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Big Fat Crisis

Excerpted from "A Big Fat Crisis"

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

by M.D. Deborah Cohen

Have you ever wondered why bars from New York to Los Angeles serve beer in twelve-ounce servings, wine in five-ounce servings, and liquor in 1.5-ounce shots? It’s because beer, wine, and liquor all contain different concentrations of alcohol, so the standardized serving of each contains 0.6 ounce of pure alcohol. Standardized serving sizes ensure that a drink is a drink is a drink: 0.6 ounce of alcohol, no more, no less, no matter what you choose to imbibe.

Compare that to food, where serving sizes are all over the map. A double cheeseburger at McDonald’s has 440 calories and a medium fries has 380. At Carl’s Jr., a Super Star Cheeseburger has 940 calories and a medium fries has 430. At Denny’s, a cheeseburger and fries is 1,400 calories. And at Chili’s, the burger-and-fries platters range from 1,310 calories for the Oldtimer to 2,290 calories for the burger with ancho chili BBQ. Even with calorie labels on menus, you’d have to be pretty good at math, algebra, and geometry to figure out how to divide up your food in order to eat just 640 calories, the amount that is recommended by the Institute of Medicine for a single meal for the average person trying to maintain a normal weight. The IOM assumes adults eat three meals and one snack to obtain the recommended average of 2,000 calories per day.

Although calorie-labeling on menus was intended to help people make better choices in the same way a speedometer helps people estimate and control their driving speed, it hasn’t been very successful. Without a speedometer, people cannot precisely estimate how fast they are traveling. Their only clue might be based upon how quickly the scenery flies by. Drivers are trained to regularly check the speedometer. Road signs let them know when they can drive at which speeds and when they need to stop. But there are no signposts that define the optimal calories to choose or stop signs that indicate when we have consumed enough. It isn’t patently clear to many people how to respond to the calorie counts on menus.

Every restaurant serves different portion sizes: some are large, some giant, and others gargantuan. This leaves many of us confused and prone to eating far too much. How much easier would it be to control our intake if we knew that a cheeseburger had 400 calories whether we purchased it at McDonald’s, Burger King, or Denny’s? Or that lunch was going to contain just 640 calories, regardless of what we ordered?

Why can’t restaurants be held responsible for designing and serving meals that contain what we need? If people eat too much at one meal, they usually don’t eat less at the next to compensate. Similarly, if we don’t get enough of something at one meal, like fruits and vegetables, we don’t usually make it up by eating more of those foods later. This means that when restaurants serve us too much food with too many calories and too few essential nutrients, they put us at risk for chronic diseases.

Right now, as a society we accept this risk, and we don’t expect restaurants to be responsible for taking care of us. However, this is something we need to seriously reconsider, because it is too difficult for most people to figure out how to compensate for meals with too many calories and too few nutrients that protect us from disease.

Just as policies like standardized serving sizes evolved to support the moderate consumption of alcohol, we need commonsense regulations that will moderate our consumption of food. Alcohol regulation provides an excellent model for food because of the inherent similarities: consuming too much alcohol—just like consuming too much food—leads to chronic disease. In the case of alcohol, it’s cirrhosis of the liver, hypertension, and a variety of cancers. In the case of eating too much of the wrong kinds of food, it’s diabetes, hypertension, heart disease, stroke, and a variety of cancers. (Binge drinking also leads to injury and aggression, but there is no parallel to food in that regard.)

Alcohol control policies have a proven track record of keeping the public safe—or at least safer—from harm. Although they have not eliminated alcohol-related problems or alcoholism, such policies have been highly effective in controlling alcohol’s harms. Over the past three decades, deaths from alcohol-related traffic crashes have declined by 60 percent. Alcoholic liver cirrhosis declined by 48.3 percent between 1970 and 2005. Compare this to the incidence of obesity and diet-related chronic diseases, which have been skyrocketing.

We are beginning to recognize that people are limited in their ability to control how much they eat. We have already recognized that many people have limitations when it comes to behaviors like smoking, drinking, and substance use. Although eating food is not the same as drinking alcohol or taking illegal drugs, the evolution of our understanding of people’s ability to control how much they consume of these substances is quite instructive. It is only because we changed our view of alcohol that our society developed public health responses that have reduced alcohol-related illnesses and deaths.

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