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Anger Management

by John Hoffman and Judith A. Salerno
Blackstone Audio, 2012
Review by Roy Sugarman, Ph.D, on Dec 25th 2012

The Weight of the Nation

Arising from the HBO series documentary, this audio book sets the scene for why the USA, and other developed countries such as Australia and the UK, have a problem with up to 70% of adults overweight or obese, and why this is a threat to the countries themselves in many areas. I will give you just a few of the multiple facts in this compendium, a great listen over five or so hours.

Disc One sets the history in focus.  Firstly, we didn't evolve to consume what we consume now, and secondly, we were evolved for movement rather than being sedentary.  Not too long ago, 50% of jobs involved hard physical work, and now this is increasingly not so.  Secondly, as Americans moved West under the Homestead Act signed by Lincoln in 1862 in order to encourage farming in the West to feed the rapidly expanding cities of the East, farmers switched to corn, wheat, soy and rice, as this could be transported long distance. Food such as vegetables and fruit disappeared from our 9" plates and nearly 1800 calories a day was mostly now derived from those four grains to populate our 12" dinner plates, and portion sized expanded 2-5 times more than before, while we sat more. Worse, animals now were feed these grains as well, and so our eating behaviour changed.  Even though the genome from hunter gatherers has remained unchanged for the last 150 000 years, we have changed our world dramatically and the food within it, or what is now considered food, has changed along with that.  The creation of two income families means increasingly we run on deficit time, and so we look to processed, convenience food. Anomalies such as damage to fruit harvest created a new product, not whole fruit, but juice, bereft of fibre, and allowing again for greater consumption as the labour of preparation was reduced to save time. The risks of obesity and attending diabetes are of course well known, but given 100million Americans are now insulin resistant or frankly diabetic, and the military ejects 1200 troops a year for having become too unhealthy, and given the fatty liver syndrome, cardiac and stroke risks, and the costs attached, America and the rest of the fatty world, is increasing in trouble. Of course, little things make a huge difference, and so the ability to lose just 5-7% of the excess weight can reverse a host of dangers, but overall this is looked at only in passing, as the 100 genes or so that make us seek to overeat, dominate. Also, the fact that fat cells are well implanted finally by puberty, forever, means they can only be shrunk, not eliminated, and the rot starts early. History has changed what constitutes food and energy consumption, and the influences on us all.

The major issue kicking off chapter five is calorie consumption, up about 300 a day per adult in America, and 200 a day for kids, and the consumption of snacks, up to 6 a day in some kids, vs. one snack a day in 1980 for a kid. Where these 300 calories come from is another issue, usually from processed food.  The dangers of the processed foods such as trans-fats containing junk, provides double whammies for the metabolism.  Baked and fried foods from outside your kitchen are a no-no, with their partially hydrogenated oils. Refined grains are also bad, given the loss of the fibre. As noted, refined grains could be transported far, but whole grains would be preferred which are full of the fibre.  'Whole' is not a regulated term unfortunately, and so the whole grains need to dominate 100% of the content. Add over 150lbs of sugary substances a year….480cal a day extra in teenagers. Pleasure and learning can thus be linked which are not necessarily useful, for things we should not equate to being good. Salt, fat and sugar can come together to form a habitual target. Scans of drug addicts are similar to those consuming junk food.  All that stands between us and unhealthy habits is the prefrontal cortex, able to overcome the influence of the pleasure centres.  We have never had to turn down food before in our histories.

Biologically we are therefore at odds with our modern world. We evolved in the savannah of Africa, and now live in CandyLand. There are forces arrayed against us, so that the fast food industry for instance, serves one in four Americans each day. We know it is not good for us, but it serves up more food for the dollar than healthy food. Convenience is another issue. Red and yellow colours signify ripeness in the open bush, standing out well against a sea of green leaves, but for us today, they are most often the colours of fast food logos, deliberately so, fifty feet down the pavement. Yellow is the easiest to see in daylight, red to raise our blood pressure.  It is more expensive to eat the smaller serving, but the same satiety is in the smaller bag, even with less food.  Supersize and value meals are biological traps for us, playing on emotions, not hunger for their attraction, nor do they serve satiety, namely, we could feel just as satisfied on less.

Chapter nine notes that it is restaurants that are against us as well in health terms. Food is a national obsession, over the wrong kind of food.  We don't cook much, getting double the amount we used to 30 years ago in terms of food eaten out. 12% of us eat out more than once a day. Full service restaurant menus also offer oversized and unhealthy options.  More indulgent menu items would stretch to 1000 calories, but there are now items regularly seen that offer more than your daily nutritional needs in a single hit. One meal could be 4-8 hours of jogging in the wrong restaurant.  The atmosphere is also engineered to make us eat more, using clever design.  Loud music makes you eat faster, TV's distract us and make us consumer more calories; dim lighting is also against us in similar ways.  In the world of marketing food, value trumps health on any day.

Big food companies are also against us. A handful of large global agribusiness companies. They are highly represented by legal and lobby groups to protect their interests. Profit markets are higher on processed food. Food manufacturers rely on commodity products for that reason. Bright colours and taste in a breakfast cereal mimic the ripeness and health of real fruit, although they might have no such ingredients.  The profit margin on fresh fruit is about 10%, on sodas, about 90%.  The labels may mislead as well: Zero fat may mean a small enough serving size would contain less than half a gram of fat or trans-fat. So a tin with 40% fat may be listed as fat free, as each serving, if labelled small enough, would be fat free: overall, your serving may have several of the unrealistic labelled serving sizes in it, which would mean some fat is being delivered, not zero.

Big Food is now as bad as Big Tobacco was, and they need to bolster their images. If we want better foods, they will gladly sell it to us.  So supermarkets are also against us.  Low margins in this industry mean there is a strong need to capitalize on every square inch of floor space.  Certain 'hot selling' areas of the store are reserved for high profit items, and we know what they are. Processed food. 60% of purchases in supermarkets are unplanned, and fresh produce is usually the drawcard, but surrounded by aisles of impulse buying products in bags, boxes and cans.  Pseudovariety, eg a whole aisle devoted to an unhealthy food, increases the likelihood we will buy from it without planning to, by a factor of about 40%.  End of aisle displays, even if not on sale, increase our chances of purchase by 30%.  So, supermarkets charge manufacturers more for those slots in the shop, and so increase the profit margin. And, who can afford that extra cost? Large food companies. They want to sell therefore their highest margin foods which are the ones with the cheapest ingredients, which is their highly processed commodity ingredients, like high fructose corn sugar.  A smaller independent company with a healthier product is not going to get that choice position, and we are not going to buy as much of it as we would if it had prime retail positioning.  Not content with the end of aisle position, the same food will appear in multiple positions so that it gets noticed anyway. The repetition suggests to us we are focussing on something we need, so we get it.

Chapter 12 looks at marketing vs. us.  $30 billion a year in advertising comprised with at least 50% targeting junk food and our kids. Children younger than 7 or 8 do not understand advertising is different to general programming, and is trying to sell them, 5500 ads a year for each kid, and 98% is for bad food, presented as fun and part of the good times of life.  Parents are thus undermined by the food industry in their attempts to install healthy eating.  Targeted advertising, including white areas having the least advertising for unhealthy foods, black and Latino neighbourhoods the most.  Social media now enter the fray as well, making Facebook and Google wealthy from the advertising that fuel community events and organizations. Kids cereal boxes, the bright coloured ones, are low down on the shelves where they can see and seize.  Reducing TV time reduces exposure to adverts, and hence to supermarket tantrums spurred on by the advertising. A ban on such adverts would lead to nearly 20% less obese children.  Fashion and beauty are also against us.  It's not the way you look it's the way you live.  Sedentary lifestyle is against us. 8hours a day for adults, kids spending 70% of their time sedentary now.  It's killing us, and not slowly.  Age, smoking and other factors aside, exercise likewise not helping, you are much more likely to die if you sit for long times as your physical parameters change immediately and get worse the longer you sit. 5 days of bed rest involve dramatic changes in your metabolic profile.  We just expend far less physical activity.  TV time is likewise worse for us in this way, as well as helping us consume more calories and watch more adverts for bad stuff.  At schools, financial imperatives replaced government excess stocks for all kinds of commodities that contribute to obesity.  Most now do not meet the standards of healthy eating, rather, they serve junk food dressed up as real.  That place is where they spend most of their time, and take in most of their calories without regular gym class and in some cases without recess. We all know about Pizza being a vegetable in congress' eyes.  Bottom line counts, and congress bowed, so tomato paste makes it a vegetable. Potatoes count as a vegetable even as a French fry or TaterTot.  Ketchup and relish were close to making it into the standards as vegetable serving but were narrowly defeated by public outrage. Desire and commitment, as well as the USDA political will.

Competitive foods? These are the competition for federally approved meals which are part of the cafeteria lunch. Vending machines are still mostly present. School stores as well. These are an Achilles heel for the kids. There are many out there generally, and a kids debit card could be used for these things in 100% of the High Schools, adding 200cal to each day.  Add to this only 4%-8% provide daily exercise at all. Less than 1/3 of children burn any real calories during any form of exercise, an inactive child is likely to be an inactive adult, so there is a lack of activity and the consumption of bad foods will undo any attempt to focus funding on math and reading scores by diverting funding away from PE. Several studies, as championed by Dr John Ratey and Dr Friedan and others, have shown the value to test scores provided by exercise.

Losing weight and keeping it off is hard if you are afraid to sit the whole day for the Superbowl, or pass up the popcorn for a movie with the kids, or ditch the cheesecake forever. Western diets that invade communities that were like the Papuan New Guinea to start, create the transformation of their health and life that mimics ours that robs them of health, bringing heart disease, stroke, and any other lifestyle related disease you can think of: a shorter and sicker life.

The rest of the book from Section 4 onward is devoted to how to avoid this disaster. The last four chapters thus are there to launch the fight back to health and longevity.  Eat less, move more.  Not much of a secret.

Chapter 16 is what not to do, and what to do about it. Most dieters regain all their weight back. You have to stop dieting as you know it, following each fad or fancy diet or swallowing a pill or eating frozen delivered meals endorsed by some TV star. Diets don't work for the long term.  Yoyo dieting is not great, so this is an anti-diet book, relying on small changes making a big difference.

There are several myths here, which they discuss. 7-10% weight loss is usually enough to change things dramatically, you don't have to go to 20-30% of your weight, but it would help. First 10% of body weight loss actually does most of the health benefit is gained.

Cave man genetics will undo dieting if it is too severe, slowing your metabolism in that the body becomes more efficient.  3 months would be required to lose 20lbs, and losing faster would hurt as the body fought back. Frequent failures lead to more weight retention over time, as motivation is sabotaged. Crash diets don't work.

Slow metabolism? Myth again. Misguided: relative to our size, we all have the same metabolism.  Obese people expend more energy than others do.  Efficiency with weight loss does slow us down in weight losing potential.

The Biggest Loser show? They move a lot more.  Most experts cringe, the principles proposed there are the antithesis of what is proposed here for the obese. The only people who can devote the whole day to movement are professional athletes. Exercise has benefits, but a single energy drink or muffin could undo that. It's not enough.  But it does help keep it from coming back.

Activity has to be part of your life, and changing the way you eat. A set of guidelines provide advice from Washington University at St Louis, with Dr Klein. No diets, or secrets. Hard work to lose weight and get healthier requires some guidance: most is easy to do on your own. Ongoing reliable support systems work, with your own cheerleading squad. The more, the better. Relatedness is key, not everyone is on board if they can't change what they are doing to suit you.  Groups on the same journey do the same as AA for alcoholics when it comes to losing weight.  Social media can also support you at 2am when the junk is calling. Commitment to health is lifelong. Goals have to be wise, for eating, for exercising. First steps are also important, namely account for what you are eating or how much you are moving. 2400 calories a day is more than you need, but is average, and most of us have no idea. We all underestimate our intake and overestimate how much we need or are using. Measuring and managing is a vital first start, eg pedometers and Calorie Kings and the like online, in terms of basic metabolic rate parameters, eg www.nutrition.gov.

Goals have to be reasonable, managing microgoals is essential, lofty goals can create ambivalence which destroys chances of success. Milestones need to be small and fit within our existing life demands.

The home improvement tips for the body then follow, with multiple levels of advice, to assist behavioural change that leads to health. After all they rightly allege, we consume half the calories we would in a restaurant by eating at home. This means we need to improve the house we live in for our entire lives, our bodies, by the home improvements they suggest. This will include not losing sleep over it, because losing sleep is as deadly as anything you might eat or sit through. Infants and toddlers who sleep less are quite at risk, more than double, for obesity.

Keeping it off also requires a lifetime commitment. There is more advice about this here as well, as you would understand by now, this would be about lifestyle and not dieting. Vigilance here is no different from dealing with any other health condition, such as blood pressure, or diabetes, and cannot be just done for 6 months, but for life.  And nearly half the people who succeed do it on their own and not with a weight loss programme such as Weight Watchers. They all include exercise in their regime.  Not only in the macro arena of you, but in the country's governance, as much as the Republicans would refuse to countenance. Okay, so business would have to self-regulate.  But for each pound you lose, someone else gains it, and the statistics show this is likely to be a child.

Improvements in lifestyle have led to the decline of the nation. Early recruits to the USA during the wars were turned down, owing to malnutrition, but today, from the opposite cause, and still we lose valuable people both young and old to diseases that we do not need to see as lethal, or see them at all.

Much in modern life conspires against us. Not in the stars, but in the world around us.

This book, in audio form or written, sets out to not only point out the problem, but to help the majority, demanding more than the individual. The message is that the weight of the nation requires a group effort, engaging government and private enterprise. Much is made of Michelle Obama and Walmart, both setting a fine example, but more contestants in this arena are needed.

Disc Five is devoted to short sessions on giving advice and tips for healthy eating while watching calories to start, foods for a healthy lifestyle,  homemade treats, perfect portions, what not to eat, how not to buy into bogus claims, no such thing as a free lunch, secret sugars, sweet by another name, skip bakery and coffee shop desserts, what to drink, what about diet soda, what not to drink, tips for active living, physical activity guidelines, moderate activities, vigorous activities, have it your way, healthy pregnancy and baby, and a host of other pregnancy related titles, child's health, the question of weight loss surgery is also covered.

The book ends here.

To say this is a monumental work is missing the point.  It is a book that has to be read, or listened to completely, because not a single bit of it is boring or meaningless. The main part of it is 4 cd's, about an hour or so each, but you have to read the last disc as well, as it is full of tips.

So easily listened to on any medium haul flight, or journey in a car to a distant city, and absolutely necessary for any person, parent, child or anyone else who is threatened by a modern, Western lifestyle.  Read it early, the rot starts early, and hard to reverse an unhealthy life.

It is not just about weight, although this dominates, it is about health. Buy it.

 

© 2012 Roy Sugarman

 

Roy Sugarman, PhD, Senior Clinical Lecturer, University of New South Wales, Medical School