A Big Fat Crisis

October 28, 2013
With a kind but brisk bedside manner, RAND Corporation scientist Cohen (co-author of Prescription for a Healthy Nation) delivers a diagnosis in layman’s terms in this powerful book: two-thirds of American adults and one-third of children are overweight or obese, not because of a lack of self-control, but because of the “modern food environment” that makes it easy to consume too many calories. In the first half of the book, Cohen presents numerous research studies that level myths about “mindful” eating, instead arguing that we’re “biologically designed to overeat” and easily influenced by 24-hour fast-food drive-thrus, oversize restaurant portions, supermarket displays, candy in checkout aisles, and TV commercials. She argues for a “critical paradigm shift”: to view the epidemic as a public health crisis and institute controls that guide eaters to “choose health over heft.” Anticipating resistance, Cohen spends the rest of the book defending government interventions, citing examples like ratings for restaurant hygiene and conjecturing how “common-sense regulations” resembling those on alcohol sales might “make unhealthy foods” less accessible and enticing. While Cohen believes that collective action is the only real solution to epidemic, she also helpfully suggests ways to modify one’s food environment and offers dietary guidelines in the appendix. Photos.

Starred review from December 1, 2013
Cohen, an epidemiologist and medical doctor at the RAND Corporation, makes a convincing case that obesity involves far more than a failure of willpower. Were people really more disciplined 30 years ago, when only one in six U.S. adults was obese, instead of the one in three today? Unlikely, she says. Physiologically, our capacity for self-control has not shrunk over the past several decades. She blames both the way humans are wired to overeat when presented with the opportunity and the transformed food environment, which makes large portions of cheap, high-calorie foods too easily available. Little nibbles add up: The average individual weight gain of 22 pounds over the past 30 years in the U.S. can be explained by our eating just seven extra calories per day. Cohen proposes standardizing portion sizes and running counter-advertising against unhealthy food products. Her other ideas include following the model of state limits on the number of places that can sell alcohol: why not do the same with doughnut shops and ice cream parlors? And why not restrict all-you-can-eat buffets, and use warning labels, like those for cigarettes and alcohol? Though some ideas seem far-fetched, Cohen certainly presents a fresh, thought-provoking take on how to fight the obesity epidemic.(Reprinted with permission of Booklist, copyright 2013, American Library Association.)

November 15, 2013
What can be done about "the public health crisis of our time"? The national conversation about obesity, childhood or otherwise, has been a bus mired in the mud and spinning its wheels to get out. No matter that the first lady of the United States has been driving the bus or that the critical mass of diet/obesity books ensures that nearly every obese American could have their own individual text. RAND senior natural scientist Cohen (co-author: Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World, 2005, etc.) acknowledges as much--she consigns healthier eating guidelines to the appendix--but her work, with one foot in science and the other in culture, instead examines the driving forces behind the obesity epidemic. Specifically, she poses the challenge as twofold: human nature and the unconscious and/or irrational decision-making process around what and how much to eat, and "the modern food environment": inexpensive, high-calorie, convenient, low-nutrition foods, crafted in labs to push all the right "tastes good, give me more" buttons. Cohen takes a behaviorist approach to identifying the antecedents for eating choices, suggesting that the focus on self-control as a key element actually undercuts efforts to make change, given people's assumptions about human nature and our genetic makeup. Studies indicate that biological imperatives, coupled with increasingly complex methods of marketing, hobble even the best intentioned plans. The author makes a compelling case. If an "epidemic" of obese people are finding it too difficult to achieve their health goals, it's a societal imperative to address the environmental factors that undermine these attempts. Think of it as preventative care rather than knee-jerk reactionary responses. If Cohen's book can get more obese people onboard that aforementioned bus, perhaps the conversation can finally move forward.

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