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 FrenchAmerican 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.