The vital question is what it is about the successful 20 percent—referred to as weight “maintainers” in the literature—that makes them able to lose weight and keep it off. They seem to have certain habits in common that set them apart from the relapsers. One thing is that maintainers are much more likely to engage in regular exercise, ideally an hour or more of moderate physical activity every day. This pattern has been confirmed by numerous studies: relapsers do not exercise consistently, whereas maintainers do. We do not know whether exercise helps prevent relapse because of the expenditure of energy, because it’s time when you are not eating, or because it contributes to a sense of well-being: the dopamine and serotonin released when exercising can help prevent depression. Of course, it may also be that the kind of people who persist with weight loss are also the kind who persist with exercise. Correlation is not necessarily causation.
There are certain other habits that “maintainers” have in common. A study of more than 4,000 of them found that they tend to eat breakfast every day and stick to a consistently moderate diet across the week and across the year, rather than holding back during the week and splurging on weekends and holidays (5:2 dieters—take note!). Long after the initial weight-loss “diet” is over, they continue to monitor what they eat, and they are flexible enough to deal with small slips before they turn into major relapses, without beating themselves up. Some of their success may be because of their emotional state. They are less likely to be depressed, and they are much less likely to be binge eaters. “Disinhibition” around food and emotional eating is a strong predictor of weight regain. It is, as always with eating, hard to unravel the complex web of cause and effect here. Relapsers tend to have lower self-esteem and poorer body image than maintainers, but this may be precisely because when they look in
the mirror, they feel bad about the weight they have regained. They also seem to feel worse about the whole process of eating.
Counterintuitive as it might sound, the maintainers
enjoy their food more.
This key difference between maintainers and relapsers was identified by a 1990 study from California. The lead researcher, Susan Kayman, a public health nutritionist, noted that “surprisingly little is known about those who lose weight and regain it.” Kayman decided to find out more by conducting in-depth interviews with three groups of mostly middle-aged women: formerly obese women who had successfully maintained weight loss, formerly obese women who had lost weight and regained it, and average-weight women who had neither put on weight nor lost it. The interviews revealed that in many ways, the maintainers were not so different from the relapsers. They did not differ much in marital status or whether they had children, though the maintainers were slightly more likely to have a university education and to work outside of the home. The most substantial difference was the way they ate.
Maintainers told interviewers that they had never completely restricted their favorite foods, and that they “made efforts to avoid feelings of deprivation while changing food patterns.” As time went on, their appetites had changed. They no longer wanted to eat such large quantities, and many had lost their taste for candy and doughnuts, finding them excessively sweet and fatty. They had changed the way they cooked, not frying food as much as before or using as much sugar, and they included more fruits and vegetables and made smaller portions. But the real change was on the inside, because this was how they now wanted to eat. Like the Japanese, they did not start off eating well; but they were able to change their habits and preferences until they got to a point where delicious food and healthy food were one and the same.
By contrast, the relapsers associated weight loss with eating foods they did not like. While the maintainers devised diet plans to suit their own lives and tastes, the relapsers tended to follow rigid diet programs that actively went against their own food preferences. While “on a diet,” the relapsers would forbid themselves from eating anything they actually enjoyed. As Kayman puts it, they “perceived their diet foods as special foods, different from the foods their family could have and different from the foods they
really wanted.” The whole time they were eating these foods, they felt deprived. It didn’t take much for them to give up the struggle and return to the old patterns of eating. Seventy-seven percent of relapsers interviewed by Kayman said that the trigger for weight gain was life throwing up some kind of complication that made them revert to their normal foods. The major obstacle to dietary change is in some ways the most obvious one: no one—adult or child—wants to eat foods that they do not like.
Though this sounds obvious, it stands in contradiction to the way that almost all of our schemes for healthy eating up until now have been constructed—whether on a personal level or a social one. Adam Drewnowski, a professor of public nutrition who studies ways that diets can be improved in whole populations, notes that “nutrition education and intervention strategies aimed at improving diet quality have focused almost exclusively on the nutritional quality of foods and not on the taste or pleasure response.” This is a huge wasted opportunity, because nutrition will only improve if you get people to consume healthier food. And people will only consume healthier food over a lifetime if they consistently choose to eat it. Other things being equal, and assuming that healthier food is available and not too expensive, you will only choose it if it’s something that you enjoy. Instead of intervening at the level of nutrition and information—eat less sugar!—a better place to start would be pleasure. This can be illustrated with a list. The following shows, roughly speaking, how we arrive at the nutritional advantages of eating healthy food. Let’s take broccoli as an example.
1.
Sense:
You see, smell, and taste the broccoli: its green color; its sweet, crunchy stalks; and its soft, fluffy florets.
2.
Response:
You respond to the broccoli. Maybe with pleasure, maybe with pain. Your response here will be influenced by whether the broccoli is forced upon you or offered with enthusiasm, the skill with which it is cooked, whether you are a “bitter taster,” and how many times you have been offered the broccoli before.
3.
Preference:
Based on your response, you form a preference. Either you become a broccoli lover, a broccoli hater, or somewhere in between.
4.
Eat:
The preference you form about broccoli decides whether you regularly choose and eat broccoli or not.
5.
Nutrition:
Whether you eat broccoli will decide whether you gain all the nutritional advantages of eating it, which include folate, fiber, vitamin C, and calcium, along with certain disease-fighting phytochemicals.
There is small chance of getting the health benefits of broccoli unless we take the right path through 1, 2, 3, and 4. It doesn’t matter how much “nutrition” there is in a given food unless someone puts it in her mouth. Public health campaigns and diets, however, almost always start at stage 4 or 5. We are told how many benefits there are to eating green, leafy vegetables, and urged to eat more of them. When we fail to change our behavior, they tell us again. And then again. But no one thinks to check first whether we like green, leafy vegetables, or whether we have even tasted them. In 2010, Jamie Oliver’s TV series
Food Revolution
revealed that many children could not correctly identify common raw vegetables by sight, including potatoes, cauliflower, tomatoes, beets, and eggplant. This suggests that the adults in their lives had never learned to like and cook these vegetables either. You are unlikely to eat something if you don’t know what it is. It’s like being pushed into the swimming pool. The real aim should be to get people to like healthy eating sufficiently that they jump in of their own accord. By the time we are at stage 4 or 5, it’s too late. For a real change in our diets to happen, we need to go back to 1, 2, and 3. When our preferences are in order, nutrition should take care of itself.
Back in the Introduction, I asked what it would take for us to enjoy a “hedonic shift” to enjoying real, whole food. It will perhaps come as no surprise by now that the answer is frequent, positive exposures to those health-giving foods. The surprising part is what a short time frame may be required to shift our palates in a healthier direction. Our tastes are built over decades and reinforced daily by meals and snacks. Yet experiments have shown that at least some of our flavor responses can be relearned over a matter of weeks. The olfactory system is one of the very few parts of the adult brain that is constantly regenerating itself. The brain is flexible enough (the technical term is “plastic”) to change its responses to
flavors over a very short period of exposure. This has been demonstrated with salt and sugar, which you might expect to be the most immovable of our tastes.
If we consistently eat less sugar, it actually changes our sense of sweetness. In the late 1990s, biologists at Clark University in Massachusetts started experimenting to find out whether being intensively exposed to fructose or glucose could affect an individual’s ability to perceive low concentrations of other sugars. They found that just five short exposures to glucose over a few weeks could make individuals more responsive to sweetness in very weak sugar solutions. The good news, however, is that the effects were reversible. After the experiment was over, the subjects returned to their normal responses to sugar after just a few weeks. This suggests that, if we could only take a fortnight’s holiday from sugar, we might return to it less fondly.
The same is true of salt. Experiments suggest that reducing salt in the diet for a period of just eight to twelve weeks is enough to reduce the pleasure of eating very salty foods. Interestingly, it seems to take hypertensive (salt-sensitive) people longer than others to kick the salt habit, though it is not clear why this is so. But a study of both normal and salt-sensitive adults found that after three months on a low-sodium diet, “a significant hedonic shift occurred” in all of the adults. Before the experiment started, they all rated salty foods as more enjoyable than non-salty ones. After twelve weeks, this changed. The subjects no longer found reduced-sodium versions of chicken broth, potato chips, and crackers any less pleasurable than the “normal” high-sodium varieties.
By making enough of these tweaks to our diets, we may reach the happy state where the foods we crave the most—give or take the odd French fry—are ones that do us good. It is possible to go back to learning to like basic healthy foods just as we did when we were children. As Dr. Spock wisely remarked in his best-selling
Baby and Child Care
from 1946, “feeding is learning.”
My daughter has a friend called Lily. She used to be one of the
fussier children we knew. She couldn’t stand “mixed-up” food or anything
that came in a sauce. The main things she liked were meat and potatoes and plates of plain cut-up cucumber. Not only could she not stand to eat a tomato, she couldn’t bear to have so much as a trace of a tomato on her plate. This prevented her from trying most pasta dishes, and salads, and curries, and stews, and her mother’s homemade pizza. She also wouldn’t eat any fruit, except for raspberries. This was difficult both for Lily and for the rest of her family, who are adventurous eaters and lovers of spicy Indian dishes, such as
sag aloo
made with spinach, potatoes, ginger, and tomatoes. Often, she ended up eating separate meals of fish sticks and fries. There seemed to be no way out of her limited diet.
Then, aged ten, she was casting around for a good New Year’s resolution and suddenly decided to do something about her restricted tastes. The idea was her own; her parents did not pressure her into it. Lily—a sunny, chatty person—set herself the task of trying one new food each month. At the end of the month, she still might not like the new food, but at least she would have given it a go. Somehow, the spirit of fun and adventure in this little project made it possible for her to put foods into her mouth that previously she would have recoiled from. It was the opposite of most grown-up New Year’s resolutions, which tend to involve cutting things out rather than adding them. Whenever we saw Lily that year, she was excitedly talking about the food of the month. The very first month, she successfully taught herself to like homemade pizza, despite the fact that it combined cheese and tomatoes, two of her no-go foods before. In subsequent months, she learned to eat chicken curry and apples and spaghetti bolognese and meat in sauces. By the end of the year, she still wasn’t crazy about bananas or salads, or any kind of fish except for fish and chips. But in just twelve months she had vastly expanded her repertoire of foods, and had also proved to herself that it was possible to enlarge her world of eating, whenever she needed to.
Because we live in Britain, Lily’s yearlong resolution was seen by her friends as rather unusual, maybe even a bit weird. In Finland, however, this kind of sensory exploration has now become a basic part of every child’s education. Lessons on taste are also given in schools in Sweden, Denmark, the Netherlands, and some parts of Switzerland and France. This education in eating is part of the growing “Sapere” movement. In
Latin,
sapere
has three meanings: “to taste,” “to be able,” and “to know.” The idea behind Sapere—and the Sapere Association that promotes the Sapere Method of food education throughout Europe—is that it is possible to educate children in the pleasures of food, and that doing so will set the children up for a lifetime of healthy eating. Feeding is learning.
The inspiration behind teaching children about taste—which may not amaze you—is French. In France, more than elsewhere, there has long been a deeply cherished belief that a child’s education involves being “civilized” in the pleasures of the table. In a famous experiment in the nineteenth century, Dr. Jean-Marc-Gaspard Itard brought a wild boy into his care. He named him Victor. For twelve years, Victor had been living in the woods of Aveyron, and at first he only wanted to eat the fruits of the forest, to which he was accustomed. Over time, Itard succeeded in “awakening” new tastes in the boy for “a whole quantity of dishes he had hitherto always disdained.” Itard indoctrinated Victor in the joys of French cuisine, which he saw as a passport to civilization.