Connor McCreaddie, an 8-year-old British boy who weighs about 200 pounds, made headlines recently when social workers considered taking him into protective care, which would prevent him from endangering his health by overeating. They later relented and allowed him to remain with his mother on the condition she take steps to safeguard his welfare.
Unfortunately, Connor is just an extreme example of the obesity epidemic sweeping across Britain, the United States and many other developed countries. Why is this happening?
More than 100 years ago Ivan Pavlov won the Nobel Prize for his work on digestion. He is best remembered for recognizing the phenomenon of environmental conditioning. By linking an environmental stimulus with food, Pavlov got dogs to salivate upon hearing a bell, whether or not food was provided and whether or not the dogs were hungry.
Since then, advertisers have linked their products to desirable traits and outcomes in order to increase sales. Although adults become unhealthy if they consume more calories than they burn, the food industry has created an environment that sells more food than people need — by utilizing the same environmental conditioning and principles of association that made Pavlov's dogs salivate. The food environment includes food outlets, food advertising and food itself.
After two decades of accelerating rates of obesity, coupled with the inability of most people to lose weight and keep it off, it's clear people are being manipulated to overeat. Some are more sensitive to environmental cues than others. Unfortunately, most people don't have the insight into how manipulation occurs and will never be able to identify the cues and forces that lead them to eat more than they should. These cues are often as innocuous as an end-aisle display at the supermarket, the vending machine at work or a 2-for-1 burger special.
Eating too much of the wrong types of food can cause obesity and a host of other chronic diseases. Unfortunately, we can't tell precisely how many calories of fat are in a portion or how much salt there is simply by looking at a food item.
We need regulations to make the food environment transparent, since individuals cannot see the risks on their own. People usually do not realize the frequency, quantity and quality of the food they eat is determined not by themselves, but by their food environment.
What sorts of regulations are needed? New ways of inspecting and rating food outlets, as well as how food is provided in schools, worksites and communities. We need new standards for how food is made available in shops and vending machines.
For example, restaurant inspections are currently limited to safety issues with respect to food-borne illnesses. The standards should be revised so that outlets are also rated on their ability to provide appropriate portions of nutritious foods that facilitate weight control.
With revised standards, a restaurant that only serves super-sized portions of burgers and fries would receive a "D" rating, whereas one that serves fresh salads, fruits and portions with three to four ounces of meat and at least one cup of vegetables will receive an "A".
Another regulation might have to do with controlling shelf space and placement of products. Marketers know that if they place an item — mostly unhealthy foods, such as chips, candy or sugar-sweetened beverages — at the end of an aisle or in special floor displays, or increase the amount of shelf space, they can increase sales of the product.
While these placement practices make good business sense — unhealthy products provide a greater profit to large food corporations — the arrangement results in people buying too many unhealthy foods.
We'd like to believe that as individuals we are in control, but the truth is, our environment guides our behaviors. Studies show that the more aisles we traverse in a supermarket, the more items we buy on impulse, simply because they catch our eye. Store factors control our purchases more than individual factors do.
Just as we require buildings to use appropriate materials and follow safety rules so the buildings are strong and won't collapse in a storm or earthquake, the food environment should also keep us healthy and safe, and not lead us to overeat or become ill with a chronic disease.
Just as we require reasonable accommodations for those who are handicapped, the food environment should be designed to accommodate the needs of all people, and in particular the average person, who would benefit from fewer calories, less salt and more fruits and vegetables to stay healthy. It's not just the Connor McCreaddies of the world who need help. We all do.
© 2007 United Press International
Deborah Cohen is a physician and a senior natural scientist at the RAND Corporation, a non-profit research organization. She is the co-author of the book "Prescription for a Healthy Nation, a New Approach to Improving Our Lives by Fixing Our Everyday World" (Beacon Press).
This commentary originally appeared in United Press International on March 7, 2007. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.