Obsessed: America's Food Addiction--and My Own Part 3

I'd be vigilant for a while and lose some weight. Then I would hit a plateau and think, Why bother? Or I'd start sneaking snacks that "didn't count," like a spoonful of peanut b.u.t.ter right out of the jar, or anything that I could eat over the sink. A gla.s.s of wine on Sat.u.r.day night became a c.o.c.ktail and a gla.s.s of wine, and eventually I was having a gla.s.s or two every night of the week. I tried to be honest and count the calories allotted for the day or the week, but eventually the counting and the weighing and the vigilance would break down again.

Luckily for me, my husband was always supportive of my weight-loss efforts. I never suffered from the sabotage syndrome so many women complain about. He wasn't ordering pepperoni pizzas while I was dieting, but when I was willing to indulge, he was, too, and that meant Friday night pizza or Chinese takeout and lots of eating out. I'd indulge, feeling like a normal person for a while. But I never compensated quickly for the extra calories, so I steadily gained weight. Then I'd be back on another strict regimen, trying to drop twenty-five or more pounds.

Over time I went from a size 10 to a 16. Talk about denial.

The only time in my life when I was not obsessed with food was in the mid-1990s, when my doctor prescribed the drug combination fenfluramine-phentermine, commonly known as fen-phen. Losing weight became effortless because I was never hungry. I stopped thinking about food all the time. For the first time in my life I could go to a party without heading to the buffet table. I no longer cleaned my plate at every meal and our dog discovered table sc.r.a.ps for the first time, because there actually were leftovers. I packed a lunch for work, and at the end of the week five of them would be sitting in the newsroom fridge. I had forgotten to eat, something that was once unheard of for me.

I got back to my ideal weight and actually wore a size 10 again. I was elated, and not only because of the serotonin release triggered by the drugs. But as my TV station's consumer reporter used to say, "If a deal seems too good to be true, it probably is." That was definitely the case with fen-phen. A thirty-eight-year-old client at the nail salon I frequented, who had been obese since childhood, started using fen-phen about the same time I did. She got very thin, and then suddenly died. There was no autopsy, but people whispered that fen-phen had killed her.

This made me nervous, but I kept on using it because it felt so good to be thin again. As a TV journalist I even reported on studies suggesting the dangers of fen-phen, but my desire to look good was so strong that I ignored the health risks. I was probably lucky when the matter was taken out of my hands. By the late 1990s, the drug combination had been linked to pulmonary hypertension and heart valve problems and pulled from the market. I decided not to join the cla.s.s action lawsuits against the manufacturers, but I held my breath for years, fearing that cardiac damage would show up. Thank goodness it never did.

I kept the weight off for a while even without the drug, but as you have probably figured out by now, I gained it all back.

For me and just about everyone else who has weight issues, the real trouble is keeping off the pounds after you lose them. I've always felt a kinship with Mark Twain, who once observed, "It's easy to quit smoking. I've done it hundreds of times." The same could be said of me; just subst.i.tute the words lose weight for smoking. I can't even begin to calculate how many pounds I have lost and gained over the years.

When I was forty-nine I set a goal: 50 by 50, meaning I would lose fifty pounds by my fiftieth birthday. At that point I was out of TV news and commuting three hours a day, round trip, to my radio job. My alarm went off at 2:30 a.m. After I had done my radio show, most days I headed to the PBS station in Hartford where I produced and hosted a magazine show. I was tired, but I knew I had to start exercising again if I was going to reach my goal. I joined a gym and lost about twenty pounds. I was on my way to 50 by 50.

Then my health problems began. First came stress fractures in both feet, then a painful neuroma in one foot that led to plantar fasciitis and tendonitis. I spent the entire summer in physical therapy. Pain kept me out of the gym, and my weight inched back up. A year later I tripped over my dog (yes, really) and broke my foot and my elbow. Another reason not to go to the gym.

With few other options to consider, I began to think about bariatric surgery. It seemed like an easy answer. Just about everyone who undergoes the surgery loses weight-a lot of it and quickly, too. Bette, a gifted video editor and one of my close friends, had gone through the "lap band" procedure, and I watched how well it worked for her. In gastric banding, a surgeon actually wraps a device around the upper part of the stomach to form a ring. The ring is attached by a tube to an access port left under the skin. The doctor can then control how tight the ring is by inserting saline through the port. So your "new" stomach is smaller, you eat less, and feel full with what seemed to me like teeny amounts of food. Bette lost more than two hundred pounds. Even more importantly, other health problems, known by the scary term comorbidities, cleared up.

Prior to the surgery, Bette had been taking insulin and two oral medications for diabetes, two medications for high blood pressure, and one for her cholesterol. She suffered from swelling so severe that sometimes she could barely keep shoes on her feet. And because she had developed sleep apnea, a dangerous condition closely linked to overweight, she was tethered at night to a continuous positive airway pressure (CPAP) machine to help her breathe.

After surgery Bette needed none of that. She was off all her medications, worked out almost daily at a gym, started riding a motorcycle, and trained to be an emergency medical technician. She even posed nude for an art cla.s.s. It was obvious the weight loss had transformed her life, and I suspect it may have even saved it.

But like most medical procedures, bariatric surgery has its down-sides, and I saw some of those up close with Bette. Vomiting, nausea, nighttime acid reflux, and other postoperative complications can be enduring problems. Bette also had a significant amount of loose skin, and considered extensive plastic surgery to get rid of it.

Still, bariatric surgery was tempting. There are a number of possible approaches, but as I did my research, I was not entirely surprised to learn that none of them are the perfect fix they appear to be. Never mind the TV stars you see showing off their s.e.xy new bodies after bariatric surgery. It is definitely not that simple.

The procedure does change your life, but some of the long-term implications are daunting. I wasn't sure I could live permanently on a diet that counts a half cup of food as a full meal, requires that you chew your food to the consistency of a fine paste, and advises you not to eat food and drink liquids at the same time.

I was also concerned about one common and often permanent side effect of "gastric bypa.s.s," which is a type of bariatric surgery that involves disconnecting the stomach from the small intestine and connecting it to the large intestine instead. The side effect, called dumping syndrome, happens when the undigested contents of the stomach move too rapidly into the small bowel. When people who have had the surgery eat sweets, dairy, fats, or carbohydrates they sometimes get very ill with symptoms that can include weakness, feeling faint, nausea, sweating, cramping, and diarrhea.

I had watched two other friends struggle with the aftermath of bariatric surgery. One woman about my age had a procedure called vertical sleeve gastrectomy. Her surgeon removed 85 percent of her stomach. She chose that procedure because it avoids some of the side effects and weight regain that can accompany gastric bypa.s.s. Still, a full meal for her is about three ounces of food, and she must be constantly vigilant about what she eats. The other friend is much younger, barely out of her teenage years, and she spent weeks in a hospital and months in recovery after complications from her gastric bypa.s.s.

Despite all that, both women considered the procedure to be a life saver. But they were also substantially heavier than I am. With a BMI of 38, I was just below the level that officially qualified for the surgery, though I'm pretty sure I could have persuaded a doctor to take me on as a patient.

Another downside was the cost. The lap band procedure can cost between $8,000 and $30,000. My insurance company would have paid for it if I had a BMI of 40 or above, or a BMI of 35 coupled with a comorbidity, such as diabetes. Thankfully, I had no comorbid conditions.

All the medical literature says the surgery is to be used only as a last resort. It might have been worth paying for it out of pocket if it was truly my only option, but I couldn't convince myself of that, despite my long and checkered career as a dieter. Wouldn't it really be better to improve my eating habits and exercise more? Reluctantly, I ruled out surgery. There had to be another way.

At the time Mika hit me over the head about my weight, I was in deep denial about how dire my situation was. I was in my mid-fifties and weighed 250 pounds. There, I said it. 250 pounds. I can hardly breathe just writing down that number on the page. It is so shocking, even to me. I weighed more than some NFL players.

At the time Mika hit me over the head about my weight, I was in deep denial about how dire my situation was. I was in my mid-fifties and weighed 250 pounds.-Diane How did this happen? I look in the mirror and I cannot believe what I see. I was never skinny, but at size 10, I was once described by a TV critic as "comely." Now I am pushing a size 20? My heart is pounding as I read and reread this line, but I'll say it again: 250 pounds.

"You're fat," Mika said. I was.

I began to craft a program that I hope will bring long-term permanent change. I'm done with promises of a quick fix, and I know from experience that restricting what I eat is not enough. After years of yo-yo dieting, I know firsthand that people who don't exercise lose muscle and fat while dieting, but when they rebound, they gain back the fat.

The first thing I needed to do was to get off the couch and into the gym. But with all my pains, aches, and general loss of fitness, I was nervous about getting injured. Those stress fractures in my feet, which developed after the ambitious weight-loss program I had started several years earlier, eventually led to a raft of related orthopedic problems. For several years I had been in and out of physical therapy. I couldn't afford to go through all of that again.

I asked my doctor and my physical therapist how to transition from physical therapy into the gym without injury, but neither had a solid recommendation. I'd worked with trainers on and off with some success, but this time I needed someone who could also address the myriad medical issues I was developing. I looked at several hospital-sponsored programs, but most were targeted at cardiac patients.

The more I looked, the less I was convinced I could find a trainer and a gym that could really help me. I knew I couldn't afford another injury, and besides, in my current condition I was less than enthusiastic about being surrounded by Skinny Minnies. Then two very caring friends came to me with a suggestion (you might even call it an intervention). They were getting great results with a trainer who had a radically new approach and a rare ability to motivate clients and inspire change.

My friend Anna is fit and athletic, but she'd had to undergo knee surgery. She said this trainer had helped her to heal, and to take her workouts to a new level. The other friend is a TV weatherman whose weight had climbed to over three hundred pounds. Joe was a longtime colleague, and I knew he had struggled with his weight for years. He was turning fifty, and had recently lost eighty pounds and maintained the loss. He said he was in better shape than he had been in his days playing college football. The trainer, he told me, counseled him on nutrition and "gets inside your head."

At their urging, I looked into Akua Ba Fitness, a one-on-one training center in West Hartford operated by D'Mario Sowah. I needed someone special. My fear of being injured again, coupled with my embarra.s.sment about my size, called for someone who could go above and beyond the usual requirements. It was a tough combination to deal with, but I was lucky enough to meet someone who could. D'Mario is a master trainer who is experienced and well versed in fitness and anatomy. The small size of his studio also meant I would have some privacy-definitely a plus.

In terms of life circ.u.mstances, D'Mario and I are polar opposites. He is a young African American born in Ghana, plucked from an orphanage and forced into slavery as a child soldier. As we worked out together, I slowly learned his extraordinary life story, including his escape that led him to America. The way he rebuilt his life is incredibly uplifting.

D'Mario's regimen involves healthy eating and a training method that foregoes most exercise equipment, relying instead on using your own body weight as the resistance in your workout. At our first meeting he a.n.a.lyzed my fitness level (virtually nonexistent) and talked to me about my goals and my failure to lose weight over the last fifteen years. My tears flowed (again), and in spite of our differences I sensed the inner spirit of this man, his nurturing soul. About my weight and my awful physical condition, D'Mario simply said, "Lay down that burden; that burden is mine to carry now."

About my weight and my awful physical condition, D'Mario simply said, "Lay down that burden; that burden is mine to carry now."-Diane No one had ever referred to my weight like that before; as a burden I had been carrying. And yet of course it was. I had felt so much shame because I had not been able to rid myself of it. I felt like a failure after all the false starts, all the dashed hopes of recent years.

Through my career I had been seen as a winner: popular, talented, and able to reinvent myself every time a curve ball was thrown my way. When I was downsized from my position as a news anchor, I became a morning talk show host at the biggest radio station in the state, and landed a contract to produce and host programs at the PBS network in Connecticut. I turned my TV work into six successful books.

But at the age of fifty, after I was downsized from the radio job and had my PBS work outsourced after ten successful years, I was shaken. And now I couldn't even control my own body. I was fat and feeling miserable.

It wasn't easy for me to let go of the sunny personality I showed the world, but D'Mario let me see that I could, at least in the privacy of our training sessions. "I want you to let go of the pain and just believe," he said. "That's hard, but I want to help you see that this is just a stage of your life, and there is a lot more ahead for you."

So I started Mika's challenge with new optimism. Little did I know that a major health crisis would derail my plan, and that I would spend months getting back on track. This journey was going to be a b.u.mpy ride.

CHAPTER FOUR.

FAT: WHOSE FAULT?.

MY STORY, WITH MAYOR MICHAEL BLOOMBERG,.

GOVERNOR CHRIS CHRISTIE, REBECCA PUHL,.

SENATOR CLAIRE MCCASKILL, DR. DAVID KATZ,.

DAVID KIRCHHOFF, FRANK BRUNI, GAYLE KING,.

DR. EMILY SENAY, LISA POWELL, DR. EZEKIEL EMANUEL,.

ASHLEY GEARHARDT, MICHAEL PRAGER, JOE SCARBOROUGH,.

BRIAN STELTER, DR. ROBERT l.u.s.tIG, KIMBER STANHOPE,.

LEWIS CANTLEY.

Not long ago on Morning Joe, New York City mayor Michael Bloomberg made a startling statement. "This year more people in the world will die of the complications of overweight than from starvation."

Have we all really turned into gluttons? Are we all poorly disciplined and lacking character? It just can't be that our nation's collective weight problem is entirely our fault as individuals. With so many Americans overweight, something else must be going on. Each of us may have our own challenges, but it is the nation that has an obesity crisis. As New Jersey Governor Chris Christie said, it is ignorant "to believe that being overweight is merely a function of willpower."

And yet that is just what we tend to think, says Yale researcher Rebecca Puhl. "The prevailing perception in our culture is that obesity is an issue of lack of willpower, lack of discipline, or personal responsibility." Each one of us tends to think we are struggling alone.

I'm convinced that a lot more is involved. To get to the root of the problem, we need to look hard in many directions. At the highly processed food that is so readily available. At the systems we have structured to make food that is laden with fat, sugar, and salt so much cheaper than wholesome foods. At the vending machines in school, hospital, and employee cafeterias where chips, candy, and soda are the only things available. At the limits of the labeling requirements we impose on food in stores and restaurants. At the look we consider healthy and beautiful, especially in our young girls. At how we talk about weight with one another.

I can go on and on about the sources of the problem, because we have created a hydra-headed monster here. We've surrounded ourselves with unhealthy foods that we just can't stop eating.

Here is one shocking example: students consume almost 400 billion junk food calories at school every year according to Still Too Fat to Fight, a 2012 report by Mission: Readiness.1 That's equal to almost 2 billion candy bars. (The report also notes that the weight of those candy bars is considerably more than the weight of the Midway, the longest-serving aircraft carrier in the US Navy.) At the same time, as few as 4 percent of high school students have the opportunity to take a daily gym cla.s.s. We're setting them up to become fat.

Yes, of course we all need to take personal responsibility, but those kinds of statistics suggest we should be thinking differently about what that really means. It's not just that we are responsible for getting our own weight under control, although that's part of the solution. But we also need to think about the role each of us can play in initiating conversations that can change the whole society.

"We can control our health care costs, we can control our national debt and our deficit if everybody in America would recognize obesity as the public health hazard that it has become," declares Senator Claire McCaskill.

We can control our health care costs, we can control our national debt and our deficit if everybody in America would recognize obesity as the public health hazard that it has become.

-Senator Claire McCaskill To understand how we got here, let's take a look at evolution and human biology.

"The truth is, we are the first generation, or the second, where getting fat is the path of least resistance," says David Katz, MD, director of the Yale Prevention Research Center and editor of the medical journal Childhood Obesity. "Throughout most of human history, people were struggling to get enough to eat." For most Americans, that struggle is a thing of the past. "If you look at the food supply of the United States today versus, say, 1970, we have about five hundred to six hundred additional calories available per capita per day now than we did then," explains David Kirchhoff, CEO of Weight Watchers. "Most of those new foods are coming with added sugars and fats, otherwise known as heavily processed foods and known in some quarters as junk food."

Our biology makes it hard to say no to junk food. We're hardwired to go after the concentrated energy in high-calorie fats and sweets. Just look at me: I know that empty calories are the quickest route to unwanted pounds, and that's the last thing I want. I know I'll have to make up for an extra snack with an extra run. I've learned these lessons the hard way, and I've learned them over and over again. Yet what I know flies out the window when I see that bag of chips or that pint of ice cream; it's as if my body is overriding my logic. There are days when I struggle not to pick up the fork.

Same thing with Diane. She loses the battle more often than I do, yet she's got more drive than most people I know. Her problem is not that she lacks discipline.

What's really going on here?

"We're simply not genetically programmed to refuse calories when they're within arm's reach." That's what Thomas Farley, New York City's health commissioner, told New York Times columnist Frank Bruni. Bruni makes the case that America's obesity crisis is partially the result of its prosperity and economic dominance. "Over the last century," he writes, "we became expert at the ma.s.s production of crops like corn, soybeans and wheat-a positive development, for the most part."2 The less positive element in that equation is that America also became efficient at "processing those crops into salty, sweet, fatty, cheap, and addictive seductions," Bruni explains. "Densely caloric and all-too-convenient food now envelops us, and many of us do what we're chromosomally hardwired to, thanks to millenniums of feast-and-famine cycles. We devour it."

Densely caloric and all-too-convenient food now envelops us.-Frank Bruni Soda and sugary drinks are one of the worst culprits, providing the single largest source of calories in the American diet. We're drinking twice as much of them as we did forty years ago. For many Americans, it's all feast and no famine. We no longer need those stores of energy to keep us going through the lean times. Instead, the extra calories turn into fat.

"We are products of our times," says Yale's David Katz. "Human character hasn't changed, personal responsibility hasn't changed, but the world has changed, and it's a very obesigenic world."

One feature of that world is that food is everywhere, available 24/7, and marketed to the tune of some $36 billion per year. Yale's Rudd Center reports that the fast food industry alone spends $4 billion in advertising yearly, much of it aimed at children.3 By comparison, for every dollar the industry spends pushing fast food, the US Department of Agriculture spends about one-tenth of a penny encouraging people to eat their vegetables.

When there's a downturn in the economy, those marketing dollars flow even more freely, and the stock prices of fast food companies often rise as they roll out offers like "dollar menus" and consumers perceive fast food meals as bargains. There is definitely a payoff in the corporate bottom line. Marketing dollars spent translates into food eaten. One survey by the Rudd Center showed that the week before it was conducted, 84 percent of parents had taken their child to a fast food restaurant.4 I remember watching fast food ads when I was a kid, and I clearly remember that they sparked cravings in me. And I am certainly not the only one to hear the food marketers' siren calls. My friend Gayle King, who co-hosts CBS This Morning, says she has never stopped being motivated by commercials. "You're talking to somebody who saw a McRib commercial and left the house in the rain," Gayle chuckles. "I put on some boots and took an umbrella because the McRib sandwich was a limited-time offer! So I went to McDonald's in the rain, though the whole time I'm saying to myself, 'Turn around. Turn around. Turn around.'"

Supermarkets jump into the game, too, deliberately placing candy bars, sweet snacks, and sugary cereals where children will see them. "In most places, the bad food is about eye level of where the kids are," points out Dr. Emily Senay, a Morning Joe regular who teaches in the Department of Preventive Health at Mount Sinai School of Medicine and is the medical correspondent for the PBS show Need to Know. "The candy, the chips, all that stuff is low enough in the store where they can easily see it. If you have little kids, it makes going out on a simple excursion a battle. The world we live in conspires against us when it comes to healthy eating."

Even if you avoid fast food chains and choose healthy foods in the market, eating out a lot is also asking for trouble because serving sizes in most restaurants have grown so dramatically in this country. The Centers for Disease Control and Prevention (CDC) estimates that restaurant portion sizes are more than four times larger now than they were in the 1950s.

If portion sizes had increased overnight, says Lisa Powell, director of Nutrition at Canyon Ranch Health Resort in Tucson, Arizona, "people would be horrified. But it was just a little here, a little there, and our eyes got used to it and our stomachs got used to it. It makes me fear for people who are under thirty years old because it means they've never seen normal portions modeled."

The world that Dr. Katz calls "obesigenic" is also a place where takeout and packaged foods dominate, and healthy home cooking has become increasingly rare. A report led by Harvard University economists says that in the 1960s, "the bulk of food preparation was done by families that cooked their own food and ate it at home. Since then there has been a revolution in the ma.s.s preparation of food that is roughly comparable to the ma.s.s production revolution in manufactured goods that happened a century ago."5 In 1965, a married woman who didn't work outside the home spent over two hours a day cooking meals and cleaning up afterward. By 1995, that same woman spent less than half that time in the kitchen. As we moved into the twenty-first century, those numbers fell even further. We spend less and less time preparing meals at home, and people eat more and more ma.s.s-produced foods. Cooking from scratch seems to have become a hobby for a small group of people and a ch.o.r.e that the rest of us no longer bother with.

"My grandmother's full-time job, basically, was to feed a big family, and she worked from morning till night," says Canyon Ranch's Lisa Powell. "In the sixties, women were beginning to enter the workforce, and the notion of convenience foods became popular. As our society changed, the environment was ripe for packaged and processed foods, which saved time. Today, you get your food out of a box or a can, you don't have to think about it, you don't have to mess with it, and you don't have to touch it."

The less frequently we cook, the more we rely on ma.s.s-manufactured foods that are quick and easy to prepare. Most people aren't giving much thought to what's packed into them, but Powell certainly is. "Packaged food is high in salt, high in sugar, high in fat-all of those basic, primordial food preferences that people have. Seeking out salt, fat, and sugar ensured survival in previous eras, and we still have that same tendency." The more we consume highly processed foods, she says, "the more our preferences have been directed that way, and we've lost the appreciation for fresh and whole food. The only thing that resonates with people is flavor and the intensity of flavor."

Along with pa.s.sing up healthier foods for convenience, we have changed some of our basic customs. We no longer expect to eat three meals a day, sitting at a table with our families. In a family dinner setting, people can be more mindful of what they are eating and how much they are consuming. When meals are more "grab and go," we end up doing a lot more grazing and snacking.

"We don't take time to eat," said Lisa Powell. "We stuff in a sandwich at our desk and think we had lunch. We've lost that connection; we've just lost contact with the whole experience of eating. As a result, I think we're not satisfied, so we're looking for more and more and more and more."

We've just lost contact with the whole experience of eating. As a result, I think we're not satisfied, so we're looking for more and more and more and more.-Lisa Powell Then there's the fact that social mores in America encourage eating just about everywhere. "If you go to j.a.pan, it's sort of socially prohibited to eat on the street," says Ezekiel Emanuel, MD, a former White House advisor on health and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Zeke is also a Morning Joe regular. "People just don't do it. It's very different in America."

Price also plays a role. The fact is that eating nutritious food is more expensive than the alternative. "Compared to things like fresh fruits and vegetables, processed foods have a decreased price per calorie, and the economists will tell you that has a role," Emanuel acknowledges.

On top of that, our lives no longer require much physical activity. The kind of hard labor we used to do has been largely replaced by machines. We no longer walk to work; we drive. We have to deliberately seek opportunities to burn off calories because they are no longer built into everyday life, as they were for earlier generations. Put that together with today's food environment and we begin to understand why we've gotten fat.

"Everything about modern living that makes it modern is obesigenic," says Katz. "The problem is a flood of highly processed, hyperpalatable, energy-dense, nutrient-diluted, glow-in-the-dark, bet-you-can't-eat-just-one kind of foods" coupled with "wave after wave of technological advances giving us devices to do all the things muscles used to do."

The problem is a flood of highly processed, hyperpalatable, energy-dense, nutrient-diluted, glow-in-the-dark, bet-you-can't-eat-just-one kind of foods.

-David Katz That pretty much sums up why the American obesity crisis started about forty years ago. David Kirchhoff of Weight Watchers calls it "a perfect storm of overeating and under-exercising."

If my theory that some of us are addicted to unhealthy foods is confirmed by science, we'll be able to understand a lot more about why we eat when we don't want to. Ashley Gearhardt, PhD, a faculty member in the Department of Clinical Psychology at the University of Michigan, is a research pioneer in that area. When, as a graduate student at Yale University, she first began examining the possibility that food could be addictive, the very idea was mocked. Now, people are looking a lot more closely at the science that could explain food addiction, and her work is considered groundbreaking.

Although we still need to understand the biology better, it is no longer fringe thinking to suggest that foods "jacked up in their level of sugar, fat, and salt are addictive to some people," says Gearhardt. "I think one reason that people don't take food addiction seriously is because we all need food to survive. But in looking at the obesity epidemic, you realize that it's a certain type of food that shows this addictive potential."

The villain is no surprise: the food we call ultraprocessed, or highly palatable. Another term for it is junk food. It contains ingredients in quant.i.ties that are simply not natural to the body.

Gearhardt's research is built on well-accepted principles of addiction. As she explains it, the addictive potential of any substance is based on two factors: the speed of its absorption into the body and the level of activation in the brain's reward system. "If you look at a food that's naturally occurring, like a banana, it has a decent amount of sugar in it, but it comes naturally packaged in a way that is high in fiber and high in other antioxidants that slow down the absorption of the sugar into our bloodstream," she explains.

Now, let's compare that to a handful of jellybeans. There is more sugar in the candy, but more significantly, that sugar gets into the bloodstream a lot faster because it has no fiber or antioxidants. This means our response to the rewards in those jellybeans is a lot stronger than our response to the rewards in the banana-and that's what can make a food addictive.

"There are foods that are naturally elevated in sugar, like fruits, and there are foods that are naturally elevated in fat, like nuts and meats, but there are very, very few foods that are naturally elevated in both sugar and fat," notes Gearhardt. "Just by combining sugar and fat, we're creating a food that is abnormally rewarding." That's why we crave it. "So even though you know it's causing you ma.s.sive health issues and mental health concerns, you feel compelled to keep consuming it and really struggle to stop," she says.

Sounds a lot like a drug addict, doesn't it?

Besides fat, sugar, and salt, Gearhardt says other additives in foods, such as caffeine, have properties that make them potentially addictive. And caffeine sometimes shows up in places that the average consumer wouldn't expect-like candy and chips. "If you are consuming caffeine in these products, you're going to crave it a little more and feel a little more withdrawal when you stop eating it," she says. Gearhardt's research shows that a person eventually needs more of the processed food to get the same pleasurable response, another cla.s.sic signal of addiction. In other words, if one handful of M&Ms is good, the whole package is better.

Zeke Emanuel is a little less certain that processed foods are actually addictive, but he does think the theory needs further study. "It's being explored, how the brain becomes habituated to certain things and not others," he responds. "For anyone to definitively say, 'Yes, there's an addiction pathway there that these manufactured foods plug into'-I think it's just too early in the research. But it's very interesting."

Echoing Governor Christie, he added, "This is not simply a matter of willpower."

Michael Prager is one man who is persuaded that food can be addictive. Prager, who has tipped the scales at 365 pounds, told Diane and me that he once felt totally out of control around food. Now he calls himself a recovering food addict. As a newspaper editor on the Hartford Courant. Michael worked the night shift. On his short commute home, he would sometimes get off the highway at an exit that has a Wendy's, Burger King, and McDonald's, side by side by side.

"One time I hit 'em all, the fast food triple play," he told us. "I went through the drive-thru at the first place. I pulled over so I could eat in secret, although I'm fully aware that you can see through the windows of cars. Then I went next door to the next one. I bought another entire meal-soda, fries, sandwich-pulled over, ate it, and then I went to the next one and did the same thing. Three of them at one time. I was trying to get back at people who I had decided had wronged me in some way, as if I could hurt them by doing this."

His bad behavior didn't end there.

"At my worst, you could find me lying on the floor of my living room at three in the morning," Michael continues. "The reason I'm not sitting up anymore is I've had too much food, and it's too painful to be sitting up. And lying down made it possible to get more food in." That was important, he says, because "I was more into volume than I was into any particular substance. I didn't discriminate. I would go to a convenience store after work and get a quart of milk and a box of cereal and a loaf of bread and a jar of peanut b.u.t.ter and a jar of jelly. My goal was to have enough food to get me through the night so that I didn't have to get up at four in the morning to go out and get more.

"At work, I would try to figure out how many times I could go to the vending machine without people noticing. I was over three hundred pounds. People know that I'm an overeater, so who was I kidding? I would go to the vending machine and buy three things and go in the bathroom and eat one of them and then bring one back, and that would be the one that everybody could see. And then I'd have another one that I'd keep in my pocket and try to sneak."

Michael doesn't behave like that anymore, as he explains in his memoir, Fat Boy, Thin Man. Today, he follows a food plan that involves weighing and measuring most everything that goes in his mouth. He now weighs 210 pounds, a weight he has maintained for more than twenty years. How did he get there? A big part was in-patient treatment: exactly what a drug addict or an alcoholic needs to confront substance abuse.