Incentives Model

One proven way to get people to eat better is to provide a cash incentive.  Since I don’t expect the government to provide blanket subsidies for better eating, we turn to the only other institutions that have an incentive to pay people to eat better: health insurers and employers.  Since both are exposed to the rising cost of medical care should an insured/employee develop an avoidable chronic disease, either might provide a “carrot” for preventative wellness through healthier diet.

Safeway is the case study for adopting a cash incentives program that improved employee health.  And numerous insurers now offer premium discounts for insured customers who improve on biometric markers of health (blood pressure, blood glucose, weight, smoking cessation, etc.) over time.  Even one startup is trying to get into the cash incentives game.

However successful these programs have been, they are hamstrung by the reality that most insured people will change employers or insurance carriers every few years.  What that means is that investments made in an employee or insured today may not pay off for a decade or more, so most employers and insurers have not made material investments in better eating.  For the time being, this is a dietary “fix” incentive available to a minimal fraction of U.S. citizens.

The Subversive Psychology Model

Change is easier when choices have already been made for you.  The field of psychology is rich with examples of behavior change catalyzed by subtle (or even not-so-subtle) environmental alterations.  One of my favorite examples along these lines highlights our “default bias”.  In European countries where motorists being issued new drivers’ licenses are designated, by default, as organ donors, more than 90% of people ended up registering as organ donors.  In European countries where new licensees were designated, by default, as non-donors, only some 10% of people ended up opting in as organ donors.  People tend to accept the default they are presented with.

Now, extrapolate such findings to dietary behavior.  People will generally eat as much as they are given, without even realizing how much they eat.  But people can also be anchored to consume less.  Reduce serving sizes so that people have to order two servings instead of one to consume the same amount of food, or have to return to a buffet multiple times instead of passing through once, and they will eat less.  These effects are probably familiar to all of us: if I don’t keep Oreos in the house (a particular Achilles’ heel for me), I won’t eat them.  And if I do eat them, I will eat fewer from a four-pack than I might from a family-sized container.  Environmental structure and psychological nudges matter.

The allure of subversive psychology is that it works for pretty much everyone.  Moreover, it is low-touch and low-cost.  Shrinking plate sizes does not require multi-week counseling: the change is built into the decision process from the front end.  The same cannot be said about other methods of behavior change.  And that is why I think subversive psychology is our cheapest and most-likely-to-succeed way of changing the diet of the mainstream consumer.

(Author’s note: if you can provide evidence of other meaningful and economical behavior change models, please do so!  I love being proven wrong.)

Fast Food as Savior?

The cover story in the July 2013 issue of The Atlantic magazine is David H. Freeman’s piece How Junk Food Can End Obesity.  Upon scanning the title, my inner Pollanite began frothing at the mouth and mentally mapping out an erudite, 2,500-word retort.  Why even bother reading a defense of the titanic commercial demons that had turned us from a lively nation of trim Wally Cleavers into a waddling amalgamation of gelatinous aortic congestions?  I set upon reading Freeman’s piece as a predator sets upon prey: you poor thing, you never stood a chance.

But my inner Pollanite was steadily quieted as Freeman’s arguments began to win me over.  You see, Freeman builds to the same conclusion that I have: fast food has already won.  The unholy trio of commercial success (taste, cost, distribution) is firmly in industrial food’s clutches, and there’s no easy path to wresting it away.  Nor would the majority of Americans want the food landscape to change: as it turns out, the unholy trio is the recipe for commercial success precisely because it is what consumers demand from their corporate paragons.  To a Pollanite, the tale of the American food landscape is one of master and slave.  To many, many Americans, the tale of that same landscape is one of happy marriage.

Which is why I think no mainstream obesity solution can occur without the use of subversive psychology through industrial food channels.  In Freeman’s article, we see that McDonald’s’ greatest successes reformulating products to make them more healthy came when consumers didn’t know healthy changes were being made.  Conversely, many of McDonald’s’ greatest failures came when they tried to sell healthfully branded food items.

But think of the massive impact McDonalds (or Coke, or Pepsi, or Frito Lay, or Yum Brands) could have if they began cleaning up the most obesogenic foods clogging American alimentation.  Take the sum of all the calories avoided by people who changed their diet to address illness, or who improved their dietary education, or who began cooking more at home, and I am willing to bet that number will pale in comparison to the caloric consumption that was eliminated from the system when McDonald’s eliminated Super Sizing as a menu option.  There are simply too many people eating too many calories through industrial food channels to think that we can’t treat industrial food as The Front Line in the war on obesity.

If you agree with me at this point (and I know that some won’t), the next question is obvious: would these companies make those changes?  Why would they pull the rug out from under their customers, at risk of being outed as “value destroyers” or losing market share to competitors?  To assume industry giants will make such benevolent changes is to invite cognitive dissonance, ignore the inevitable outcome of the prisoner’s dilemma, and take on faith that the impossible is possible.

But for once in this long missive, I will espouse optimism.  The enlightened Pollanites of San Francisco and Manhattan can and should continue to pressure industrial food to clean up its act.  To date, incremental change has proven possible.  McDonald’s got rid of super sizing.  Pepsi has reduced sodium across much of its product portfolio.  And WalMart has stocked its shelves with a laudable array of healthier food options.  These are real wins.

(For now, I won’t engage in the question of “what types of changes are best?”  Obviously, smaller portions and real foods are preferred.  But is a Big Mac with 10% fewer calories but more synthetically engineered ingredients a “win”?  For obesity alleviation, probably.  For general health?  That’s an exceedingly complicated and subjective debate.)

And the non-Pollanites (most people, good people, the salt of the earth that make our country and economy tick) will continue to learn and ask for better.  Despite the labyrinthine zig-zag of nutritional science headlines and diet fads, people increasingly “get it”.  Americans drink less soda.  Obesity trends have leveled off in key parts of the country.  Most people probably feel a healthy pressure to make better food decisions every week, day, or meal.  Does that mean they’ll start shopping at the farmer’s market and start cooking at home?  Probably not.  But the needle is moving.

Furthermore, I won’t rule out regulation as a means to reform the corporate food giants.  I don’t oppose government strictures to remedy the ills brought about by government subsidies (in this reasoning, two wrongs at least point in the direction of a right.)  But Americans’ libertarian streak is a real hurdle, as evinced by the strong backlash to New York City mayor Michael Bloomberg’s ban on large serving-size sodas.

In sum, I believe you can’t really change the way the American mainstream eats unless you fiddle with the places where the American mainstream eats their food.  The industrial food machine has a vice-grip on our appetites, and that’s a hard truth to acknowledge.  But real changes cannot be made unless those hard truths are wrestled with.  The Pollanite doctrine may work for some of us, but we are the economically and geographically privileged few.  One of the largest errors I believe the food reform movement can make is to bifurcate the country into “the enlightened” and “the rest”.  Instead of eschewing McDonald’s altogether, go buy a salad there and then write them a letter telling them that the salad was great and the Big Mac had so many calories that you threw half of it away.  And then ask them to add broccoli to the salad.  Rinse, repeat, and see what happens.

This is not to say that we, the food reform advocates, should not push forward on all fronts complementarily, in parallel, and apace.  But we cannot expect the juggernauts of our food system to change course unless we push and pull them, hand by hand, in a new direction.  That is the biggest way we can put a real dent in the American obesity crisis.

Note:
*For Type 1 diabetics, the choice was even starker.  A major trip-up in daily diet could lead to hospitalization or death.  Because the impact of poor diet was so temporally acute, I found that the Type 1 diabetics I interviewed were among the best eaters I knew, period.