A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic-and How We Can End It

by Deborah Cohen

Obesity is the public health crisis of the twenty-first century. Over 150 million Americans are overweight or obese, and across the globe an estimated 1.5 billion are affected. In A Big Fat Crisis, Dr. Deborah A. Cohen has created a major new work that will transform the conversation surrounding the modern weight crisis. Based on her own extensive research, as well as the latest insights from behavioral economics and cognitive science, Cohen reveals what drives the obesity epidemic and how we, as a nation, can overcome it.Cohen argues that the massive increase in obesity is the product of two forces. One is the immutable aspect of human nature, namely the fundamental limits of self-control and the unconscious ways we are hard-wired to eat. And second is the completely transformed modern food environment, including lower prices, larger portion sizes, and the outsized influence of food advertising. We live in a food swamp, where food is cheap, ubiquitous, and insidiously marketed. This, rather than the much-discussed “food deserts,” is the source of the epidemic.The conventional wisdom is that overeating is the expression of individual weakness and a lack of self-control. But that would mean that people in this country had more willpower thirty years ago, when the rate of obesity was half of what it is today! The truth is that our capacity for self-control has not shrunk; instead, the changing conditions of our modern world have pushed our limits to such an extent that more and more of us are simply no longer up to the challenge.Ending this public health crisis will require solutions that transcend the advice found in diet books. Simply urging people to eat less sugar, salt, and fat has not worked. A Big Fat Crisis offers concrete recommendations and sweeping policy changes—including implementing smart and effective regulations and constructing a more balanced food environment—that represent nothing less than a blueprint for defeating the obesity epidemic once and for all.

Genres: Nonfiction, Health, Politics, Food, Psychology, Self Help, Science

272 pages, Paperback

First published January 1, 2013

Reviews

[Carrie Rubin · Rating 5 out of 5]

A wonderful exploration about the forces behind obesity, with most emphasis on the food environment. What I particularly liked about this book was that the author gave specifics on how best to approach changing the food environment in order to reverse the overweight/obesity trend in the US (and elsewhere). Because what we've done so far is clearly not having much of an effect.

[Heather · Rating 2 out of 5]

I wavered between 2 and 3 stars on this one. Parts of it were interesting, other parts were over-the-top preachy. It started out well with a discussion of how we are wired to eat and our environment makes it extremely difficult for us to overcome that wiring. The science was a little weak, and some of the studies used as arguments just seemed pointless, like having people choose between a glue stick and a pack of M&M's.

The rest of the book was about how we need more regulations to make people eat better. I'm not opposed to regulations on principle, but I thought these proposals were not realistic. What I do think is realistic is to encourage (through laws or preferably through public pressure) restaurants to provide more healthy options.

My fear in regulating healthy foods is that I suspect the obesity epidemic was caused in part by really poor dietary guidelines set by the government in the first place. Today's healthy food is tomorrow's evil food (trans fat) or vice versa (coconut oil). I don't think we have it totally figured out yet, and if the author was the one making the recommendations, I think she would mandate a "healthy diet" that I have not found to work for me in practice.

There were some interesting ideas, but the general overbearing tone wore on me.

[David Kinchen · Rating 4 out of 5]

BOOK REVIEW: 'A Big Fat Crisis': Dr. Deborah A. Cohen Says It's Not Your Fault -- Entirely -- If You're Fat

Most books on the nation's obesity crisis -- which affects more than 150 million Americans, almost half the nation's population -- blame the individual for pigging out. Or they blame fast food restaurants like the ubiquitous McDonald's for "super-sizing" portions and our bellies and posteriors.


Call it the "Spurlock Syndrome" for Morgan Spurlock's documentary on obesity. McDonald's was in the crosshairs in the West Virginia native's 2004 film "Super Size Me." (You can watch it at: http://www.hulu.com/watch/63283).

Deborah A. Cohen, M.D. in her groundbreaking "A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic -- And How We Can End It" (Nation Books, 272 pages, $26.99) argues that the obesity epidemic is the product of two forces:

(1) Immutable aspects of human nature, namely the fundamental limits of self-control, the lazy decision-making of the brains non-cognitive system, and the automatic and unconscious way that we are hard-wired to eat; and

(2) A completely transformed food environment: all of the food-related elements of our surroundings, including food stores and restaurants, prices, portion sizes, the types of food available to us, and food marketing and advertising.

I have problems with many of Dr. Cohen's positions, including her flat out statement that "Diets don't work." I'll explain my own experience with losing weight -- almost 30 pounds since May 2013 -- later in this review; meanwhile, I'll present Dr. Cohen's arguments as fully -- and as sympathetically -- as I can. I'm doing this because I agree with so many of her positions.

To arrive at the above two forces behind the obesity epidemic, Dr. Cohen used her own research at the RAND Corporation, as well as the latest insights from behavioral economics, psychology, cognitive science, and the social sciences to demonstrate to her satisfaction that we as a nation must take action to standardize food portion sizes, limit impulse marketing of candy and other foods that make us fat and run counter advertising like that on tobacco products and alcohol with warning labels on junk food.

These are among the many suggestions Dr. Cohen makes in her argument that it's not your fault that you're fat -- it's those darn candy displays at the checkout counter at your pharmacy. She argues that willpower can only take us so far, that advertising, among other forces, makes it much too easy to access the kinds of low nutrition, high calorie junk food that leads inevitably to obesity. To this I would argue that life is a series of decisions, that you can decide if you want to smoke or drink or pig out, that you are not a robot lacking willpower.

In Chapter 8, beginning on Page 109, Dr. Cohen writes how laws against open sewage and waste in the streets and yards of England reduced epidemics of cholera and typhoid in the crowded industrial cities of the early 1800s. This is a fascinating and educational chapter, but I think it's a big leap to link sanitary regulations to legislating against junk food, the way outgoing Mayor Michael Bloomberg did in New York City.

Or maybe not: Warning labels on cigarettes have greatly reduced smoking and pregnant women tend to avoid alcohol because of labels.

In Chapter 13 -- the book's conclusion -- Dr. Cohen discusses (Pages 197-198) New York City's "Children Can't Fly" campaign.

She writes how, In the hot days of the summer of 1972, the New York City Health Department investigated an unusually high incidence of deaths among toddlers who fell out of tenement windows.

Just as wide-body people -- the kind we see waddling around in TV programs about obesity -- are blamed for their condition, mothers and caregivers were blamed for not being alert, not properly supervising children, or simply neglecting naturally curious toddlers and adventurous young children who leaned out of apartment windows, or crawled onto fire escape stairwells to try to cool off. If you've visited NYC in the summer, you know what it's like in a place where the majority of people are renters.

After an investigation, the health department launched a campaign, “Children Can't Fly” and offered free window guards to families in tenement buildings. The next summer, there were no falls from buildings that had the new window guards.

Dr. Cohen argues that this story from 40 years ago is an apt analogy for the problem and the solution to the obesity epidemic. Just as children are born curious and may wander to an open window even if (or because) we tell them to stay away so too all of us were born with the capacity and inclination to eat more than we need.

In a world where there is too much food, Dr. Cohen argues that -- currently -- we have no constraints that limit our natural tendencies to automatically eat what is readily available.

Sections of the book that deal with our couch potato lifestyle I can agree with wholeheartedly. Dr. Cohen explores the importance of exercise -- even if it means just getting up and walking around, as I do periodically after a computer session (I'm doing it right now…hold that thought)….OK, I just came back from the patio, where it will be another beautiful late December day in south Texas, with temps in the 70s. It felt good. Dr. Cohen wants exercise breaks for cubicle dwellers especially, since much of our work-life these days is of the sedentary kind.

Modifying urban design is another way to reduce obesity, Dr. Cohen argues. On Pages 172-173, she cites a study she conducted with her RAND colleague Roland Sturm on the impact of urban sprawl. The study revealed that people who live in places like Atlanta, where the average person drives four to five miles to a supermarket, have more health problems -- including obesity -- than people in San Antonio and Pittsburgh, where it is much easier to walk to a supermarket.

In another RAND study examining the expansion of the light-rail transit system in Charlotte, N.C., researchers found that light rail users increased their physical activity and reduced their risk of obesity.

In a trip to Portland, Oregon a few years ago, I found this to be true: Portland has an excellent transit system, with light rail tied in with buses. I didn't need a car to get around and I noticed that Portlanders tend to be less obese than people living in cities that lack decent public transportation. I live in a small city in Texas, but if I had to pick a city to live in, Portland would be high on my list.

Now about that statement from Dr. Cohen that dieting doesn't work, we jump to Page 180 and following pages, where she makes her points. This is in Chapter 12, "In the Meantime: What Individuals Can Do."

Maybe what I did to drop from 247 pounds in May 2013 to a relatively svelte 219 (svelte given my large frame 6-1 body; my goal is about 200, but I seem to be stuck on 219, so maybe that's my ideal weight) wasn't technically dieting. Maybe I changed my lifestyle, but not so much. I still need to exercise more, but I've continued my practice of not parking close to stores, choosing instead to walk more. My portions are smaller and I've mostly eliminated pasta and bread. No more cheese, either (and I love cheese, especially a good grilled cheese sandwich).

As I said at the beginning, Dr. Deborah A. Cohen has written a groundbreaking book on obesity. It should be read by everybody.

[Sara · Rating 2 out of 5]

Review of A Big Fat Crisis by Deborah A. Cohen, MD

I will let you know off the bat: I was not impressed with this book. In fact, it irked me. Let me start off with the good.

Dr. Cohen makes some valid points:
* The obesity epidemic is due in large part to the unhealthy food environment.
* Companies should not advertise unhealthy foods to children.
* Restaurants should make healthier meals available to consumers on a regular basis.
* Grocery stores should be redesigned to highlight healthy foods instead of junk.

I'm sure there are others, but I cannot think of them at the moment. Either way, they are far outweighed by the fact that despite saying she has studied public health, Dr. Cohen misses the mark in a big way in this book. The book is biased to her upper-middle class view of the world, essentially ignoring the millions of people in America living in poverty who can rarely afford and, when they do, can only afford the fat, salt, and sugar-laden things the movement rails against. Some of the particular things that stuck in my craw were the following:
* Dr. Cohen suggests that schools should add extra intramural teams so that everyone gets a chance at sports, whether or not he or she made the varsity team. This comment is so culture biased and out of left field. In theory it's a good idea, but the truth of the matter is that most schools in America don't have enough money for actual school supplies, let alone their athletics (though most seem to find sponsors or boosters for that). [The fact that many places still don't even have parity for girls' teams under Title IX is another topic for another day.] But to suggest that the already burdened educational system add yet another cost to its budget - that's ridiculous. This was spurred by her sons not making their school team. Here's a thought: How about YOU start a local intramural team. If people are really interested, they will help sponsor it. Try contacting some healthy food businesses. Keep in mind, this will only happen in neighborhoods where people have the money for such things. In poor urban and rural neighborhoods, people are just trying to survive and can't afford the gear and supplies associated with sports.
* Although I agree with the ideas of healthier restaurant menus and updated grocery chains, once again, Dr. Cohen completely ignores the fact that most of the people affected by the obesity epidemic cannot actually afford restaurants. The others get their food from the very things she wants to hide in the grocery stores. If they can't afford real food from the grocery store, how will adjusting the restaurant menus help them? It won't. But it will help people who are blessed with the funds to have a meal that isn't fast food and wasn't cooked in their own kitchens.
* She also essentially dismisses the concept of food desserts, saying they aren't the problem. She says there are food swamps of junk food. Well, I have news for you. There are places so poor that not only is there no money, there is no food – junk or otherwise – because suppliers don't bring items where no one can afford them. They don't make money that way.

Overall, I think Dr. Cohen meant well with this book, and she did had some valid points, but she essentially dismissed a majority of the population suffering from the obesity epidemic – the poor who live in urban and rural food desserts. If you don't have money, it doesn't matter how much a restaurant changes its menu. Essentially her suggestions were ones that would ease her upper-middle class life and help her check her and her own family's self control, while completely avoiding the big issue of poverty, food desserts, junk food overload, and malnutrition that affect much of the rural South and inner cities. She also completely avoids food quality aside from fat, sugar, and salt, namely the poisonous chemicals and processes that, even if you can afford “healthy” foods at the grocery store are sickening us and adding to the chronic illnesses she touts about.

You may have a different opinion when you read this book, but I was thoroughly unimpressed.

[Marta Veenhof · Rating 5 out of 5]

Some favourite quotes:

Page 25
"The obesity epidemic is the result of the unique interplay between human nature and the contemporary food environment. Three aspects of human nature make it impossible for most of us to remain in control of what and how much we eat consistently, day in and day out. These are: limited self-control... limited cognitive capacity... automatic functioning."

Page 26
"Today, the food environment assaults us at every turn in ways we cannot ignore, stimulating us to feel hungry or at least to think about eating. From the displays of candy at cash registers in supermarkets, hardware stores, and even clothing stores to the constant product placements of soda and junk food on television and at the movies, it's difficult to have anything on our minds except our next meal or snack. And when we do sit down to eat, most of us cannot easily limit the amount we consume per meal if too much food is available. That's what happens when we dine out. According to Dr. Lisa Young and Dr. Marion Nestle, experts on the impact of supersized meals, most restaurants serve two to five times the calories we need."

Page 26
"The food environment has become a tsunami. If it doesn't drown us, it waterlogs even the strongest of swimmers, who have to exert more energy, be more alert and more conscientious than ever before just to stay afloat. Indeed, given the evolution and limitations of human nature, there is simply no way for most of us to avoid succumbing to the enticements to eat that we are bombarded with ceaselessly."

Page 29
"You might think that because nurses know more than the average person about health, they would tend to be healthier than the rest of us. Yet between 1976 and 2005, the number of overweight study participants doubled, while the number of obese participants tripled - a pattern very similar to changes in the rest of the population. By 2005 only, 44 percent could be classified as having a normal weight. Excluding nurses who were pregnant or had cancer or other serious medical problems, fewer than 3 percent reported losing at least 10 percent of their weight. Of the entire group of nurses, fewer than one in three hundred were able to lose and then maintain the 10 percent weight loss for four years. So even among a group of people who are supposed to be experts in health issues, only a small fraction were able to reduce and maintain a lower weight. Like most of us, the nurses could not stick to a diet, even when armed with the necessary information and the best of intentions."

Page 31
"One of the problems with dieting is that our bodies respond slowly to changes in calorie consumption, unlike the instantaneous responses we get upon touching a hot stove. If we touch fire, we learn immediately to stay away or protect our hands. But if we eat an extra chocolate chip cookie every day, a scale may not register that we gained weight until a month later, so that immediate negative feedback and the associated learning experience are not there."

Page 71
"The dramatic changes in the food environment at my alma mater mirror the thirty-year transformation of the American food environment as a whole, and I strongly believe that these changes are the direct cause of the obesity epidemic. In this short period o time, three important things have happened: the relative price of food has declined, especially for high-calorie foods filled with fat and sugar; food has become increasingly accessible; and cues to eat are more salient as advertising has become increasingly sophisticated and ubiquitous. Together, these three changes have made it possible for people to eat as much as they can, whether or not they intend to do so."

Page 72
"Consider the facts: in the 1920s the average American family spent 25 percent of its income on food. In 2011, we spent only 9.8 percent. And because we spend relatively less on food, more people can afford the convenience of having others cook it for us... And even though we are spending less of our overall budget on food, we are consuming more calories."

Page 75
"Just twenty years ago, nearly 90 percent of purchases of food for the home were made in traditional grocery stores. Today, grocery store purchases account for 69 percent of at-home food purchases, and 21 percent are obtained from nontraditional food stores like Costco, Target, and Wal-Mart, where people can buy more food in bulk quantities."

Page 76
"As obesity has climbed over the past thirty years, the time devoted to television commercials has also grown considerable, while the length of the typical commercial has shrunk. The typical ad length has decreased from sixty to fifteen seconds."

"Advertisers have increasingly targeted children, who now view about sixty-five messages from television advertising each day (about half are food), along with many additional marketing messages from websites and in retail stores. In 2005, the National Academies' Institute of Medicine found that food advertising affects children's food choices, food purchase requests, diets, and health."

Page 77
"Unhealthy food ads are also targeted more heavily toward minorities... Overall, the food industry spend a staggering $9.65 bullion on food advertising in 2009, and nearly $1.8 billion of that was directed at children and teens."

"The profit motive has infected even nonprofit and public institutions like hospitals, schools, colleges, universities, and our military - all presumably concerned about the health and well-being of their clients, enrollees, and personnel. Because they get a percentage of sales when their captive audiences eat too much in company cafeterias or buy junk foods from on-site vending machines, these nonprofit institutions may be undermining the very people they want to help."

Page 82
"The fact is, we are very seldom in a situation where there is nothing to eat. We would have to be pretty far out in the wild, perhaps in the middle of one of our national parks. This observation is not just anecdotal: in a ten-year period, from 1986 to 1996, the number of commercial food establishments in the United States increased by 78 percent, fast food outlets by 85 percent, and restaurants and lunchrooms by 62 percent. And in the past forty years, the total number of restaurants in this country has tripled."

Page 86
"People are more prone to avoid losses than to seek gains, so an advertisement that promotes a product as preventing a health problem is likely to be more effective than one that presents the product as improving health. It could be the same product with the same purpose, but people perceive them differently."

Page 87
"Much of today's strategic marketing pushes us to make poor choices by confronting us when we are unprepared to make a thoughtful choice."

"As companies adopt more effective marketing strategies, our risk for obesity increases."

Page 90 - Atmospherics
"Factors like lighting, crowding, layout, scent, and music all influence buying decisions. Although all these factors are either in plain sight or can be noticed by consumers, typically most people are unaware of the way atmospherics influence their choices."

Page 93
"So why does subliminal exposure to a smiling face make someone consume more than seeing a neutral or negative expression? A smile does not just lull us into complacency; it is an indication of happiness. Psychologists have proposed that happiness sensitizes people toward rewards; in other words, a smile might make us react a little more strongly to food. When we are in a positive mood, we react more quickly and resort to automatic, heuristic-based (think shortcut) processing. Restauranteurs know that people order more when they are in a good mood. Maybe that's why Ronald McDonald is always smiling, as are nearly all mascots that advertise products."

Page 96
"Repeatedly seeing an ad for a soft drink, for example, increases our preference for that beverage. We don't have to be aware that we saw it. In fact, the effect of mere exposure is stronger when we don't even remember that we saw that particular drink. Once we consciously perceive something, then we have the opportunity to evaluate it and attach meaning. but if we see it without paying attention, it becomes part of a familiar background. If there is nothing negative about the drink, our brain evaluates it as safe... This is one reason why the large food and beverage companies try to make their advertising ubiquitous."

Page 106
“Hardwired cognitive limitations make it nearly impossible for most of us to consistently resist overeating (or to spontaneously engage in physical activity), so ending the obesity epidemic will require changing the food and activity environments or changing ourselves. It is unlikely that human nature is going to change anytime soon, which is why I firmly believe that the best way to tackle the obesity epidemic is by creating a more balanced environment in which individuals can automatically make healthy decisions about when, what, and how much to eat (or exercise). The quickest and most efficient way to do that is through new public health regulations.”

Page 107
“Yet calls for change and more regulation always encounter resistance among those who are profiting massively from the current conditions. The beneficiaries of the current situation argue that their right to sell whatever they want, however they want, is a matter of personal liberty - that it is up to individuals to make better choices if they really care about their health. Yet these kinds of arguments do not fly in other areas, like the auto industry. Today seat belts and air bags are not optional features... The defenders of the status quo count on the fact that most people are ignorant of how they are being influenced and believe that their choices are completely independent.”

Page 112
“It’s not the role of public health to force you to eat healthier food or compel you to exercise. However, I believe it is the role of public health to make it easier for us to obtain a healthy diet and to be physically active by minimizing the risk factors that undermine and overwhelm us. I’m not splitting hairs: there is a big difference between regulating people’s behavior directly and regulating the environment in which we live. It is not appropriate, for example, for the government’s public health department to stop you from eating a candy bar every day if that’s what you want to do. But it is appropriate for the government to protect you from marketing practices that force you to confront a candy bar every day.”

[Sarah · Rating 4 out of 5]

I found this book to be extremely fascinating and compelling. I loved the research and knowledge contained within and learned a ton!

[Ladz · Rating 4 out of 5]

Having worked at Cornell Food and Brand Lab for two years in my college career, a book that covers the obesity epidemic as a function of our environment rather than a weakness in individual's willpower was refreshing. Deborah Cohen has a wonderful, optimistic tone of voice for the future of America amidst this crisis. Her made good use of studies and took care in citing them--I find this missing in factual books of this nature. Her examples were relevant. I generally dislike the use of alcohol addiction as a comparison to obesity, she compared the two by comparing the way research was used to inform legislative decisions. One point that I think should be mentioned in a sequel is that the collective societal attitude towards health and fitness is still mostly cosmetic, as opposed to a health outcome. It would also be interesting to look into two budding social media communities--HAES and fitspo--and see what they contribute to attitudes towards food and the dichotomy between looking a healthy body and having a healthy body.

My favorite aspect might have been her grassroots call-to-action at the end, which proposes measures within our supermarkets and restaurants to curb over consumption and over-buying of food using clever marketing tricks as opposed to outright banning foods.

This book was a quick read and it definitely helps gain some perspective aside from the very individualistic approach to the epidemic that has been employed and has--thus far--been largely unsuccessful.

[Jessica · Rating 5 out of 5]

Who's to blame for the obesity epidemic in the United States? Deborah Cohen, a medical doctor and public health researcher, examines the food environment and the psychology of impulse consumption. Her conclusion? We evolved to crave sugar, fat, and calories, which were scarce for most of human history, but now the glut of energy-dense and nutrient-empty foods in our society is making us sick. She concludes: "The food environment has become a tsunami. If it doesn’t drown us, it waterlogs even the strongest of swimmers, who have to exert more energy, be more alert and more conscientious than ever before just to stay afloat."

With clear writing and lots of good examples, Dr. Cohen's book is a pleasure to read, and the policy solutions she proposes are just what we need now. And, if you're sick of our culture's crazy double standard -- where we celebrate fatty food that makes us feel like crap and in the same breath, shame anyone who's not a size 0 -- you'll love it even more.

[Bonnie Samuel · Rating 3 out of 5]

Interesting ideas. Kind of pie in the sky, though. Americans being as independent and "it's all about individual responsibility" as we are, you'd have a heck of a time getting people to accept the idea of having the government regulate our food environment beyond food safety, even if it makes people healthier and lowers the cost of medical care. I can see this working in a progressive society like Denmark or Sweden, but it's a little too fantastic for the United States.

[Tressa · Rating 2 out of 5]

She made good points, but this isn't anything new. Yes, we are hard wired to eat. Yes, food manufacturers will do anything to get us to buy their product. Yes, we have an abundance of food. I don't need a MD to figure that out. I was looking for more chemistry rather than psychology. I also don't need the government in my shopping cart.

[Becky · Rating 2 out of 5]

I found Deborah A. Cohen's A Big Fat Crisis to be a compelling read. Did I agree with the book? Well, that's another story. First, I want to say that her approach is different from those I've read before, read recently I mean. Her approach is more psychological perhaps.

Cohen basically tries to persuade readers of two things: 1) that people who are obese are victims and they cannot possibly be held responsible for what they consume or how much they consume 2) that people who are obese are obese because of their surrounding environments and that if the environments changed, then, their behavior would most likely change as well as they adapt to a new normal.

Let's look at these individually first.

People are obese because they naturally lack the will power to say no to food that is easily, consistently available; people are obese because of an inability to think things through and make good-for-them-in-the-long-run decisions. Her argument is essentially that people fall victim to their environment, and, they physically--psychologically--can't help succumbing to cues from their environment. People aren't smart enough to 'see through' or 'see beyond' the obvious tricks of the food industry. They are fooled one hundred percent of the time, at least, that is what Cohen argues. She dismisses the third of Americans that are not overweight or obese as almost abnormal, inexplicable phenomenons. (Because their existence disturbs her findings about what is natural for humans, they're largely ignored or dismissed. What could she possibly learn from people who have self-control, when, clearly she argues for hundreds of pages that self-control isn't natural and can't be taught?!)

Let's slow it down. Is this true? Do we want this to be true really? Do we really want to argue that no one is ever responsible for their behavior, and, that they are just following the cues of their environment, and they don't have any other choice but to do what they're led to do? Think about what this argument means for all areas of life where decision making is involved--which is essentially everything.

I don't think this is true. This "excuse" may temporarily give you a "feel good" feeling if you're overweight or obese, but, isn't it also slightly insulting and condescending. At least one or the other. You can't change. You can't do it. You're not capable. It's beyond your ability or capacity. The only way you could ever change is if a lot of other people come together and act on your behalf by changing "the environment" so that you stand a chance. Isn't it better to be honest and say, "You know I understand exactly how difficult and tough it is. BUT. You can do it. It may be hard. It may mean always choosing the more difficult path before you. But you know what, you can do it. Some days will be easier than others. There will be moments of doubt and despair. But it is doable. You'll have to change how you think, how you react, how you cope. You'll have to rewire your brain and change your lifestyle. But it isn't as impossible as it sounds."

What do you think? If you struggle with weight would you rather be told that you're a victim and that it is actually impossible for you to do anything to "fix" the situation yourself OR would you rather be told that you can do something, that you can start taking steps right here, right now to be healthier?! I do want your opinions!

The second half of her argument is that the environment must be changed on behalf of the overweight/obese in society. The environment should be changed through both regulations (I'm assuming legislation?) and voluntary submission to new health guidelines. She's talking about making-over a country so that workplaces, restaurants, supermarkets, and stores of all sorts will no longer prove "a threat" to the nation's health.

Let's look at some of her ideas for restaurants. Standardized/regulated portion sizes across the nation. Most entrees--if not all--should be 700 calories or less. So that no one "accidentally" eats more than a third of their daily calories. Require 10% of a restaurant's menu to be healthy, following current government approved nutrition tips. Train waiters on health and nutrition, so they can warn customers about the risks and dangers of ordering certain things off the menu.

Let's look at some of her ideas for supermarkets. Smaller supermarkets, for one. Fewer choices overall, perhaps. All unhealthy food will be available, but, put in places where you really have to search it out to find it. Stores arranged by meal: a breakfast area, a lunch area, a supper area. If "fruits and vegetables" end up being in two or three places, all the better, in her opinion. Stores should have cooking demonstrations, lots of free samples, give out recipe books, and teach about meal planning.

Essentially, her idea is that if you happen to change the environment so that it is easier to eat healthy and more difficult to eat unhealthy, then health will probably most likely improve because people will always do what is easiest and takes the least amount of thought. Though she admits that she has no idea if changing the environment would actually work and solve the nation's obesity crisis because no one has attempted it yet, not even in a few small, "trial" areas.

Do I agree with the second half of her argument? That's a tough one. Do I think it's a good idea for waiters to start lecturing customers on what they're ordering and telling them that they shouldn't eat that because it will make them fatter?! Of course, that's an exaggeration. Cohen is not arguing for rude behavior. But still.

I do think this half of the argument isn't quite as flawed. I do wish that every restaurant had actually healthy options. Not pretend-healthy options that are slightly healthier by comparison. I do wish that restaurants were perfectly straightforward about what is in each dish and how it's prepared. I do think it's a good idea to portion things better. For example, instead of over-portioning you on carb-heavy items like rice and pasta, they'd give you exactly a serving size: half a cup. Of course, carbs aren't the only things that need to be portioned. (For example, I know a restaurant where the chicken-fried steak meal is TWO battered-and-fried steaks topped with gravy. Two is *the* portion. You have to ask for the "child's plate" or the "senior" plate to receive just ONE steak.) I would REALLY, REALLY love to see vegetable options in restaurants that aren't fried, creamed, covered in gravy, or buttered-to-death. And I would really, really, really love to see fresh fruit as an option in restaurants. I agree with her that I think it is really difficult to stay out of restaurants all together. She mentions work-related and family-related gatherings at restaurants, and, it can be tough to find that "one" healthy option at a restaurant that is doable some of the time.

As for grocery stores, they are in the promoting-and-selling business. And I'm not sure that "free samples" of vegetables are going to sell more vegetables. Though I do believe that vegetables *can* be prepared in yummy, yummy ways. I eat a LOT of vegetables myself. I don't think it's a lost cause, and, that vegetables and fruits should be neglected so scientists can work on futuristic foods that are "healthy and taste good too." (Can you tell I'm still annoyed by reading Stuffed: An Insider's Look at Who's (Really) Making America Fat?!)

One thing that she doesn't really mention needing to change is television. She does mention the Food Network, saying that if grocery stores offered cooking demonstrations and cooking classes then people would benefit after all they love to watch the Food Network. The Food Network is not in the business of creating/teaching healthy recipes designed to help people watch what they eat, to lose weight, to prevent chronic diseases. You hardly ever--if at all--see them caution you against using too much salt, too much cream, too much butter, too much sugar, too much white flour, etc.

Some ideas seemed potentially good--ideal. But I'm not sure all of them are. And even the good ideas seem like it would be an uphill battle to achieve implementation. Not that that reason alone is worth giving the matter all up. But it is asking us to potentially place a lot of trust and power/authority into the government.

Am I convinced that all of society needs to be rebuilt/redesigned with the overweight/obese victim in mind? I found it an engaging read. But it read more like a dystopia to me.

[Yofish · Rating 3 out of 5]

Really more like 3.5 stars.

I’ve certainly read various newspaper and magazine articles about the obesity crisis/epidemic/emergency/whatever. I thought that reading a book would give me deeper insight. This book was almost there, but not really.

It was broken into three parts. The first was (more or less) on human psychology and food; the second was on advertising and layouts of menus/supermarkets/restaurants; the third was on her proposed solutions.

The first two parts felt a lot like all the magazine articles stapled together. Not that it was disjointed---it was connected nicely and well-written. More that I didn’t really feel like I learned much new. She was more thorough in her discussions of the various experiments conducted to that lead us to our current knowledge. And I liked that---understanding how we get knowledge is interesting.

The third part was definitely different. Unfortunately, I wasn’t all that convinced that government intervention is workable, or even useful. She certainly foresaw such objections, and tried to address them. (Even to the point of an additional FAQ at the end.) Her metaphors/analogies just didn’t work for me. It doesn’t feel like mandating supermarkets to put junk food on the back shelf is the same as laws prescribing clean water or building codes.

There were places where it was a little out-of-date (which I guess I should expect when I’m reading a 2013 book in 2021---that’s on me). Like how Jell-o pudding tries to make itself family-friendly by associating themselves with Bill Cosby. (Ick.) The Stanford Marshmallow Experiment has had trouble being replicated. So now I’m wondering which of her arguments might have been repudiated (or strengthened!) since the book was written.

[Adam · Rating 5 out of 5]

This book is a JAMMMMMMMMER. It shows the ways in which something as clearly individualistic as eating is actually a very social act. Dr. Cohen convincingly presents a plethora of ways our environment influences our health. It's influenced my own thinking and health, as well as how I explain health issues from a psychological perspective. Her son once gave a lecture on the psychology of taste perception at my college. Family of champs! I highly recommend this book to EVERYONE!

[Derek Lacoursiere · Rating 4 out of 5]

This book presents a thoughtful, research-supported discussion of our environment's role in the obesity epidemic in North America. It presents a case in defense of those who have unsuccessfully tried to control their weight through the traditional exercise and dieting approach and instead points a finger squarely in the face of the forces which try to turn our dinnertime into profit.

[Pamela Schneider · Rating 1 out of 5]

eating is a personal decision

Nobody puts a gun to anyone’s head to eat junk. It is a personal choice. Self-indulgence is driving obesity. No other entity is to blame.

[Chris Demer · Rating 4 out of 5]

This is a very readable and on-target book that addresses the crisis of obesity in today's world and the public health crisis that is on its way as a result.Deborah Cohen is a physician with a background in epidemiology. She provides statistical evidence that obesity decreases life expectancy and increases the risks of diabetes, heart disease, stroke and some types of cancers. Meanwhile-what do we do about it??

While it is easy to throw the responsibility for being overweight or obese onto those who have the problem, assuming they just don't have any will power in terms of food choices and eat far too much junk - and food in general. If fatness were simply a problem of individual will power, why has is burgeoned to gigantic proportions (no pun intended)? If few folks were obese 50 years ago, does that mean they had more self control than folks now? (A question I had not thought of before...)
Her answer is NO. The difference is in the food environment which has developed. Not by itself-- but intentionally-- by food producers, manufacturers, and marketers.
Today's food environment is dramatically different. Food is abundant and cheap. Foods that appeal to us by their high caloric content, high fat, sugars and salt- are adjusted to maximize their appeal-which we evolved to need and seek through our evolution. These products are marketed aggressively (when did you last see a commercial for lettuce or carrots?) and positioned in store locations where they cannot be missed: at the ends of aisles, at the checkout counter, in hundreds of thousands of convenience outlets that didn't even exist 30 years ago. It's not hard to find candy, soda, cookies, chocolate etc, in stores.

Another problem is how frequently people eat in restaurants. With two working parents, two incomes and less time, it is easy to "eat out". Chain restaurants across the country have been serving ever larger portions to ever more people. It is typical for people to eat the amount they are served.

There is also less physical activity, an especially big problem for children. Schools have decreased or eliminated recess, Phys ed classes meet only the most minimal requirements of the states. Children are driven from one event to another and spend their free time in front of a computer or TV.

Solutions. While Dr. Cohen has many good ideas for solutions, I can see big trouble in developing the political will to confront the perpetrators of the fattening of America. However, I would support them. Here are some of her suggestions: develop standards for food marketing; businesses should promote healthier foods, not just label the unhealthy stuff, restaurants should have a percentage of their menus devoted to healthy meals, have options for smaller portions.
Of course there are things individuals can also do-increase their activity, avoid impulse buying, and others.

I heartily recommend this book. I think it is important for those of normal weight as well as those with weight problems to read it and think about what needs to change to prevent a public health crisis.

[Katie · Rating 2 out of 5]

A look at the obesity epidemic with suggestions on what we can do about it, mostly circulating around government regulations to shrink restaurant portion sizes, remove candy displays at checkout, and increase usage of public parks for exercise.

Honestly, I'm on board with the government regulations, simply because I think this is a bigger crisis than people even realize right now. Just thinking about all the increased health care costs (which we will ALL PAY even if we are not obese) can be shocking and frightening. I feel desperate for any potential solution. But this book casts the obese as victims, and I just cannot get on board with that. Yes, soda is everywhere, portion sizes at restaurants are ridiculous these days, food is basically shoved down your throat everywhere you go. Yet, I am not obese, because I exercise like a maniac and refuse to eat any processed foods. It's not rocket science and I'm not special.

One ridiculous quote: "In general, we should not expect everyone to spontaneously exercise on their own, as if the conditions they live in had no influence." Really?? Making oneself exercise is inconceivable and is too much to expect from people? Give me a break!

Here is one interesting point she made though: secondhand smoke increases your risk of lung cancer by between 13-47 percent, and we have banned smoking in restaurants. Yet, eating red meat increases your risk of colon cancer by the same amount, and it's impossible to imagine restaurants banning red meat or even warning against it. We find that preposterous, yet it's the same risk.

The best suggestion in this book in my opinion was to train yourself to view all processed foods as toxins--as a corporate conspiracy to addict you to their freakish lab creations. May be a bit of a stretch, but arguably this is perfectly accurate (just look at the chemicals in the ingredient list of most processed foods). If you do that, you won't want them. That's what I've done. I never eat any processed foods (and do not feel deprived b/c I think they're basically poison), and you can't get fat on whole foods, even eating a lot of them.

I give it two stars because there were some interesting studies cited and it made me think, but I thought the victim perspective was ridiculous.

[Hailey Cleek · Rating 5 out of 5]

While many works focus on issues of personal responsibility or attempt to moralize these issues in health, Cohen, instead, illuminates the food environment’s role in shaping the psychology of food and consumption. Cohen includes many helpful examples with conclusive policy directions, and while I do not necessarily agree with everything that she writes, I appreciated the opportunity to learn from her (particularly regarding issues of the limitations of conscious attention and the political/economic incentives behind the foods available to us). Cohen argues that due to the limitations of human self-control, our brains are not wired to handle the modern food environment. Thus, it is not the “fault” of any one person to shelter the burden of obesity as a reflection of a personal character flaw.

This is an excellent introductory overview to the forces that help to shape the modern obesity epidemic. I would challenge Cohen’s deterministic thinking when she argues that it is not the “fault” of any person, however, and instead, I would say that issues in obesity are not a demonstration of failure. Though this may seem to be only nitpicking, I think that it helps to illustrate how we are lifelong learners, and we can better empower ourselves and others to meet the forces of advertising, marketing, cognitive limitations, etc.

[E · Rating 4 out of 5]

This book presents an argument that is important to understand and not getting anywhere near enough attention in our "if you're unhealthy it's your own damn fault, put down the box of doughnuts" culture, namely, that our food environment sets people up to fail. This argument, then, puts the blame where it more appropriately belongs: on the food manufacturers, advertisers, supermarkets, and restaurants that push and push and push us to eat more, and more crap, than we really need. Sadly, although I have no doubt that Cohen's prescriptions for change would bring about powerful results, our country is full of Tea Party-type "keep your government hands off my Medicare" morons whose black and white beliefs automatically paint any government intervention in anything whatsoever for any reason whatsoever as evil.

This is a solid, readable, educational primer on what's really going on with America's obesity crisis and what we can do to address it. The problem is, in our current political climate and what I foresee the political climate being for many years or even decades to come, nothing is going to come of it. We'll just keep getting fatter and sicker and the corporate barons will keep laughing all the way to the bank.

[Jerry Smith · Rating 3 out of 5]

Quite an interesting take on how and why we, as a culture, are fatter than we have ever been and continue to worsen in this regard. The line is basically that we need to quit focusing on obesity being a result of some form of character flaw such as the inability to resist temptation or some form of weakness, and lean more towards two things: we are wired to eat when food is in abundance, because in evolutionary terms this was a smart thing to do, and secondly that the current market for food in terms of advertising, food availability, portion sizes and food constituents (salt, sugar, fat) from the big companies and restaurants leads us to eat unhealthily.

Add other elements such as the ease of getting food and the all pervasive sense of food in western culture and we are essentially doomed to be fat. Dieting doesn't therefore work in the face of these overwhelming odds and the solution is to legislate our way out of the situation.

I get it, and at a basic level it makes sense. I am not sure I would give those overweight a completely free pass however, I think that there is definitely a case for self-regulation of food consumption, but I do agree that we need to look at this with new eyes, since the current obesity situation is bad for everyone.

[Jim Kahn · Rating 4 out of 5]

The author presents a case for explaining how our culture's epidemic with obesity is due to the overabundance, ruthless marketing and the science of getting people to eat more than they need to. She reviews a multitude of studies indicating the subconscious effects of various situations and how we can be exploited by clever advertising to eat more and thus become obese.

She goes on to explain how the government should take collective action to impose regulations to combat obesity in the same way it has for workplace safety, environmental protection, infectious disease, automobile safety, etc. She does not call for straight up prohibition, acknowledging that this both irritates people and does not work but does call for requiring restaurants to offer reasonable calorie meals, limiting direct advertising to children, and facilitating more physical education.

This is well researched, easy to read and presented in an impartial way. Anyone, like me, who is fascinated by the fact that almost 75% of Americans are overweight and obese and want an explanation besides 'they are mentally weak' because it cannot be true will be glad they read this.

[Lisaal · Rating 3 out of 5]

Lots of great research. Premise that in order to solve the “fat crisis”, we need government regulation. Hmmmm... Parallels the pre-germ theory 19th century with today’s consumerist food culture. We limit alcohol and tobacco sales. Junk food should be the same.
-change the way food is marketed & sold - availability of high-calorie, low-nutrient foods, too-large portion sizes, and food advertising.
-People in our society do not have a chance to be healthy because we are bombarded with garbage.
-Nutritional info should be on all menus. All restaurants would have to serve at least 1/3 of their menu as health alternatives (or meet a certain point level by adding up various categories of healthy options) and should serve small meals as the norm (instead of plates that contain 3-4 servings each).
-No more junk food at the ends of aisles or cash register lines.
Interesting face: in 1978, we ate 1,803 calories per day. 2003, 2,374 per day. (in one year, that equals 59 pounds!)

[Dinah · Rating 1 out of 5]

I started out really liking this book. The first few chapters talked about brain function and how an individual faced with many choices every single day tends to choose the easiest, most comforting choices when it comes to food, especially towards the end of a long day. However, about half way through this book, the author started to blame global warming on obesity. Yup. We are fat because we eat too much red meat and since read meat comes from cows and cows emit carbon dioxide which threatens the ozone -- the result of our fatness is global warming. Oh boy. I lost all interest at that point. I mean, I tried reading, but it was tough and then, to be honest, I skimmed the last 40 pages explaining how various government initiatives, regulations and rules would make us slimmer, fitter and healthier. Really disappointed in this book and the author's solutions to the obesity epidemic.

[Eleanor · Rating 5 out of 5]

Deborah Cohen has written a compelling book about how the food environment often works against us and nudges us toward obesogenic choices. Her clear, engaging writing style is filled with solid science. Many of the studies she cites are intriguing and surprising on their own, but she pulls them together into a comprehensive whole. The picture she paints allows the reader to see the food environment through the eyes of scientist who is concerned about the health of our nation and compassionate about individual choices. Some of her recommendations for curbing the epidemic are quite optimistic, yet she also offers very practical suggestions. One of my favorites is standardized portion sizes in restaurants, comparable to the standardized serving sizes already used in the U.S. to help people regulate alcohol intake.

[Irene · Rating 2 out of 5]

Heather said it better than I could: "My fear in regulating healthy foods is that I suspect the obesity epidemic was caused in part by really poor dietary guidelines set by the government in the first place." The basic premise of the book is that we can't help eating the junk food that manufacturers deliberately entice us with (so that they can make a profit); therefore the government has to regulate it for us. I certainly don't have any great love for food manufacturers who are inundating us with junk, but the author's solution of involving government bureaucrats with their own personal and financial agendas into this morass is certainly not the answer. Even the author admits she has no idea if regulating the food environment would work. Sheesh. Nothing like experimenting with peoples' lives and health. No, thanks.

[Pat Herndon · Rating 4 out of 5]

Well researched, yet surely controversial. Cohen examines the environmental conditions that lead a majority of Americans to be overweight. She places less blame on the individual than she does on an over abundant, affordable, food supply and the marketers and retailers who use techniques to constantly bombard us with easily made bad choices. She looks to environmental protection laws, clean water laws, public hygiene laws, regulation of alcohol sales and the passage of the ADA as models of regulation and public policy that could positively impact the ravages of chronic disease (diabetes, hypertension, etc.) on public health. Lots to ponder.

[Gabriella Bugge · Rating 3 out of 5]

I appreciated the unique view of the obesity epidemic as it was explained in this book. Cohen provides persuasive arguments for the need of government intervention in the food industry and outlines some great policies that I believe should be implemented. However, she also uses one too many analogies that I believe distract from her point and she also ignores a lot of outside factors, such as the inability for those in low-income areas to use their parks and sidewalks due to excessive crime rates. While there is a lot of personal opinion, Cohen raises some great points that persuade me to share her book with others.

[Melanie · Rating 3 out of 5]

Interesting information about how humans have evolved and the resulting difficulty with the overabundance of unhealthy food. Her solutions involve government regulation of the food environment. It only addresses the issue of weight when it talks about the health of Americans. I believe health involves many aspects of lifestyle that interact with weight that also need to be addressed to solve the obesity crisis. Many "normal" weight individuals are very unhealthy while many "overweight" individuals are very healthy.

[Lindsay · Rating 3 out of 5]

Nothing groundbreaking here. However, she has a very readable style and I liked the ideas that she had for making it easier for people to make smarter choices at restaurants. One idea is to prohibit restaurants from charging patrons for sharing dishes. But in general she wrote of stuff I think most people know--portion sizes have gone up, and it's cheaper to get processed food than healthy stuff.

[Jennifer · Rating 4 out of 5]

I am giving it four stars because I think it's worth reading. I have learned a lot by reading it- for example only 7 extra calories per day can explain our average weight gain of 23 lbs. I definitely feel more aware of our food- pushing surroundings from having read this- which is exactly what I wanted- to feel refreshed and reinspired to continue calorie counting.