Why did it take so long to embrace what scientists had known for years? Because changing society requires changing culture -- and that is a slow process.
Cultural norms are best represented by the advertising that directly influences what we choose to consume and how we choose to consume it. Using imagery of aspirational lifestyles and attitudes (picture young adults, all holding cigarettes, having fun on a beach or "Joe Camel" wearing a leather jacket while sitting on a motorcycle), cigarette marketers effectively convinced Americans to buy tobacco en masse.
And for several decades, the same methods have been used to promote a style of consumption for something that seems less innocuous but can be life threatening: food. Food advertising and marketing has helped convince the average American that it's OK to eat lower quality foods more often and in larger portion sizes.
In other words, our culture has unwittingly accepted a marketing scheme which promotes a lifestyle that is literally killing us.
On average, we consume more calories than we did just 30 years ago, without a corresponding biological need for more calories. Between 1971 and 1974, the average American adult consumed almost exactly 2,000 calories per day. Thirty years later, that number increased to more than 2,200 calories
. This seemingly small increase of just more than 200 more calories in daily food intake is the driving force behind the obesity problems we see today.
As a full-time pediatric emergency room doctor, the effects of childhood obesity are increasingly obvious in the work I do. More and more, I am seeing children, often toddlers, who are already obese and may be plagued by chronic disease and shortened life spans.
But it's so difficult to treat these children knowing that advertisers will only to continue to encourage them to consume bad calories and in larger quantities.
Just as in the case of tobacco, connecting the dots between the marketing of food and obesity is complex and aggressively fought by industries that profit from our national appetite. The argument offered by defenders of the industry is that food advertising only seeks to promote one brand over another (brand choice) and doesn't influence overall consumption.
However, in 2016, two of the most extensive meta-analyses
to date, published in the American Journal of Clinical Nutrition and Obesity Reviews, reported that food advertising does indeed influence individual eating behavior, especially in children, leading to weight gain.
Let's take a closer look at food advertising in practice.
An average adult person should eat somewhere in the range of 2,000 calories per day. Calories are fuel for our cells, like gasoline for your car. Calories come from three sources: carbohydrates, lipids (or fats) and protein. We need all three of these as fuel, including fats and carbs. Limits for each of these calorie sources have been established by medical science to help define the parameters of a basic healthy diet.
And yet an ad for a $4 "deal"
from Hardee's, which includes a cheeseburger, fried chicken sandwich, soda and fries, clocks in at 1,420 calories -- comprised of 61 grams of fat, 43 grams of protein and 187 grams of carbohydrates. With close to 3,000 mg of sodium, this one meal surpasses the American Heart Association's recommended sodium limit of 1,500 milligrams per day. And, worse yet, it has more than half the calories a person should consume in one day in only one meal.
But how many wince at the sight of the $4 deal ad? All of us, adults and children alike, are constantly bombarded with messages that consciously and unconsciously influence our decision-making. We think people in the ad seem happy, so why not follow suit?
Enter example two
. "Larry the Cable Guy" appears sleeveless and grinning in ad for Prilosec, a heartburn medication. The caption above his head reads, "Suffering from heartburn day after day is as unnecessary as wearing sleeves."
Now this ad might not raise any eyebrows on its own, but Larry appears in a second ad for spicy chicken batter, endorsing the very food that leads to heartburn. In an almost identical outfit, Larry poses beside a plate of chicken nuggets and fries, and says, "You gotta try it!"
Only in America would we have the celebrity who promotes poor eating habits also endorse the medication that treats the health complications that may result from those habits!
Unfortunately, we cannot wait to address this food marketing issue.
Projections for health care costs will be unsustainable unless we make drastic changes now. In 2015, we spent approximately $3.2 trillion
(17.8% of our GDP) on health care, and that number has steadily been rising. Notably, obesity-related illnesses now make up about 21% of these costs
And based on current trends, a New England Journal of Medicine study published in 2005
reported that children today may be the first generation predicted to likely not live longer than their parents. This is largely because of health problems related to obesity.
So how do we begin to address this advertising issue? As anyone experienced in addiction will tell you, the first step in treating the problem is admitting you have one. So we need to acknowledge that we are a culture in love with excess.
Next, we can learn from the war on tobacco. As scientific evidence mounted, legislators began to make widespread changes to the rules of marketing cigarettes. Similarly, research around obesity must influence the making and marketing of food.
And, as consumers, we have to open our eyes to the fact that food ads today promote and encourage irrational decisions. The companies defending these ads are doing so at the expense of a sustainable way of life.
Employing behavioral economic research, we can also be more innovative in our approach to convincing consumers to eat healthier. Things like the positioning of healthier products in cafeterias, the names the products are given and celebrity endorsement of healthy eating habits can all help drive us toward a future where food promotes wellness rather than disease.
Years from now, we will undoubtedly look back at how we approve of food advertising today as illogical -- and possibly immoral. The sooner we can change the rules of the game for food advertising and realize that we are nurturing poor eating habits, the sooner we can make an impact.
Overeating is the new smoking, but it doesn't have to be.