Almost every time I took a break from this book, I found my wife watching a cooking show demonstration of how to concoct some delicious decadent complicated huge meal.
Deborah Cohen is a public health physician in California, now working for the Rand Corporation, a large think tank. She is certainly knowledgeable and passionate in her efforts to deal with what she describes as the epidemic of obesity in America. She advocates using the public heath measures that were used in the past to reduce the harm from poor sanitation, uncontrolled alcohol use, and tobacco to fight this blight.
Almost the first third of the book is devoted to an uncritical analysis of over one hundred social science studies that fairly convincingly show that modern obesity is not the result of poor self control on the part of individuals. It is rather the result of our unchanged evolutionary survival instinct to eat as often and as much as we can, combined with a changed “food environment”. The latter includes increased outlets for food (think vending machines, gas stations, food trucks, Costco), aggressive marketing of unhealthy but delicious foods, and coupling of these same foods with other pleasures in the media and movies. About thirty percent of grocery sales is of generally unhealthy items displayed at the end of isles or at the check out counter. And allegedly most grocery store chains make more profit from charging wholesalers for prime display sites than they do from retail sales. Appropriate comparisons are made to the devious and sometimes illegal marketing strategies of the tobacco industry in the past. As I read about the effectiveness of display site marketing, I began to question whether or not my reading choices were being subtly manipulated by the shelf placement of books at the Beaverbrook Library. None of us are immune to subliminal nudges.
I will not detail all of Cohen’s recommendations to remedy this situation, some of which seem realistic, some pipe dreams and some that seem quite silly to me. There is a heavy emphasis on draconian legislation, as one might expect from a public health guru. Dictate that all vendors standardize the size of some common items such as hamburgers? Require licensing for all food outlets and limit their numbers geographically? Force grocers to display healthy food choices in prime sites? Perhaps the silliest recommendation is to require licensing for waitstaff and busboys in restaurants. We do not need more restriction on the job opportunities for uneducated and unskilled workers by self-serving licensing boards. But there is a precedent with tobacco for limiting or banning advertising of harmful products. Could we ban all-you-can-eat advertising and the bundling of different foods together as combos which is a very effective strategy in the fast food industry? If I had to order the fries separately from the burger, or the eggs, toast, bacon and home fries all separately, I might decide that I didn’t need the fries or the bacon. But protests about bundling retail products together have not altered the business plans of Rogers, Bell, or Shaw. Should the Toblerone join the cigarettes out of sight behind the counter- still available but not in temptation’s path? There is a dearth of suggestions on how we might be ‘nudged’ as per Richard Thaler and Cass Sunstein in Nudge, as opposed to being forced to make healthy choices.
The discussion of the environmental impact of food choices is interesting. In Europe, an estimated 31,000,000 tons of food waste rots in landfills annually, contributing vast amounts of methane pollution to the atmosphere. Raising animals for food is not only inefficient energy usage, it also is environmentally harmful. Animals, especially ruminants, belch and fart vast amounts of methane into the atmosphere. I get a faint twinge of guilt when I cut into a sirloin. But if we eschew methane-producing foods, we need to cut out rice too, as the paddies also spew vast amounts of methane.
Some recommendations seem to lack any scientific backing. Eschew bananas and other products shipped from afar because of the environmental harm of shipping? Not according to Mike Berners-Lee in How Bad Are Bananas? The carbon footprint of everything. Get lots of sun exposure to avoid vitamin D deficiency? Not wise, according to most dermatologists.
The writing style is a bit dry, pedantic, preachy and repetitive although she relates personal anecdotes that readers will find interesting. There is one major unwarranted assumption that underlies all the recommendations, i.e. that we know what a healthy diet consists of. There are hundreds of contradictory dietary recommendations even from experts, not counting the celebrity-endorsed quacks, and the experts have a long history of backing the wrong horse. Dr. Robert Lustig (Fat Chance), Nina Teicholz (The Big Fat Surprise), Gary Taube (The Case Against Sugar) and Helen Bishop MacDonald (The Big Fat Misunderstanding) all convincingly show that the recommendations of the heart-health and cholesterol-obsessed gurus with tunnel vision in the last half of the last century contributed to the epidemic of heart disease, obesity and diabetes, rather than reducing them. Helen Bishop MacDonald (full disclosure-she is an acquaintance and neighbour) even recommends that we enjoy the mutton fat and marbled beefsteak fat from those belching and farting ruminants because of the favourable ratio of different omega fatty acids therein. Phew! Now I feel better about my love of red meats.
Economics is said to be the dismal science, but perhaps nutrition science should win that label. Or psychology, with its penchant for contrived experiments on university students and its frequent confounding of correlation with causation. Cohen draws on all three of these fields to not-entirely-convincingly explain the increasing problem of obesity, and to provide less than entirely realistic solutions. In spite of recommendations to reduce its use, this book should be widely read-but with a pinch of salt.
Next week- another great historical novel and an insight into prison life.
The Passionate Reader 
But don’t forget, no more than a pinch of salt!
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