Why We're So FAT (And the French Are Not)
WHY AMERICANS ARE SO FAT (and the French are not)
Psychology Today, Nov, 2000
By Paul Rozin
1) The French have their cake and eat it, but don't show it their bodies. Americans supposedly deny themselves the cake--but show it on their bodies nonetheless. This is the French paradox, the apparent conflict between low cardiovascular disease in France and what we take to be the rather unhealthful French diet.
2) The American dilemma actually has two parts: First, Americans think the French situation is a paradox. Second, Americans are more concerned about health and heart disease than the French (and try to do more about them), and yet our rate of heart disease is about 30% higher. On the face of it, this seems like a violation of Newton's second law of mechanics (which deals with the conservation of energy)--something that has more certainty and status than any claim ever made by a psychologist. But the French paradox isn't really a paradox at all.
3) In many ways, the French do eat more healthful diets than Americans. Most critically, they eat fewer calories and a more varied overall diet. Yes, they eat more grams of fat by and large, but the major effect of fat is its contribution to excess calories. Americans are the ones who have the problem with excess calories. And even if the French ate an unhealthful diet, there would still be no paradox. After all, the Dutch and Swedes eat what we would call an unhealthful diet, and they live longer than Americans. The reason is simple: Although there are relationships between diet and health, there are many other determinants of health.
4) Partly persuaded by a sizable segment of the American medical establishment, Americans believe that diet is the principal cause of disease. But the biggest predictor of mortality is simply age. Diet indeed contributes to health but so do genetics, lifestyle, quality of medical care, quality of environment, stress, and many other factors.
5) Compare our attitudes toward medicine, for example. The standard American prescription for illness is antibiotics, diets and the like. For the French, illness is seen primarily as an internal imbalance, and is likely to be treated with relaxation, vacations and spa visits.
6) When it comes to diet, the fact is that we know very little about why people eat as much as they do, or what makes them choose one food over another. This is partly because psychology, as a field, has had very little interest in food choice. We have focused instead on the amount of food eaten--in an attempt to understand that very visible condition, obesity, which causes grief and compromises health. I think that as a field, psychology has erred in both ignoring food choice, and in studying food intake in nonoptimal ways.
7) Generally, researchers in this field (and I have been one of them, to a modest extent) illustrate a very understandable predisposition in scientists. We like clarity, simplicity and control. It is like the story of the man who is looking for something at night under a street light. Someone asks him what he is doing, and he says he is looking for his keys. He is asked where he thinks he lost them, and he points, across the street, to a much darker area. When asked why he doesn't look there, he says because the light is here.
8) We have looked for the secrets of how meals begin and end, where we have good control and techniques: we look at the physiological events that precede and follow the meal. But I hold, as do a number of other major investigators in this field, particularly Peter Herman, Ph.D., at the University of Toronto, that the major determinants of how much we eat during a meal are not physiological. And, by the way, they are not that hard to study.
9) Perhaps the biggest determinant of how much we eat in a meal is how much we are served. If food is reasonably palatable, we tend to eat what is put in front of us. And here is part of the resolution of the French paradox: French portion sizes are notably smaller than American portions. This is particularly striking when comparing the size of ice cream cones--the French serve small golf ball-sized spheres while Americans get tennis ball-sized mounds. The standard size individual portion of yogurt in France is 125 grams; the standard size in America: 225 grams. Yes, the French yogurt has somewhat more fat, but it has many fewer calories.
10) Another major determinant of how much we eat during a meal is how much we like the food. This is so obvious that it needs no documentation. But another main determinant is less obvious. It has to do with culture and situation. We eat at certain times and in certain contexts, and typically eat a culturally prescribed meal. For Americans, lunch is most likely a sandwich, a beverage, perhaps some chips and a dessert. We eat it in the early afternoon, and we stop when we finish the dessert. Do we stop primarily because we are not hungry? That's doubtful, since we probably lost our hunger before we started the dessert. We're just accustomed to ending meals with dessert. The French snack much less than Americans, and do almost all of their eating at extended lunches and dinners. However, when we are served an appropriate meal at an appropriate time, we eat it.
11) My colleagues Sara Dow, Morris Moscovitch, and Suparna Rajaram and I recently demonstrated the importance of this practice. We offered a full lunch to two severely amnesic people, who have no memory of having just eaten. After they completed lunch we removed the tray, and 10 or so minutes later announced that lunch had arrived (a meal identical to the first). On three occasions, the amnesiacs readily downed the second serving. And both started to eat eagerly again when we brought a third meal more than 10 minutes after they finished the second. When we tried this with people with a normal memory, they looked at us as if we were crazy when the second meal arrived, and said something like, "I just ate." (Note: They didn't say they weren't hungry!).
12) There are other nonphysiological factors determining how much we eat. These include the social context of eating, our beliefs about eating and health, whether we are dieting, and so on. The point is that we can spend another 30 years measuring blood glucose at the onset and termination of meals, but we will find out only a small part of what determines the size of a human meal. Indeed, several important metabolic factors influence our eating, but they only modulate our meal size and seem to work in a subtle way from meal to meal, day to day, and week to week.
13) When it comes to why we eat what we do--namely, food choice--the situation is different. There has been very little work done on this problem, perhaps a few per cent of all of the studies on eating. It seems obvious that culture is a major determinant of what we eat; does anyone doubt that a Chinese person raised in an American household will have American food habits?
14) Furthermore, there is not a simple "coin of the realm" for food choice. Calories fill the bill for food intake. But for food choice, there are also macronutrients (carbohydrates, fat and proteins) and a variety of minerals and vitamins, all of which have to be consumed in minimal amounts. The complexity of food choice and the clear involvement of culture probably put psychologists off. But we cannot continue to ignore the study of why we eat what we do. Food is a major part of our life, a great source of pleasure, and in the U.S. in recent decades, a major source of worry and stress.
15) There is no doubt that our culture has shaped how we view food. For Americans and many others in the industrialized world, food intake has undergone a major change during this century, giving rise to the "American dilemma." There are at least five aspects of this change.
16) First, there is the epidemiological revolution. At the beginning of the century, life expectancy was about half of what it is now, and most deaths resulted from infectious diseases such as cholera, malaria, influenza and the like. With the conquest of most of these diseases in the industrialized world, along with public health measures, the major health threats today are degenerative diseases such as coronary heart disease, cancer, stroke and Alzheimer's disease. In the era of infectious diseases, the delay between behaviors and illness was generally short. But the behaviors related to degenerative diseases are often separated by decades, making the consequences of our actions seem too distant to pose a salient threat in the here and now.
17) Second, there is an excess of food. We were built to eat food when it became available. We are now faced with a surfeit, in both amount and variety, though we still don't embrace variety as the French do.
18) Third, there is the reduction in activity. Modern technology has reduced the amount of physical effort that most people need to earn a living. Of course, it's also provided a wide variety of labor-saving devices, as well as forms of entertainment that require no physical effort. So we're eating more and moving less--a sure recipe for weight gain.
19) Fourth, while there is an abundance of risk information linking food and other habits to long-delayed positive or negative health consequences, these relationships are often very small. They would never be discoverable within an individual lifetime, so they become irrelevant.
20) Fifth, we are not educated to understand risks, benefits, nutrition or the nature of science, all of which are critical for acting prudently in the face of all the risk information we are exposed to. For example, colleagues and I have discovered that a substantial minority of Americans think of fat and salt as toxins, such that any amount of these necessary nutrients is considered unhealthful. But, of course, that is untrue.
21) With the great publicity for diet/health links, and a great desire, especially among women, to be thin, eating has become an ambivalent act. True, it is necessary for life. True, it is often a source of great pleasure. But, especially in America, it is also viewed as unhealthful, in many ways. Almost everyone believes that not eating is riskier than eating; but eating the "right" things and staying off the usually highly palatable "wrong" things has become a daily stress in life.
22) Many have pointed to the prevalence of eating disorders, the fact that obesity is actually increasing in the United States, and the fact that our stores are simultaneously filled with "low cal" and "low fat" foods, adjacent to tempting high-calorie, high-fat foods. The American supermarket's yogurt section (unlike that of the French) is populated almost entirely by low- or nonfat yogurt. But have a look at our bakeries. The ambivalence is present in the store itself.
23) The evidence of ambivalence, or worse, about eating among American women is abundant. In a questionnaire given to American college students on six different campuses nationwide, Rebecca Bauer, Dana Catanese, and I found that an average of 71% of females thought their thighs were too fat, and 13% admitted that they would be embarrassed to buy (that is correct: buy) a chocolate bar at a store. More so, ironically, than to buy a condom!
24) Stimulated by all these differences, the "French paradox" and the "American dilemma," my colleagues Claude Fischler in France and Sumio Imada in Japan, and my students Allison Sarubin and Amy Wrzesniewski, set out to measure the differences in attitudes toward eating, diet and health in four countries: the United States, France, Flemish Belgium and Japan.
25) In each country we sampled both college students and adults waiting in airports and train stations. We asked about the importance of food in life, beliefs about diet and health, food choices, and modes of thinking about food. I will focus on our analysis of the French-American contrast. It suggests several factors that constitute the culturally distinct relationships to food.
26) We gave subjects a choice of a one week vacation of luxury accommodations with average food or average accommodations with excellent food, both at the same price. Americans choose the better food alternative almost half as often (42%) as the French (86%). We find that in general, food brings to mind, in the French, the experience of eating, while for Americans, it is more likely to conjure thoughts of calories, nutrients, or the effects of food on the body.
27) It is particularly ironic that although the Americans do much more worrying about food and health, and consume a much higher proportion of foods that have been modified to reduce fat, a substantially larger percent of the French (74%) see themselves as healthy eaters than do the Americans (34%).
28) In all four cultures studied, women have a more negative attitude toward food than men. It can not simply be attributed to greater concern among women about weight and appearance; after all, we also see a more negative attitude among women regarding factors affecting the food-health link as well as the food-appearance link. The most extreme contrast exists between the American female and the French male: she is troubled by food, while he's content.
29) What we are seeing with these French-American differences about food is probably something more general in the French-American contrast. There is a tendency toward moderation in French culture, in contrast to the American inclination toward excess.
30) Americans have a particular predisposition to spend a lot of money on making their lives easier, and minimizing exercise or effort: microwaves, air conditioners, power windows, automatic garage door openers, driving to a store only a few blocks away. These are expenditures that the economist Tibor Scitovsky calls "comforts."
31) The French spend much less money on such things, and as a result get more exercise. They are more inclined to spend money on what Scitovsky calls "pleasures": unique experiences such as fine meals, plays, flowers, and conversation with friends. Scitovsky notes that pleasures contribute more to happiness than do comforts; we appreciate our air conditioning only when it breaks!
32) It's clear that French-American differences in milieu -- such as reliance on cars and availability of snacks --have a lot to do with French-American differences in attitudes toward life and food. I doubt that the French hypothalamus--the part of the brain involved in food intake--is any different from that of the American. It's more a matter of cultural values and styles of life. For the French, yum means only moderate amounts of pleasure but for Americans the same word means piles of food, and pleasure mixed with worry.