Читать книгу Clinical Obesity in Adults and Children - Группа авторов - Страница 25

In the mid‐1980s, one of the authors W.P.T. James was invited by the UK government to join an expert panel examining broad aspects of national industrial policy ranging from financial management to manufacturing and the service sector. The author’s remit was to deal with the food, drink, and agricultural industry. Each member led a team with Delphi exercises involving a variety of experts and industrialists and with workshops held in different parts of the country. Given the extraordinary changes in agriculture and food policy that supported self‐sufficiency during the Second World War [64], the author was alarmed to discover the proportion of food, including fruit and vegetables, that were now imported from abroad. Discussions with the Treasury Ministry revealed that they were more concerned about the balance of trade than the availability and access to quality food for the British public. At that time, food product development and marketing were unsophisticated, but suggestions around introducing new health criteria for food composition with the recently proposed WHO criteria based traffic light labeling of healthy food [65] were viewed with horror as this was an industrial enhancement, not a health promotion exercise. However, behavioral research began to develop rapidly in the United States and Europe, leading to a very sophisticated understanding of human behavior and how to manipulate it. Exceptionally detailed analyses of human reactions in shops around time spent examining foods, their position in relation to the height of customers, the value of big rather than small displays, the huge bonus of stacking special price inducements at the end of aisles, and the degree of price manipulations needed to stimulate buying all became carefully defined features for selling more product. Then they discovered the value of stimulating people’s curiosity and providing unexpected stimuli for purchases at all hours of the day and night through the provision of food and drinks in machines or other facilities wherever people might pass or congregate. A multiplicity of flavors in a variety of products encourages greater consumption as using just one flavor leads to what Rolls termed “sensory‐specific satiety.” [66]. Then with the discovery of the range of molecular olfactory receptors for different flavors [67] came the special development of food and drinks with specifically added flavors which were known to have a powerful effect on the brain’s pleasure and addictive centers. Author W.P.T. James had a detailed account from a major industrialist of the finding that specific flavors were favored by women in both the follicular or luteal phases of their menstrual cycle, so these flavors were then used with vodka to produce alcopops, which then in practice transformed the drinking habits of young women in the United Kingdom. This strategy was so successful that alcohol consumption by young women rose alarmingly in the 5 years following the introduction of these new products leading to medical concerns about the impending problem of alcoholism and indeed cirrhosis of the liver in young women – a feature never seen before in the United Kingdom [68]. Neurological MRI testing is now one of the routine assessments of new food products, many of which have added flavorings aimed at stimulating the pleasure centers with huge factories synthesizing the specific sensory enhancing products. Whether their greater use has anything to do with what Brownell now recognizes as food addiction [69] is still unclear. The subtlety of marketing is also illustrated by the use of a picture of a salad in the options of a famous fast‐food chain. This representation of healthy food stimulates young women to not necessarily purchase the salad but to treble their purchases of fried potato chips as the salad image creates a false association with the healthiness of the whole menu and thus provides an excuse to purchase chips. Such sales ensure a good profit margin for the company but have very dubious effects on weight gain and health!

Globalization, modern food supply chains, advanced food processing techniques, and ever more sophisticated and aggressive marketing approaches have created a modern food environment that Swinburn et al. [70] have termed obesogenic (literally designed to induce obesity). The current food supply and consumption patterns are dominated by the wide availability of ultra‐processed food products that are highly palatable, cheap, convenient, long‐lasting, and heavily promoted. A high level of consumption of these products replaces core foods (such as fresh fruits and vegetables, meat, milk, and wholegrain cereals). Modern lifestyles have also led to changes in eating and lifestyle behaviors. We have fewer formal meals, we eat in front of the TV, we take away more food rather than cook it at home, and at home, we rely more on ready‐prepared foods. These behaviors are associated with poorer diet quality. Food is also now cheaper and more widely available than it has been at any point in human history, and the portion size of a single serving has increased dramatically. In addition, we are encouraged by marketing to consume even when we are not hungry. Many of these issues are addressed in later chapters.

So we can conclude that major industrial developments have reduced the need for energy expenditure, but the normal physiological adaptive lowering of food intake to match this new lower requirement is counterbalanced by intense food marketing. Furthermore, the greater weight and energy requirements of the obese frame mean, for example, that in the United States, the food industry is profiting from the extra food purchases required to maintain the population with obesity. This has been estimated to amount to many hundreds of billions of dollars of extra sales each year if one considers the excess food eaten by children with obesity both in childhood and then in their adult life [71] plus the extra food sales for adults with obesity.