"Healthy" Food Options Lead to Unhealthy Food Choices

I mentioned several theories of obesity from low carb and Paleo gurus in a previous post. Today, I want to show some psychological reasons why people make poor food choices, potentially ending up obese. The theory of eating cues is not meant to replace any other theories about obesity, merely to supplement them. External triggers are very real.

Two important studies in the Journal of Consumer Research show why “healthy” choices in a restaurant may lead to unhealthy meal selection. Words like “healthy” are in quotations marks, as the dominant paradigm of these studies is that low fat, high carb is good and high fat is bad. We Paleo and low carb types know better. Still, they make for very interesting reading and offer yet another reason why obesity may be increasing.

In the first study, consumers who went to Subway believed they were eating healthy food. This led to choosing a “healthy” sandwich, but several “unhealthy” sides, such as sugary drinks and cookies.  When asked to estimate the number of calories they consumed, they estimated, on average, 35% fewer calories than they actually consumed. They did not make this magnitude of error estimating calories when eating at McDonald’s. Subway is permeated by a “health halo” that implies all of the menu items at Subway are healthy. In reality, some sandwiches have more calories than a Big Mac. At McDonald’s, people are not under the illusion that they are eating healthy foods, so they may actually consume fewer calories than at Subway.

A second study explains why this is happening. Consumers have a goal of eating healthier, and “healthy” items on the menu confirm their goal of healthy eating. The mere presence of a “healthy” menu choice does three things.  First, it vicariously fulfills a desire or goal the make more “healthy” eating choices. Second, it focuses the consumer’s attention on the least healthy item in the choice set. And finally, it provides consumers with a license to indulge. Their goal of eating at a “healthy” restaurant is met, so they don’t actually have to eat in a “healthy” manner, just eat at a “healthy” restaurant. This is what focuses their attention on the unhealthy menu options and leads them to indulge, and this study demonstrates convincingly that this is even true with individuals who have a high degree of self-control. The authors of this paper demonstrated this effect in four different studies across different contexts. It also works in vending machines with more “healthy” options (sales of Snickers bars go up).

What does this all mean? In the rush to add “healthier” items to the menus at unhealthy restaurants, the net effect is an increase in sales of unhealthy items. When “healthy” items are not present, consumers make “wiser” decisions about their “healthy” food choices.

So as I have shown before (here and here), cues, such as "healthy" food options, plate size, container size, 100-calorie packages, etc., have a direct and unrecognized impact on how people eat what they eat. So it is not all food palatability, carbs, toxins, NADs, modern lifestyle, genetics, or infections that lead to obesity. Sometimes, it is also pure psychology.


There are a lot of other food cues to report on, but all in due time. Keep watching this space!

Why We Get Fat, According to...

Gary Taubes blames carbs, especially the refined carbs like wheat and sugar.

Laura Dolson is generally with Taubes on the refined carbs, but she also blames marketing.

<Rant>
As a marketing professor, I find straw men arguments like this patently ridiculous. Marketing is not all powerful; if it were, I would have created a junk product and marketed it to all of you idiots out there, who would have bought it. You wouldn't have a choice; marketing would have forced you to buy it, and I could retire in style to the French Riviera. Unfortunately, life isn't like that. Consumers have brains and can choose to not purchase marketed products. Up to 95% of new products fail, despite massive amounts of marketing. The influence of the home can swamp any marketing campaign. Massive amounts of food industry marketing do not work on me, for example, or the example I set in my family. I have a brain and I choose differently.

Also, does marketing/advertising create food attitudes, or merely reflect already existing attitudes in people? Any competent social scientist will tell you it is very hard to change behavior. While I think marketing can help to create attitudes, it mostly reflects what already exists. Take smoking, for example. Reasons people smoke include parental example/rebellion against parents; peer pressure; stress and anxiety reductions; desire to lose weight, etc. Marketing, though often blamed for smoking (Exhibit A: Joe Camel), is not even mentioned as a factor (I would argue that marketing only informs brand choice, not the decision to smoke).  Get real, folks. Marketing is just not as powerful as you would like to believe. It may be a convenient whipping boy, but your belief in the absolute power of marketing is a fantasy.
</Rant>

Kurt Harris blames the Neolithic Agents of Disease, including fructose, wheat, and seed oils.

Stephan Guyenet blames highly palatable food choices for weight gain.

Paul Jaminet blames malnutrition, dietary toxins, and infections for obesity.

Chris Kresser says there is no single cause of or treatment for obesity. Later, he says that modern lifestyle + genetic predisposition = obesity.

What do I believe? I used to believe Gary Taubes, because the solution he proposed worked for me, to a point. Harris, Jaminet, and Kresser are all singing variations of the same tune, so I suppose I am in their camp now. I am following the Perfect Health Diet, though I am stalled at the moment. They seem the most reasonable, the most scientifically based, even though I have criticized science as a justifying principle for belief. But I guess I have to hang my hat somewhere.

Justifying Principles

An epistemological question: why do people believe what they believe about low carb/paleo/ancestral ways of living? What are your justifying principles? I have written before about how tough it is to justify dietary dogmas. But I think I would like to revisit that question in more detail.

It seems to me that in the low carb world, the overarching belief is that "carbs are bad." Gary Taubes, at least as interpreted by his adherents, seems to be a big proponent of this philosophy. According to this view, carbs are fattening, and therefore, cutting carbs causes people to lose weight. But I have actually read Taubes' two main books, and while he is certainly down on carbs, he does seem to be especially down on fructose and refined carbs, not all carbs. Also, this theory is under attack, with many paleo and primal types rejecting it. As Chris Kresser pointed out, just because cutting carbs is a cure to obesity, it doesn't logically follow that carbs cause obesity. We are confusing a cure with a cause.

Yet, as I peruse the Internet, it seems to me the belief that carbs are fattening is widely held. I don't believe this and I personally think that we lose weight on a low carb diet because when we cut out sugar and refined carb products, we spontaneously consume fewer calories, as fat and protein (the foods with which we replace all those carbs we cut) are much more satiating. And limiting your intake of carbs cuts out an awful lot of food choices. That said, if you eat too much low carb food, you will gain weight, especially if you consume too much fat. Calories do matter.

What is the justifying principle for Paleo? Paleo types try to eat what they guess our Paleolithic ancestors ate. For example, J. Stanton of Gnolls.org suggests, "Eat like a predator, not like prey." Unlike low carb dieters, many Paleo adherents don't do dairy, because have you ever tried to milk a wild buffalo? But do we really know what our ancestors ate? It seems to me that a lot of Paleo adherents have a romanticized view of what our ancestors ate.  Some Paleo adherents (e.g., Jaminet, Harris) advocate eating "safe" carbs, such as potatoes, rice, tapioca, etc., in addition to adding dairy. Apparently, Harris is currently eating 40% of his calories as carbs, including a lot of Rice Krispies and half and half (you'll have to listen to a rather long [but interesting!] podcast to hear him admit this).

My main problem with Paleo: its justifying principles are rather shaky. I can find all varieties of people who follow the "Paleo" lifestyle: those who do low carb Paleo; those who eat fruit, since not all ancient fruits were small, bitter, and low in sugar; those who will add some dairy to the previous list; those who will add dark chocolate; those who will add rice or potatoes; those who do vegetarian variants of the Paleo lifestyle; those who do low fat Paleo; and those who try to do some version of Paleo, but who cheat, a little or a lot. There have also been some high profile people quit the Paleo lifestyle, such as Don Matesz. Since there is so much argument about what our Paleolithic ancestors ate, it seems to me that members of the "Paleo" community are more united by what they avoid than by what they eat. They avoid things that make modern man sick, such as refined carbs, dairy, seed oils, processed foods, etc.

I actually appreciate all of the discussions within the Paleo community. As General George Patton once said, "If everyone's thinking the same thing, nobody is thinking." At least some thinking and progressing is going on in the Paleo community. Sometimes, it doesn't seem to me like as much thinking is going on in the low carb community. There does seem to be a lot of agreement in most Paleo camps that modern wheat, seed oils, refined carbs, and processed foods are not healthy to consume. The debate about dairy (fermented, cheese, cream), fruit, potatoes, rice, dark chocolate, etc., is actually very healthy. I know it has helped me change my mind on some topics. And at least they avoid nonsensical arguments like, "All carbs are fattening."

How Does One Justify Dietary Dogma?

Chris Masterjohn has quite an important blog post about dietary dogma and why we should not be dogmatic. I recommend everyone read it.

But it did bring up an important idea on which I would like to elaborate. Where do our dietary dogmas come from, and how are they justified?

Is our dietary dogmas based on religion? Religion often offers an absolute standard for Why We Do What We Do. Dietarily speaking, do we eat Halal (Islam), Kosher (Judaism), lacto-ovo vegetarianim (7th Day Adventist), or abstain from coffee, tea, tobacco, alcohol, eat lots of wheat but eat meat sparingly (Mormon)? Religion uses some form of revelation to justify the dietary dogma, but this begs an important question: whose source of revelation is the "right" one? This is not a question that can be answered empirically. The religious adherent is backed up to the wall of faith, and there she or he must make a stand.

Is the dogma based on science? Scientific justification is not as solid as many suppose. For example, here is a question with no answer, despite decades and perhaps centuries of trying: what is the demarcation between "science" on the one hand and "non-science" on the other? We almost venerate science by assuming it is a special, different sort of knowledge, containing Truth. So non-science must equate to non-Truth. If this is so, then it is important to know the dividing line between "science" and "non-science." Is it possible to come up with a definition of science that gives "scientific" knowledge a privileged status over "non-scientific" knowledge, one that no one can poke holes in? This is not a trivial question.

For a really good primer on this "problem of science," read the book, What is This Thing Called Science? by Alan Chalmers. This is a philosophy of science primer often used in college courses and remarkably easy to read.  He starts with logical positivism and in a balanced fashion looks at each of the definitions of science, then pokes holes in them all. He does this for falsificationism, Kuhnian paradigms, research programs, methodological approaches, Bayesian approaches to science, scientific realism, new experimentalism, and even Feyerabend's "anything goes" view of science. He leaves us with the distinct impression that science, as a justification for anything, is built on a foundation of sand. The history of scientific progress is actually quite messy, and the sociology of science has a lot to say as well. For example, how objective can a scientist be, when scientific progress is dependent on a funding source and when tenure depends on getting the right type of articles published in the right outlets?

When people realize they cannot draw the demarcation between science and non-science, they often retreat to a Justice Stewart Potter type of defense: "I can't define it, but I know it when I see it." This is also an indefensible way of justifying scientific knowledge, as it is open to subjective judgment.


Then there is the "it works" defense. I have used this one to defend low carb diets, as it has unquestionably worked in my case. But I am a sample size of one; does it "work" for everyone? Do I have a right to project my success onto others? Is it possible that it won't work for someone else? Also, can I conceive that it might stop working for me in the future? So this is an equally poor justification. Weight Watchers also worked for me, but I never want to go back to that plan. For that matter, starvation will also work to control diabetes and to lose weight. But is it wise?


So why do we believe that low carb is "The One True Way of Eating?" Because it works? Because science tells us so? Because we have faith in it? Because an authority figure wrote a book about it?

Without critically thinking through some of these issues, I might as well check my brain in at the door and stop learning new things. Follow, but not question, the "received" wisdom of the Low Carb Elders. When they have spoken, the thinking has been done. Line up and follow, or else you're an infidel!

Or learn wisdom and seek out that which is good, that which works for you. Recognize that there is more to learn and discover out there, and keep an open mind. Challenge your beliefs; it will make your rationale for following your particular dietary plan stronger.