Interview With David Kessler, Author of 'The End of Overeating'

David Kessler had a SnackWells problem. The fat-free cookies, he writes in his new book, "The End of Overeating," would not "relinquish their grip" on him. But he's better now. "No more SnackWells," the former Food and Drug Administration commissioner happily reports. Kessler freed himself from the cookies' clutches by "deconditioning." It's that kind of mental shift, he says, that is required to tackle the nation's obesity epidemic, a problem that was in the spotlight last week at the Centers for Disease Control and Prevention's first Weight of the Nation conference in Washington. Outlook's Rachel Dry spoke with Kessler about how food is more difficult to demonize than tobacco, why Union Station is a "food carnival" and why lemon cake isn't anyone's friend. Excerpts:

The medical costs of obesity could have risen to $147 billion in 2008, according to a new study. What do you think when you hear that number?

It's a staggering number. But what concerns me as much is if you project out what's going to happen in the future. One of my greatest concerns, especially as a pediatrician, is the increase we're seeing in the number of children who are developing Type 2 diabetes.

You write about people whose lives are totally controlled and consumed by food. What do you think the $147 billion number and the discussion around it means to them?

When I started writing the book, I started listening to people who were struggling with their eating and their weight. They didn't understand what was driving their behavior. They didn't understand why they were engaging in behavior that they knew they didn't want to be engaging in. So to me, the real cost is the personal cost and the personal torment. Sure, the medical and economic consequences worry all of us, but it's the personal struggle that is as important and as profound.

The CDC issued 24 recommen- dations for communities to help prevent obesity. Some of the measures are about restriction and limitation. How does that fit in with the notion of a personal struggle?

We're going to need to change how America looks at food. Look at the success to date with tobacco. The real success wasn't with laws or regulations. That's not what drove it. Thirty or 40 years ago, we used to look at a cigarette as something that was sexy, glamorous and cool. We changed how America looked at tobacco. Now we view it for what it is -- a deadly, addictive product. In some ways tobacco was easy. We can live without tobacco. Food is hard.

You worked directly on the tobacco effort.

I spent 15 years working on that. And the challenges that we face from obesity make tobacco look easy. Our kids are growing up in an environment where fat, sugar and salt are on every corner and have been available 24/7. It's socially acceptable to eat anytime. We've made food into entertainment. Walk into Union Station on the lower-level food court and watch kids and adults eat. It's as if we're living in a food carnival.

How will the fight against food have to differ from anti-tobacco efforts?

It is going to require a public health effort and campaign that far outstrips the campaign against tobacco. It's only beginning to dawn on people how hard it is going to be to reverse this epidemic. I have colleagues who are not optimistic and think that we've lost the battle. I don't agree. This is doable. But it's going to be harder than anything we've ever experienced in public health. Our brains have become wired to respond to fat, sugar and salt. When I was growing up in the '50s and '60s, we used to eat at meals. There were some boundaries with our eating.