The Food Environment Is Doing the Eating for You

[00:00:00]We're going to talk about the idea that you're choosing most of the foods that you put in your body, not only the what you're eating, right, but how much you're eating. This is the part that answers the number that we opened with, that obesity tripled, because the thing making the decisions or heavily influencing the decisions, the environment, changed like a rug being pulled out from underneath us.

[00:00:22]So, most of what you eat, you don't actually decide from a conscious standpoint. We kind of envision the sort of control panel and a person just flips switches, making calls all day, but most of the time we're actually running on autopilot. It's on habit and whatever is in the room or in the environment around us. This isn't actually a hot take. This is not like a Barbell Medicine. We just created this.

[00:00:43]>> The model goes back to a 2008 paper called Eating as an automatic behavior.

[00:00:48]>> And they suggest that intake is mostly triggered by the environment. It's not deliberated upon, which is why nutrition lectures and the sort of try harder mantra keep losing, um, you know, this battle to sort of change how people are eating.

[00:01:02]The one of the best studies on this, it's almost comical to me. If you serve someone more food and they eat more, they don't notice that they actually ate more. This comes out of a Barbara Rolls lab, and they've been doing this for over 20 years. In one study, they served the same people a plate of macaroni and cheese on different days, quietly changing only the size of the serving. If you increase the portion size, the intake went up by about 30% over about 150 calories. And afterward, people rated themselves just as full as the smaller portion.

[00:01:34]In a restaurant version, an entree made of a 50% bigger portion got people eating 43% more of it. It's the same person, same food, same hunger and satiety ratings. The only thing that changed was how much food was in front of them, and their eating tracked what was served to them, not their appetite.

[00:01:53]Nobody at the table quote decided to eat more. It was just presented to them and they thought, "Yeah, I'll eat this." Uh this also isn't a one-meal novelty. If we were really good at compensating, for example, you wouldn't expect this to really move the needle when it comes to weight.

[00:02:07]When the same lab ran the similar type of study over 11 straight days, the people never caught on and they didn't they didn't compensate by eating less later. They just ate more the whole time. Um in a Cochrane review, an analysis of 72 trials like this, they came up with the same sort of conclusion. Bigger portions and packages reliably drive more eating across body weights and appetites. So, one of the biggest drivers of how much the whole country is eating has nothing to do with discipline. It's the size of what shows up on a plate or in a package and that's been going up for decades. When you look at the portion sizes across different foods that we commonly eat from 1970s to now, yeah, that'll blow your wig back.

[00:02:50]>> Not not honestly not surprising and I think both of us probably are people who have experienced this and we can kind of relate of like in more more often than not if we're like going out to eat, what you are served is a serving for one.

[00:03:05]Almost regardless of what what that serving is. And further and and we know this from like an adjacent concept and and you know, we've talked about this before this idea of like, you know, food variety and sensory specific sensory specific satiety and things like that where if you have much more variation, you're ordering like, you know, five different things that come out, you're going to end up, you know, bouncing between them and end up ultimately consuming more, but it's all there in front of you as well. And so, I often discuss this with folks when it comes to the environment that they are sometimes in a little bit more control of. I just had this conversation with a gentleman the other day who, you know, had had described his experience and and we came to the conclusion that look, if it's in the house, it's going down the hatch. And so, there were certain food items for him that we just decided were probably best not to be kept in the house because again, if they are they were they were going down. Uh >> Yeah, I had a I had a client a few years back and you know, she had been struggling with weight her entire [clears throat] life, right? And she's like, I'm I'm finally motivated enough. I'm going to make these changes.

[00:04:09]I'm ready. And I'm like, great. Can you tell me about what kind of foods you keep in the house?

[00:04:14]Right? And she's telling me she's like, look, me personally, I buy what you would probably consider healthy foods.

[00:04:20]But my husband, oh man, that is not the case and also he I feel like he's trying to sabotage me because he's hiding things around the house for me to find inadvertently, you know, these ultra-processed foods package, you know, snacks and candies and such like that. And I'm like, well, what happens when you find them? She's like, well, well, I'm going to eat them cuz they're there and like I want to eat them. I'm like, >> Understandable.

[00:04:41]>> No hate comments. I get that. But I also think he needs to be on board with this, otherwise it's going to be very challenging if not impossible.

[00:04:48]Um you set me up perfectly for this because this really gets at the heart of the matter. What actually changed in the environment? If we zoom out to the whole food supply, the portion effect is part of that but it's relatively small compared to what happened elsewhere.

[00:05:02]Between about 1970 and 2010, the calories available per person in the US food supply went up roughly 450 calories a day.

[00:05:11]Ultra-processed food, the engineered stuff, now makes up about 58% of the calories American adults eat and about 67% for kids. Now, we should say that just because something is ultra-processed doesn't necessarily mean it's bad. So, like whey protein, Greek yogurt, whatever, that's all technically ultra-processed and can be health promoting, but the majority of ultra-processed foods are those that have added sugar, added sodium, added fat to sort of get to this bliss point, this very tasty mouthfeel that makes people eat more. And unfortunately, while it is high in calories, it's not proportionally satiating or filling.

[00:05:47]So, this all changed recently, uh you know, over the last 40 to 50 years, and it didn't happen by accident.

[00:05:54]>> In the 1980s, the tobacco companies, Philip Morris and R.J. Reynolds, bought up the major food brands, Kraft, General Foods, Nabisco, and brought their scientists with them to engineer food that is easy to keep eating.

[00:06:06]>> There was as an active lawsuit in San Francisco right now that we went through on the Trial of Big Food episode. If that part interests you, it's in the show notes below. You can go listen to that. But, today we only need one piece of it. The food around us changed a lot in the last 40 to 50 years.

[00:06:22]So, did the genes change with it or not?

[00:06:25]Obviously, they did not.

[00:06:27]Now, some people uh are going to push back and say, "Look, maybe some populations are just genetically susceptible or genetically prone, and the tripling um in obesity is just due to those genes finally showing up."

[00:06:39]So, what happens when you test this?

[00:06:41]Take a group with shared genes, change the environment only, and see what happens. That experiment exists, uh and we didn't even have to like uh artificially engineer it. The Pima Indians are a clean setup for this. One population, common ancestry, confirmed genetically similar down to hundreds of DNA markers. Some lived in Arizona in the modern American food environment, and some lived in the Sierra Madre in Mexico. They were farming and eating a traditional diet. Same gene pool, but two different environments.

[00:07:09]The Arizona Pima are among the heaviest studied populations on Earth. Uh average BMIs in the mid-30s, obesity running from about 64% in men up to 75% in women. The Mexican Pima, same ancestry, sit at a BMI in the mid-20s, with obesity in the uh around 6% in men. Type 2 diabetes prevalence was around 38% in the Arizona Pima, and near 7% in the Mexican Pima.

[00:07:36]And you can watch it happen inside individuals, not just across uh environmental border. If you track immigrants to the US by how long they've lived here, uh, in one big analysis, obesity was about 8% among people in the country uh, for less than a year. They live in the United States for less than a year. And about 19% amongst those who've been here for 15 years or more, climbing toward the US-born rate the longer they've been in this environment.

[00:08:01]The same people, they didn't swap out their genes at the border, that wasn't required. The food that they were living around is what changed.

[00:08:08]Now, again, some some pushback here.

[00:08:10]These are cross-sectional uh, snapshots in time, right? Not the uh, same people tracked start to finish necessarily. And the two Pima groups differ in physical activity, too, obviously. Uh, one group farms and the other is in the modern sort of obesogenic environment, which is not just related to the food supply, but also what we habitually do activity-wise day to day.

[00:08:28]And their genes aren't perfectly identical. It's not just a bunch of twins that we're studying.

[00:08:33]None of that really saves this willpower narrative, though. Um, it just kind of fills in some of the gaps around this uh, environmental argument that we're making.

[00:08:41]So, this is the answer to the number that we opened with. Genes set your guardrails, and over 40 years the environment kind of moved the whole population up against the top one, right? And we don't have any predators, so that top number may have shifted even higher in uh, some of the population as well. Obesity didn't triple because 100 million people lost their willpower or got dumber all at once. It's because the environment, particularly the food environment around them, changed. And biology, again, remains undefeated. So, so Austin, why, in your opinion, is ultra-processed food so easy to overeat?

[00:09:18]Uh, is there like a mechanism behind this? What sort of stories do you hear from your patients that sort of corroborates that or or makes you uh, kind of think, "Look, there's something in this food that is unique."

[00:09:27]>> There's a couple layers to this question. It is an interesting one on on on multiple of these levels. One is just what is an ultra-processed food, and there's certainly been a lot of discussion and debate and controversy around this including topics like the NOVA classification system that has some some pros but also some some cons and some some limitations because as we have discussed before as you alluded to a little while ago on this episode that just simply the degree of {quote} processing alone like doing things to a food does not necessarily automatically or inherently making make it less healthy.

[00:10:02]There's also the aspect of like food fortification and that is more often beneficial than it is likely to be net negative on these kind of things and there are some elements of vagueness and subjectivity to that classification. So it's not something that I think you or I, you know, regularly rely on at least you know, practically when we're working with folks but it has some general heuristic value I suppose to decide what is classified as you know, highly processed or {quote} ultra-processed but but I think that our best understanding of this is that many of these foods are um in in in many ways deliberately designed to just like light up all of the you know, areas of our brain that we like to have lit up. There is this these these types of hunger that we've talked about before as well. There's you kind of the more physiologic homeostatic kind of hunger type mechanisms the things that are really you know, much more closely oriented to energy intake that you need to fuel those metabolic processes to keep yourself alive or for fertility or for pregnancy or whatever the case is. There's some physiologic drive to it. But then there's the what's called hedonic hunger aspect of things and this is an interesting way to describe it because I've also heard you know, modern anti-obesity medicines like GLP-1s and things like that called by like the CEO of Lilly I believe I heard him in an interview describe them as anti-hedonic drugs which I found to be a very interesting descriptor because they're to some extent targeting that mechanism a bit more because when they're applied properly to a clinical population, we're not aiming to eliminate the homeostatic hunger that's like, oh, we're just making sure we're trying to prevent you from getting the minimum calorie needs that you need for your metabolic rate. We're trying to better align your overall calorie intake on that dimension while maybe reducing the amount of excess energy consumption that led to the body fat accumulation often times by way of these hedonic mechanisms. Not exclusively, but a bit a big part of it relies on that. So, many of these foods that are so easy to overeat, they really light up those kind of hedonic mechanisms making them very enjoyable to eat. There are often either flavor profiles, textural profiles, various other unique elements of them while also offering very little in terms of satiation value. They do not tend to be very filling and this is on purpose and also on accident as a result of the the same types of things that light up our brains don't tend to be, oh my gosh, I can't take another bite of this like incredibly delicious thing.

[00:12:28]>> Yeah, that's a really interesting that the, you know, being describing these drugs these medications as anti-hedonic medications. I've been calling them like behavior change agents for a while because they change the behavior, but that's interesting. So, so one of the pushbacks people often have against GLP-1s for example is they're like, well, look, some people get on these they don't change their dietary habits because they're still eating junk food, right? And and actually I almost think that's a proof of concept. So, so thing one, a proof of concept of how durable the sort of desirability of these foods are. So, it's not just that they taste awesome, right? And have all these unique engineered characteristics, again, by design. They are heavily marketed to us, they are ubiquitous, they're cheap. You can't outrun them, they're everywhere, right? So, the idea that people are just going to stop eating them, you know, cold turkey, highly unlikely. However, with the modern advances in pharmacology, people are eating less of them, which is the goal. Really, that's and it so, even these drugs can stop people from eating as much, which is ultimately what you you would want. And maybe sure, in a perfect world, everybody who started GLP-1 would overnight become, you know, a well-trained chef. They would have the resources to procure and pre- and prepare all of the food all the meals are going to eat at the in their home in their domicile.

[00:13:44]>> Yeah. Super.

[00:13:45]Oh, sorry, go ahead.

[00:13:47]>> No, but in a in a less perfect, maybe more realistic world, you're still exposed to the modern food environment. And like, look, you might have some food that will fall in the ultra-processed range or whatever, and some people would frown upon morally, but guess what? They're going to eat less of them.

[00:14:04]Which again, is how the medication's supposed to work. If it were to truly target this stuff at the level of the brain. And ultimately, again, the outcome outcomes are undeniable. So, I find that really interesting.

[00:14:16]>> Yeah, I agree. It it is admittedly super frustrating to have conversations with some of these folks that you're that you're talking about. And also why I tend to not have very many of these conversations. Most often, arguments on social media because many of them at the outset will be like, "Look, it's just all about calories. You just need a calorie deficit." And it's like, "Okay, well, if we have a medicine that facilitates people getting a calorie deficit, you'd be on board with that, right?" And then suddenly, it's like, "Well, no, because they just end up eating less and they don't end up changing their eating habit." It's like, "Oh, okay. So, if I showed you evidence that overall people tend to actually shift their eating habits, they tend to purchase less of these kind of like ultra-processed foods, their intake of healthier foods tends to go up, you'd be in favor of that, right?" It's like, "No, also not like that."

[00:14:53]>> [laughter] >> It's just like, you know, you're playing chess with a pigeon, it's pointless, just move on. These people, you know, they're they're too wedded to their position. It's like, if your position was, you know, as stated at the outset, then, you know, it would seem to logically follow that you'd be in favor of using these tools because they're achieving the outcome that you're most interested in. But if you add a moral layer on top of it, or you feel like you are better because you can do this um maybe more consistently or more effectively than someone else can, um or if it's uh in your business interest to do so because you're a coach or something like that, uh, then, you know, it's going to be a we're going to have a hard time changing changing minds on that front. Fortunately, we do have plenty of friends [snorts] and colleagues in this space and coaches and and folks like that who are just like, "Yeah, let's use the best tools we have for the job because we actually view this as a mission for, you know, the broader, uh, you know, public health for society for the world."

[00:15:44]Yeah, we actually care for if the people get better.

[00:15:46]>> Um, but in speaking to that question, you know, again, people have been fighting about this for for a long time. Is it only calories and macros that drive how much we eat or does how uh, processed the food is change intake on its own?

[00:16:01]And Dr. Kevin Hall's team, um, actually, uh, addressed this. They turned the fight into an experiment.

[00:16:06]They admitted 20 adults into a research ward and controlled everything. So, if just think it it's not like you're going to prison where where the you're being punished, but effectively, the intake is controlled meticulously. Two weeks eating mostly ultra-processed food, two weeks mostly unprocessed. The order was randomized. The key move here, the two menus were matched for calories offered, protein, carbohydrates, fat, sugar, salt, and fiber intake. Eat as much or as little as you want. So, if you match the macros and the calories on offer and the only thing left different is the processing, any gap in how much people actually consume comes down to the processing itself. And since everyone lived on the ward in the ward, nobody, uh, needs a food diary. You don't need to rely on that. The result here.

[00:16:59]On an ultra-processed food diet, people ate about 508 calories a day more and gained about a kilo in 2 weeks. The same people on an unprocessed food diet ate less and lost about a kilo, roughly a kilo each way in just 14 days. Now, the catch here. This was only 20 people. It was only in 2 weeks. And by the way, it's in a research ward. So, this is the ecological validity, like in the real world, where you know, things are more or less ubiquitous, have more or less effort to go ahead and procure them.

[00:17:30]Yeah, it's different. This is mostly a tight mechanism study.

[00:17:34]Um and researchers will still argue about why ultra-processed food does this. Is it because of the energy density, how many calories you have per unit volume of food? Is it the texture? Is it the mouthfeel? Is it the marketing, right? A lot of children's textbooks, for example, in school have been sponsored by various food organizations and have their stuff advertised to them, you know, from the time they get into the education system.

[00:17:57]So, we see the directionality here, but yeah, as far as the why, that is still um it hasn't been settled yet. But in any case, same person, same amount of willpower, the same so-called choices, if you change the food that's in the room, the intakes going to move by about 500 calories a day. That's the food environment doing the eating for you.

[00:18:19]>> [music] [music]