By Lyndsey Layton
Washington Post Staff Writer
Monday, April 27, 2009
He went in the middle of the night, long after the last employee had locked up the Chili's Grill and Bar. He'd steer his car around the back, check to make sure no one was around and then quietly approach the dumpster.
If anyone noticed the man foraging through the trash, they would have assumed he was a vagrant. Except he was wearing black dress slacks and padded gardening gloves. "I'm surprised he didn't wear a tie," his wife said dryly.
The high-octane career path of David A. Kessler, the Harvard-trained doctor, lawyer, medical school dean and former commissioner of the Food and Drug Administration had come to this: nocturnal dumpster diving. Sometimes, he would just reach in. Other times, he would climb in.
It took many of these forays until Kessler emerged with his prize: ingredient labels affixed to empty cardboard boxes that spelled out the fats, salt and sugar used to make the Southwestern Eggrolls, Boneless Shanghai Wings and other dishes served by the nation's second-largest restaurant chain.
Kessler was on a mission to understand a problem that has vexed him since childhood: why he can't resist certain foods.
His resulting theory, described in his new book, "The End of Overeating," is startling. Foods high in fat, salt and sugar alter the brain's chemistry in ways that compel people to overeat. "Much of the scientific research around overeating has been physiology -- what's going on in our body," he said. "The real question is what's going on in our brain."
The ingredient labels gave Kessler information the restaurant chain declined to provide when he asked for it. At the FDA, Kessler pushed through nutritional labels on foods sold through retail outlets but stopped short of requiring the same for restaurants. Yet if suppliers ship across state lines, as suppliers for Chili's do, the ingredients must be printed on the box. That is what led Kessler, one of the nation's leading public health figures, to hang around dumpsters across California.
The labels showed the foods were bathed in salt, fat and sugars, beyond what a diner might expect by reading the menu, Kessler said. The ingredient list for Southwestern Eggrolls mentioned salt eight different times; sugars showed up five times. The "egg rolls," which are deep-fried in fat, contain chicken that has been chopped up like meatloaf to give it a "melt in the mouth" quality that also makes it faster to eat. By the time a diner has finished this appetizer, she has consumed 910 calories, 57 grams of fat and 1,960 milligrams of sodium.
Instead of satisfying hunger, the salt-fat-sugar combination will stimulate that diner's brain to crave more, Kessler said. For many, the come-on offered by Lay's Potato Chips -- "Betcha can't eat just one" -- is scientifically accurate. And the food industry manipulates this neurological response, designing foods to induce people to eat more than they should or even want, Kessler found.
His theory, born out in a growing body of scientific research, has implications not just for the increasing number of Americans struggling with obesity but for health providers and policymakers.
"The challenge is how do we explain to America what's going on -- how do we break through and help people understand how their brains have been captured?" he said.
Kessler is best remembered for his investigation of the tobacco industry and attempts to place it under federal regulation while he was FDA commissioner from 1990 to 1997. Although he was appointed by George H.W. Bush, Kessler became popular among Democrats for his tough regulatory stance. He got the nickname "Eliot Knessler" after he authorized the U.S. attorney's office in Minnesota to seize a large quantity of Citrus Hill Fresh Choice orange juice in 1991 because it was labeled "fresh" when it was, in fact, partially processed. After he was elected in 1992, President Bill Clinton asked Kessler to continue to run the FDA.
Kessler's aggressive approach toward the tobacco industry led to billion-dollar settlements between Big Tobacco and 46 states and laid the groundwork for legislation now pending in Congress that would place tobacco under FDA regulation.
Kessler, 57, sees parallels between the tobacco and food industries. Both are manipulating consumer behavior to sell products that can harm health, he said.
Whether government ought to exercise tougher controls over the food industry is going to be the next great debate, especially since much of the advertising is aimed at children, Kessler said.
"The food the industry is selling is much more powerful than we realized," he said. "I used to think I ate to feel full. Now I know, we have the science that shows, we're eating to stimulate ourselves. And so the question is what are we going to do about it?"
The idea for the book came seven years ago as Kessler was channel-surfing and came across an overweight woman named Sarah on "The Oprah Winfrey Show." While Sarah was successful in nearly every aspect of her life, she tearfully told Winfrey, she could not control her eating.
Kessler was mesmerized by Sarah -- she was describing his own private struggle. "I needed to not only figure out Sarah -- I needed to figure out myself," he said. "Little did I know it would lead me into real fundamental issues of what makes us human and how our brains are wired."
At 5-foot-11, Kessler's weight has swung from 160 pounds to 230 pounds and back, many times over. He owns pants in sizes ranging from 34 to 42.
"I was a fat kid," he said. "I grew up in the world of Entenmann's cakes. I was pretty much of a science nerd. If you looked in my refrigerator in college, it was Entenmann's."
Every few years, Kessler would go on a diet and apply the kind of discipline that enabled him to earn a law degree from the University of Chicago while attending Harvard Medical School. "I'd lose weight and over time gain it back," said Kessler, who also completed a medical residency at Johns Hopkins Hospital in Baltimore at the same time he worked as a staffer to Sen. Orrin Hatch. "I couldn't control it."
The man who took on Big Tobacco was helpless when confronted with a plate of chocolate chip cookies. He couldn't focus on anything else until he had eaten them all.
"My weight was yo-yoing all the time," said Kessler, who estimates that 70 million Americans struggle with conditioned hyper-eating. "And I never understood why."
He embarked on a mission to figure it out while serving as dean of the medical school at Yale University and later the University of California at San Francisco. UCSF fired Kessler from his position as dean in December after he alleged financial malfeasance at the institution. The university maintains there were no financial misdeeds; Kessler says he was forced out because he blew the whistle. He remains on the faculty at the medical school and lives in San Francisco with his wife, Paulette, a lawyer. They have two grown children, both of whom live in Washington.
Paulette says that she was not taken aback when her husband of 34 years would disappear in the middle of the night on his dumpster tour. "Nothing surprises me anymore," she said. "When he wants to find something out, there's really no stopping him."
Through interviews with scientists, psychologists and food industry insiders, and his own scientific studies and hours spent surreptitiously watching other diners at food courts and restaurants around the country, Kessler said, he finally began to understand why he couldn't control his eating.
"Highly palatable" foods -- those containing fat, sugar and salt -- stimulate the brain to release dopamine, the neurotransmitter associated with the pleasure center, he found. In time, the brain gets wired so that dopamine pathways light up at the mere suggestion of the food, such as driving past a fast-food restaurant, and the urge to eat the food grows insistent. Once the food is eaten, the brain releases opioids, which bring emotional relief. Together, dopamine and opioids create a pathway that can activate every time a person is reminded about the particular food. This happens regardless of whether the person is hungry.
Not everyone is vulnerable to "conditioned overeating" -- Kessler estimates that about 15 percent of the population is not affected and says more research is needed to understand what makes them immune.
But for those like Kessler, the key to stopping the cycle is to rewire the brain's response to food -- not easy in a culture where unhealthy food and snacks are cheap and plentiful, portions are huge and consumers are bombarded by advertising that links these foods to fun and good times, he said.
Deprivation only heightens the way the brain values the food, which is why dieting doesn't work, he said.
What's needed is a perceptual shift, Kessler said. "We did this with cigarettes," he said. "It used to be sexy and glamorous but now people look at it and say, 'That's not my friend, that's not something I want.' We need to make a cognitive shift as a country and change the way we look at food. Instead of viewing that huge plate of nachos and fries as a guilty pleasure, we have to . . . look at it and say, 'That's not going to make me feel good. In fact, that's disgusting.' "
Kessler said he's made that shift in his own life, eating small portions of foods that contain fat, salt and sugar, part of a "food rehab" plan he suggests in the book. He has certain rules -- no french fries, ever -- that help him navigate through vulnerable moments.
He has embraced spinning -- the first time he has regularly exercised. "I hated physical activity, all of my life, mostly because I was fat and it was hard to do," he said. "But I just wanted to do something. I picked spinning because you can't fall off the bike." He worked with a private trainer for weeks just to be ready to take a class. "I was embarrassed to go into the class," he said.
Now Kessler tries to spin every day and belongs to multiple health clubs so that he has more options for class times.
He avoids the cues that focus his brain on "highly palatable" foods, going so far as to chart a different route through San Francisco International Airport so that he doesn't walk past the fried dumpling stand.
Kessler's weight is relatively stable at 162 pounds. But there's something else that's changed. As he has come to better understand himself, the food cravings and the resulting anguish he felt have subsided.
"So I'm at peace," he said. "After 30 years, I'm at peace."