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June 24, 2013 11:30 AM There’s No Easy Answer to Obesity

By Aaron Carroll

Any reader of the blog knows of my interest in obesity and health. My wife also runs a program to help children eat healthier and lose weight. So this is a topic that gets a fair amount of discussion in our house. In general, we tend to lean toward the “anything” in moderation philosophy. My kids eat extraordinarily healthy diets, with a wide variety of foods, the vast majority of which are good for you. So I don’t care if they get soda once in a while, or a huge slice of pie. They’re fit, active, and healthy. I consider that a job well done.

But my wife becomes obsessed once in a while with the whole “organic” or “natural” thing. I tend to be more agnostic on all of that. I think a locally grown tomato is much more tasty than a store bought one, but I don’t think it’s any healthier. I’m not sure my wife agrees. She will buy many things at Whole Foods or Trader Joe’s that seems just bizarre to me. Last week, she whipped out a bag of these things called “Inner Peas”. They were lightly fried pea pods that were crispy and salty. She offered them to the kids, who didn’t seem too interested. “They’re vegetables!” my wife proclaimed. I looked at the back of the bag, and was annoyed to see that they had 140 calories per serving (or close to that). I replied, “The kids don’t need the extra calories.”

I could not have been more excited to read this in the Atlantic yesterday:

After my excursion to Whole Foods, I drive a few minutes to a Trader Joe’s, also known for an emphasis on wholesome foods. Here at the register I’m confronted with a large display of a snack food called “Inner Peas,” consisting of peas that are breaded in cornmeal and rice flour, fried in sunflower oil, and then sprinkled with salt. By weight, the snack has six times as much fat as it does protein, along with loads of carbohydrates. I can’t recall ever seeing anything at any fast-food restaurant that represents as big an obesogenic crime against the vegetable kingdom. (A spokesperson for Trader Joe’s said the company does not consider itself a “‚ÄČ‘wholesome food’ grocery retailer.” Living Intentions did not respond to a request for comment.)

Vindicated! The whole piece is excellent. Here’s another gem pulled right from my playbook:

The Pollanites seem confused about exactly what benefits their way of eating provides. All the railing about the fat, sugar, and salt engineered into industrial junk food might lead one to infer that wholesome food, having not been engineered, contains substantially less of them. But clearly you can take in obscene quantities of fat and problem carbs while eating wholesomely, and to judge by what’s sold at wholesome stores and restaurants, many people do. Indeed, the more converts and customers the wholesome-food movement’s purveyors seek, the stronger their incentive to emphasize foods that light up precisely the same pleasure centers as a 3 Musketeers bar. That just makes wholesome food stealthily obesogenic.

And this, which should be shouted from the rooftops:

Where the Pollanites get into real trouble—where their philosophy becomes so glib and wrongheaded that it is actually immoral—is in the claim that their style of food shopping and eating is the answer to the country’s weight problem. Helping me to indulge my taste for genuinely healthy wholesome foods are the facts that I’m relatively affluent and well educated, and that I’m surrounded by people who tend to take care with what they eat. Not only am I within a few minutes’ drive of three Whole Foods and two Trader Joe’s, I’m within walking distance of two other supermarkets and more than a dozen restaurants that offer bountiful healthy-eating options.
I am, in short, not much like the average obese person in America, and neither are the Pollanites. That person is relatively poor, does not read The Times or cookbook manifestos, is surrounded by people who eat junk food and are themselves obese, and stands a good chance of living in a food desert—an area where produce tends to be hard to find, of poor quality, or expensive.
The wholesome foodies don’t argue that obesity and class are unrelated, but they frequently argue that the obesity gap between the classes has been created by the processed-food industry, which, in the past few decades, has preyed mostly on the less affluent masses. Yet Lenard Lesser, a physician and an obesity researcher at the Palo Alto Medical Foundation Research Institute, says that can’t be so, because the obesity gap predates the fast-food industry and the dietary dominance of processed food. “The difference in obesity rates in low- and high-income groups was evident as far back as we have data, at least back through the 1960s,” he told me. One reason, some researchers have argued, is that after having had to worry, over countless generations, about getting enough food, poorer segments of society had little cultural bias against overindulging in food, or putting on excess pounds, as industrialization raised incomes and made rich food cheaply available.
The most obvious problem with the “let them eat kale” philosophy of affluent wholesome-food advocates involves the price and availability of wholesome food. Even if Whole Foods, Real Food Daily, or the Farmhouse weren’t three bus rides away for the working poor, and even if three ounces of Vegan Cheesy Salad Booster, a Sea Cake appetizer, and the vegetarian quiche weren’t laden with fat and problem carbs, few among them would be likely to shell out $5.99, $9.95, or $16, respectively, for those pricey treats.

Go read the whole thing. I sent it to my wife a few minutes ago. We’ll see how that goes.

[Originally posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Childrenís Health Services Research at Indiana University School of Medicine.
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