Book Review: The End of Overeating

The End of Overeatingcame highly recommended to me by some of my clients at my previous practice, and I'd heard some of the Internet buzz when it first came out. Its author, Dr. David Kessler, is a pediatrician known for his role as former commissioner for the US Food and Drug Admistration (FDA). During his tenure (from 1990-1997), he played a role in speeding the process of drug approvals and setting regulations for tobacco marketing, standardized Nutrition Facts tables and food safety. In the past, he had also struggled with his weight, which was part of his impetus for writing The End of Overeating.

The overarching theme behind the book is Kessler's theory of "conditioned hypereating" - foods that are high in sugar, fat and salt cause neurological changes that motivate us to seek more of those foods to get that same "high". As we eat more of these foods, it continues to reinforce that "high" and eventually, eating these foods becomes a subconscious, automatic response as opposed to a conscious choice, which has ultimately led to the obesity epidemic today. However, Kessler notes that the problem of overeating is not exclusive to those with weight problems - I'm sure most people can relate to sitting down and snacking on something mindlessly until the package is empty, unconsciously scooping up a few candies from the candy bowl sitting on their co-worker's desk every time they walk by, or consistently picking at a bowl of chips or popcorn at any party (that's me!).

Kessler explains, "I've termed the resulting behaviour 'conditioned overeating.' 'Conditioned' because it becomes an automatic response to widely available food and its cues, 'hyper' because the eating is excessive, driven by motivational forces we find difficult to control."

I was quite fascinated by the first few sections of the book, as Kessler reviewed some of the studies done with foods high in sugar, fat and/or salt and how subjects (animals and humans alike) responded to them as a reward, or how MRI scans showed that they activated our brains. It was particularly interesting to read how the combinations of sugar, fat and salt that you find in restaurant meals or packaged foods are by no means an accident.

Kessler then goes on to elaborate on the neurological/psychological basis of "conditioned overeating" and some of the psychological theories behind reversing it. I wasn't as impressed with these sections of the book as I found the writing to be a bit "clunky" - Kessler would present a hypothesis (i.e. highly palatable foods drive a cycle of overeating behaviour via reinforcement learning), add in a few quotes from researchers working on the topic (usually *not* in a food/nutrition context), repeat. The skeptical, evidence-based practitioner in me sees why this is a book as opposed to say, a review article - while Kessler's statements make sense and could be proven if study design allowed, there really isn't enough, if any, evidence to prove that it is true. Ultimately, this is why health practitioners may not use these theories in practice.

As an aside, I think that's the sad thing when it comes to health research and innovation - there's obviously some great research that's being done on new theories and therapies, but it takes a lot of research to finally have enough evidence to have something included into practice, and ultimately that does not get communicated to the public because all that stuff is stuck in scientific journals as opposed to books or other forms of media. At the same time, anyone can write a book, no matter their credentials, so the market is saturated with misinformation and we have to slog through a lot of crap to get to the good stuff.

Anyway...

I was a little disappointed to see that the "solutions" section of The End of Overeating was very small as I think a lot of the times when people pick up books like these they are looking for answers. Kessler calls his system Food Rehab (as per the book the term is trademarked but I haven't been able to find more information anywhere), and some of the basic principles are concepts that I've already heard. For example, "Treating conditioned hypereating means recognizing it as a chronic problem that needs to be managed, not one that can be completely cured," sounds almost exactly like Dr. Arya Sharma's approach to obesity management. Although the concepts were not new to me, I do like seeing how other people present them to help me explain them differently to my own clients. Kessler goes on to say, "I don't offer a one-size-fits-all technique, because I know it will not work. New learning that sticks is new learning that resonates for you."

I particularly liked his idea of setting "rules" - while I try to avoid being very restrictive with people because it can often backfire, I do see how making rules can help to simplify the process of trying to overcome overeating. Instead of trying to force your thoughts onto something else when you see the prohibited food, you simply tell yourself that you're not allowed. I think it could work as a starting strategy for a person's "problem foods", and then as a person tries some of the other strategies in the book to make food a more conscious choice, they can slowly reintroduce foods that had caused them problems in the past.

Despite some of my qualms with the quality of the writing in parts of the book, I would recommend it to anyone who is interested in a more psychological versus physiological look on overeating, and by extension, obesity and weight loss.

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